AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May...AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.展开更多
AIM: To provide statistical evidence for the use of antibiotics in ophthalmology by assessing the distribution and antibiotic sensitivity of bacterial isolates from ocular specimens with suspected microbial infections...AIM: To provide statistical evidence for the use of antibiotics in ophthalmology by assessing the distribution and antibiotic sensitivity of bacterial isolates from ocular specimens with suspected microbial infections.METHODS: This study applied a retrospective analysis of 3690 bacterial isolates from ocular specimens, which were obtained from the conjunctiva, cornea, aqueous humor, vitreous body, and other ocular sites of the patients at Shandong Eye Institute in northern China from January 2013 to December 2017. The parameters assessed mainly included the distribution of isolated bacteria and the results of susceptibility tests for antibiotics. In the analysis of antibiotic sensitivities, the bacteria were divided into four groups according to gram staining, and statistical methods were used to compare their antibiotic sensitivities. RESULTS: Among the 3690 isolated bacterial strains, Staphylococcus epidermidis(2007, 54.39%) accounted for the highest proportion. As for the total isolates, their sensitivity rate to gatifloxacin was up to 90.01%, with four types of gram-stained bacteria being all highly sensitive to it, but their sensitivity rate to levofloxacin was only 51.91%. The sensitivity rate of gram-negative bacilli(G-B) to levofloxacin was 83.66%, significantly higher than the other three types of gram-stained bacteria(P<0.05). Gram-positive cocci (G+C, 97.95%) and gram-positive bacilli(G+B, 97.54%) were more sensitive to vancomycin than gram-negative cocci(G-C, 70.59%) and G-B(68.57%;P<0.05). For fusidic acid, the sensitivity rates of G+C(89.83%) and G+B(73.37%) were significantly higher than that of G-B(29.83%;P<0.05). The gram-negative bacteria's sensitivity rate to cefuroxime was as low as 59.25%, but only G-B was less sensitive to cefuroxime(57.28%), while G-C was still highly sensitive(89.29%). The sensitivity rate of gram-positive bacteria to moxifloxacin was as high as 80.28%, but only G+C was highly sensitive to moxifloxacin(81.21%), while G+B was still less sensitive(32.00%). CONCLUSION: Staphylococcus epidermidis is the predominant isolate in all ocular specimens with bacteria. Gatifloxacin is more suitable for topical prophylactic use than levofloxacin in ophthalmology when necessar y. Vancomycin and fusidic acid both have better effects on gram-positive bacteria than gram-negative bacteria. More accurate antibiotic sensitivity analysis results can be obtained when a more detailed bacterial classification and more appropriate statistical methods are performed.展开更多
Corneal diseases are currently the second main cause of blindness in China.Although most of the corneal blindness could be treated by corneal transplantation,only about 10 000 operations were carried out each year owi...Corneal diseases are currently the second main cause of blindness in China.Although most of the corneal blindness could be treated by corneal transplantation,only about 10 000 operations were carried out each year owing to the severe shortage of corneal donors and limited eye bank programs.A feasible cornea donation program was established through the organization of the Red Cross,and in situ corneal removal techniques were developed to avoid conflicts with Chinese traditions of keeping the deceased intact.The number of donated corneas,which had a safe and secure quality,increased significantly year by year.展开更多
AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHOD...AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. RESULTS: The patients were followed up for an average of 24.3 ±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting >1 000/mm2 , although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells.CONCLUSION: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long -term safety and efficacy are required. Alarger study population and longer follow-up may be beneficial.展开更多
AIM:To evaluate the correlation between Demodex infestation and keratitis,and to assess demodicosis using a simple approach.METHODS:A modified slit lamp illumination(at 40×magnification)was used to observe Demode...AIM:To evaluate the correlation between Demodex infestation and keratitis,and to assess demodicosis using a simple approach.METHODS:A modified slit lamp illumination(at 40×magnification)was used to observe Demodex tails in 40patients with refractory keratitis and 80 healthy controls.Bacterial smear and culture of the conjunctival sac and corneal lesion were performed to identify the pathogen.Tea tree oil ointment(TTOO)was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed.RESULTS:Demodex tails were found in all patients compared to 42/80 of the controls(P<0.01).Seventeen patients presented blepharitis,while 23 were free of scales and inflammation at the lid margin.The demodicosis was mild,moderate,and severe in 8,19,and 13 patients,respectively,compared to mild in 42 controls(P<0.01).The keratitis was mild,moderate,and severe in 13,19,and 8patients,respectively.The severity of Demodex infestation was not correlated to the severity of keratitis(P=0.126).The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment.Patients’signs and symptoms got resolved after the lid scrub with TTOO.CONCLUSION:Ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis.A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.展开更多
AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus(DM).·METHODS: Of 118 eyes(118 patients) with type 2 DM(DM group) and 100 eyes of 100 control subjects(co...AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus(DM).·METHODS: Of 118 eyes(118 patients) with type 2 DM(DM group) and 100 eyes of 100 control subjects(control group) were enrolled. After completing an ocular surface disease index(OSDI) questionnaire, the non-invasive tear film break-up time(NI-BUT) and the structure of the meibomian glands(MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0(no loss) to grade 3(lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy(LSCM). The primary outcomes were meibomian gland acinar unit density(MGAUD),meibomian gland acinar longest diameter(MGALD) and meibomian gland acinar shortest diameter(MGASD).·RESULTS: Compared with control group, the OSDI was significantly higher in DM group(Z =-5.916; P <0.001),while the NI-BUT was significantly lower(Z =-7.765; P <0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group(Z =-3.937; P <0.001).LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group(Z =-10.120,-9.4442,-7.771; P <0.001).· CONCLUSION: Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye.Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.展开更多
AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from th...AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from the corneal ulcer, Group 2 from the conjunctival sac of the infected eyes, and Group 3 from the conjunctival sac of the fellow eyes) and 10 healthy eyes(Group 4 from the conjunctival sac). Bacterial 16 S rDNA V4-V5 region sequencing was performed to characterize the bacterial communities on the ocular surfaces of the patients with FK. RESULTS: Our metagenomic data showed that 97% of the sequence reads were categorized into 245 distinct bacterial genera, with 67.75±7.79 genera detected in Group 1, 73.80±13.44 in Group 2, 74.57±14.14 in Group 3, and 89.60±27.49 in Group 4. Compared with the healthy eyes(Group 4), both infected(Groups 1 and 2) and fellow eyes(Group 3) of the patients with FK showed reduced bacterial diversity and altered ocular surface microbiota compositions, with lower abundance of Corynebacterium and Staphylo coccus and higher abundances of Pseudomonas, Achromobacter, Caulobacter and Psychrobacter. CONCLUSION: Our report depicts the altered ocular surface bacterial community structures both in the affected and fellow eyes of patients with FK. These changes may contribute to the pathogenesis of FK or the increased risk for FK.展开更多
AIM:To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis.· METHODS:A retro...AIM:To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis.· METHODS:A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae.Local and systemic antifungal therapy more than one week for all patients,corneal ulcer enlarge or no shrink.Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm.Anterior segment optical coherence tomography(AS-OCT)examine the depth of corneal ulcer between 1/3-1/2,infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis.Complete removal lesions until transparent of stroma,make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva.Continued antifungal therapy.The vision,fungal recurrence,conjunctival flap rollback or desquamate were analysed.· RESULTS:Ten patients had success done this surgery,the corneal ulcer was not enlarge and healing afteroperation.7 cases were bridging conjunctival flap and 3cases were single conjunctival flap.Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery,while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap,no conjunctival flap desquamate.· CONCLUSION:It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.展开更多
AIM: To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China. METHODS: Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of inju...AIM: To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China. METHODS: Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis. RESULTS: A total of 117 eyes of 117 patients (96 boys and 21 girls) with unilateral injuries (66 right and 51 left eyes) were included in the study. The mean (SEM) age at diagnosis was (6.6 ±3.2) years (range, 1.3-13.8 years). Each cataract was categorized according to the type of trauma: closed-globe (n =26) or open-globe (n =91) injuries. The most common injuring objects were sharp metal objects (37.61%). The most common complication in open-globe injuries was corneal laceration, whereas traumatic mydriasis was most common in closed-globe injuries. Of 68 eyes in patients with open-globe injuries who received cataract extraction, intraocular lens (IOLs) were primarily implanted in 47 eyes (68.12%), whereas 18 eyes with closed-globe injuries received cataract extraction, and IOLs were primarily implanted in 17 eyes (94.4%). The surgical procedures included reconstruction of the anterior segment, synechiolysis, excision of the membrane, lensectomy, vitrectomy and related techniques. Postoperative vision was significantly improved compared with preoperative vision. CONCLUSION: Pediatric traumatic cataract should be treated in time to attenuate the complications, and education on pediatric traumatic cataract and improvements in pediatric health care are needed for the early detection of cataract in children.展开更多
AIM: To compare the therapeutic effects of polysaccharide extract from Spirulina platensis (PSP) and extract from amnion membrane (AME) on alkali burn-induced corneal neovascularization (CorNV).METHODS: PSP and AME we...AIM: To compare the therapeutic effects of polysaccharide extract from Spirulina platensis (PSP) and extract from amnion membrane (AME) on alkali burn-induced corneal neovascularization (CorNV).METHODS: PSP and AME were extracted from dry powder of Spirulina platensis and human aminion membrane respectively. Murine CorNV was induced by applying 1N sodiumhydroxide (NaOH) solution directly on the mice corneas. PSP and AME extracts were administered topically on the corneas 4 times daily for 7 days. The therapy effects of PSP and AME extracts were evaluated daily using slit-lamp. At the end of the therapy, corneas were harvested for H&E staining, masson trichrome staining, immunohistochemical study, and semi-quantification reverse transcriptive PCR (RT-PCR) was utilized for measurement of inflammation- related molecules.RESULTS: Topical application of PSP extract had significant therapeutic effects on CorNV that could be shown in various assays of the corneas. Compared with AME extract, PSP extract treatment was more effective in suppressing CorNV in terms of vessel length and levels of cluster of differentiation 31 (CD31) proteins or the angiogenesis related genes like vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP2) and matrix metalloproteinase-9 (MMP9). PSP also inhibited inflammation more markedly by more effectively inhibiting mononuclear and polymor- phonuclear cells infiltration into the corneal stroma and reducing levels of stromal cell-derived factor-1 (SDF1), tumor necrosis factor-alpha (TNFα) and macrophage inflammatory protein-3 (MIP3a). In additon, corneas of PSP group had a more regular and compact architecture of collagen with thinner corneal thickness than in the AME group. CONCLUSION: Polysaccharide extract from Spirulina platensis inhibited alkali burn-induced inflammation and CorNV more effectively than AME extract at the studied doses, thus may be used for the therapy of corneal diseases involving neovascularization and inflammation.展开更多
AIM: To investigate into the potential involvement of pyrin containing 3 gene(NLRP3), a member of the nucleotide-binding oligomerization domain-like receptors with cytosolic pattern recognition, in the host defense of...AIM: To investigate into the potential involvement of pyrin containing 3 gene(NLRP3), a member of the nucleotide-binding oligomerization domain-like receptors with cytosolic pattern recognition, in the host defense of corneas against viruses.METHODS: The herpes viral keratitis model was utilized in BALB/c mice with inoculation of herpes simplex virus-1(HSV-1). Corneal tissues removed during therapy of patients with viral keratitis as well as a Simian vacuolating virus 40(SV40)-immortalized human corneal epithelial cell line were also examined.Immunohistochemistry was used to detect NLRP3 in these subjects, focusing on their distribution in tissue or cells. Western blot was used to measure the level of NLRP3 and another two related molecules in NLPR3 inflammasome, namely caspase-1 and IL-1β.RESULTS: The NLRP3 activation induced by HSV-1infection in corneas was accompanied with redistribution of NLRP3 from the cytoplasm to the nucleus in both murine and human corneal epithelial cells. Furthermore,in the SV40-immortalized human corneal epithelial cells,NLRP3 was exclusively located in the nucleus, and treatment of the cells with high concentration of extracellular potassium(known as an inhibitor of NLRP3activation) effectively drove NLRP3 back to the cytoplasm as reflected by both immunohistochemistry and Western blot.· CONCLUSION: It is proposed that herpes virus infection activates and causes redistribution of NLRP3 to nuclei. Whether this NLRP3 translocation occurs with other viral infections and in other cell types merit further study.展开更多
AIM: To uncover the mutations profile of transforming growth factor beta-induced(TGFBI) gene in Chinese corneal dystrophy patients and further investigate the characteristics of genotype-phenotype correlations.·M...AIM: To uncover the mutations profile of transforming growth factor beta-induced(TGFBI) gene in Chinese corneal dystrophy patients and further investigate the characteristics of genotype-phenotype correlations.·METHODS: Forty-two subjects(6 unrelated families including 15 patients and 8 unaffected members, and 19 sporadic patients) of Chinese origin were subjected to phenotypic and genotypic characterization. The corneal phenotypes of patients were documented by slit lamp photography. Mutation screening of the coding regions of TGFBI was performed by direct sequencing.·RESULTS: We detected four corneal dystrophy types.The most frequent phenotypes were granular corneal dystrophy(GCD)(including 3 families and 8 sporadic patients) and lattice corneal dystrophy(LCD)(including 2families and 9 sporadic patients). The next phenotypes were corneal dystrophy of Bowman layer(CDB)(1 family and 1 sporadic patient) and epithelial basement membrane dystrophy(EBMD)(1 sporadic patient). Six distinct mutations responsible for TGFBI corneal dystrophies were identified in 30 individuals with corneal dystrophies. Those were, p.R124 H mutation in 1 family and 2 sporadic patients with GCD, p.R555 W mutation in 2families and 3 sporadic patients with GCD, p.R124 C mutation in 2 families and 7 sporadic patients with LCD,p.A620 D mutation in 1 sporadic patient with LCD, p.H626 R mutation in 1 sporadic patient with LCD, and p.R555 Q in1 family and 1 sporadic patient with CDB. No mutationwas detected in the remaining 3 atypical GCD patients and 1 EBMD patient.·CONCLUSION: GCD and LCD are the most frequent phenotypes in Chinese population. R555 W was the most common mutation for GCD; R124 C was the most common mutation for LCD. Our findings extend the mutational spectrum of TFGBI, and this is the extensively delineated TGFBI mutation profile associated with the various corneal dystrophies in the Chinese population.展开更多
AIM: To investigate the expression of succinate receptor GPR91 and its pathogenic roles in Mooren's ulcer(MU).METHODS: Biopsy specimens were obtained from 7 patients with MU and 6 healthy donors. The expression of...AIM: To investigate the expression of succinate receptor GPR91 and its pathogenic roles in Mooren's ulcer(MU).METHODS: Biopsy specimens were obtained from 7 patients with MU and 6 healthy donors. The expression of GPR91 in MU tissues was evaluated using quantitative realtime reverse transcription polymerase chain reaction(qRTPCR) and immunohistochemistry(IHC). Succinate was used to activate GPR91 signaling, and the effect of GPR91 on the expression of interleukin-1β(IL-1β), NLRP3, vascular endothelial growth factor(VEGF) and matrix metalloproteinase-13(MMP-13) in human peripheral blood mononuclear cells(PBMCs) was determined. The influence of GPR91 on the nuclear factor-κB(NF-κB) signaling in PBMCs was investigated by detecting the phosphorylation of p65. Moreover, the expression of IL-1β, VEGF, MMP-13 and phosphorylated p65(p-p65) in the tissues of MU was examined by qRT-PCR or IHC.RESULTS: GPR91 mRNA expression showed a higher level in the MU group than in the healthy control group. IHC analysis also revealed that the expression of GPR91 was elevated in patients with MU compared with healthy controls. Moreover, ligation of GPR91 with succinate promoted the lipopolysaccharide-induced production of NLRP3, IL-1β, VEGF and MMP-13 in PBMCs through increased phosphorylation of p65. Pharmacological inhibition of the NF-κB signaling reversed GPR91 induced production of NLRP3, IL-1β, VEGF and MMP-13. These findings, coupled with the elevated amounts of IL-1β, VEGF, MMP-13 and p-p65 observed in the MU biopsies, constituted a rational basis for the involvement of GPR91 in the pathogenesis of MU.CONCLUSION: This study indicates the increased succinate receptor GPR91 in conjunctival or corneal tissues is involved in the pathogenesis of MU through elevated NF-κB activity, which may provide a new therapeutic target for MU.展开更多
AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of...AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of surgery in the treatment.METHODS: The clinical records of 27 patients(27 eyes)with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained.RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule,accounting for 56%, 26%, 15% and 2.5%, respectively.Fusarium was identified in 44%(12/27) of the eyes,followed by Aspergillus in 22%(6/27). Posterior segment infection was involved in 78%(21/27) of the patients. The corneal infection was larger than 3 mm×3 mm in 89%(24/27) of the patients, and 22%(6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes(81.5%) underwent penetrating keratoplasty(PKP), and over half of them(54.5%)were operated within 3d from the onset of antifungal therapy. Fourteen eyes(52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes(55.6%) underwent pars plana vitrectomy(PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60%(9/15),lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes(16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes(18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis.Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy(especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.展开更多
AIM:To investigate the effect of anti-vascular epithelial growth factor(VEGF)agents on the expression of fibrosisrelated inflammatory mediators under normoxic and hypoxic conditions,and to further clarify the mechanis...AIM:To investigate the effect of anti-vascular epithelial growth factor(VEGF)agents on the expression of fibrosisrelated inflammatory mediators under normoxic and hypoxic conditions,and to further clarify the mechanism underlying fibrosis after anti-VEGF therapy. METHODS:Human retinal pigment epithelial(RPE)cells were incubated under normoxic and hypoxic conditions.For hypoxia treatment,CoCl_2 at 200μmol/L was added to the media. ARPE-19 cells were treated as following:1)control group:no treatment; 2)bevacizumab group:bevacizumab at 0.25 mg/mL was added to the media; 3)hypoxia group:CoCl_2 at 200 μmol/L was added to the media; 4)hypoxia+bevacizumab group:CoCl_2 at 200 μmol/L and bevacizumab at 0.25 mg/mL were added to the media.The expression of interleukin(IL)-1β,IL-6,IL-8 and tumor necrosis factor(TNF)-α were evaluated using real-time polymerase chain reaction(RT-PCR)and enzyme-linked immunosorbent assay(ELISA)at 6,12,24 and 48 h. RESULTS:Both m RNA and protein levels of IL-1β,IL-6 and IL-8 were statistically significantly higher in the bevacizumab group than in the control group at each time point,and TNF-α gene and protein expression was only significantly higher only at 24 and 48h(P<0.05). Under hypoxic conditions,bevacizumab significantly increased the expression of IL-1β,IL-6,IL-8 and TNF-α at 6,12,24 and 48h(P<0.05). IL-1β,IL-8 and TNF-α peaked at 24 h and IL-6 peaked at 12 h after the bevacizumab treatment under both normoxic and hypoxic conditions. CONCLUSION:Treatment of ARPE-19 cells with bevacizumab can significantly increase the expression of fibrosis-related inflammatory mediators under bothnormoxic and hypoxic conditions. Inflammatory factors might be involved in the process of fibrosis after antiVEGF therapy,and the up-regulation of inflammatory factors induced by anti-VEGF drugs might promote the fibrosis process.展开更多
AIM:To assess the effect of myopia on the thickness of retinal nerve fiber layer(RNFL) measured by 3D optical coherence tomography(3D-OCT) in a group of nonglaucomatous Chinese subjects.METHODS:Two hundred and fifty-e...AIM:To assess the effect of myopia on the thickness of retinal nerve fiber layer(RNFL) measured by 3D optical coherence tomography(3D-OCT) in a group of nonglaucomatous Chinese subjects.METHODS:Two hundred and fifty-eight eyes of 258 healthy Chinese myopic individuals were recruited and four groups were classified according to their spherical equivalent(SE):low myopia(n=42,-0.50<SE<-3.0D),moderate myopia(n=120,-3.0D≤SE<-6.0D),high myopia(n=58,-6.0D≤SE<-8.0D) and extreme high myopia(n=38,SE ≥-8.0D).The RNFL thickness profile including superior,nasal,inferior and temporal quadrant and each of the 12 clock-hour thicknesses were measured by 3DOCT.The RNFL thicknesses among four sample groups were performed by one-way analysis of variance(oneway ANOVA) and least significant difference test(LSD test).Correlations between RNFL thickness and axial length/spherical equivalent were performed by linear regression analysis. RESULTS:The overall RNFL parameters shown significant differences between groups excluding 7,9,10,11 o'clock hour thickness.The RNFL thickness of superior,nasal,inferior,average and 1,2,3,4,5,6,12 o'clock sectors were decreased with the increasing axial length and higher degree of myopia.In contrast,as axial length and the degree of myopia increased,the temporal and 8,9 o'clock sectors thicknesses were increased.A considerable proportion of myopic eyes were classified as outside the normal limits.Six o'clock was the most notable of the total,which 43.4% were outside the normal limits. CONCLUSION:On the measurement of RNFL,the characteristics of RNFL with the change of the degree of myopia were observed.As the degree of myopia increases,the RNFL thickness measured by 3D-OCT including the average and superior,nasal,inferior sectors decreases.And due to the change of RNFL thickness,it should be considered when using OCT to access for the damage of glaucoma especially people with myopia.展开更多
AIM: To evaluate the corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome (PEX). · METHODS: Medical records of 16 patients (20 eyes) with PEX who presented to our in...AIM: To evaluate the corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome (PEX). · METHODS: Medical records of 16 patients (20 eyes) with PEX who presented to our institution between July 2008 and June 2010 were retrospectively reviewed. Thirteen eyes had combined glaucoma. The information of five apparently normal fellow eyes in these patients was also recorded. Left eyes of 20 patients with bilateral senile cataracts but no other eye disease were included as controls. Specular microscopy was performed in all eyes to analyze for corneal endothelial cell density and morphology. Cell density, coefficient of variation in cell size, and percentage of hexagonal cells in corneal endothelium were evaluated. · RESULTS: The mean corneal endothelial cell density in the PEX eyes was 2298±239 cells/mm2, significantly lower than that in the cataract eyes (2652±18 cells/mm2, P =0.026), but there were no significant differences in coefficient of variation of cell size and frequency of hexagonality between these two groups. No significant differences in the three parameters were found between the apparently normal fellow eyes and the PEX eyes or the cataract eyes, or between the PEX eyes with and without glaucoma. · CONCLUSION: Corneal endothelial cell density may decrease in Chinese patients with PEX. The development of glaucoma in PEX eyes does not seem to be related with the change in corneal endothelial cell density or morphology.展开更多
AIM: To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS: A total of 209 patients(209 eyes) with fungal keratitis, involving no more than ...AIM: To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS: A total of 209 patients(209 eyes) with fungal keratitis, involving no more than 50% of the stromal depth and not responding to antifungal agents for 2 wk, were recruited in this retrospective, noncomparative study. The patients were treated with modified corneal ulcer debridement. All visible corneal infiltrates were removed under an operating microscope to obtain a clean stromal bed and smooth incised edges. Antifungal drugs were used immediately after surgery. Healing time of the ulcers was recorded. Fungal recurrence, visual acuity, corneal thickness and risk factors for treatment failure were monitored.RESULTS: The follow-up was 13.6±5.8m o. The corneal ulcers healed in 195 of 209 eyes(93.3%), with a mean healing time of 8.4±6.8 d. The other 14 eyes were further treated by penetrating keratoplasty(PK)(1 eye), anterior lamellar keratoplasty(LK)(7 eyes), conjunctival flap covering(4 eyes) or amniotic membrane transplantation(2 eyes). The best corrected visual acuity(BCVA) was ≥20/70 in 80.3% of the eyes, ≥20/40 in 56.9% of the eyes, and ≥20/25 in 27.3% of the eyes. The corneas at the lesions became thinner, but all in the safe range. No fungal recurrence or corneal ectasis developed during the follow-up. The risk of treatment failure was higher in patients with preoperative hypopyon(P=0.036) and ever using steroid(P=0.025).CONCLUSION: Modified surgical debridement is a simple and effective method for the treatment of superficial fungal infection of the cornea, with improved visual acuity and no recurrence. Such an intervention in time can rapidly control fungal infection and largely shorten corneal ulcer healing time.展开更多
● AIM: To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucom...● AIM: To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma(POAG) and chronic primary angle-closure glaucoma(CPACG). ● METHODS: Retrospective, comparative study. A total of 60 eyes(60 patients) receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes(30 patients) had the combined procedures for POAG, and the other 30 eyes(30 patients) for CPACG.● RESULTS: The follow-up was 39.37±7.09mo(range 3 to 49mo) in patients with POAG and 37.10±9.26mo(range 9 to 49mo) in patients with CPACG(P=0.29). The mean change in best corrected visual acuity was 0.41 log MAR for POAG and 0.38 log MAR for CPACG at the last follow-up(P=0.22). The postoperative intraocular pressure(IOP) of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18 mo after surgery(P=0.02, 0.00, 0.04, 0.01) with similar glaucoma medications after surgery(P>0.16). At 3y after surgery, the cumulative complete and qualified success rates were 63.3%(POAG) and 53.3%(CPACG), 83.3%(POAG) and 73.3%(CPACG)(P=0.41, 0.49), respectively. The POAG group had more hypotony than the CPACG group(P=0.04).● CONCLUSION: The long-term outcomes show the ExPRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.展开更多
Objective Fungal keratitis(FK) is a vision-threatening infection,whose treatment requires more effective and safer anti-fungal agent exploitation urgently.With this aim,we focused on the effect of an extracellular pol...Objective Fungal keratitis(FK) is a vision-threatening infection,whose treatment requires more effective and safer anti-fungal agent exploitation urgently.With this aim,we focused on the effect of an extracellular polysaccharide on fungal adhesion to human corneal epithelial cells.Methods We performed the cytotoxicity assays of the extracellular polysaccharide EPS-II from an antarctic bacterium Pseudoaltermonas and evaluated its inhibitory effect on Candida albicans cells' adherence to human corneal epithelial cells(HCECs).Results EPS-II,which displayed minor cytotoxicity but also promoted proliferation of HCECs,could inhibit the adherence of yeast cells to HCECs in a dose-dependent manner.EPS-II could also suppress the subsequent PI3K/AKT signaling pathway,and thereby decrease the expression of early inflammatory cytokines.Conclusions ExtracellularpolysaccharideEPS-IIwassuggestedasanewnaturalagentforattenuatingFK.展开更多
基金Supported by National Natural Science Foundation of China(No.30630063)
文摘AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.
基金Supported by the National Natural Science Foundation of China(No.81670839)the Shandong Medical and Health Science and Technology Development Program(No.2016WS0265)the Qingdao People’s Livelihood Science and Technology Project(No.16-6-2-14-nsh)
文摘AIM: To provide statistical evidence for the use of antibiotics in ophthalmology by assessing the distribution and antibiotic sensitivity of bacterial isolates from ocular specimens with suspected microbial infections.METHODS: This study applied a retrospective analysis of 3690 bacterial isolates from ocular specimens, which were obtained from the conjunctiva, cornea, aqueous humor, vitreous body, and other ocular sites of the patients at Shandong Eye Institute in northern China from January 2013 to December 2017. The parameters assessed mainly included the distribution of isolated bacteria and the results of susceptibility tests for antibiotics. In the analysis of antibiotic sensitivities, the bacteria were divided into four groups according to gram staining, and statistical methods were used to compare their antibiotic sensitivities. RESULTS: Among the 3690 isolated bacterial strains, Staphylococcus epidermidis(2007, 54.39%) accounted for the highest proportion. As for the total isolates, their sensitivity rate to gatifloxacin was up to 90.01%, with four types of gram-stained bacteria being all highly sensitive to it, but their sensitivity rate to levofloxacin was only 51.91%. The sensitivity rate of gram-negative bacilli(G-B) to levofloxacin was 83.66%, significantly higher than the other three types of gram-stained bacteria(P<0.05). Gram-positive cocci (G+C, 97.95%) and gram-positive bacilli(G+B, 97.54%) were more sensitive to vancomycin than gram-negative cocci(G-C, 70.59%) and G-B(68.57%;P<0.05). For fusidic acid, the sensitivity rates of G+C(89.83%) and G+B(73.37%) were significantly higher than that of G-B(29.83%;P<0.05). The gram-negative bacteria's sensitivity rate to cefuroxime was as low as 59.25%, but only G-B was less sensitive to cefuroxime(57.28%), while G-C was still highly sensitive(89.29%). The sensitivity rate of gram-positive bacteria to moxifloxacin was as high as 80.28%, but only G+C was highly sensitive to moxifloxacin(81.21%), while G+B was still less sensitive(32.00%). CONCLUSION: Staphylococcus epidermidis is the predominant isolate in all ocular specimens with bacteria. Gatifloxacin is more suitable for topical prophylactic use than levofloxacin in ophthalmology when necessar y. Vancomycin and fusidic acid both have better effects on gram-positive bacteria than gram-negative bacteria. More accurate antibiotic sensitivity analysis results can be obtained when a more detailed bacterial classification and more appropriate statistical methods are performed.
基金Supported by the National Natural Science Foundation of China(No.81500702,No.81530027)the Shandong Provincial Natural Science Foundation(No.2016GSF201216)+1 种基金the Taishan Scholar Program(No.spd20150215,No.20161059)the Innovation Project of Shandong Academy of Medical Sciences
文摘Corneal diseases are currently the second main cause of blindness in China.Although most of the corneal blindness could be treated by corneal transplantation,only about 10 000 operations were carried out each year owing to the severe shortage of corneal donors and limited eye bank programs.A feasible cornea donation program was established through the organization of the Red Cross,and in situ corneal removal techniques were developed to avoid conflicts with Chinese traditions of keeping the deceased intact.The number of donated corneas,which had a safe and secure quality,increased significantly year by year.
文摘AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. RESULTS: The patients were followed up for an average of 24.3 ±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting >1 000/mm2 , although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells.CONCLUSION: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long -term safety and efficacy are required. Alarger study population and longer follow-up may be beneficial.
基金Supported by the National Natural Science Foundation of China(No.82271052,No.82271058,No.U20A20386)the Taishan Scholar Program(No.tspd20150215,No.tsqn201909188)。
文摘AIM:To evaluate the correlation between Demodex infestation and keratitis,and to assess demodicosis using a simple approach.METHODS:A modified slit lamp illumination(at 40×magnification)was used to observe Demodex tails in 40patients with refractory keratitis and 80 healthy controls.Bacterial smear and culture of the conjunctival sac and corneal lesion were performed to identify the pathogen.Tea tree oil ointment(TTOO)was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed.RESULTS:Demodex tails were found in all patients compared to 42/80 of the controls(P<0.01).Seventeen patients presented blepharitis,while 23 were free of scales and inflammation at the lid margin.The demodicosis was mild,moderate,and severe in 8,19,and 13 patients,respectively,compared to mild in 42 controls(P<0.01).The keratitis was mild,moderate,and severe in 13,19,and 8patients,respectively.The severity of Demodex infestation was not correlated to the severity of keratitis(P=0.126).The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment.Patients’signs and symptoms got resolved after the lid scrub with TTOO.CONCLUSION:Ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis.A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.
文摘AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus(DM).·METHODS: Of 118 eyes(118 patients) with type 2 DM(DM group) and 100 eyes of 100 control subjects(control group) were enrolled. After completing an ocular surface disease index(OSDI) questionnaire, the non-invasive tear film break-up time(NI-BUT) and the structure of the meibomian glands(MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0(no loss) to grade 3(lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy(LSCM). The primary outcomes were meibomian gland acinar unit density(MGAUD),meibomian gland acinar longest diameter(MGALD) and meibomian gland acinar shortest diameter(MGASD).·RESULTS: Compared with control group, the OSDI was significantly higher in DM group(Z =-5.916; P <0.001),while the NI-BUT was significantly lower(Z =-7.765; P <0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group(Z =-3.937; P <0.001).LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group(Z =-10.120,-9.4442,-7.771; P <0.001).· CONCLUSION: Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye.Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.
基金Supported by the National Natural Science Foundation of China(No.81670839)the Key Research and Development Plan of Shandong Province(No.2018CXGC1205)
文摘AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from the corneal ulcer, Group 2 from the conjunctival sac of the infected eyes, and Group 3 from the conjunctival sac of the fellow eyes) and 10 healthy eyes(Group 4 from the conjunctival sac). Bacterial 16 S rDNA V4-V5 region sequencing was performed to characterize the bacterial communities on the ocular surfaces of the patients with FK. RESULTS: Our metagenomic data showed that 97% of the sequence reads were categorized into 245 distinct bacterial genera, with 67.75±7.79 genera detected in Group 1, 73.80±13.44 in Group 2, 74.57±14.14 in Group 3, and 89.60±27.49 in Group 4. Compared with the healthy eyes(Group 4), both infected(Groups 1 and 2) and fellow eyes(Group 3) of the patients with FK showed reduced bacterial diversity and altered ocular surface microbiota compositions, with lower abundance of Corynebacterium and Staphylo coccus and higher abundances of Pseudomonas, Achromobacter, Caulobacter and Psychrobacter. CONCLUSION: Our report depicts the altered ocular surface bacterial community structures both in the affected and fellow eyes of patients with FK. These changes may contribute to the pathogenesis of FK or the increased risk for FK.
文摘AIM:To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis.· METHODS:A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae.Local and systemic antifungal therapy more than one week for all patients,corneal ulcer enlarge or no shrink.Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm.Anterior segment optical coherence tomography(AS-OCT)examine the depth of corneal ulcer between 1/3-1/2,infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis.Complete removal lesions until transparent of stroma,make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva.Continued antifungal therapy.The vision,fungal recurrence,conjunctival flap rollback or desquamate were analysed.· RESULTS:Ten patients had success done this surgery,the corneal ulcer was not enlarge and healing afteroperation.7 cases were bridging conjunctival flap and 3cases were single conjunctival flap.Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery,while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap,no conjunctival flap desquamate.· CONCLUSION:It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.
文摘AIM: To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China. METHODS: Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis. RESULTS: A total of 117 eyes of 117 patients (96 boys and 21 girls) with unilateral injuries (66 right and 51 left eyes) were included in the study. The mean (SEM) age at diagnosis was (6.6 ±3.2) years (range, 1.3-13.8 years). Each cataract was categorized according to the type of trauma: closed-globe (n =26) or open-globe (n =91) injuries. The most common injuring objects were sharp metal objects (37.61%). The most common complication in open-globe injuries was corneal laceration, whereas traumatic mydriasis was most common in closed-globe injuries. Of 68 eyes in patients with open-globe injuries who received cataract extraction, intraocular lens (IOLs) were primarily implanted in 47 eyes (68.12%), whereas 18 eyes with closed-globe injuries received cataract extraction, and IOLs were primarily implanted in 17 eyes (94.4%). The surgical procedures included reconstruction of the anterior segment, synechiolysis, excision of the membrane, lensectomy, vitrectomy and related techniques. Postoperative vision was significantly improved compared with preoperative vision. CONCLUSION: Pediatric traumatic cataract should be treated in time to attenuate the complications, and education on pediatric traumatic cataract and improvements in pediatric health care are needed for the early detection of cataract in children.
基金Supported by Natural Science Foundation of Shandong Province of China for Distinguished Young Scholars under Grant(No.JQ200908)Shandong Province Natural Science Foundation,China(No.Q2008C02)Yiqiang Wang is partially supported by Shandong Taishan Scholar Program(QDU-EYE)
文摘AIM: To compare the therapeutic effects of polysaccharide extract from Spirulina platensis (PSP) and extract from amnion membrane (AME) on alkali burn-induced corneal neovascularization (CorNV).METHODS: PSP and AME were extracted from dry powder of Spirulina platensis and human aminion membrane respectively. Murine CorNV was induced by applying 1N sodiumhydroxide (NaOH) solution directly on the mice corneas. PSP and AME extracts were administered topically on the corneas 4 times daily for 7 days. The therapy effects of PSP and AME extracts were evaluated daily using slit-lamp. At the end of the therapy, corneas were harvested for H&E staining, masson trichrome staining, immunohistochemical study, and semi-quantification reverse transcriptive PCR (RT-PCR) was utilized for measurement of inflammation- related molecules.RESULTS: Topical application of PSP extract had significant therapeutic effects on CorNV that could be shown in various assays of the corneas. Compared with AME extract, PSP extract treatment was more effective in suppressing CorNV in terms of vessel length and levels of cluster of differentiation 31 (CD31) proteins or the angiogenesis related genes like vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP2) and matrix metalloproteinase-9 (MMP9). PSP also inhibited inflammation more markedly by more effectively inhibiting mononuclear and polymor- phonuclear cells infiltration into the corneal stroma and reducing levels of stromal cell-derived factor-1 (SDF1), tumor necrosis factor-alpha (TNFα) and macrophage inflammatory protein-3 (MIP3a). In additon, corneas of PSP group had a more regular and compact architecture of collagen with thinner corneal thickness than in the AME group. CONCLUSION: Polysaccharide extract from Spirulina platensis inhibited alkali burn-induced inflammation and CorNV more effectively than AME extract at the studied doses, thus may be used for the therapy of corneal diseases involving neovascularization and inflammation.
基金Supported by National Natural Science Foundation of China(No.81273212,81100651)Project of Science and Technology of Shandong Province(No.2014GSF118044)
文摘AIM: To investigate into the potential involvement of pyrin containing 3 gene(NLRP3), a member of the nucleotide-binding oligomerization domain-like receptors with cytosolic pattern recognition, in the host defense of corneas against viruses.METHODS: The herpes viral keratitis model was utilized in BALB/c mice with inoculation of herpes simplex virus-1(HSV-1). Corneal tissues removed during therapy of patients with viral keratitis as well as a Simian vacuolating virus 40(SV40)-immortalized human corneal epithelial cell line were also examined.Immunohistochemistry was used to detect NLRP3 in these subjects, focusing on their distribution in tissue or cells. Western blot was used to measure the level of NLRP3 and another two related molecules in NLPR3 inflammasome, namely caspase-1 and IL-1β.RESULTS: The NLRP3 activation induced by HSV-1infection in corneas was accompanied with redistribution of NLRP3 from the cytoplasm to the nucleus in both murine and human corneal epithelial cells. Furthermore,in the SV40-immortalized human corneal epithelial cells,NLRP3 was exclusively located in the nucleus, and treatment of the cells with high concentration of extracellular potassium(known as an inhibitor of NLRP3activation) effectively drove NLRP3 back to the cytoplasm as reflected by both immunohistochemistry and Western blot.· CONCLUSION: It is proposed that herpes virus infection activates and causes redistribution of NLRP3 to nuclei. Whether this NLRP3 translocation occurs with other viral infections and in other cell types merit further study.
基金Supported by the National Natural Science Foundation of China (No.81370990)the Young and MiddleAged Scientists Research Awards Fund of Shandong Province, China (No. BS2013YY013, No. BS2015YY014)the Science and Technology Foundation of Shinan District, Qingdao, Shandong Province, China (No. 2013-13-014-YY)
文摘AIM: To uncover the mutations profile of transforming growth factor beta-induced(TGFBI) gene in Chinese corneal dystrophy patients and further investigate the characteristics of genotype-phenotype correlations.·METHODS: Forty-two subjects(6 unrelated families including 15 patients and 8 unaffected members, and 19 sporadic patients) of Chinese origin were subjected to phenotypic and genotypic characterization. The corneal phenotypes of patients were documented by slit lamp photography. Mutation screening of the coding regions of TGFBI was performed by direct sequencing.·RESULTS: We detected four corneal dystrophy types.The most frequent phenotypes were granular corneal dystrophy(GCD)(including 3 families and 8 sporadic patients) and lattice corneal dystrophy(LCD)(including 2families and 9 sporadic patients). The next phenotypes were corneal dystrophy of Bowman layer(CDB)(1 family and 1 sporadic patient) and epithelial basement membrane dystrophy(EBMD)(1 sporadic patient). Six distinct mutations responsible for TGFBI corneal dystrophies were identified in 30 individuals with corneal dystrophies. Those were, p.R124 H mutation in 1 family and 2 sporadic patients with GCD, p.R555 W mutation in 2families and 3 sporadic patients with GCD, p.R124 C mutation in 2 families and 7 sporadic patients with LCD,p.A620 D mutation in 1 sporadic patient with LCD, p.H626 R mutation in 1 sporadic patient with LCD, and p.R555 Q in1 family and 1 sporadic patient with CDB. No mutationwas detected in the remaining 3 atypical GCD patients and 1 EBMD patient.·CONCLUSION: GCD and LCD are the most frequent phenotypes in Chinese population. R555 W was the most common mutation for GCD; R124 C was the most common mutation for LCD. Our findings extend the mutational spectrum of TFGBI, and this is the extensively delineated TGFBI mutation profile associated with the various corneal dystrophies in the Chinese population.
基金Supported by National Natural Science Foundation of China (No.81530027 No.81500767+3 种基金 No.81570821)Natural Science Foundation of Shandong Province (No. ZR2018PH020 No.ZR2015YL037)the Innovation Project of Shandong Academy of Medical Sciences
文摘AIM: To investigate the expression of succinate receptor GPR91 and its pathogenic roles in Mooren's ulcer(MU).METHODS: Biopsy specimens were obtained from 7 patients with MU and 6 healthy donors. The expression of GPR91 in MU tissues was evaluated using quantitative realtime reverse transcription polymerase chain reaction(qRTPCR) and immunohistochemistry(IHC). Succinate was used to activate GPR91 signaling, and the effect of GPR91 on the expression of interleukin-1β(IL-1β), NLRP3, vascular endothelial growth factor(VEGF) and matrix metalloproteinase-13(MMP-13) in human peripheral blood mononuclear cells(PBMCs) was determined. The influence of GPR91 on the nuclear factor-κB(NF-κB) signaling in PBMCs was investigated by detecting the phosphorylation of p65. Moreover, the expression of IL-1β, VEGF, MMP-13 and phosphorylated p65(p-p65) in the tissues of MU was examined by qRT-PCR or IHC.RESULTS: GPR91 mRNA expression showed a higher level in the MU group than in the healthy control group. IHC analysis also revealed that the expression of GPR91 was elevated in patients with MU compared with healthy controls. Moreover, ligation of GPR91 with succinate promoted the lipopolysaccharide-induced production of NLRP3, IL-1β, VEGF and MMP-13 in PBMCs through increased phosphorylation of p65. Pharmacological inhibition of the NF-κB signaling reversed GPR91 induced production of NLRP3, IL-1β, VEGF and MMP-13. These findings, coupled with the elevated amounts of IL-1β, VEGF, MMP-13 and p-p65 observed in the MU biopsies, constituted a rational basis for the involvement of GPR91 in the pathogenesis of MU.CONCLUSION: This study indicates the increased succinate receptor GPR91 in conjunctival or corneal tissues is involved in the pathogenesis of MU through elevated NF-κB activity, which may provide a new therapeutic target for MU.
文摘AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of surgery in the treatment.METHODS: The clinical records of 27 patients(27 eyes)with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained.RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule,accounting for 56%, 26%, 15% and 2.5%, respectively.Fusarium was identified in 44%(12/27) of the eyes,followed by Aspergillus in 22%(6/27). Posterior segment infection was involved in 78%(21/27) of the patients. The corneal infection was larger than 3 mm×3 mm in 89%(24/27) of the patients, and 22%(6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes(81.5%) underwent penetrating keratoplasty(PKP), and over half of them(54.5%)were operated within 3d from the onset of antifungal therapy. Fourteen eyes(52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes(55.6%) underwent pars plana vitrectomy(PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60%(9/15),lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes(16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes(18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis.Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy(especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.
基金Supported by Shandong Provincial Natural Science Foundation,China(No.ZR2014HM029)
文摘AIM:To investigate the effect of anti-vascular epithelial growth factor(VEGF)agents on the expression of fibrosisrelated inflammatory mediators under normoxic and hypoxic conditions,and to further clarify the mechanism underlying fibrosis after anti-VEGF therapy. METHODS:Human retinal pigment epithelial(RPE)cells were incubated under normoxic and hypoxic conditions.For hypoxia treatment,CoCl_2 at 200μmol/L was added to the media. ARPE-19 cells were treated as following:1)control group:no treatment; 2)bevacizumab group:bevacizumab at 0.25 mg/mL was added to the media; 3)hypoxia group:CoCl_2 at 200 μmol/L was added to the media; 4)hypoxia+bevacizumab group:CoCl_2 at 200 μmol/L and bevacizumab at 0.25 mg/mL were added to the media.The expression of interleukin(IL)-1β,IL-6,IL-8 and tumor necrosis factor(TNF)-α were evaluated using real-time polymerase chain reaction(RT-PCR)and enzyme-linked immunosorbent assay(ELISA)at 6,12,24 and 48 h. RESULTS:Both m RNA and protein levels of IL-1β,IL-6 and IL-8 were statistically significantly higher in the bevacizumab group than in the control group at each time point,and TNF-α gene and protein expression was only significantly higher only at 24 and 48h(P<0.05). Under hypoxic conditions,bevacizumab significantly increased the expression of IL-1β,IL-6,IL-8 and TNF-α at 6,12,24 and 48h(P<0.05). IL-1β,IL-8 and TNF-α peaked at 24 h and IL-6 peaked at 12 h after the bevacizumab treatment under both normoxic and hypoxic conditions. CONCLUSION:Treatment of ARPE-19 cells with bevacizumab can significantly increase the expression of fibrosis-related inflammatory mediators under bothnormoxic and hypoxic conditions. Inflammatory factors might be involved in the process of fibrosis after antiVEGF therapy,and the up-regulation of inflammatory factors induced by anti-VEGF drugs might promote the fibrosis process.
基金Ningxia Medical University Funding,China(Grant-XT201014)
文摘AIM:To assess the effect of myopia on the thickness of retinal nerve fiber layer(RNFL) measured by 3D optical coherence tomography(3D-OCT) in a group of nonglaucomatous Chinese subjects.METHODS:Two hundred and fifty-eight eyes of 258 healthy Chinese myopic individuals were recruited and four groups were classified according to their spherical equivalent(SE):low myopia(n=42,-0.50<SE<-3.0D),moderate myopia(n=120,-3.0D≤SE<-6.0D),high myopia(n=58,-6.0D≤SE<-8.0D) and extreme high myopia(n=38,SE ≥-8.0D).The RNFL thickness profile including superior,nasal,inferior and temporal quadrant and each of the 12 clock-hour thicknesses were measured by 3DOCT.The RNFL thicknesses among four sample groups were performed by one-way analysis of variance(oneway ANOVA) and least significant difference test(LSD test).Correlations between RNFL thickness and axial length/spherical equivalent were performed by linear regression analysis. RESULTS:The overall RNFL parameters shown significant differences between groups excluding 7,9,10,11 o'clock hour thickness.The RNFL thickness of superior,nasal,inferior,average and 1,2,3,4,5,6,12 o'clock sectors were decreased with the increasing axial length and higher degree of myopia.In contrast,as axial length and the degree of myopia increased,the temporal and 8,9 o'clock sectors thicknesses were increased.A considerable proportion of myopic eyes were classified as outside the normal limits.Six o'clock was the most notable of the total,which 43.4% were outside the normal limits. CONCLUSION:On the measurement of RNFL,the characteristics of RNFL with the change of the degree of myopia were observed.As the degree of myopia increases,the RNFL thickness measured by 3D-OCT including the average and superior,nasal,inferior sectors decreases.And due to the change of RNFL thickness,it should be considered when using OCT to access for the damage of glaucoma especially people with myopia.
文摘AIM: To evaluate the corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome (PEX). · METHODS: Medical records of 16 patients (20 eyes) with PEX who presented to our institution between July 2008 and June 2010 were retrospectively reviewed. Thirteen eyes had combined glaucoma. The information of five apparently normal fellow eyes in these patients was also recorded. Left eyes of 20 patients with bilateral senile cataracts but no other eye disease were included as controls. Specular microscopy was performed in all eyes to analyze for corneal endothelial cell density and morphology. Cell density, coefficient of variation in cell size, and percentage of hexagonal cells in corneal endothelium were evaluated. · RESULTS: The mean corneal endothelial cell density in the PEX eyes was 2298±239 cells/mm2, significantly lower than that in the cataract eyes (2652±18 cells/mm2, P =0.026), but there were no significant differences in coefficient of variation of cell size and frequency of hexagonality between these two groups. No significant differences in the three parameters were found between the apparently normal fellow eyes and the PEX eyes or the cataract eyes, or between the PEX eyes with and without glaucoma. · CONCLUSION: Corneal endothelial cell density may decrease in Chinese patients with PEX. The development of glaucoma in PEX eyes does not seem to be related with the change in corneal endothelial cell density or morphology.
基金Supported by the Natural Science Foundation of Shandong Province(No.ZR2014HQ059)
文摘AIM: To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS: A total of 209 patients(209 eyes) with fungal keratitis, involving no more than 50% of the stromal depth and not responding to antifungal agents for 2 wk, were recruited in this retrospective, noncomparative study. The patients were treated with modified corneal ulcer debridement. All visible corneal infiltrates were removed under an operating microscope to obtain a clean stromal bed and smooth incised edges. Antifungal drugs were used immediately after surgery. Healing time of the ulcers was recorded. Fungal recurrence, visual acuity, corneal thickness and risk factors for treatment failure were monitored.RESULTS: The follow-up was 13.6±5.8m o. The corneal ulcers healed in 195 of 209 eyes(93.3%), with a mean healing time of 8.4±6.8 d. The other 14 eyes were further treated by penetrating keratoplasty(PK)(1 eye), anterior lamellar keratoplasty(LK)(7 eyes), conjunctival flap covering(4 eyes) or amniotic membrane transplantation(2 eyes). The best corrected visual acuity(BCVA) was ≥20/70 in 80.3% of the eyes, ≥20/40 in 56.9% of the eyes, and ≥20/25 in 27.3% of the eyes. The corneas at the lesions became thinner, but all in the safe range. No fungal recurrence or corneal ectasis developed during the follow-up. The risk of treatment failure was higher in patients with preoperative hypopyon(P=0.036) and ever using steroid(P=0.025).CONCLUSION: Modified surgical debridement is a simple and effective method for the treatment of superficial fungal infection of the cornea, with improved visual acuity and no recurrence. Such an intervention in time can rapidly control fungal infection and largely shorten corneal ulcer healing time.
基金Supported by the Key Laboratory Program of Shandong Eye Institute(No.2014-1)Medicine Science and Technology Development Program,Shandong,China(No.2015WS0204)+1 种基金the Science and Technology plan of Qingdao,China(No.15-9-1-35-jch)the Innovation Project of Shandong Academy of Medical Sciences
文摘● AIM: To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma(POAG) and chronic primary angle-closure glaucoma(CPACG). ● METHODS: Retrospective, comparative study. A total of 60 eyes(60 patients) receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes(30 patients) had the combined procedures for POAG, and the other 30 eyes(30 patients) for CPACG.● RESULTS: The follow-up was 39.37±7.09mo(range 3 to 49mo) in patients with POAG and 37.10±9.26mo(range 9 to 49mo) in patients with CPACG(P=0.29). The mean change in best corrected visual acuity was 0.41 log MAR for POAG and 0.38 log MAR for CPACG at the last follow-up(P=0.22). The postoperative intraocular pressure(IOP) of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18 mo after surgery(P=0.02, 0.00, 0.04, 0.01) with similar glaucoma medications after surgery(P>0.16). At 3y after surgery, the cumulative complete and qualified success rates were 63.3%(POAG) and 53.3%(CPACG), 83.3%(POAG) and 73.3%(CPACG)(P=0.41, 0.49), respectively. The POAG group had more hypotony than the CPACG group(P=0.04).● CONCLUSION: The long-term outcomes show the ExPRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.
基金partially supported by the National Natural Scientific Foundation (81000369)the Doctor Foundation of Shandong Province (BS2009SW018)
文摘Objective Fungal keratitis(FK) is a vision-threatening infection,whose treatment requires more effective and safer anti-fungal agent exploitation urgently.With this aim,we focused on the effect of an extracellular polysaccharide on fungal adhesion to human corneal epithelial cells.Methods We performed the cytotoxicity assays of the extracellular polysaccharide EPS-II from an antarctic bacterium Pseudoaltermonas and evaluated its inhibitory effect on Candida albicans cells' adherence to human corneal epithelial cells(HCECs).Results EPS-II,which displayed minor cytotoxicity but also promoted proliferation of HCECs,could inhibit the adherence of yeast cells to HCECs in a dose-dependent manner.EPS-II could also suppress the subsequent PI3K/AKT signaling pathway,and thereby decrease the expression of early inflammatory cytokines.Conclusions ExtracellularpolysaccharideEPS-IIwassuggestedasanewnaturalagentforattenuatingFK.
