Emergency treatment of ocular trauma is a systematic and complicated work. Rapid and correct diagnosis and treatment are needed to maximize the recovery of ocular structure and function. In recent years, China has made remarkable progress in the emergency treatment of ocular trauma, including the development of Expert consensus on the norms of emergency treatment of ocular trauma in China (2019), the establishment of a national ocular trauma database, and the development of VisionGo Artificial Intelligence prediction system for ocular trauma. These measures improve the treatment level of ocular trauma and provide support for the prediction of postoperative visual acuity in severe traumatic eyes. However, with the development of economy and society, the characteristics of ocular trauma in our country have changed. For example, the majority of hospitalized patients were open ocular injuries, farmers and workers were the main occupational groups, and the proportion of eye injuries caused by traffic injuries increased year by year, and the proportion of women and minors increased. Although the annual loss of life of ocular trauma disability in China has decreased faster than the world average, the emergency treatment of ocular trauma still faces many challenges, such as regional differences, insufficient primary medical resources, lack of standardized training, and insufficient promotion of emergency treatment standards. In order to cope with these challenges, it is necessary to further strengthen the popularization of science and technology for the prevention and treatment of ocular trauma, standardize the emergency treatment process, strengthen the training of grass-roots medical personnel, strengthen the safety of emergency surgery, and pay special attention to the particularity of children's ocular trauma. In addition, relevant research has been actively carried out to establish a complete database of emergency patients with ocular trauma to promote the accurate prevention and treatment of ocular trauma.
ObjectiveTo create a new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment (RRD), and to evaluate its safety and effectiveness. MethodsA scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination was performed in 6 eyes of 6 patients with RRD, including 2 males and 4 females. The mean age was 51 years old with a range from 23 to 66 years old. Proliferative vitreoretinopathy (PVR) were diagnosed of grade B in all 6 eyes. Duration of retinal detachments until surgery was 5.8 days with a range from 2 to 13 days. The mean preoperative intraocular pressure (IOP) was 12 mmHg with a range from 9 to 15 mmHg (1 mmHg=0.133 kPa). A 23-gauge optic fiber was used to provide an intraocular illumination. Fully examination of the ocular fundus and cryoretinopexy of retinal breaks was performed under a noncontact wide-angle viewing system. Subretinal fluid drainage through the sclerotomy and buckling procedure were performed under the operating microscope. Intravitreal injection of sterile air bubble was performed in 4 eyes. Antibiotic eye drops was applied in all eyes postoperatively, and all the eyes were followed up for at least 6 months. ResultsRetinal reattachment was achieved in all eyes, and the conjunctiva healed well. The best corrected visual acuity (BCVA) increased in all eyes. The mean postoperative IOP was 15 mmHg with a range from 12 to 19 mmHg. No complications were found intra and postoperatively. ConclusionsThis new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for RRD is safe and effective. Advantages such as higher successful rate, less complication, shorter operating time, and less discomfort of patients were showed comparing with the previous scleral buckling surgery using indirect ophthalmoscope.
Objective Methods Ninety male Wister rats were randomly divided into normal control group, diabetic group and FTY720 group, thirty rats in each group. Diabetes was induced by giving a single intraperitoneal injection of streptozocin. FTY720 group was administered with FTY720 at a dose of 0.3 mg/kg by oral gavage daily for 3 months after establishment of diabetes. All rats were used for experiments following intervention for 3 months in FTY720 group. Immunohistochemical staining was used to observe the expression and distribution of intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1), and the positive cells were counted. Real-time reverse transcription PCR was used to measure mRNA expression of ICAM-1 and VCAM-1. Fluorescein isothiocyanate-Concanavalin A perfusion was used to detect retinal leukocytes adhesion. Evans blue (EB) perfusion was used to analyze retinal vascular permeability. Immunofluorescence staining was used to detect retinal inflammatory cells infiltration. Results In diabetic group, both ICAM-1(t=12.81) and VCAM-1 (t=11.75) positive cells as well as their mRNA expression (t=16.14, 9.59) were increased compared with normal control group, with statistical significance (P < 0.05). In FTY720 group, both ICAM-1(t=-9.93) and VCAM-1 (t=-6.61) positive cells as well as their mRNA expression (t=-15.28, -6.10) were decreased compared with diabetic group, with statistical significance (P < 0.05). Retinal leukocytes adhesion (t=16.32) and EB permeability (t=17.83) were increased in diabetic group compared with normal control group, while they were decreased in FTY720 group compared with diabetic group(t=-9.93, -11.82),with statistical significance (P < 0.05). There were many CD45 positive leukocytes infiltration in retina of diabetic group, including CD11b positive macrophage/activated microglia, while both of them were little in FTY720 group. Conclusions FTY720 can decrease retinal leukocytes adhesion, reduce retinal vascular permeability and inflammatory cells infiltration, which is associated with down-regulation of ICAM-1 and VCAM-1.
Proliferative vitreoretinopathy (PVR) is a common complication and major cause of blindness of ocular trauma. Many cytokines, including vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF), participate in the process of the pathogenesis of traumatic PVR. VEGF competitively inhibits binding of PDGF to its receptor (PDGFRα), enables indirect activation of PDGFRα by non-PDGF ligands, resulting in reduced p53 expression, cell proliferation and migration, which is a key point in the pathogenesis of traumatic PVR.
Open-globe injuries (OGI) result in complicated and diverse conditions with different mechanisms and anatomical locations, which lead to completely different outcomes based on when to perform pars plana vitrectomy (PPV) after trauma. The PPV operation time points are generally divided into early (0 - 3 days), delayed (4 - 14 days), and late (> 2 weeks). There are still some controversies about the PPV time points after OGI. Injuries with intraocular foreign bodies or high risk of infection usually need early surgery to reduce the occurrence of endophthalmitis. However corneal edema and vitreous hemorrhage can increase the difficulties for early diagnosis and surgery. If there is choroidal hemorrhage or severe trauma in the back part of the eye, delayed intervention can allow the blood clots to be liquefied and removed easily. But there is higher incidence of postoperative complications. Late surgery can reduce the difficulty of PPV, but the increased incidence of proliferative vitreoretinopathy may lead to severe retinal traction, tears and postoperative scar formation.
Objective To investigate the protective effect of Niacin on blood-retina barrier (BRB) in diabetic rats and related mechanism. Methods The male Wistar rats (60) were divided into control (CON) group, diabetes (DM) group and Niacin-treated (NA) group, 20 rats in each group. Rats diabetes models were induced with streptozotocin injection. Niacin (40 mg/kg·d) was administrated orally everyday in Niacin-treated group until sacrificed after 3 months. Pathological outcomes, total cholesterol (TC) and high-density lipoprotein (HDL) were evaluated at month 3. Optical microscopy was used to observe the retinal structure. The integrity of BRB and the vascular permeability was quantified by analyzing albumin leakage using Evans blue (EB) method. The relative expressions of Claudin-5, Occludin, zonula occluden (ZO)-1 and GPR109A mRNA in rat retinas were detected by reverse transcription PCR (RT-PCR) and relative expression of GPR109A, tumor necrosis factor (TNF)-α and interleukin (IL)-6 by Western blot. Results Compared to CON group, the TC content was increased and HDL content was decreased in DM group (t=4.034, 5.831; P < 0.05). Compared to DM group, the TC content was decreased and HDL content was increased in NA group (t=6.868, 3.369; P < 0.05). The retinal structure of CON group was normal. Pathological changes were found in the DM group, such as tumescent nuclei and disorganized structures. The retinal structure of NA group was similar to the control group. Evans blue dye that the microvascular leakage in DM group was increased compared with CON group (t=24.712, P < 0.05), while in NA group was decreased compared with DM group (t=16.414, P < 0.05). The mRNA expression of Occludin, Claudin-5, ZO-1 in DM group were decreased compared with CON group (t=11.422, 12.638, 12.060; P < 0.05), while in NA group were increased compared with DM group (t=5.278, 3.952, 8.030; P < 0.05). The mRNA expression of GPR109A in NA group were increased compared with DM group (t=5.053, P < 0.05). The protein expression of GPR109A, IL-6, TNF-αin DM group were increased compared with CON group (t=4.915, 11.106, 6.582; P < 0.05). Compared to DM group, the protein expression of GPR109A was increased (t=5.806, P < 0.05), while the protein expression of IL-6 and TNF-α were decreased (t=10.131, 5.017; P < 0.05). Conclusion Niacin has the protective effect for BRB by up-regulating GPR109A expression which may suppress inflammation.
Objective To evaluate the relative factors of effect of vitrectomy on corneal endothelial cells. Methods Retrospective analysis of the results of corneal endothelium microscopy performed on 213 eyes of 213 patients undergone vetrectomy operations including single vitrectomy (78 eyes), vitrectomy combined with cataract extraction (135 eyes), silicone oil injection (34 eyes), and C3F8 injection (53 eyes) before and after 1 week, 1 and 3 moths of these surgical procedures. Results There was no significant difference between pre- and postoperative corneal endothelium density in single vitrectomy group and vitrectomy combined with cataract extraction with posterior capsule integrity group (Pgt;0.05). The corneal endothelium density significantly decreased postoperatively in C3F8or silicone oil injection group with broken posterior capsule (Plt;0.05). Conclusion C3F8 and silicone oil may damnify corneal endothelium in patients undergo vitrectom y combined with cataract extraction with broken posterior capsule. (Chin J Ocul Fundus Dis，2004，20：101-103)