Corticosteroid eyedrops induced blepharoptosis and atrophy of levator muscle.

PURPOSE: The purpose of the study is to analyze the incidence, manifestations, and treatment of blepharoptosis caused by long-term use of corticosteroid eyedrops. METHODS: Retrospective case series include 46 patients with a history of using corticosteroid eyedrops unilaterally for at least 2 months. The palpebral fissure, MRD1, and levator function were evaluated. RESULTS: Among 46 patients, the differences of mean MRD1 (p < 0.0005), palpebral fissure height (p < 0.0005), and levator function (p = 0.003) between eyes with and without corticosteroid eyedrops application were significant. Ptosis existed in 40 out of 46 eyes with corticosteroid; the differences of the mean MRD1 (p < 0.0005) and palpebral fissure height (p = 0.001) between eyes with and without ptosis were significant. Nine patients underwent levator aponeurosis repair surgeries. Pathological examinations revealed mainly vascular fibers and few muscle fibers, as well as apoptosis of levator palpebrae muscle and Muller muscle. CONCLUSION: Blepharoptosis is frequently observed after chronic corticosteroid eyedrops use in Chinese population.

A Qualitative Study Exploring Coping Strategies in Chinese Families During Children's Hospitalization for Cancer Treatment.

PURPOSE: To explore how Chinese families cope with children's hospitalization for cancer treatment. DESIGN AND METHODS: A descriptive qualitative inquiry was employed. Semi-structured interview was conducted in four pediatric oncology departments in four hospitals from November 2017 to June 2018. The interviews focused on how families cope with the challenges resulting from their children's hospitalization for cancer treatment. Twenty one parents participated into the study. RESULTS: Four categories related to family coping strategies emerged from the data, including increasing family strength, maintaining optimistic thoughts, seeking external support, and not disclosing the unfavorable information. CONCLUSIONS: Families had adopted multiple coping strategies to handle the challenges caused by children's hospitalization for cancer treatment. The influences of Chinese culture on family coping should be taken into consideration during family-centered interventions development. Further studies could analyze whether the spouse perspectives are independent from one another and whether the coping strategies change as the time of hospitalization. PRACTICE IMPLICATIONS: This study has reminded nurses' to become more concerned about the influences of culture on families' coping strategies during this challenging period. Other nurses in the world could understand how to enhance family coping strategies of Chinese clients.

Ocular manifestations as first signs of systemic T cell lymphoma in two cases.

BACKGROUND: Intraocular involvement of systemic T-cell lymphomas are uncommon and have been broadly regarded as markers of poor prognosis. We reported two cases of uveitis patients finally diagnosed as systemic T cell lymphoma. CASE PRESENTATION: Case one is a 19-year-old female presented with fever and liver dysfunction, and was diagnosed as EBV-associated chronic active hepatitis. Fourteen months later, she suffered from recurrent granulomatous anterior uveitis in both eyes, which failed to respond to steroid and immunosuppressant therapy. A mass on the left side of pharynx was found and the final diagnosis was pharynx T cell non-Hodgkin's lymphoma. After 13 cycles of chemotherapy, her systematic symptoms and uveitis relieved a lot, and eye condition is stable after cataract surgery. Case two is a 37-year-old male complaining bilateral blurred vision and recurrent abdominal pain. Panuveitis was diagnosed and anterior inflammation did not release after topical steroid. During the following days, the patient complained intermittent abdominal pain and fever, with rapidly progressive bilateral visual decrease. Final diagnosis was gallbladder type II enteropathy-associated T-cell lymphoma. The patient died of multiple organ failure 4 days after operation that was only 26 days after presenting to our hospital. CONCLUSIONS: Ocular manifestations as first signs of systemic T cell lymphoma were rare. Diagnosis of lymphoma has to be suspected when patients have systemic manifestations including fever, fatigue, abdominal pain, EBV-associated liver disease, et al., and uveitis fails to respond to steroid therapy.

Validation of the nonmotor symptoms questionnaire for Parkinson's disease: results from a Chinese pilot study.

We performed a cross-sectional study of 82 Chinese patients with Parkinson's disease (PD) enrolled during an 18-month period. We used a clinical interview to evaluate a Chinese version of the nonmotor symptoms questionnaire (NMSQuest) as an instrument for measuring the nonmotor symptoms (NMS) in Chinese patients with PD. The patients' cognitive deficit, depression/sleep, disease severity and motor status were assessed based on the mini-mental state examination (MMSE), the Hamilton depression scale (HAMD)/Parkinson's disease sleep scale (PDSS), the modified Hoehn and Yahr staging scale (H&Y) and the unified Parkinson's disease rating scale part III (UPDRS III), respectively. Thirty items distributed in nine different domains of the NMSQuest were evaluated, and the association between the NMSQuest and MMSE, H&Y, UPDRS, HAMD and PDSS was identified. Significant correlations were observed between the NMSQuest and disease duration (rs = 0.272, p = 0.013), UPDRS total score (rs = 0.444, p < 0.001), UPDRS II (rs = 0.415, p < 0.001) and UPDRS III (rs = 0.228, p = 0.039). Furthermore, the sleep disorder and mood (depression/anxiety) domain of the NMSQuest were significantly correlated with the PDSS (rs = -0.471, p < 0.001) and HAMD (rs = 0.687, p < 0.001), respectively. Our results indicate that the Chinese version of the NMSQuest, a useful screening tool, can be considered as a comprehensive, practical measure for NMS evaluation in Chinese PD patients. The NMSQuest highlights the prevalence of the wide range of NMS and indicated good responsiveness and interpretability. We strongly recommend routine use of the simplified Chinese version of NMSQuest in this country.

A novel controllable hydrogen sulfide-releasing molecule protects human skin keratinocytes against methylglyoxal-induced injury and dysfunction.

BACKGROUND/AIM: Delayed wound healing is a common skin complication of diabetes, which is associated with keratinocyte injury and dysfunction. Levels of methylglyoxal (MGO), an α-dicarbonyl compound, are elevated in diabetic skin tissue and plasma, while levels of hydrogen sulfide (H2S), a critical gaseous signaling molecule, are reduced. Interestingly, the gas has shown dermal protection in our previous study. To date, there is no evidence demonstrating whether MGO affects keratinocyte viability and function or H2S donation abolishes these effects and improves MGO-related impairment of wound healing. The current study was conducted to examine the effects of MGO on the injury and function in human skin keratinocytes and then to evaluate the protective action of a novel H2S-releasing molecule. METHODS: An N-mercapto-based H2S donor (NSHD)-1 was synthesized and its ability to release H2S was observed in cell medium and cells, respectively. HaCaT cells, a cell line of human skin keratinocyte, were exposed to MGO to establish an in vitro diabetic wound healing model. NSHD-1 was added to the cells before MGO exposure and the improvement of cell function was observed in respect of cellular viability, apoptosis, oxidative stress, mitochondrial membrane potential (MMP) and behavioral function. RESULTS: Treatment with MGO decreased cell viability, induced cellular apoptosis, increased intracellular reactive oxygen species (ROS) content and depressed MMP in HaCaT cells. The treatment also damaged cell behavioral function, characterized by decreased cellular adhesion and migration. The synthesized H2S-releasing molecule, NSHD-1, was able to increase H2S levels in both cell medium and cells. Importantly, pretreatment with NSHD-1 inhibited MGO-induced decreases in cell viability and MMP, increases in apoptosis and ROS accumulation in HaCaT cells. The pretreatment was also able to improve adhesion and migration function. CONCLUSION: These results demonstrate that the novel synthesized H2S donor is able to protect human skin keratinocytes against MGO-induced injury and behavior dysfunction. We believe that more reasonable H2S-releasing molecules will bring relief to patients suffering from delayed wound healing in diabetes mellitus in the future.

[Factors associated with visual prognosis of acute retinal necrosis syndrome].

OBJECTIVE: To investigate relevant factors affecting the prognosis of acute retinal necrosis syndrome (ARN). METHODS: Case-series study. The clinical data of 41 patients (53 eyes) with ARN were retrospectively analyzed. Eyes were divided into two groups according to best corrected visual acuity at final visit. The groups were best corrected visual acuity better than 0.1 (group A, 28 eyes) and worse than 0.1 (group B, 25 eyes). Data were analyzed using the χ(2) test, Fisher exact test, Mann-Whitney test, bivariate correlation statistics, and multinomial logistic regression analysis. RESULTS: All patients were treated with systemic antivirus drugs and glucocorticoid. Ten eyes were treated with prophylactic laser retinopexy, 26 eyes underwent intravitreal ganciclovir, and 31 eyes underwent vitrectomy. All contralateral eyes of unilateral ARN patients were not involved after systemic antivirus treatment. Compared to group B (16.0%, 4/25), more eyes with best corrected visual acuity better than 0.1 at first visit were observed in group A (85.7%, 24/28) (χ(2) = 23.037, P = 0.000). Duration from onset of symptoms until first administration of antivirus drugs was shorter in group A [(15 ± 13) days] than in group B [(30 ± 34) days, Z = -2.414, P = 0.016]. Compared to group A (25.0%, 7/28; 10.7%, 3/28; 7.1%, 2/28; 39.3%, 11/28), more eyes in group B suffered from retinal detachment (80.0%, 20/25), occlusive central retinal vasculopathy (56.0%, 14/25), optic atrophy (36.0%, 9/25) and proliferative vitreoretinopathy (92.0%, 23/25) (χ(2) = 13.862, 10.440, 5.048, 13.749; P = 0.000, 0.001, 0.025, 0.000). Logistics regression analysis showed that visual prognosis were related to factors including best corrected visual acuity better at first visit (OR = 27.225, P = 0.003) and occlusive central retinal vasculopathy (OR = 0.065, P = 0.053). No difference in the number of eyes with increased intraocular pressure was observed between group A and group B (P > 0.05). Prophylactic laser retinopexy before retinal detachment and intravitreal ganciclovir were not associated with visual prognosis (P > 0.05). CONCLUSION: Worse visual acuity at first visit and occlusive central retinal vasculopathy are major relevant factors threatening visual prognosis.

Risk factors and their interactive effects on severe acute pancreatitis complicated with acute gastrointestinal injury.

BACKGROUND: There are many risk factors for severe acute pancreatitis (SAP) complicated with acute gastrointestinal injury (AGI), but few reports on the interaction between these risk factors. AIM: To analyze the risk factors for SAP complicated with AGI and their interactive effects. METHODS: We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022. They were divided into AGI group and non-AGI group according to whether AGI was present. Demographic data and laboratory test data were compared between the two groups. The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression, and an analysis of the interaction of the risk factors was performed. RESULTS: The percentage of patients with multiple organ dysfunction syndrome, acute physiological and chronic health scoring system II (APACHE II) score, white blood cell count and creatinine (CRE) level was higher in the AGI group than in the non-AGI group. There was a statistically significant difference between the two groups (P < 0.05). Logistic regression analysis indicated that an APACHE II score > 15 and CRE > 100 µmol/L were risk factors for SAP complicating AGI. The interaction index of APACHE II score and CRE level was 3.123. CONCLUSION: An APACHE II score > 15 and CRE level > 100 µmol/L are independent risk factors for SAP complicated with AGI, and there is a positive interaction between them.

Inhibition of ROS-activated ERK1/2 pathway contributes to the protection of H2S against chemical hypoxia-induced injury in H9c2 cells.

Hydrogen sulfide (H(2)S) has been shown to exert cardioprotective effects. However, the roles of extracellular signal-regulated protein kinases 1/2 (ERK1/2) in H(2)S-induced cardioprotection have not been completely elucidated. In this study, cobalt chloride (CoCl(2)), a chemical hypoxia mimetic agent, was applied to treat H9c2 cells to establish a chemical hypoxia-induced cardiomyocyte injury model. The results showed that pretreatment with NaHS (a donor of H(2)S) before exposure to CoCl(2) attenuated the decreased cell viability, the increased apoptosis rate, the loss of mitochondrial membrane potential (ΔΨm), and the intracellular accumulation of reactive oxygen species (ROS) in H9c2 cells. Exposure of H9c2 cells to CoCl(2) or hydrogen peroxide (H(2)O(2)) upregulated expression of phosphorylated (p) ERK1/2, which was reduced by pretreatment with NaHS or N-acetyl-L-cysteine, a ROS scavenger. More importantly, U0126, a selective inhibitor of ERK1/2, mimicked the above cytoprotection of H(2)S against CoCl(2)-induced injury in H9c2 cells. In conclusion, these results indicate that H(2)S protects H9c2 cells against chemical hypoxia-induced injury partially by inhibiting ROS-mediated activation of ERK1/2.

Spectral domain optical coherence tomography of Vogt-Koyanagi-Harada disease: novel findings and new insights into the pathogenesis.

OBJECTIVE: To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. METHODS: Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. RESULTS: Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. CONCLUSIONS: Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

Methotrexate for chronic non-necrotizing anterior scleritis in Chinese patients.

AIM: To evaluate the effectiveness and corticosteroid-sparing capabilities of methotrexate (MTX) in the treatment of chronic non-necrotizing anterior scleritis in Chinese patients. METHODS: A retrospective chart review of all patients with active anterior scleritis between January 2015 and June 2019 was conducted. All patients received 10 to 15 mg/wk MTX orally, and corticosteroids (10 to 40 mg/d prednisolone or equivalent methylprednisolone) with slow tapering. Topical corticosteroid eye drops (1% prednisolone actate, 0.1% dexmathosone or 0.1% fluoromethalone) were applied to control comorbid anterior uveitis at presentation or during follow up. The main outcomes were inflammation control and corticosteroid-sparing success, and secondary outcomes were reduction of immunosuppression load and best-corrected visual acuity (BCVA). RESULTS: Thirty-two eyes (22 patients) were included. The proportion of patients who achieved corticosteroid-sparing success was 50.0% at 3mo and 77.3% at 12mo [8 (36.4%) patients discontinued corticosteroid]. The proportion of eyes that achieved inflammation control was 59.4% at 3mo and 78.1% at 12mo. The immunosuppression load was 5.14±0.87 at presentation and 2.76±2.34 at 12mo (P<0.01). BCVA maintained unchanged or improved in 29 (90.6%) of all affected eyes. One patient discontinued MTX treatment because of an abnormal liver function test, and no other serious adverse effects were observed. CONCLUSION: According to this pilot study, low dose MTX appear to be a well-tolerated and effective treatment for chronic non-necrotizing anterior scleritis patients in the Chinese population.

Protective effects of early hypoxic post-conditioning in cultured cortical neurons.

PRIMARY OBJECTIVE: Recent evidence suggests that delayed hypoxic post-conditioning is neuroprotective. The aim of the present study was to test whether early post-conditioning applied immediately after hypoxia could protect cultured neurons from hypoxia/reoxygenation (H/R)-induced injuries. METHODS: Primary cortical neuronal culture depleted of microglia was exposed to H/R. Post-conditioning started immediately after hypoxia and consisted of three cycles of 15-minutes of reoxygenation and 15-minutes of hypoxia. Cell viability assay was performed using Cell Counting Kit-8 (CCK-8). Apoptosis was evaluated by Hoechst 33258 staining, FITC-Annexin V/PI double staining and Western blot assay (testing the cleaved caspase-3 expression). Reactive oxygen species (ROS), intracellular Ca(2+) and mitochondrial membrane potential (MMP) were examined using confocal laser-scanning microscopy. MAIN RESULTS: H/R significantly reduced cell viability and increased neuronal apoptosis and necrosis. Furthermore, the expression of cleaved caspase-3, ROS production and intracellular Ca(2+) were increased. MMP was attenuated. Injuries induced by H/R were substantially attenuated by early hypoxic post-conditioning. Changes in cleaved caspase-3 expression, ROS production, intracellular Ca(2+) level and MMP in response to H/R were significantly decreased by the post-conditioning. CONCLUSIONS: The findings demonstrated that early hypoxic post-conditioning could protect neurons against H/R-induced injuries independent of microglial cells, possibly by inhibiting ROS over-production and intracellular Ca(2+) accumulation and maintaining MMP.

[Novel exploration of emergency treatment for ueitic acute angle closure glacuma].

OBJECTIVE: To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope for the emergency treatment of uveitic acute angle closure glaucoma (ACG). METHODS: In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy (LPI). The intraocular pressure (IOP), degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint. RESULTS: The IOP values for the paracentesis plus pupillary block relief group were (9.2 ± 2.1) mm Hg, (12.4 ± 3.7) mm Hg and (14.1 ± 2.6) mm Hg at 1, 48 h and 10 d vs (24.5 ± 7.1) mm Hg, (22.2 ± 8.6) mm Hg and (19.3 ± 9.3) mm Hg respectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupillary block relief group at Day 10. Pupillary block was observed in 1(1/14) patient from the paracentesis plus pupillary block relief group and 6 (6/10) patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days. CONCLUSION: Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG. And it may offer a basis for further therapy.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis.

AIM: To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone. METHODS: We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate. RESULTS: In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD=-0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success. CONCLUSION: Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.

A single nucleotide polymorphism in the IL1RL1 gene is associated with Behcet's disease in a Chinese Han population.

AIM: To explore the association of single nucleotide polymorphisms (SNPs) in the IL33/IL1RL1 gene region with the susceptibility to Behcet's disease (BD) in a Chinese Han population. METHODS: A total of eight SNPs in the candidate gene region (rs11792633, rs7025417, rs10975519 and rs1048274 in IL33; rs2310220, rs12712142, rs13424006 and rs3821204 in IL1RL1) were genotyped in783 BD patients and 701 healthy controls by the Sequenom Mass Array iPLEX platform. RESULTS: A statistically significant association was observed between IL1RL1 rs12712142 and BD patients. The frequency of IL1RL1 rs12712142 variant allele A was significantly lower in BD patients than that in controls (OR=0.8, 95%CI: 0.69-0.94, Pc=0.039); the genotype distribution (Pc=0.043) and additive and dominant genetic model analyses (OR=0.8, 95%CI: 0.69-0.94, Pc=0.040 and OR=0.72, 95%CI: 0.58-0.88, Pc=0.011) also indicated a strong association between rs12712142 and BD patients. CONCLUSION: This is the first study to reveal the association between IL1RL1 rs12712142 variant allele A and the decreased risk of BD in the Chinese Han population, indicating a protective role of IL1RL1 in the pathogenesis of BD.

[The short-term efficacy and safety treatment study of recurrent uveitis in Behcet disease with etanercept].

OBJECTIVE: To investigate the short-term efficacy and safety of etanercept for recurrent Behcet disease (BD). METHODS: Retrospective review of 12 recurrent BD uveitis patients (16 eyes) who were followed up in Department of Ophthalmology and Department of Rheumatology of Peking Union Medical College Hospital during April 2007 to June 2008 and received etanercept for treatment of uveitis. On the basis of conventional corticosteroid and immunosuppressive therapy, subcutaneous injection of 25 mg etanercept twice per week was instituted initially, followed by a tapering to once per week based on efficacy and economic consideration. Complete ocular examination including visual acuity, intraocular pressure, anterior segment and fundus conditions were well documented at base line and at each visit. Fundus photography, fluorescein angiography, ocular B ultrasound were conducted when necessary. Endpoint of observation: substantial improvement of ocular inflammation or etanercept treatment was stopped for various reasons. RESULTS: Of 12 patients, 9 had shown improvement on visual acuity at least in one eye, although 3 of them did not show improvement. At end point, as compared to base line, of 16 eyes, 10 (63%) had better visual acuity, 6 (37%) had the same visual acuity, and none decreased; substantial improvement or remission of both anterior and posterior segment inflammation were observed for all patients. No serious adverse reaction was observed during follow up. CONCLUSION: On the basis of corticosteroid and immunosuppressive therapy, etanercept has good short term efficacy and safety for recurrent BD uveitis.

Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema.

AIM: To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide (TA) injections for treating uveitic macular edema (UME). METHODS: This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6mo. The main outcome measure was central macular thickness (CMT). The secondary outcome measures included best-corrected visual acuity (BCVA), recurrence rate and intraocular pressure (IOP). RESULTS: In total, 65 patients (80 eyes), mainly including idiopathic uveitis in 33 patients (50.77%) and Vogt-Koyanagi-Harada (VKH) syndrome in 19 patients (29.23%), were enrolled in this study. The mean CMT decreased from 457.6±173.0 µm at baseline to 325.9±176.8, 302.7±148.2, 332.2±177.3 and 270.6±121.6 µm at 1-, 2-, 3- and 6-months postinjection, respectively (all P<0.001). BCVA increased from logMAR 0.5±0.3 at baseline to logMAR 0.4±0.3, 0.4±0.3, 0.4±0.4 and 0.4±0.3 at the 1-, 2-, 3- and 6-months postinjection visits, respectively (all P<0.001). Twenty-one (21/80, 26.25%) eyes underwent relapse of UME within 6mo. A total of 20/80 (25%) eyes exhibited elevated IOPs, of which 13 eyes were controlled with topical IOP-lowering agents and 7 eyes underwent surgical removal of subconjunctival TA deposit. CONCLUSION: Subconjunctival TA injections appear to be safe and effective for UME.

[To pay attention to syphilitic uveitis].

There has been a dramatic increase in the incidence of syphilis over the last five years in the world. Some of the syphilitic patients have ocular uveitis as the initial presentation of syphilis, which may be misdiagnosed and can lead to a delay of treatment. Multiple manifestations of ocular syphilis include interstitial keratitis; anterior, intermediate, posterior uveitis and optic neuropathies. Uveitis, which may involve unilateral or bilateral eyes, is the most common ocular manifestation of syphilis. The serologic tests for syphilis should be considered for unexplained uveitis patients. All patients diagnosed with ocular syphilis should be tested for co-infection with human immunodeficiency virus. The preferred treatment for ocular syphilis remains high dose intravenous penicillin G.

[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.

[Observation on surgical results of complicated cataract in patients with uveitis].

OBJECTIVE: To evaluate the efficacy of surgical intervention of complicated cataract in patients with uveitis. METHODS: Fifty-one patients (69 eyes) with complicated cataract secondary to uveitis who had cataract surgery in Peking Union Medical College Hospital between January 2000 and August 2006 were retrospectively analyzed. Surgical procedures, visual outcome, postoperative recurrence of uveitis and complications were investigated. RESULTS: Phacoemulsification was performed on 64 eyes (92.8%), while extracapsular cataract extraction (ECCE) was performed on the remaining 5 eyes (7.2%). Posterior chamber intraocular lens (IOL) was implanted in 61 eyes (88.4%), while the remaining 8 eyes (11.6%) remained aphakic, 6 of those were in patients who were blind in the other eye. At the final follow-up, 38 eyes (55.0%) had a best corrected visual acuity of 0.5 or better, an improvement that was highly significant (Z = 8.26, P < 0.001). Postoperative recurrence of anterior uveitis occurred in 19 (27.5%) eyes, however, 18 of them were pseudophakic, among which 5 eyes had 3 or more episodes of recurrence. Neodymium: YAG (Nd: YAG) laser posterior capsulotomy was performed in 24 (34.8%) eyes, however, 23 of them were pseudophakic, among which 7 eyes underwent at least two separate capsulotomies. CONCLUSIONS: Surgical intervention of complicated cataract in patients with uveitis is effective and safe. In comparison with the pseudophakia group, less postoperative complications are found in patients without IOL implantation. Accordingly, it seems feasible that cataract extraction without IOL implantation is the procedure of choice for treating uveitis patients who are blind in the other eye.

[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.