Analysis of clinical and pathological features of ciliary body medulloepithelioma

AIM:To analyze and summarize the clinical and pathological features of ciliary body medulloepithelioma.METHODS:The clinical and pathological data of 11 patients(11 eyes) who were diagnosed with ciliary body medulloepithelioma at Beijing Tongren Hospital,Capital Medical University,from 2007 to 2021 were retrospectively analyzed.RESULTS:The initial symptoms of 11 patients included vision loss(6 eyes),atrophia bulbi(1 eye),proptosis(2 eyes),and leukocoria(2 eyes).Most patients suffered with corneal opacity,anterior chamber flare and hyphema.Iris neovascularization and synechia,complicated cataract,and secondar y glaucoma occurred in several cases.Three patients even had lens subluxation and retinal detachment.B-scan ultrasonography showed vitreous opacity and a medium-high uneven echo mass in the eyeball.Ultrasound biomicroscopy examination showed a spherical or hemispherical ciliary body mass with uneven internal echoes and irregular cystic spaces.All of the 11 patients were diagnosed with malignant ciliary body medulloepithelioma by pathological evidence.In this study,6 patients had enucleation(2 patients had systemic chemotherapy after surgery),and the other 5 patients had local tumor resection(1 patient had plaque radiotherapy after surgery).CONCLUSION:Ciliary body medulloepithelioma is a rare intraocular tumor and may be easily confused with retinoblastoma.Analyzing the clinical and pathological features of ciliary body medulloepithelioma is useful to further understand ciliary body medulloepithelioma,and can make an accurate diagnosis and better treatment.

Extracting intraocular foreign body at or near the ciliary body with scleral indentation in direct visualization

Dear Editor,I＇m Dr. Qing-Huai Liu from Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University,Nanjing, China. I write to present four cases diagnosed with the intraocular foreign body （IOFB） at or near the ciliary body and to evaluate the effect of extracting IOFB with scleral indentation in direct visualization.

Case Report:Adenoma of nonpigmented epithelium in ciliary body:literature review and case report

Adenomas of the nonpigmented ciliary epithelium (NPCE) are often clinically indistinguishable from amelanotic malignant melanomas of the ciliary body or metastatic carcinomas. This paper reports a case study of a distinctive variant of adenoma of the NPCE, which clinically appears as epiretinal membrane in the macular region. Histopathologic studies have revealed this is an adenoma of the NPCE. Identification of this clinic feature is important because it will miss the diagnosis of the adenoma of the NPCE. In this case study, B-scan ultrasonography as well as computerized tomography (CT) has been used to provide help in diagnosing the ciliary body tumor. Because of their anterior location in the ciliary body, partial lamellar sclerou-vectomy is an effective method of treatment.

Ultrasound biomicroscopic imaging demonstrate thinner ciliary body thickness in eyes with angle closure

·AIM:To compare the ciliary body thickness between eyes with primary angle closure(PAC)and primary angle-closure glaucoma(PACG)with the normal eyes,and to investigate the association between ciliary body thickness and ciliary processes situation.·METHODS:In this cross-sectional study,57 patients with PAC/PACG were matched to 57 normal subjects after propensity score matching(PSM)adjusting for age and gender.All subjects underwent conventional ocular examinations and ultrasound biomicroscopy(UBM)examination,among which the patients with PAC/PACG performed the examinations one month after laser peripheral iridotomy(LPI).Quantitative parameters were measured,which included ciliary body thickness at the position of 1 mm posterior to the scleral spur(CBT1),trabecular-ciliary process distance(TCPD)and trabecularciliary process angle(TCA).·RESULTS:Eyes with PAC/PACG presented significantly thinner CBT1,shorter TCPD and smaller TCA(P<0.001)than the normal eyes,both in comparison of the means of four quadrants and in comparisons of each quadrant.After removing images with peripheral anterior synechia(PAS),the same results were also found in comparisons between the two groups.Significant correlations were found between TCPD(R~2=0.537,P<0.001)and TCA(R~2=0.517,P<0.001)with CBT1.·CONCLUSION:Eyes with PAC/PACG have thinner ciliary body thickness and more anteriorly situated ciliary processes.Thinner ciliary body thickness is associated with anterior situation of the ciliary processes.

Immunohistochemical Studies of Macrophages and MHC Class Ⅱ -positive Cells in the Iris and Ciliary Body of Lewis Rats

Purpose:To investigate the density, distribution and morphology of macrophages and MHC class II -positive dendritic cells in the iris and ciliary body of lewis rats. Methods:Immunohistochemistry was performed using monoclonal antibodies specific to monocytes and macrophages (ED1,ED2) and MHC class II -positive cells (OX6) on wholemounts of the iris-ciliary body complex isolated form normal lewis rats.Results:A well developed network of macrophages was present in the iris and ciliary body of normal lewis rats. These cells, morphologically displaying dendriti-form or pleiomorphic appearance, were more densely arranged in mid-iris (950 + 189 cells/mm2) than in iris base (482 ± 78 cells/mm2) and pupil margin (595 ± 92 cells/mm2). A similar network of MHC class II -positive cells with a cell density 452 ± 78 cells/mm2 was almost uniformly distributed in the iris of normal lewis rats.Conclusions : A network of macrophages and MHC class II -positive cells was established in the iris and ciliary body of

Ciliary body detachment after secondary intraocular lens implantation in childhood

Dear Sir,Iam Dr.Li-Na Meng,from the Qingdao Eye Hospital,Shandong Eye Institute,Shandong Academy of Medical Sciences,Qingdao,China.I want to present a rare case of secondary intraocular lens(IOL)implantation in an11-year-old boy who developed the complication of ciliary body detachment.When he was 2 years old,the boy underwent bilateral cataract extraction for congenital cataract in the other

Choroidal and ciliary body tubercle: a case report

Dear Editor,I am Bing Li from the Department of Ophthalmology,Peking Union Medical College Hospital in Beijing, China,and I write to present a case report of choroidal and ciliary body tubercles.Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition with variable manifestations[1].

Lymphocyte infiltration and activation in iris-ciliary body and anterior chamber of mice in corneal allograft rejection

AIM: To investigate the infiltration and activation of lymphocyte in iris-ciliary body and anterior chamber after allogenic penetrating keratoplasty (PK), for further revealing the role of iris-ciliary body in corneal allograft immune rejection. METHODS: In the mice models of PK, BALB/C mice received orthotopic isografts (n =35) or C57BL/6 donor allografts (n=25). Grafts were examined daily for 3 weeks by slit-lamp microscopy and scored for opacity. The infiltration of CD4(+) T lymphocyte in iris-ciliary body and anterior chamber was examined by immunohistology and the mRNA of CD80 and CD86 in both cornea graft and iris-ciliary body by RT-PCR was analyzed in allograft recipient at days 3, 6, 10 and the day when graft rejection occurred. Isograft recipients were examined as control at the corresponding time points. Transmission electron microscope was used to study the ultrastructure, especially cell infiltration, of iris-cilary body and corneal graft at day 3, 7 and the day when rejection occurred after allogenic PK. RESULTS: Rejection was observed in all the allograft recipients followed more than 10 days, at a median time of 15 days (range 12-18 days), but not in any of isografts. CD4(+) T cells were first detected at day 6 after transplantation in limbus and Ciliary body, and then in the stroma of recipient, iris, anterior chamber and corneal allograft with an increased number until graft rejection occurred. CD80 and CD86 mRNA were detected under RT-PCR examination in both graft and iris-ciliary body of allograft recipient, but not in any of isograft recipient. Three days after operation, lymphocytes and monocytes macrophages were visible in iris blood vessels and the anterior chamber, and vascular endothelial cell proliferation and activation were significant under transmission electron microscopy examination. At day 7, corneal endothelial cells became thinner. Lymphocytes and mononuclear macrophages were found with great number in the anterior chamber and adhered to the corneal endothelium. Blood vessels in iris increased and were filled with lymphocytes. And lymphocytes were detected to migrate through endothelial cell gap out of vessels. When allograft rejection occurred, macrophages attached to endothelial cells with large number of lymphocytes and macrophages infiltrating in iris. CONCLUSION: Lymphocyte infiltration and activation occurred in iris-ciliary body after allogenic PK, and the lymphocytes could migrate from iris blood vessel to the anterior chamber, which might play an important role in corneal allograft immune rejection.

Angioleiomyoma of the Ciliary Body: A Case Report

Purpose:To report a rare case of angioleiomyoma of the ciliary body Methods:The clinical manifestation, imaging findings, histopathologic characteristics were analyzed in a 32-year-old male patient with angioleiomyoma of the ciliary body.Results:The tumor was removed intact with local resection. Histopathologic examination revealed that the tumor was full of vessels and it was composed of spindle cells with abundant cytoplasm. Immunohistochemical studies showed positive for SMA and Desmin and negative for S100 and HMB-45. Conclusions:Angioleiomyoma of the ciliary body is a rare tumor that can be successfully treated with local surgical resection in this area. It needs to be differentiated from other tumors, especially malignant melanoma. Eye Science 2004;20:19-22.

Prejunctional 5-HT Receptors Enhance Cholinergic Neurosecretion in the Rabbit and Human Iris-ciliary Body

Purpose: To characterize prejunctional 5-HT heteroreceptors which modulate nacetylcholine (3 H-ACh release) in isolated rabbit and human iris-ciliary bodies (ICBS) . Methods: ICB tissue segments were incubated with H-choline, superfused and electrically stimulated four times (S1,S2,S3,S4) at 3 - 10 Hz for 1 min to elicit 3H-ACh. secretion. Test agents (5-HT agonists and antagonists) were added before S2,S3 and S4 and their effects determined by the stimulation ratio (Sx/S1) of evoked 3H-ACh. release. 3H-ACh in super-fusate fractions was fractionated and quantified by ion exchange chromatography. Results: In rabbit ICBs, evoked 3H-ACh. release was enhanced in a concentration-dependent manner by 5-HT (10- 9 - 10-5 M, EC50 = 5.8× 10-8 M). The maximum effect of 5-HT (10-6M) corresponded to a 45. 14 ± 7.40%) (n = 6) increase in 3H-ACh release. Higher concentrations of 5-HT ( > 10- M) induced desensitization. The response to 5-HT ( 10-6 M) in the presence of the 5-HT3/4 antagonist tropisetron (10-9 M) ,

雷珠单抗联合半量睫状体光凝术治疗新生血管性青光眼的效果观察

目的探讨雷珠单抗联合半量睫状体光凝术治疗新生血管性青光眼(NVG)的效果观察。方法选取2021年1月至2023年1月在首都医科大学宣武医院治疗的NVG患者110例(110眼)作为研究对象。在组间基线特征匹配的原则上,按照简单随机数表法将入组NVG患者分为观察组与对照组,各55例。对照组行半量睫状体光凝术,观察组在其基础上加用雷珠单抗治疗每月1次,连续3次。比较两组新生血管消退时间、治疗成功率、术后并发症及6个月复发率,治疗后1个月、3个月和6个月最佳矫正视力(BCVA)和眼压恢复情况,及治疗前、治疗3个月后血清检测指标[血清白细胞介素-1β(IL-1β)、IL-6和血管内皮生长因子水平(VEGF)]。结果观察组患者新生血管消退时间及成功率优于对照组(P<0.05)。治疗后1个月、3个月和6个月,两组患者BCVA均比治疗前明显升高,但组间比较差异无统计学意义(P>0.05);两组患者眼压均比治疗前明显降低,且观察组各时间点更低,差异有统计学意义(P<0.05)。治疗后两组患者IL-1β、IL-6和VEGF水平均低于治疗前,且观察组比对照组更低(P<0.05)。两组患者的并发症发生率及术后复发率差异均无统计学意义(P>0.05)。结论雷珠单抗联合半量睫状体光凝术治疗NVG成功率较高,可以有效改善眼压和炎症水平。

超声生物显微镜在超声睫状体成形术中的应用

目的 探讨超声生物显微镜在超声睫状体成形术中的应用。方法 采用回顾性病例分析方法,纳入2020年8月—2021年7月在兰州大学第二医院眼科进行超声睫状体成形术的23例青光眼患者,对比术眼术前、术后1周、术后1个月、术后3个月的超声生物显微镜检查结果,记录分析不同时间段睫状体与睫状突形态学上的差异。结果 23例患者术前平均眼压为(44.83±6.25) mmHg,术后1周平均眼压降低了38.9%,术后1个月平均眼压降低了43.2%,术后3个月平均眼压降低了43.8%,差异均有统计学意义(P <0.001)。超声生物显微镜检查发现青光眼患者在超声睫状体成形术术前和术后不同时间中睫状突厚度,睫状突数量均有变化,与术前相比,术后不同时间段睫状突厚度减小,睫状突数量减少,差异均具有统计学意义(P <0.05)。结论 超声生物显微镜可准确观察睫状体的形态学变化,并可以定量分析,对超声睫状体成形术术前与术后睫状体形态学的观察效果明显,临床上可以用于指导超声睫状体成形术治疗参数的设定,并预判术后的治疗疗效。

晶状体周围解剖结构与临床的关系

由于晶状体高度透明,且周围结构比较复杂,再加上其特殊的生物力学特性,想要精确地观察到晶状体周围的解剖结构有较大的难度。但近些年随着显微集成术中相干光层析成像术(OCT)的问世,眼科医生得以细致准确地观察晶状体周围结构[1,2],也使得越来越多的人开始探寻晶状体周围结构在临床上的应用。本文将综述以往相关文献,就晶状体周围结构与眼科临床的关系予以阐述。

Clinical prediction of insufficient vaults after implantable collamer lens implantation

AIM:To determine the factors related to preoperative ocular characters that are predictive of insufficient vault(<250μm)after implantable collamer lens(ICL V4c;STAAR Surgical)implantation.METHODS:The participants underwent ICL surgery and were divided into the low(<250μm)and normal(250-1000μm)vault groups based on the postoperative vault at 3mo.The preoperative biometric parameters and clinical outcomes were compared between the two groups.The relationship between the 3-month vault values and preoperative ocular parameters were evaluated by Generalized estimating equations.RESULTS:Sixteen(23 eyes)and 36 patients(63 eyes)were in the low and normal vault groups,respectively.All implantation procedures were uneventful with no cataract formation in the early postoperative period.The sulcusto-sulcus lens rise(STSL)and iris ciliary angle(ICA)were correlated with vault at 3mo after surgery.Every 0.1 mm increase in STSL was associated with 38.9μm decrease in the postoperative 3-month vault.A rise of 1 degree in ICA is associated with a reduction of 4μm in vault.CONCLUSION:Eyes with a narrow ciliary sulcus are associated with a higher rate of low vault after ICL implantation,suggesting a need for adjustments to the ICL size in these patients.Evaluating the characteristics of the ciliary sulcus contributes valuable information to predict low vault after surgery.

儿童眼恶性髓上皮瘤7例临床分析并文献复习

目的 分析并研究眼恶性髓上皮瘤(MEPL)的临床表现、影像学特征、病理学特点、治疗及预后情况。方法 对2020年1月1日—2022年3月1日期间北京同仁医院儿科收治的7例病理确诊为眼恶性MEPL的病例进行回顾性分析,并随访预后。结果 7例恶性髓上皮瘤患者中,男5例,女2例,发病年龄范围20天~153个月:2例小于12个月,3例为1-3岁,2例大于3岁。临床表现主要包括白瞳(5例)、眼红(5例)、眼球突出(3例)、斜视(2例)、畏光(1例)、视力障碍(1例)等,均发生于单侧眼,其中右侧眼5例,左侧眼2例;1例发生中枢神经系统(CNS)转移合并淋巴结转移。肿瘤复发3例。病理分型1例MEPL畸胎瘤样型和6例MEPL非畸胎瘤样型。肿瘤侵及脉络膜及神经、神经管包括单纯侵犯大范围脉络膜、侵犯大范围脉络膜及视神经至切除断端和侵犯大范围脉络膜并存在脉管内瘤栓者各1例。治疗方法包括局部切除手术、眼球摘除术、全身静脉化疗、鞘注化疗、放疗等。仅局部切除的患者,病程2年后出现复发。规范治疗的5例患者,均获得完全缓解;1例CNS转移患儿化疗后获得了部分缓解。随访至2022年8月30日,1例死亡,6例患者存活。结论 国际尚无眼恶性MEPL的规范化治疗方案,多无以局部治疗为基础的综合治疗,静脉化疗及鞘注化疗可应用于眶外浸润、转移的患者,并获得较好疗效。

原发性闭角型青光眼发病因素的再认识

原发性闭角型青光眼(PACG)目前仍是我国常见的致盲眼病之一,因为其视力丧失的不可逆性,所以早期影响青光眼发生和发展的因素倍受关注。人们对浅前房、短眼轴、厚虹膜及大而前置的晶状体等高危眼前节静态解剖结构的认识并不能完全解释PACG转化的过程,所以要进一步考虑眼部结构动态改变在青光眼发生和发展中的具体作用。本文阐述了正常人和PACG患者虹膜体积和弹性的动态变化过程,晶状体在眼球发育过程中与眼球内结构的不协调性,睫状体、玻璃体和脉络膜发生的动态阻滞与扩张,以及眼部神经和血管系统异常调节及变化与PACG发病之间关系的最新研究,以期为深刻认识PACG的发病机制、临床的精准诊断和治疗策略的制定提供指导。

超声睫状体成形术治疗不同类型青光眼的研究进展

超声睫状体成形术(ultrasound cyclo-plasty,UCP),是一种新型的睫状体治疗手术,目前已应用于治疗不同类型的青光眼。UCP通过微型高强度聚焦超声(high-intensity focused ultrasounds,HIFU)设备,高度选择性作用于睫状体,实现温和可控、稳定的降眼压(intraocular pressure,IOP)效果。相较于传统的睫状体破坏手术,UCP具有操作简单、耗时短、可重复性高及安全性高的特点。该文从UCP的由来、结构特点、作用机制、疗效、特点及安全性对UCP治疗不同类型青光眼的研究进展进行综述。

推拿促进房水内源性前列腺素的生成调节大鼠睫状体淋巴管增生

目的:探讨推拿促进大鼠眼内前列腺素的生成,诱导大鼠眼部睫状体内淋巴管的增生,进而降低青光眼眼压的作用机制。方法:将48只SD大鼠造模后随机分为青光眼模型组、推拿组、拉坦前列腺素组和推拿结合拉坦前列腺素组,每组12例。治疗过程中分别抽取各组不同时间段房水进行酶联免疫吸附试验(ELISA),采用蛋白质印迹法、定量聚合酶链反应、免疫荧光法、免疫组织化学法检测同源盒基因转录因子1(Prox-1)、5′-核苷酸酶(5′-Nase)表达水平,淋巴管酶组织化学染色法检测各组睫状体内淋巴管的增生情况。结果:推拿结合拉坦前列腺素组眼压均低于其他组(P<0.05);推拿结合拉坦前列腺素组中Prox-1、5′-Nase表达水平均高于其他组(P<0.05);推拿结合拉坦前列腺素组睫状体组织淋巴增殖均高于其他组。结论:推拿可以有效促进睫状体淋巴管的增生,而增生的淋巴管能吸收多余的房水导致眼压下降。

细胞蜡块的临床应用进展

细胞蜡块是采集临床体液细胞学标本的细胞经过脱水浸蜡制作而成,可长期保持,连续切片可进行特殊染色、免疫组织化学和分子病理学等检查。本研究主要对目前包括一般离心法、丙酮固定法、乙醇凝固—甲醛固定法、介质包埋法、涂片回收法等主要细胞蜡块制作方法进行探讨,并对细胞蜡块制作过程的相关内容和注意事项进行综述。

Ocular manifestations of central insulin resistance

Central insulin resistance, the diminished cellular sensitivity to insulin in the brain, has been implicated in diabetes mellitus, Alzheimer’s disease and other neurological disorders. However, whether and how central insulin resistance plays a role in the eye remains unclear. Here, we performed intracerebroventricular injection of S961, a potent and specific blocker of insulin receptor in adult Wistar rats to test if central insulin resistance leads to pathological changes in ocular structures. 80 mg of S961 was stereotaxically injected into the lateral ventricle of the experimental group twice at 7 days apart, whereas buffer solution was injected to the sham control group. Blood samples, intraocular pressure, trabecular meshwork morphology, ciliary body markers, retinal and optic nerve integrity, and whole genome expression patterns were then evaluated. While neither blood glucose nor serum insulin level was significantly altered in the experimental or control group, we found that injection of S961 but not buffer solution significantly increased intraocular pressure at 14 and 24 days after first injection, along with reduced porosity and aquaporin 4 expression in the trabecular meshwork, and increased tumor necrosis factor α and aquaporin 4 expression in the ciliary body. In the retina, cell density and insulin receptor expression decreased in the retinal ganglion cell layer upon S961 injection. Fundus photography revealed peripapillary atrophy with vascular dysregulation in the experimental group. These retinal changes were accompanied by upregulation of pro-inflammatory and pro-apoptotic genes, downregulation of anti-inflammatory, anti-apoptotic, and neurotrophic genes, as well as dysregulation of genes involved in insulin signaling. Optic nerve histology indicated microglial activation and changes in the expression of glial fibrillary acidic protein, tumor necrosis factor α, and aquaporin 4. Molecular pathway architecture of the retina revealed the three most significant pathways involved being inflammation/cell stress, insulin signaling, and extracellular matrix regulation relevant to neurodegeneration. There was also a multimodal crosstalk between insulin signaling derangement and inflammation-related genes. Taken together, our results indicate that blocking insulin receptor signaling in the central nervous system can lead to trabecular meshwork and ciliary body dysfunction, intraocular pressure elevation, as well as inflammation, glial activation, and apoptosis in the retina and optic nerve. Given that central insulin resistance my lead to neurodegenerative phenotype in the visual system, targeting insulin signaling may hold promise for vision disorders involving the retina and optic nerve.