Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropath...Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.展开更多
AIM： To evaluate the value of ultra-wide field（UWF） imaging in the management of traumatic retinopathy under the condition of corneal scar or fixed small pupil after complicated ocular trauma. METHODS： Twenty-eigh...AIM： To evaluate the value of ultra-wide field（UWF） imaging in the management of traumatic retinopathy under the condition of corneal scar or fixed small pupil after complicated ocular trauma. METHODS： Twenty-eight patients（28 eyes） with complicated ocular trauma were enrolled in the study from June 2016 to May 2017, including 19 males and 9 females with age ranged from 11 to 64（43.42±12.62）y. All patients were treated with secondary vitrectomy after emergency operation for wound repair of open ocular trauma. Direct ophthalmoscopy and 45-degree fundus photography were taken at each time point of follow up for comparison of findings with UWF images. Routine eye examination including visual acuity, intraocular pressure, slit lamp examination were performed and analyzed as well.RESULTS： Among the 28 traumatized eyes, the positive rate for identification of traumatic retinopathed was 32.1%（9 cases）, 14.9%（5 cases）, and 85.7%（24 cases） with direct ophthalmoscopy, 45-degree fundus photography, and UWF imaging, respectively. The detective rate of UWF imaging under the condition of corneal scar or fixed small pupil was statistically greater than that of 45-degree fundus photography and direct ophthalmoscopy（Bonferroni correction, P〈0.001）. UWF image was obtained in 19 eyes with opaque corneal scar, otherwise their fundus could not be seen by conventional methods. The additional findings of traumatic retinopathies by UWF imaging included periretinal membranes or pre-retinal proliferating strip, retinal holes, hemorrhage in the vitreous or sub-retinal space.CONCLUSION： UWF imaging is superior to traditional fundus photography in the evaluation of traumatic retinopathies under the condition of corneal scar or fixed small pupil after complicated ocular trauma.展开更多
Background： The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell...Background： The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts. Methods： A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty （PKP） eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density （ECD）, and best-corrected visual acuity （BCVA） were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD. Results： Of the 54 eyes included in this study, extracapsular cataract extraction （ECCE） was performed in 34 eyes of 33 patients （ECCE group） whereas phacoemulsification was performed in 20 eyes of 20 patients （phacoemulsification group）. There was no signifcant difference in the median age （P = 0.081） or preoperative ECD （P = 0.585） between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group （P = 0.043）. In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months （P = 0.018）, 4 months （P 〈 0.001）, and 6 months （P 〈 0.001） after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group （P 〈 0.001） and phacoemulsification group （P 〈 0.001）, but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts （P 〈 0.001）. There was no signifcant difference in postoperative BCVA between the two groups （P = 0.065）. Conclusion： ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.展开更多
Corneal graft melting is a severe complication of keratoplasty.This review is to summarize the incidence,the pathogenesis,the risk factors,the prognosis and the prevention of corneal graft melting after keratoplasty.W...Corneal graft melting is a severe complication of keratoplasty.This review is to summarize the incidence,the pathogenesis,the risk factors,the prognosis and the prevention of corneal graft melting after keratoplasty.We systematically searched PubMed,Web of Science and WanFang database to retrieve potentially eligible articles about relevant clinical reports and animal experiments.We read the full texts to identify eligible articles.The selection of studies and data extraction were performed independently by two reviewers.In conclusion,the pathogenesis of corneal graft melting is complicated,and many risk factors are closely related to corneal graft melting.Analysis of pathogenesis and risk factors of corneal graft melting can facilitate the development of targeted therapies to better guide clinical practice.展开更多
文摘Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.
基金Supported by Sichuan Province Scientific Research Project of Institutions of Higher Education (No.2017ZRQN-108)
文摘AIM： To evaluate the value of ultra-wide field（UWF） imaging in the management of traumatic retinopathy under the condition of corneal scar or fixed small pupil after complicated ocular trauma. METHODS： Twenty-eight patients（28 eyes） with complicated ocular trauma were enrolled in the study from June 2016 to May 2017, including 19 males and 9 females with age ranged from 11 to 64（43.42±12.62）y. All patients were treated with secondary vitrectomy after emergency operation for wound repair of open ocular trauma. Direct ophthalmoscopy and 45-degree fundus photography were taken at each time point of follow up for comparison of findings with UWF images. Routine eye examination including visual acuity, intraocular pressure, slit lamp examination were performed and analyzed as well.RESULTS： Among the 28 traumatized eyes, the positive rate for identification of traumatic retinopathed was 32.1%（9 cases）, 14.9%（5 cases）, and 85.7%（24 cases） with direct ophthalmoscopy, 45-degree fundus photography, and UWF imaging, respectively. The detective rate of UWF imaging under the condition of corneal scar or fixed small pupil was statistically greater than that of 45-degree fundus photography and direct ophthalmoscopy（Bonferroni correction, P〈0.001）. UWF image was obtained in 19 eyes with opaque corneal scar, otherwise their fundus could not be seen by conventional methods. The additional findings of traumatic retinopathies by UWF imaging included periretinal membranes or pre-retinal proliferating strip, retinal holes, hemorrhage in the vitreous or sub-retinal space.CONCLUSION： UWF imaging is superior to traditional fundus photography in the evaluation of traumatic retinopathies under the condition of corneal scar or fixed small pupil after complicated ocular trauma.
文摘Background： The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts. Methods： A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty （PKP） eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density （ECD）, and best-corrected visual acuity （BCVA） were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD. Results： Of the 54 eyes included in this study, extracapsular cataract extraction （ECCE） was performed in 34 eyes of 33 patients （ECCE group） whereas phacoemulsification was performed in 20 eyes of 20 patients （phacoemulsification group）. There was no signifcant difference in the median age （P = 0.081） or preoperative ECD （P = 0.585） between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group （P = 0.043）. In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months （P = 0.018）, 4 months （P 〈 0.001）, and 6 months （P 〈 0.001） after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group （P 〈 0.001） and phacoemulsification group （P 〈 0.001）, but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts （P 〈 0.001）. There was no signifcant difference in postoperative BCVA between the two groups （P = 0.065）. Conclusion： ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.
基金Supported by National Natural Science Foundation of China(No.81870558,No.81870624,No.81700802)Major Science and Technology Projects of Zhejiang Province(No.2017C03046).
文摘Corneal graft melting is a severe complication of keratoplasty.This review is to summarize the incidence,the pathogenesis,the risk factors,the prognosis and the prevention of corneal graft melting after keratoplasty.We systematically searched PubMed,Web of Science and WanFang database to retrieve potentially eligible articles about relevant clinical reports and animal experiments.We read the full texts to identify eligible articles.The selection of studies and data extraction were performed independently by two reviewers.In conclusion,the pathogenesis of corneal graft melting is complicated,and many risk factors are closely related to corneal graft melting.Analysis of pathogenesis and risk factors of corneal graft melting can facilitate the development of targeted therapies to better guide clinical practice.
