眼科学报最新文献

Congenital cataract is a common cause of childhood low vision or blindness worldwide. Early surgery should be performed in sensitive vision development period to avoid vision deprivation in cases of strabismus and nystagmus development. Postoperative recovery of visual function is of great significance for these patients and should include proper postoperative aphakia correction by the application of a contact lens and secondary implantation of an intraocular lens (IOL). Patients should receive amblyopic training after surgery to improve their postoperative visual acuity. Although recent advances in surgery techniques and materials have brought better postoperative visual acuity and less complications, a few postoperative complications can still hamper vision condition and vision development, including posterior capsule opacification and secondary glaucoma. Surgery in early infancy are risk factors for these two complications. Life-long follow-up is essential for these patients. Further study will continue to address the surgery timing issue and methods that prevent postoperative complications.

Purpose: To investigate the efficacy of a soft bandage contact lens in the management of early bleb leak following trabeculectomy.

Methods: Between October 2011 and April 2013, 11 patients with early bleb leak following fornix-based trabeculectomy were instructed to wear a soft bandage contact lens 14 mm in diameter continuously for 1-2 weeks. The daily visual acuity, intraocular pressure (IOP), anterior chamber situation, and healing condition were measured at 1, 3, and 7 d, after con tact lens removal, and 3 months after trabeculectomy. The conditions of blebs, sensation of wearing contact lens, and adverse events were recorded.

Results: Bleb leaks were observed at 2-8 d after surgery, (4.09 ± 1.10 d on average). The daily LogMAR visual acuity did not significantly differ before and after contact lens wear (P > 0.05). The IOP was significantly raised after at 1, 3, and 7 d after lens wear (all P < 0.05).The IOP at 3 months after lens wear did not significantly differ from that measured at lens removal (t = 1.191, P = 0.089). At 1 d after lens wear, 6 cases had deeper anterior chambers. All patients presented with a significantly deepened anterior chamber at 3 d after lens wear, and were restored to the preoperative conditions. The bleb leakage was successfully treated at 7 d after lens removal in 10 patients, while 1 patient had to wear the contact lens for another 7 d for full healing of the bleb leak. No ocular infection was noted throughout the management.

Conclusion: A soft bandage contact lens of 14 mm diameter is a safe and efficacious therapy for an early bleb leak following fornix-based trabeculectomy.

Purpose: Cholesterol granuloma is usually associated with chronic middle ear disease. Involvement of the ethmoid sinus by cholesterol granuloma is rare. We describe a case with cholesterol granuloma of the posterior ethmoid sinus causing optic nerve compression. No previous reports were found in our review of the literature.

Case report: A 48-year-old man had impaired visual acuity and a relative afferent pupillary defect in the right eye. Fundus fluorescein angiography showed a swollen optic nerve head and optic disc leakage. Automated perimetry revealed a severe peripheral visual field defect with tunnel vision. Computerized tomography demonstrated an expansile, isodense mass in the right posterior ethmoid sinus, remodeling of the bony walls of the right sphenoid sinus, and lateral displacement of the optic nerve in the right orbit. Compressive optic neuropathy caused by posterior ethmoid sinus lesion was diagnosed. A transnasal endoscopic exploration of the right ethmoid sinuses demonstrated a soft expansile cystic lesion with a thick yellow cap sule that filled the inside of the posterior ethmoid sinus. Brownish fluid with shiny crystals was drained by fine needle aspiration. The capsule was removed completely, and the mucociliary clearance of the sinus was reestablished. The pathologic pictures confirmed the diagnosis of cholesterol granuloma, which included typical cholesterol clefts surrounded by inflammatory cells with focal multi-nucleated giant cells. Visual function fully recovered without recurrent lesions after a three-year follow-up.

Conclusion: Compressive optic neuropathy can be rarely caused by cholesterol granuloma in the posterior ethmoid sinus. The visual prognosis may be good after transnasal endoscopic decompression in such patients.

Purpose: To understand the growth model of axial length (AL) and height, and to explore the relationship between the two with the passage of time.

Methods: We followed twins in the Guangzhou Twin Eye Study for five years. The AL of both eyes was measured by partial coherence interferometry, and height was measured by a standard scale during each visit. A multivariate multilevel mixed model was adopted for data analysis.

Results: A total of 1217 children were included in the study. Both AL and height increased, but the rate of growth slowed down with age. The mitigation rate of height growth was -0.34 cm/year; while that of AL growth was -0.01 mm/year. AL was positively related to height, with a relevant coefficient of R = 0.22 (Cov [height intercept, AL intercept] = 1.56, 95% CI = 1.14 to 1.99). The growth rates of AL and height were also positively related, with a relevant coefficient of R=0.18 (Cov [height slope, AL slope] = 0.03, 95% CI = 0.01 to 0.05). However, taller children had slower rates of height increases, with a relevant coefficient of R = -0.12 (Cov [height intercept, height slope] = -1.33, 95% CI = -2.25 to -0.42); but had faster AL growth, with a relevant coefficient of R = (Cov [height intercept, AL slope] = 0.02, 95% CI = -0.05 to 0.08, R = 0.02). AL and its growth rate were positively related to each other, with a relevant coefficient of R = (Cov [AL intercept, AL slope] = 0.04, 95%CI = 0.03 to 0.05, R = 0.3); while the growth rates of AL and height were negatively related to each other, with a relevant coefficient of R = (Cov [AL intercept, height slope] = -0.03 95%CI = -0.16 to 0.1, R = -0.02).

Conclusion: The increase in children's AL is relevant to their height increases. The faster their height increases, the faster their AL increases.

Purpose: To evaluate the surgical effect of levator muscle shortening and levator aponeurosis tucking in treating minimal and moderate congenital blepharoptosis.

Methods: Clinical data of 28 patients (40 eyes) diagnosed with mide and moderate congenital blepharoptosis at our institution were retrospectively analyzed. Postoperative efficacy was evaluated and statistically compared between these two techniques.

Results: During 14 months follow-up, 16 eyes with ptosis undergoing levator muscle shortening were treated, 3 with undercorrection of ptosis and 1 with overcorrection of ptosis. In patients receiving levator aponeurosis tucking, 16 eyes were cured and 4 with undercorrection of ptosis.

Conclusion: Both levator muscle shortening and levator aponeurosis tucking are safe and efficacious for correcting minimal and moderate congenital blepharoptosis. (Eye Science

Purpose: To observe the efficacy of toric design orthokera- tology (ortho-k) for correcting myopia and astigmatism in myopic adolescents with moderate to high astigmatism.

Methods: This was a self-controlled clinical study. Twenty-four subjects (42 eyes) aged 9 to 16 years with myopia of 2.50-6.00 D complicated with rule astigmatism of 1.50-3.50 D were fitted with Lucid Night Toric Ortho-k Lenses (LUCID,KO- REA). The changes in uncorrected visual acuity (UCVA), spherical degree, refraction, axial length (AL), and corneal status were assessed at baseline, 1 night, 1 week, 1 month, 3 months, 6 months, and 1 year after the commencement of ortho-k lens wear.

Results: The success rate of the first lens fit was 92.8%. The UCVA after ortho-k wearing was improved significantly compared to the baseline during each visit (all P < 0.01), and became stable 1 month after ortho-k. The manifest myopia was significantly reduced from (-3.41 ± 1.27) D to (-0.41 ± 0.37) D by toric ortho-k and the degree of astigmatism from (-1.81 ± 0.53)D to (-0.41 ± 0.39) D after 1 month of lens wear (P < 0.01). The mean AL was (24.47 ± 0.91) mm at baseline, which did not significantly differ from (24.49 ± 0.87) mm and (24.48 ± 0.94) mm after 6 months and 1 year, respectively, of lens wear (both P > 0.05). Grade 1 corneal staining was observed at 1 week (23.8%), 1 month (21.4%), and 1 year (16.7%) following lens wear, and was improved by lens cleaning, discontinuing lens wear, and moistening the cornea with eye drops. No severe adverse events were reported.

Conclusion: The toric ortho-k lens was effective and safe for correction of low to moderate myopia in children with moderate to high astigmatism. The lens also effectively controlled axial length elongation during 1 year of observation. However, the long-term efficacy remains to be elucidated.