Analysis of risk and protective factors associated with retinal nerve fiber layer defect in a Chinese adult population

AIM:To investigate the risk and protective factors associated with the retinal nerve fiber layer defect(RNFLD)in a Chinese adult population.METHODS:This study was a cross-sectional populationbased investigation including employees and retirees of a coal mining company in Kailuan City,Hebei Province.All the study participants underwent a comprehensive systemic and ophthalmic examination.RNFLD was diagnosed on fundus photographs.Binary logistic regression was used to investigate the risk and protective factors associated with the RNFLD.RESULTS:The community-based study included 14440 participants.There were 10473 participants in our study,including 7120 males(68.0%)and 3353 females(32.0%).The age range was 45-108y,averaging 59.56±8.66y.Totally 568 participants had RNFLD and the prevalence rate was 5.42%.A higher prevalence of RNFLD was associated with older age[P<0.001,odds ratio(OR):1.032;95%confidence interval(CI):1.018-1.046],longer axial length(P=0.010,OR:1.190;95%CI:1.042-1.359),hypertension(P=0.007,OR:0.639;95%CI:0.460-0.887),and diabetes mellitus(P=0.019,OR:0.684;95%CI:0.499-0.939).The protective factors of RNFLD were visual acuity(P=0.038,OR:0.617;95%CI:0.391-0.975),and central anterior chamber depth(P=0.046,OR:0.595;95%CI:0.358-0.990).CONCLUSION:In our cross-sectional community-based study,with an age range of 45-108y,RNFLD is associated with older age,longer axial length,hypertension,and diabetes mellitus.The protective factors of RNFLD are visual acuity and central anterior chamber depth.These can help to predict and evaluate RNFLD related diseases and identify high-risk populations early.

曲安奈得:用于玻璃体内注射的配制法

目的:具有抗增生、抗水肿、抗炎和血管稳定作用的曲安奈得(TA)混悬液在眼水肿、新生血管和增生性疾病,特别是黄斑疾病的应用正在不断增加。本文描述玻璃体内注射用的TA的配制法并分析赋形剂(苯甲基乙醇)过滤后的实际剂量。方法:从40mgVolonA瓶中,相当于Kenalog40mg,抽取0.625mL结晶混悬液,相当于TA25mg。在无菌条件下,过滤混悬液以去除溶剂苯甲基乙醇,结晶体用9g/L氯化钠洗涤4次,进行TA玻璃体注射。需要密切随访,监测在头2wk内的眼内炎和1￣2mo的高眼压。结果:预期25mgTA的浓度在溶剂过滤后测量为23.8mg。在另一个药学实验室,同样过滤后结果是12.8mg,均不是预期的剂量25mgTA。结论:还没有玻璃体内注射TA的标准剂量。手术医生应该知道过滤后玻璃体内注射TA的剂量将比预期的要少。需要在注射后密切随访:在第1wk监测无菌性眼内炎或假性眼内炎,在第2wk要识别感染性眼内炎,它可能出现在无痛和不充血的眼,但必须立即治疗。继发性高眼压可能在注射后1￣2mo发生;一般可用抗青光眼药物控制。

Retinal vessel oxygen saturation in healthy subjects and early branch retinal vein occlusion

AIM： To measure the retinal oxygen saturation in healthy subjects and early branch retinal vein occlusion（BRVO） in Chinese population.METHODS： The retinal vessel oxygen saturation of the healthy subjects and BRVO patients were measured by a noninvasive retinal oximeter（Oxymap ehf.,Reykjavik,Iceland）.RESULTS： The study included 22 patients with unilateral BRVO（mean age： 55.1±8.8y） in the study group and 91 healthy participants（mean age： 37.5±14.0y） in the control group.In the healthy individuals,mean arterial and venous oxygen saturation were significantly（P〈0.001）higher in the superior nasal quadrant（98.5%±10.1%and 57.3%±8.7%,respectively） than in the inferior nasal quadrant（94.2%±9.0% and 54.1%±9.6%,respectively）,followed by the superior temporal quadrant（89.1%±10.1%and 51.9%±8.9%,respectively） and the inferior temporal quadrant（86.4%±9.4% and 46.6%±9.6%,respectively）.In patients with ischemic BRVO,arterial oxymetric values were significantly higher and venous measurements significantly lower for the affected vessel（107.5%±9.7% and46.4%±14.2%,respectively） than the unaffected vessel in the same eye（99.2%±12.2% and 55.5%±7.9%,respectively）and as compared to the vessel in the unaffected fellow eye（93.1%±6.9% and 55.7%±6.8%）（P=0.005 and P=0.02,respectively）.In the patients with non-ischemic BRVO,mean venous oxygen saturation was lower in the affected vein（39.8%±12.2%） than in the unaffected vessels of the same eye（50.8%±10.5%） and in the fellow eye（58.21%±5.7%）（P=0.03）.Mean arterial oxygen saturation did not differ significantly（P=0.42） between all three groups.CONCLUSION： In patients with BRVO,the venous oxygen saturation in the affected vessels is decreased potentially due to decreased blood velocity and flow.Interestingly,thearterial oxygen saturation in eyes with ischemic BRVO is increased in the affected arteries.

10-year fundus tessellation progression and retinal vein occlusion

AIM： To access the 10-year fundus tessellation progression in patients with retinal vein occlusion. METHODS： The Beijing Eye Study 2001/2011 is a populationbased longitudinal study. The study participants underwent a detailed physical and ophthalmic examination. Degree of fundus tessellation was graded by using fundus photographs of the macula and optic disc. Progression of fundus tessellation was calculated by fundus tessellation degree of 2011 minus degree of 2001. Fundus photographs were used for assessment of retinal vein occlusion. RESULTS： The Beijing Eye Study included 4403 subjects in 2001, 3468 subjects was repeated in 2011. Assessment of retinal vein obstruction and fundus tessellation progression were available for 2462 subjects（71.0%）, with 66 subjects fulfilled the diagnosis of retinal vein occlusion. Of the 66 participants, 59 participants with unilateral branch retinal vein occlusion, 5 participants with unilateral central retinal vein occlusion, 1 participant with bilateral branch retinal vein occlusion, and 1 participant with branch retinal vein occlusion in one eye and central retinal vein occlusion in the other eye. Mean degree of peripapillary fundus tessellation progression were significantly higher in the whole retinal vein occlusion group（0.33±0.39, P〈0.001）, central retinal vein occlusion group（0.71±0.8, P=0.025） and branch retinal vein occlusion group（0.29±0.34, P=0.006） than the control group（0.20±0.26）. After adjustment for age, prevalence of tilted disc, change of best corrected visual acuity, axial length, progression of peripapillary fundus tessellation was associated with the presence of retinal vein occlusion（P=0.004; regression coefficient B, 0.094; 95%CI, 0.029, 0.158; standardized coefficient B, 0.056）. As a corollary, after adjusting for smoking duration, systolic blood pressure, anterior corneal curvature, prevalence of RVO was associated with more peripapillary fundus tessellation progression（P〈0.001; regression coefficient B： 1.257; OR： 3.517; 95%CI： 1.777, 6.958）. CONCLUSION： Peripapillary fundus tessellation progresses faster in individuals with retinal vein occlusion. This may reflect the thinning and hypoperfusion of choroid in patients with retinal vein occlusion.

Immune oppression array elucidating immune escape and survival mechanisms in uveal melanoma

AIM： To examine the genetic profile of primary uveal melanoma （UM） as compared to UM in immune escape.METHODS： Dendritic cells （DC） loaded with lysates of UM cells of high metastatic potential were used to stimulate CTLs（CTLs）. When CTLs co-cultured with the UM cells, most UM cells could be eliminated. Survival UM cells grew slowly and were considered to be survival variants and examined by a microarray analysis. These differential genes were analyzed further with Venn Diagrams and functions related to immune escape. We additionally examined transcriptional changes of manually selected survival variants of UM cells and of clinical UM samples by quantitative real-time polymerase chain reaction （qRT-PCR）, and analyzed the correlation of these expressions and patients’ survival.RESULTS： Gene expression analyses revealed a marked up-regulation of SLAMF7 and CCL22 and a significant down-regulation of KRT10, FXYD3 and ABCC2. The expression of these genes in the relapsed UM was significantly greater than those in primary UM. UM patients with overexpression of these genes had a shorter survival period as compared with those of their underexpression.CONCLUSION： Gene expression, in particular of SLAMF7, CCL22, KRT10, FXYD3 and ABCC2, differed between primary UM cells and survival variants of UM cells.

Ratio of Primary Episcleral Buckling Surgery versus Primary Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical department.Methods: The study included all patients with rhegmatogenous retinal detachments who underwent retinal or vitreoretinal surgery in the study period from 2002 to 2006. The size of the retinal defect and the amount of proliferative vitreoretinopathy were not exclusion criteria. Patients with tractional retinal detachment due to proliferative ischemic retinopathies were excluded.Results: In the study period, 875 primary retinal and vitreoretinal surgeries were performed on 875 eyes. Among the surgeries, episcleral sponges(42.9%) formed the largest part,followed by pars plana vitrectomies(35.0%) and encircling bands(22.2%). Combining episcleral sponges and encircling bands into an episcleral surgery group revealed that two thirds(65%).of the surgeries were episcleral interventions. In the episcleral sponge group, the retinal re-detachment rate after the first surgery was 13%.Conclusion: In a university department as a primary referral unit for retinal detachments, episcleral retinal surgery can still outnumber vitreoretinal interventions, with retinal re-detachment rates which do not differ markedly from the re-detachment rates reported in randomized trials comparing vitreoretinal surgery with episcleral surgery.

Relationship between the Alignment of a Non-Mydriatic Fundus Camera,Anterior Chamber Depth and Axial Length

Purpose:To evaluate the relationship between the position of the focal adjustment knob of a fundus camera and refractive error and biometric data as measured in the same eye.Methods:Normal eyes of patients presenting to clinics at the Beijing Tongren Hospital were examined with a non-mydriatic fundus camera.The position on the focal scale of a knob adjusting the distance between the camera lens and film plane,used to adjust focus the image of the patients fundus relative to the refractive power of the eye,was recorded in degrees.Ocular biometry and refractometry were performed on the same eyes.Results:The study included 136 subjects with a mean age of 36.5 ±19.6 years and a mean refractive error of-1.31 ±2.77 diopters.In univariate analysis,the position of the adjustment knob was significantly associated with refractive error.(P < 0.001;correlation coefficient r=-0.77),axial length.(P<0.001;r=0.65) and anterior chamber depth (P<0.001;r=0.48).After adjustment for age,anterior chamber depth decreased by 0.01 mm(95% confidence interval:0.003,0.017) for change per degree in the position of the adjustment knob.Conclusion:A fundus camera can be used to estimate anterior chamber depth,axial length and refractive error.In a screening setting,a fundus camera operated by a technician may be helpful to detect a shallow anterior chamber and evaluate a potential risk factor for primary angle closure.

Advances in myopia research anatomical findings in highly myopic eyes

Background:The goal of this review is to summarize structural and anatomical changes associated with high myopia.Main text:Axial elongation in myopic eyes is associated with retinal thinning and a reduced density of retinal pigment epithelium(RPE)cells in the equatorial region.Thickness of the retina and choriocapillaris and RPE cell density in the macula are independent of axial length.Choroidal and scleral thickness decrease with longer axial length in the posterior hemisphere of the eye,most marked at the posterior pole.In any eye region,thickness of Bruch's membrane(BM)is independent of axial length.BM opening,as the inner layer of the optic nerve head layers,is shifted in temporal direction in moderately elongated eyes(axial length<26.5 mm).It leads to an overhanging of BM into the intrapapillary compartment at the nasal optic disc side,and to an absence of BM at the temporal disc border.The lack of BM at the temporal disc side is the histological equivalent of parapapillary gamma zone.Gamma zone is defined as the parapapillary region without BM.In highly myopic eyes(axial length>26.5 mm),BM opening enlarges with longer axial length.It leads to a circular gamma zone.In a parallel manner,the peripapillary scleral flange and the lamina cribrosa get longer and thinner with longer axial length in highly myopic eyes.The elongated peripapillary scleral flange forms the equivalent of parapapillary delta zone,and the elongated lamina cribrosa is the equivalent of the myopic secondary macrodisc.The prevalence of BM defects in the macular region increases with longer axial length in highly myopic eyes.Scleral staphylomas are characterized by marked scleral thinning and spatially correlated BM defects,while thickness and density of the choriocapillaris,RPE and BM do not differ markedly between staphylomatous versus non-staphylomatous eyes in the respective regions.Conclusions:High axial myopia is associated with a thinning of the sclera and choroid posteriorly and thinning of the retina and reduction of RPE density in the equatorial region,while BM thickness is independent of axial length.The histological changes may point towards BM having a role in the process of axial elongation.

北京地区50岁以上人群及糖尿病和青光眼患者的脉络膜厚度及其影响因素

目的：探讨人群黄斑中心凹下脉络膜厚度（ SFCT ）的分布及影响因素；分析糖尿病及糖尿病视网膜病变、青光眼等相关疾病与脉络膜厚度的关系。方法以人群为基础的横断面研究，数据来源于“北京眼病研究2011”。包括3468名参与者，平均年龄（64.6±9.8）岁。对参与者进行系统眼科检查，并采用谱域相干光断层深度增强扫描（ EDI SD-OCT）测量脉络膜厚度。分析纳入糖尿病患者246例，青光眼患者128例。计算人群平均SFCT及相关疾病患病率；单因素及多因素线性回归分析SFCT的眼部及全身危险因素。结果人群平均SFCT为（253.8±107.4）μm。使用多因素回归分析与SFCT相关的因素包括：低龄（b＝-4.12， P＜0.001）、眼轴长度短（b＝-44.7， P＜0.001）、男性（b＝-28.5， P＜0.001）、前房深度（b＝39.3， P＜0.001）、晶状体厚度（b＝26.8， P＜0.001）、角膜曲率（b＝46.0， P＜0.001）及BCVA（b＝-48.4， P＝0.001）。糖尿病组平均SFCT 为（266±108）μm。多因素分析示SFCT与确诊糖尿病显著相关（b＝21.2， P＝0.001），但与糖尿病视网膜病变（ P＝0.61）及糖尿病视网膜病变的级别（ P＝0.14）均无显著相关性。青光眼组平均 SFCT 为（201.4±102.4.1）μm，其中开角型青光眼为（210.1±104.7）μm， PACG为（184.2±93.6）μm。多因素分析SFCT与闭角型青光眼显著相关（ b＝-32.3， P＝0.04）；而与开角型青光眼无显著相关（ P＝0.44）。结论本研究人群平均SFCT为（253.8±107.4）μm。 SFCT随年龄和近视屈光度数的增加而下降，并且与男性、前房深度、晶状体厚度及BCVA相关。糖尿病人群的SFCT较健康人稍厚，但糖尿病视网膜病变的发生及发展并不能加重脉络膜的改变。闭角型青光眼的SFCT较健康人薄，而开角型青光眼的SFCT与健康人无明显差异。（中华眼科杂志，2014，50：414-420）

北京中老年人群倍频视野缺损的患病率及原因调查

目的了解北京地区中老年人群的倍频视野(FDP)异常的患病率及其相关影响因素,并探讨其主要原因。设计人群为基础的横断面研究。研究对象北京地区农村和城市特定区域40岁以上人群4 439人。方法 2001年对上述人群进行详细的眼科检查及问卷调查。视野检查采用FDP C-20-1筛查程序检查,视野缺损标准定为至少1点出现异常。主要指标倍频视野异常率及异常原因。结果4 439人中4 350人(8 617眼)(98.0%)完成FDP及眼底照相等检查。10.6%的眼出现FDP视野缺损。40～49岁人群中,视野缺损主要原因是病理性近视、青光眼、其他视神经疾病及白内障。60～69岁人群,最常见的视野缺损原因依次是白内障、青光眼和病理性近视。70岁以上年龄组最常见的视野缺损原因依次为青光眼、白内障和病理性近视。视野缺损与年龄(P<0.001)、近视度数(P<0.001)、居住地区(P<0.001)、教育程度(P=0.01)、核性白内障分级(P<0.001)及眼压(P<0.001)显著相关。结论病理性近视、白内障、青光眼是40岁以上人群视野缺损的主要原因。

Advances in myopia research anatomical findings in highly myopic eyes

Background:The goal of this review is to summarize structural and anatomical changes associated with high myopia.Main text:Axial elongation in myopic eyes is associated with retinal thinning and a reduced density of retinal pigment epithelium(RPE)cells in the equatorial region.Thickness of the retina and choriocapillaris and RPE cell density in the macula are independent of axial length.Choroidal and scleral thickness decrease with longer axial length in the posterior hemisphere of the eye,most marked at the posterior pole.In any eye region,thickness of Bruch’s membrane(BM)is independent of axial length.BM opening,as the inner layer of the optic nerve head layers,is shifted in temporal direction in moderately elongated eyes(axial length<26.5 mm).It leads to an overhanging of BM into the intrapapillary compartment at the nasal optic disc side,and to an absence of BM at the temporal disc border.The lack of BM at the temporal disc side is the histological equivalent of parapapillary gamma zone.Gamma zone is defined as the parapapillary region without BM.In highly myopic eyes(axial length>26.5 mm),BM opening enlarges with longer axial length.It leads to a circular gamma zone.In a parallel manner,the peripapillary scleral flange and the lamina cribrosa get longer and thinner with longer axial length in highly myopic eyes.The elongated peripapillary scleral flange forms the equivalent of parapapillary delta zone,and the elongated lamina cribrosa is the equivalent of the myopic secondary macrodisc.The prevalence of BM defects in the macular region increases with longer axial length in highly myopic eyes.Scleral staphylomas are characterized by marked scleral thinning and spatially correlated BM defects,while thickness and density of the choriocapillaris,RPE and BM do not differ markedly between staphylomatous versus non-staphylomatous eyes in the respective regions.Conclusions:High axial myopia is associated with a thinning of the sclera and choroid posteriorly and thinning of the retina and RPE density in the equatorial region,while BM thickness is independent of axial length.The histological changes may point towards BM having a role in the process of axial elongation.