A case of solitary choroidal tuberculoma with highly positive tuberculin skin test and negative interferon gamma release assays

Dear Editor,Tuberculosis(TB)is an infectious disease which has been considered as a global public health emergency problem during the past 25y.The World Health Organization has estimated that approximately one-third of the world’s population are infected by TB.However,only 10%of patients with TB is symptomatic.TB can affect multiple organs throughout the body.Eighty percent of those infected are pulmonary TB.Ocular TB can occur with or without lung or other systemic TB.It is a rare extrapulmonary form of the disease and occupied about 3.5%–5%of all of the TB.It should not be disregarded as its potential influence on vision loss.The intraocular and/or extraocular structures could be impacted by ocular TB[1].Uvea was the most common affected structure[2].

Atropine 0.01% eye drops slow myopia progression: a systematic review and Meta-analysis

AIM: To evaluate the effects of atropine 0.01% on slowing myopia progression. METHODS: We searched for relevant studies in the Cochrane Library, PubMed, Embase, Ovid, CBM, CNKI, VIP and Wan Fang Data in Chinese. A supplementary search was conducted in OpenGrey(System for Information on Grey Literature in Europe), the ISRCTN registry, Clinical Trials.gov, and the WHO International Clinical Trials Registry Platform(ICTRP) from the dates of inception to June 30, 2018. RESULTS: Seven randomized controlled trials(RCTs) with a total of 1079 subjects were included(505 in the atropine 0.01% group and 574 in the control group). The results showed that the atropine 0.01% group exhibited significantly greater control of axial growth than the control group (MD=-0.12, 95%CI(-0.19,-0.06))There was also a statistically significant difference between the atropine 0.01% and control groups in the changes in axial length [MD=-0.14, 95%CI(-0.25,-0.03)], but the quality of evidence was low. There were no significant differences between the atropine 0.01% and control groups in the overall effect with respect to diopter value, change in diopter, distance vision and intraocular pressure (MD=0.08, 95%CI(-0.27, 0.42);MD=0.09, 95%CI(-0.17, 0.36);MD=-0.01, 95%CI(-0.02, 0.00);MD=0.08, 95%CI(-0.56,0.40))The sensitivity analysis showed that the conclusion of the Meta-analysis is relatively stable. With respect to adverse events, there were significant differences between the atropine 0.01% and control groups (OR=0.26, 95%CI(0.11, 0.61))CONCLUSION: Based on the available evidence, atropine 0.01% eye drops offer benefits in controlling axial growth and safety without causing significant differences in diopter values, distance vision and intraocular pressure.

A novel NF1 frame-shift mutation c.703＿704delTA in a Chinese pedigree with neurofibromatosis type 1

We analyzed the clinical features and NF1 gene mutation in a Chinese pedigree of neurofibromatosis type 1（NF1）. Three members of this family were NF1 patients presenting with different clinical phenotypes and the others were asymptomatic. Exons of NF1 were amplified by polymerase chain reaction, sequenced, compared with a reference database. One novel NF1 frame-shift mutation c.703_704delTA, which resulted in a premature stop signal at codon 720 and the synthesis of truncated, was revealed. This mutation segregated with the NF1 members is likely responsible for the pathogenesis of NF1 in the family.

ipRGCs: possible causation accounts for the higher prevalence of sleep disorders in glaucoma patients

Sleep accounts for a third of one＇s lifetime, partial or complete deprivation of sleep could elicit sever disorders of body function. Previous studies have reported the higher prevalence of sleep disorders in glaucoma patients, but the definite mechanism for this phenomenon is unknown. On the other hand, it is well known by us that the intrinsically photosensitive retinal ganglion cells（ip RGCs） serve additional ocular functions, called non-image-forming（NIF） functions, in the regulation of circadian rhythm, melatonin secretion, sleep, mood and others. Specifically, ip RGCs can directly or indirectly innervate the central areas such as suprachiasmatic nucleus（SCN）, downstream pineal gland（the origin of melatonin）, sleep and wake-inducing centers and mood regulation areas, making NIF functions of ip RGCs relate to sleep. The more interesting thing is that previous research showed glaucoma not only affected visual functions such as the degeneration of classical retinal ganglion cells（RGCs）, but also affected ip RGCs. Therefore, we hypothesize that higher prevalence of sleep disorders in glaucoma patients maybe result from the underlying glaucomatous injuries of ip RGCs leading to the abnormalities of diverse NIF functions corresponding to sleep.

Association between fetal macrosomia and risk of obesity in children under 3 years in Western China: a cohort study

Background Fetal macrosomia,defined as birth weight equal or over 4000 g,is a major concern for both neonatal and maternal health.A rapid increasing trend in fetal macrosomia is observed in different regions of China.We aimed to examine the association between fetal macrosomia and risk of childhood obesity in Western China.Methods All macrosomic live singletons (≥ 4000 g),and a random sample of singletons with normal birth weight (2500-3999 g) born in four districts of Chengdu,Western China,in 2011 were included in the cohort study.Maternal demographics,obstetric factors,labor and delivery summary at baseline were extracted from the Chengdu Maternal and Child Health Management System.Anthropometric measurements before 3 years and infant feeding information at around 6 months were also collected.Childhood obesity under 3 years was primarily defined as a weight-for-length/height z score ≥ 1.645 using the WHO growth reference.Secondary definitions were based on weight-for-age and body mass index (BMI)-for-age over the same cut-offs.Results A total of 1767 infants were included in the analyses,of whom 714 were macrosomic.After controlling for maternal age,parity,gestational age and anemia at the first antenatal visit,pre-pregnancy BMI,gestational weight gain,gestational age at birth,baby age and sex,and breastfeeding practices at 6 months,the risk of childhood obesity defined according to weight-for-length/height among macrosomic babies was 1.90 (95% confidence interval 1.04-3.49) times that of babies with normal birth weight.The risk of childhood obesity for macrosomic babies was 3.74 (1.96-7.14) and 1.64 (0.89-3.00) times higher based on weight-for-age and BMI-for-age,respectively.Conclusion Fetal macrosomia is associated with increased risk of obesity in children under 3 years in Western China.

Clinical Analysis of 1593 Patients with Infectious Endophthalmitis： A 12-Year Study at a Tertiary Referral Center in Western China

Background： Infectious endophthalmitis is a severe ocular inflammation which can cause devastating visual loss. The aim of the study was to identify the demographic and clinical features of infectious endophthahnitis in Western China for better prophylaxis and treatment of this disease. Methods： A retrospective, cross-sectional study was conducted based on the medical records of inpatients having infectious endophthahnitis in a tertiary referral center in Western China between 2005 and 2016. Results： The common cause of infectious endophthahnitis was trauma （82.6%）, endogenous （7.8%）, ophthalmic surgery （6.9%）, and corneal ulcer with perforation （2.7%）. These four etiological groups differed in age, gender, enucleation rate, visual outcome, etc. The number of cases in the first 6 years accounted for 38.7% of the total collection, which in the second 6 years accounted for 61.3%. The etiology patterns were different between these two periods. Altogether 51.3% of patients received pars plana vitrectomy, 13.9% of patients underwent evisceration, and the remaining 34.8% received other treatments. Of the 670 cases that had culture results, 266 （39.7%） were culture positive and 177 （66.5%） were Gram-positive organisms, 64 （24.1%） were Gram-negative organisms, 11 （4.1%） had fungal infection, and 14 （5.3%） were infected by multiple pathogens. Conclusions： There was an upward trend of the occurrence of infectious endophthalmitis in Western China for the past decade. The demographic and clinical characteristics of infectious endophthahnitis in Western China had its own characteristics and differed from those of developed cotintries. Here, open globe trauma was the most common cause ofendophthalmitis, most traumatic endophthalmitis patients were male, and most of the injuries were work related, implicate that we should strengthen the education and application of ocular safety regulation specifically targeting the workplace.

Weill-Marchesani-like syndrome caused by an FBN1 mutation with low-penetrance

Weill-Marchesani syndrome(WMS)is a rare connective tissue disorder characterized by brachydactyly,short stature,joint stiffness,cardiovascular abnormalities,and eye anomalies including microspherophakia,cataracts,ectopia lentis,myopia,and secondary glaucoma.Patients with incomplete WMS signs are diagnosed with Weill-Marchesani-like syndrome(WMS-like).To date,both autosomal dominant(AD)and autosomal recessive(AR)inheritance modes have been reported for WMS.Genetic heterogeneity inWMSsuggests a connection between these genes.AR and AD WMS cannot be distinguished clearly by clinical findings alone.[1]Furthermore,inter-familial as well as intra-familial clinical variability due to different fibrillin-1 gene(FBN1)mutations also exists.