Comparison of three-dimensional heads-up system versus traditional microscopic system in medical education for vitreoretinal surgeries: a prospective study.

BACKGROUND: To compare the value and efficiency of the three-dimensional (3D) heads-up surgical system and traditional microscopic (TM) system in teaching and learning vitreoretinal surgeries. METHODS: Twenty ophthalmologists and scrub nurses were recruited as teachers, and 45 junior ophthalmology residents and trainee doctors, trainee nurses, and medical students were recruited as observers. Each teacher and observer were assigned to both a 3D-assisted and TM-assisted vitreoretinal surgery and then asked to complete satisfaction questionnaires for both surgical systems at the end of each surgery. RESULTS: The 3D heads-up surgical system was rated significantly higher in most of the subscales and overall satisfaction score by both teachers and observers (P < 0.05). However, ratings for instrument adjustment were significantly higher in the TM group compared to the 3D group for junior ophthalmology residents and trainee doctors (6.1 ± 1.7 vs. 8.8 ± 1.1, P < 0.001). CONCLUSIONS: The 3D heads-up surgical system has great didactical value in the medical education of vitreoretinal surgeries, but it is important to consider the specific needs of different learners when choosing between the two systems. TRIAL REGISTRATION: Not applicable.

Development of Diagnostic Recommendations for Vitreoretinal Lymphoma.

PURPOSE: To develop diagnostic recommendations for diffuse large B-cell vitreoretinal lymphoma (VRL) in Chinese patients. METHODS: Retrospective observational case series. Seventy-three eyes of 40 VRL patients and 8 control patients were analyzed. Eighteen patients from Beijing Tongren Hospital and 46 patients from literature were involved as validations. RESULTS: Diagnostic methods included (1) typical clinical manifestations; (2) vitreous cytology; (3) immunohistochemical examination of vitreous or choroid/retina; (4) aqueous humor or vitreous cytokine; (5) vitreous cell gene rearrangement; (6) vitreous flow cytometry. If patients meet (1)+(2)+(3), or if they meet (1), and two of (4), (5), (6) are positive, they can be diagnosed as VRL. The sensitivity and specificity values for accurate diagnosis were 0.975 and 1.00. One hundred percent eyes from Beijing Tongren Hospital and 92.7% eyes from literature can be diagnosed. CONCLUSION: We developed diagnostic recommendations for diffuse large B-cell VRL through vitreous cytology combined with multiple auxiliary examinations.

Microbial spectrum and risk factors of endogenous endophthalmitis in a tertiary center of Northern China.

AIM: To study the clinical features, microbial spectrum, associated factors and prognosis of endogenous endophthalmitis (EE) in a group of Chinese patients. METHODS: The medical records from 32 eyes of 29 patients diagnosed with EE in Peking Union Medical College Hospital from January 2009 to October 2019 were reviewed. RESULTS: The initial visual acuity (VA) of 30 eyes in this study was worse than 20/400. Twenty-three eyes were diagnosed with fungal endophthalmitis and nine with bacterial endophthalmitis. The most common fungal and bacterial isolates were Candida and Klebsiella pneumoniae, respectively. Several rare fungi and bacteria species were also isolated from our patients, including Cryptococcus, Paecilomyces, Brucella, and Bacillus licheniformis. The leading risk factor for EE was diabetes. The most common extraocular infection locus was genitourinary tract. Vitrectomy was performed on twenty-nine eyes. Eight eyes achieved final VA of 20/400 or better. EE caused by Candida had a better prognosis. CONCLUSION: The visual outcome of EE is based on pathogens and prompt intervention. Early vitrectomy and antimicrobial treatment are beneficial for EE.

PUMCH experience and strategy for the management of idiopathic macular hole: a retrospective cohort study.

PURPOSE: To introduce and evaluate a modified therapeutic strategy for idiopathic macular holes (IMH). METHODS: A retrospective review of patients with diagnosis of IMH from July 2016 to January 2020 at Peking Union Medical College Hospital. These patients were managed strictly according to our therapeutic strategy. Their comprehensive clinical data were collected and analyzed. RESULTS: 209 eyes suffering stage II to IV IMH were identified. For stage II IMH, the spontaneous closure rate was 8.9%, the initial success rate of intravitreal injections (IVI) of expansile gas and pars plana vitrectomy (PPV) + internal limiting membrane peeling (ILMP) + air tamponade was 84.2% and 100%, respectively. The initial success rate of PPV + ILMP + air tamponade for stage III and stage IV IMH was 89.8% and 86.4%, respectively. Following our intervention strategy, stage II IMH achieved a final IMH closure rate of 100%, stage III of 99% and stage IV of 97%. The final best corrected visual acuity was significantly improved (P < 0.05). Sitting position air-fluid (A-F) exchange alone successfully induced IMH closure in 7/19 eyes that did not achieve IMH closure by initial PPV. For three refractory cases that failed additional PPV + ILM stuffing, intraoperative OCT assisted PPV + sub-retinal BSS injection successfully induced the IMH closure. As the remaining three unclosed IMH cases were dry and stable, no more interventions were conducted. CONCLUSION: The general IMH closure rate based on our therapeutic strategy was satisfactory with a favorable prognosis. IVI expansile gas and sitting position A-F exchange were effective and highly cost-effective under certain circumstances.

[Endophthalmitis Caused by Mixed Infections in Silicone Oil-filled Eye:One Case Report].

The incidence of endophthalmitis after vitrectomy is extremely low,especially lower in silicone oil-filled eyes.Silicone oil exerts a toxic effect on the cell membranes of microorganisms and leads to the lack of nutrients.It is thus believed to inhibit the growth of bacteria and fungi.Endophthalmitis induced by mixed bacteria in silicone oil-filled eye has been rarely reported.We reviewed the clinical manifestations,diagnosis,and treatment of a patient with endophthalmitis caused by mixed infection of Morganella morganii and Staphylococcus epidermidis in the silicone oil-filled eye,aiming to improve the understanding and diagnosis of mixed infections.

Targeted Genes Sequencing Identified a Novel 15 bp Deletion on GJA8 in a Chinese Family with Autosomal Dominant Congenital Cataracts.

BACKGROUND: Congenital cataract (CC) is the leading cause of visual impairment or blindness in children worldwide. Because of highly genetic and clinical heterogeneity, a molecular diagnosis of the lens disease remains a challenge. METHODS: In this study, we tested a three-generation Chinese family with autosomal dominant CCs by targeted sequencing of 45 CC genes on next generation sequencing and evaluated the pathogenicity of the detected mutation by protein structure, pedigree validation, and molecular dynamics (MD) simulation. RESULTS: A novel 15 bp deletion on GJA8 (c.426_440delGCTGGAGGGGACCCT or p. 143_147delLEGTL) was detected in the family. The deletion, concerned with an in-frame deletion of 5 amino acid residues in a highly evolutionarily conserved region within the cytoplasmic loop domain of the gap junction channel protein connexin 50 (Cx50), was in full cosegregation with the cataract phenotypes in the family but not found in 1100 control exomes. MD simulation revealed that the introduction of the deletion destabilized the Cx50 gap junction channel, indicating the deletion as a dominant-negative mutation. CONCLUSIONS: The above results support the pathogenic role of the 15 bp deletion on GJA8 in the Chinese family and demonstrate targeted genes sequencing as a resolution to molecular diagnosis of CCs.

Construction and analysis of a breast cancer gene-drug network model / 南方医科大学学报

<p><b>OBJECTIVE</b>To construct a breast cancer gene-drug network model for extracting and predicting the correlations between breast cancer-related genes and drugs.</p><p><b>METHODS</b>We developed an algorithm based on the ABC principle and the association rules to obtain the correlations between the biological entities. For breast cancer, we constructed 3 different correlations (gene-gene, drug-drug and gene-drug) and used the R language to implement the associated network model. The reliability of the algorithm was verified by ROC curve.</p><p><b>RESULTS</b>We identified 185 breast cancer-associated genes and 98 associations between them, 97 drugs and 170 associations between them. The breast cancer genes-drugs network contained 127 genes and 77 drugs with 384 associations between them.</p><p><b>CONCLUSIONS</b>We identified a large number of different correlations between the breast cancer-related genes and drugs and close correlations between some biological entity pairs that have not yet been reported, which may provide a new strategy for experimental design for testing personalized breast cancer treatment.</p>

Conjunctival langerhans cell histiocytosis: a case report.

Langerhans cell histiocytosis (LCH) is a rare disease, mainly involving the bone, skin, lung, liver, spleen, and skin.1 The heterogenenous nature of LCH makes it difficult to diagnose. Not only do the involved organs vary from case to case, but also its natural history. Herein, we describe a rare case of conjuctival LCH in an Asian woman.

[Vitreal surgery and etiological diagnosis of bacterial endophthalmitis].

OBJECTIVE: To evaluate the clinical effects of vitreal surgery and the importance of etiological diagnosis in the treatment for bacterial endophthalmitis. METHODS: Retrospective series case study. 20 cases (20 eyes) of bacterial endophthalmitis that were treated in Peking Union Hospital were enrolled. 14 eyes were post-traumatic endophthalmitis, and 6 eyes were postoperative endophthalmitis. Twenty cases of aged 3 to 83 years [mean (40.5 ± 23.9) years] were enrolled, including 12 male and 8 female patients. Pre-operative visual acuity: 2 cases were able to count fingers, 6 cases were able to perform hand movement, 11 cases had light perception, light projection were uncertain in all cases, and there was no light perception in 1 case. Hypopyon was seen in 13 eyes. Severe anterior chamber inflammatory reaction was seen in the other 7 eyes. The fundus could not be observed in all 20 eyes. B-Scan ultrasound examination indicated that all 20 eyes displayed moderate to severe vitreous opacity; proliferation and organization were apparent in 12 eyes, and retinal detachment in 2 eyes. Vitrectomy and intravitreal injection of antibiotics were performed in 18 eyes, and only intravitreal injection of antibiotics was administered in the other 2 eyes. At the beginning of operation, vitreous fluids were smeared and Gram stained. To eyes that showed a positive result in Gram staining, 1 mg of Vancomycin was injected into the vitreous cavity or added in the perfusion fluid (balanced salt solution, BSS) in the eyes. To eyes that showed a negative result in Gram staining, 2 mg or 4 mg of Ceftazidime was injected into the vitreous cavity or added in the perfusion fluid (BSS) in the eyes, respectively. Additionally, we examined the vitreous specimens and performed drug susceptibility testing of the bacteria cultured from the specimens. The antibiotics that the bacteria were susceptible to were chosen according to the drug sensitivity tests. The follow-up period is from 1 to 102 months (average 16.6 months). RESULTS: Thirteen eyes presented with a positive Gram staining result, and 3 eyes presented a negative result; the other 4 eyes were not infected. Bacteria were cultured in 15 eyes. The detection rate of pathogen was 75%. The result for 11 eyes was consistent with the smear results. The bacteria detected were Staphylococcus aureus in 3 eyes, Staphylococcus epidermidis in 3 eyes, and Bacillus spp in 2 eyes. Streptococcus pneumoniae, Streptococcus mitis, Plesiomonas, Pseudomonas cepacia, Klebsiella oxytoca, Loffi Acinetobacter and Pseudomonas fluorescens were detected in 1 eye. The remaining 5 eyes did not have bacterial growth. The intraocular infection of all 20 eyes was controlled, and the intraocular inflammation was relieved. The visual acuity was significantly elevated. Postoperative visual acuity achieved were ≥ 0.3 in 4 eyes, 0.1 to 0.2 in 4 eyes, 0.02 to 0.09 in 6 eyes, CF in 2 eyes, HM in 3 eyes and LP in 1 eye. The retinas of 17 eyes were normal, but recurrent retinal detachment occurred in the other 3 eyes, postoperatively. CONCLUSIONS: Vitrectomy combined with antibiotics and intravitreal injection of antibiotics were an effective treatment of bacterial endophthalmitis. We obtained the vitreous fluid smears at the beginning of surgery to quickly and accurately obtain etiological diagnoses by Gram staining. It is crucial to use etiological diagnosis to choose the susceptible antibiotics.

[Single nucleotide polymorphisms of promoter of human leukocyte antigen-DQB1 alleles in Chinese Han patients with Vogt-Koyanagi-Harada syndrome].

OBJECTIVE: To investigate the single nucleotide polymorphism of the promoter of HLA-DQB1(QBP) in Chinese Han patients with Vogt-Koyanagi-Harada syndrome. METHODS: Case-control design was applied. Eighty-eight Chinese Han patients with Vogt-Koyanagi-Harada syndrome and 88 non-Vogt-Koyanagi-Harada syndrome controls were admitted. DNA was extracted from the peripheral white blood cells of the subjects by the phenol-chloroform method. Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and clone-sequencing were applied to determine the sequences of the promoter of HLA-DQB1. Chromans and Bioedit software were used to analyze the sequences of the promoter of HLA-DQB1. Chi-square test and Fisher exact test were applied to compare the frequencies of bands of QBPs and SNPs for the two groups. RESULTS: Sixteen band patterns of HLA-QBP were shown by polyacrylamide gel electrophoresis (PAGE). The band frequencies of QBPb (corresponding gene sequence was QBP2.1 + 77C > A, chi2 = 26.01, Pc < 0.001) and QBPl (corresponding gene sequence was QBP3.3, chi2 = 16.99, Pc < 0.001) were significantly higher in patients with Vogt-Koyanagi-Harada syndrome than that in normal controls (Pc < 0.001). However, the frequencies of QBPg (corresponding gene sequence was QBP3.1, chi2 = 12.10, Pc < 0.05) and QBPn (corresponding gene sequence was QBP6.1 + 39G > A, chi2 = 14.64, Pc < 0.05) were significantly lower in patients with Vogt-Koyanagi-Harada syndrome than those of the controls. Twelve SNPs were found in all subjects. The frequency of C allele at position -189C/A in patients with Vogt-Koyanagi-Harada syndrome was significantly higher than that in controls (chi2 = 45.92, P = 0.000). However, the frequency of G allele at position -227G/A in patients with Vogt-Koyanagi-Harada syndrome was significantly lower as compared with that in the normal controls (chi2 = 15.63, P = 0.000). CONCLUSIONS: C allele of -189C/A is a genetically susceptible factor of Vogt-Koyanagi-Harada syndrome and G allele of -227G/A is the protective factor of Vogt-Koyanagi-Harada syndrome.

[Polymorphism of HLA-DQB1 alleles in Chinese Han patients with Vogt-Koyanagi-Harada syndrome].

OBJECTIVE: To investigate the frequency of HLA-DQB1 alleles in Chinese Han patients with Vogt-Koyanagi-Harada syndrome (VKH) and to analyze the relationships among the alleles and clinical manifestations. METHODS: Eighty-eight Chinese Han patients with VKH and 88 non-VKH normal controls were admitted. DNA was extracted from white blood cells of the subjects by phenol-chloroform method. Thirteen alleles were typed by polymerase chain reaction-sequence specific primer (PCR-SSP). Relationships among alleles and clinical features were analyzed. RESULTS: Twelve of thirteen already known HLA-DQB1 alleles were typed by PCR-SSP in patients with VKH. The most frequent allele in patients with VKH was HLA-DQB1*0401 (31.8%) and this was significantly higher than that of normal controls (31.8% vs. 4.6%, chi(2) = 44.00, P = 0.000, OR = 9.8, 95% CI 4.51 - 21.31). So was for HLA-DQB1*0303 (6.8% vs. 0.6%, chi(2) = 9.67, P = 0.002, OR = 12.81, 95% CI 1.65 - 99.58). On the contrary, the frequency of HLA-DQB1*0601 (1.7% vs. 9.7%, chi(2) = 10.39, P = 0.001, OR = 0.16, 95% CI 0.05 - 0.56) and HLA-DQB1*0302 (6.3% vs. 19.3%, chi(2) = 13.48, P = 0.000, OR = 0.28, 95% CI 0.14 - 0.57) in patients with VKH were significantly lower than that of normal controls. They found no statistical differences of clinical manifestations such as age of onset, visual acuity, cataract, complicated glaucoma, exudative retinal detachment between HLA-DQB1*0401 positive group and HLA-DQB1*0401 negative group in patients with VKH. CONCLUSIONS: (1) Alleles of HLA-DQB1*0401 and HLA-DQB1*0303 are susceptible to VKH. HLA-DQB1*0601 and HLA-DQB1*0302 are resistant to VKH. This is the first report that associates HLA-DQB1*0302 with resistant of VKH. (2) PCR-SSP is a rapid method for typing the HLA-DQB1 alleles and can be used routinely.

[Treatment of thyroid-associated ophthalmopathy: comparative study between prednisone and COP therapy].

OBJECTIVE: To evaluate the efficacy of two therapies, high-dose prednisone and COP in the treatment of patients with active thyroid-associated ophthalmopathy (TAO). METHODS: According to severity and compliance, the patients admitted in Peking Union Medical College Hospital from August 2000 to July 2003 were divided into two groups. Thirteen patients with active TAO were treated with high-dose prednisone. The initial dosage was 1.5-2.0 mg.kg(-1).d(-1) (maximal dosage 200 mg), tapering gradually, and shifting to alternate-day treatment. Fourteen patients in the COP group were treated with cyclophosphamide (CTX), oncovin (VCR) and prednisone. This therapy was modified from CHOP in the treatment of patients with non-Hodgkin's lymphoma: CTX 600 mg/m(2), VCR 1.1 mg/m(2) were administrated by intravenous infusion every 2-4 weeks, prednisone was given orally at 1 mg.kg(-1).d(-1) for seven days after each infusion. The duration of treatment for both groups was approximately 10 months. The parameters including clinical activity score (CAS), thickness of extra-ocular muscle as well as 24 h urinary GAG were used to evaluate the efficacy of treatment in both groups. RESULTS: There was no significant difference in age and sex between two groups. However the patients in the COP group were more severe than that in prednisone group (P < 0.05). CAS in the patients treated with prednisone before and after treatment were 4.4 +/- 1.8, 1.6 +/- 1.1 respectively, that in patients treated with COP were 6.5 +/- 1.6, 1.9 +/- 1.3 respectively. All these changes were highly significant (P < 0.01). The thickness of extra-ocular muscles in the patients treated with prednisone decreased from (6.5 +/- 1.5) mm to (5.8 +/- 1.1) mm, that in patients treated with COP decreased from (6.8 +/- 1.7) mm to (5.3 +/- 1.1) mm. Both changes were highly significant (P < 0.01). Comparative study of the changes in the thickness of extra-ocular muscle by percentage between two groups demonstrated that the muscle thickness in patients treated with COP was decreased by (23.7 +/- 4.3)%, that in patients treated with prednisone was by (13.3 +/- 4.6)%. The difference between the two groups was highly significant (P < 0.01). The 24 h urinary GAG level in patients treated by prednisone decreased from (33.6 +/- 6.6) mg/24 h before treatment to (16.7 +/- 2.5) mg/24 h after treatment. Those in COP group were (40.6 +/- 10.1) mg/24 h and (15.7 +/- 5.1) mg/24 h respectively. The difference was significant (P < 0.01) in each group. There were no serious complications during treatment. CONCLUSIONS: Both the prednisone and COP therapy are effective in the treatment of patients with active TAO. The preliminary results indicate that COP is more effective than prednisone, it suggests that COP might be feasible for treating patients with progressive and severe TAO.

[Cytomegalovirus retinitis associated with Acquired immunodeficiency syndrome].

OBJECTIVE: To investigate the fundus characteristics, systemic features and therapeutic outcomes of cytomegalovirus (CMV) retinitis associated with acquired immunodeficiency syndrome (AIDS). METHODS: Fundus features, visual acuity, fundus fluorescence angiography (FFA) and CD4(+)T-lymphocyte counts of 15 eyes (8 patients) of CMV retinitis associated with AIDS were analyzed. The time of average follow-up was 16 months. Intravitreal injection of ganciclovir (400 microg) was performed in 4 eyes (2 patients). RESULTS: In the initial examination, visual acuity of the patients was as following: < or = 0.2, 10 eyes (66.7%); no light perception (NLP) (2 eyes); light perception (LP) (2 eyes); 0.04-0.2, 6 eyes; > or = 1.0, 3 eyes (20.0%) and 0.8 or 0.9 each for 1 eye (13.3%). The fundus manifestation includes: the retinal vasculitis; dense, full-thickness, yellow-white lesions along vascular distribution, and hemorrhage on the retinal surface; granular with irregular border featured as "cheese and ketchup retinitis" was revealed in 12 eyes; the vitreous was clear or light opaque. Late stage of the retinopathy was demonstrated in 2 eyes characterized as grayish atrophic retina, vessel-sclerotic and attenuated, retinal pigment epithelium (RPE) atrophy, prominent choroid vasculature, and optic nerve atrophy. Retinal detachment was found in 1 eye. CD4(+)T-lymphocytes counts in peripheral blood were between 0 approximately 36/mm(3), average (15.0 +/- 12.9) mm(3). Visual acuity improved, fundus lesions disappeared observably and hemorrhage was absorbed in the 4 eyes after intravitreal injection of ganciclovir. CONCLUSIONS: CMV retinitis is the severest and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis of undefined cause, the antibody of serum anti-human immunodeficiency virus (HIV) should be screened. Routing eye examination should be performed if the serological test of HIV is positive.

[Modified dacryocystorhinostomy].

OBJECTIVE: To introduce a novelty-modified dacryocystorhinostomy. METHODS: With the innovated scalpels, 11 patients (13 eyes) suffering from chronic dacryocystitis were performed with the newly modified surgical procedures derived from traditional dacryocystorhinostomy. The efficacy, efficiency, and complications were observed. RESULTS: Thirteen operations for 11 patients were performed successfully and efficiently. The wound was during operation neat and with a slight hemorrhage which could be stanched easily. No serious complications were observed intra-operatively. The average time of follow-up was 7.8 months (6-12 months). All the dacryocysto-rhinal canals remained unblocked. CONCLUSIONS: The modified dacryocystorhinostomy with the help of innovated mucous scalpel has high success rate, high efficiency and low complications. It deserves wide application as the first choice for chronic dacryocystitis.