Abstract:AIM: To determine the growth rule and tendency of retinoblastoma (Rb) literature, and to provide the basis for research of diagnosis, treatment and on Rb. METHODS: Bibliometric analyses were carried out on Rb literatures which contain the descriptors of Rb in their titles or texts from 1929 to 2010 in PubMed database (www.ncbi.nlm.nih.gov/Pubmed). The biomedical journals referring to Rb by using bibliometric indicators were calculated. The principal bibliometric indicators, i.e., Price's and Bradford's laws to the increase or distribution of scientific literature, the participation index of languages and the journals were applied. By means of manual coding, Rb documents were classified according to documents studied and to statistical analysis. RESULTS: During 1929-2010, there were 16162 literatures in the PubMed database including the word Rb. According to the literature type, it includes Review (n=2026), Randomized Controlled Trial (n=7), Practice guideline (n=3), meta- analysis (n=4), letter (n=215), editorial (n=98), clinical trial (n=115) and others (n=13694). By the statistical analysis, its equation is near power index (y=3.0477x 2.6088, R2= 0.9666). From 1929 to 2010, Rb literatures in English were primarily dominant (90.71%) and the amount of the literature in Chinese ranked the fourth (1.37%). By searching PubMed, 1420(8.8%) literatures covered were from 41 of 48 ophthalmological, and 406 (2.5%) literatures from 44 of 86 pediatrics journals that correlated with retinoblastoma (SCI-indexed). The data showed that the literatures of Rb were gradually increasing year by year and were approximate near power index during 1929-2010, and the document publishes published mainly in ophthalmological journals, and in English (90.71%), and showing that the study on Rb is a popular subject in the last half century. CONCLUSION: The literatures of Rb are gradually increasing, mainly English in ophthalmologic journals.

Abstract:AIM: To probe into problems existing in gamma knife treatment of ophthalmic branch of primary trigeminal neuralgia (TN), and propose a safe and effective solution to the problem. METHODS: Through sorting the literature reporting gamma knife treatment of refractory TN in recent years, this article analyzed the advantages and problems of gamma knife treatment of primary TN, and proposed reasonable assessment for existing problems and the possible solution. RESULTS: Gamma knife treatment of TN has drawn increasing attention of clinicians due to its unique non-invasion, safety and effectiveness, but there are three related issues to be considered. The first one is the uncertainty of the optimal dose (70-90GY); the second one is the difference in radiotherapy target selection (using a single isocenter or two isocenters); and the third one is the big difference of recurrent pains (specific treatment methods need to be summarized and improved). CONCLUSION: For patients with refractory TN, gamma knife treatment can be selected when the medical treatment fails or drug side effects emerge. The analysis of a large number of TN patients receiving gamma knife treatment has shown that this is a safe and effective treatment method.

Abstract:AIM: To investigate whether bis(7)-tacrine, a multifun- ctional drug, inhibits N-methyl-D-aspartate (NMDA) -activated current in retinal ganglion cells(RGC) and provides neuroprotection against retinal cell damage. METHODS: Purified RGC cultures were obtained from retinas of 1-3 days old Sprague-Dawley(SD) rats, following a two-step immunopanning procedure. After 7 days of cultivation, the inhibition of NMDA-activated current by bis(7)-tacrine was measured by using patch-clamp recording techniques. In animal experiments, RGCs were damaged after intravitreal injection of NMDA (5μL, 40nmol) in adult rats. Bis(7)-tacrine(0.05, 0.1, 0.2mg/kg) or memantine(20mg/kg) was intraperitoneal administered to the rats fifteen minutes before intravitreally injection of NMDA. RGC damage was analyzed by histologic techniques, TUNEL and retrograde labeling techniques. RESULTS: Whole-cell patch-clamp recordings demonstrated that NMDA (30μmol/L) resulted in approximately -50 pA inward currents that were blocked by bis(7)-tacrine(1μmol/L). Histological examination and retrograde labeling analysis revealed that bis(7)-tacrine induced a significant neuroprotective effect against NMDA-induced cell damage 7 days after NMDA injection. TUNEL staining showed that pretreatment with bis(7)-tacrine was effective in ameliorating NMDA-induced apoptotic cell loss in the retinal ganglion cell layer 18 hours after injection. CONCLUSION: Bis(7)-tacrine possesses remarkable neur- oprotective activities against retinal excitotoxicity through inhibition of NMDA receptors.

Abstract:AIM: All-trans retinoic acid (RA) is the only extrinsic biochemical candidate known to date that could act as a growth controller，the aim of this study was to investigate the expression cellular retinoic acid binding proteins I (CRABP-I) and retinoic acid receptor-β (RAR-β) in retina of the guinea pig eyes with experimental myopia. METHODS: Ninety guinea pigs aged 14 days were equally and randomly divided into three groups: form deprivation (FD), -5D lens, and control. The diffusers for FD were white translucent hemispheres, and -5D lenses were used to introduce hyperopic defocus. Refraction was measured with streak retinoscopy after cycloplegia, and axial length was calculated with Cinescan A/B ultrasonography. Retina harvested at different time points were used to measure RA level with HPLC and expressions of cellular retinoic acid binding proteins I (CRABP-I) and RA receptor-β (RAR-β) were assayed with Western blot and Real-time PCR. SPSS13.0 software was used for statistical analysis. RESULTS: Up-regulations of CRABP-I and RAR-β in ocular tissues correlated with changes in the refractive status and growth rate of the guinea pig eye (P<0.05). 14 days of monocular form-deprivation led to -5.14D myopia and a 0.281mm axial elongation; 14 days of monocular defocus produced -3.64D myopia and a 0.163 mm axial elongation. The level of retinal RA started to elevate in 7 days (P<0.05) after visual manipulation in both FD and -5D lens groups and became more prominent by 14 days (P <0.01) . The expressions of CRABP-I and RAR-β increased by 14 days after visual manipulation (P<0.05), the mRNA level of RAR-β, however, increased by 7 days after visual manipulation (P<0.05), which suggested that changes of expressions of CRABP-I and RAR-β might lag behind the change of RA. CONCLUSION: The levels of CRABP-I and RAR-β were elevated in retina of the guinea pig eye with experimental myopia. During the progression of experimental myopia, the retinal RA level increased rapidly, and there might be a positive feedback between the increase of RA and up-regulation of RAR-β.

Abstract:AIM: To explore the role of unc5b in retinal neovascularization in murine oxygen-induced retinopathy (OIR). METHODS: On postnatal 7(P7), C57BL/6J mice were exposed to 75%±2% oxygen for 5 days. On postnatal 12(P12), the mice were brought back to the room air (21% oxygen) to induce retinal neovascularization. Western blot analysis was performed to examine the temporal expression of unc5b in murine retinas. Double staining for unc5b and isolectin B4 were employed to determine the location of unc5b in murine retinas. The effect of unc5b on retinal neovascularization was evaluated by intravitreal injection of unc5b-FC in mice with OIR. Retinal neovascularization was measured by counting neovascular cell nuclei above the internal limiting membrane and by angiography of flat-mounted retinas perfused with fluorescein dextran. RESULTS: Compared to age-matched normal mice, the expression of unc5b was significantly increased in retinas of OIR mice on P17 and P21. Unc5b was apparently expressed in retinal vessels of OIR while being negative in normal retinal vessels. Retinal neovascularization in eyes injected with unc5b-FC was significantly reduced. CONCLUSION: Unc5b-FC can effectively inhibit retinal neovascularization induced by OIR. It may serve as a powerful and novel therapy for ischemia-induced retinal disease.

Abstract:AIM: To study the effect of troglitazone on primary culture human pterygium fibroblasts (HPF). METHODS: Cell viability loss and apoptosis were quantified by cell counting kit-8, AnnexinV-FITC/PI double staining, caspases activity test and western blotting. Flow cytometry was used to detect mitochondrial membrane potential. RESULTS: Peroxisome proliferator-activated receptor γ (PPAR-γ) was positively expressed in pterygium specimens (n=5). Troglitazone showed dose-dependent inhibition of cell survival, induced phospholipids redistribution, activated caspase-3, -9, and altered mitochondrial potential. Western blot assay demonstrated the increase of Bax/Bcl-2 protein ratio. CONCLUSION: Troglitazone induced apoptosis of HPF through a mitochondrial-dependent pathway.

Abstract:AIM: To investigate the effect of hypoxia on the proliferation of mouse corneal epithelial cells in vitro. METHODS:Mouse corneal epithelial cells(MCEs) were cultured in normoxia (210mL/L O2 and 50mL/L CO2) and hypoxia (20mL/L O2 and 50mL/L CO2), respectively. Colony forming efficiency (CFE) and cell proliferation were determined. The expression of corneal epithelial progenitor cell marker p63 and K19 was investigated by immunostaining. RESULTS: Normoxic colonies were smaller compared with colonies formed in hypoxia. CFE was (12.50±1.50)% in hypoxic cultures, which was similar compared with normoxia cultures [(11.13±1.86)%, P >0.05)]. Cell proliferation was enhanced in hypoxia. Progenitor markers p63 and K19 were expressed in most cells under both normoxic and hypoxic conditions. CONCLUSION: Murine limbal epithelial progenitor cells can be efficiently expanded in hypoxic conditions.

Abstract:AIM: To determine if topical instillation of dihydroarte- misinin (DHA) inhibits corneal neovascularization (NV) in rats and to investigate the role of the extracellular regulated kinases (ERK) 1/2 and p38 pathways in this process. METHODS: Suture-induced corneal NV was produced in rats and the eyes were topically treated with different concentrations of DHA (20mg/L, 10mg/L or 5mg/L) or normal saline 4 times a day for 7 days. The corneal NV was quantified as the proportion of NV area to the whole cornea. Western blot was used to determine the expressions of vascular endothelial growth factor (VEGF) and the phosphorylation status of VEGF receptor-2, ERK1/2 and p38 in the corneas. Immunofluorescent staining was used to determine the expressions of phospho-ERK1/2 and phospho-p38 in the corneal tissues from the eyes treated with 20 mg/L DHA (DHA group) or normal saline (control group). RESULTS: The proportion of corneal NV area in the eyes treated with normal saline or DHA at dosages of 20mg/L, 10mg/L or 5mg/L was (23.74±3.00)%, (15.73±2.88)%, (19.53±2.42)%, and (23.38±2.79)%, respectively. In the eyes treated with 20mg/L or 10mg/L DHA, the corneal NV area was significantly reduced when compared to that in eyes with normal saline (P<0.05). Western blot analyses revealed that 20mg/L DHA significantly inhibited the expressions of VEGF and phospho-VEGFR-2. Both 20mg/L and 10mg/L DHA inhibited the expressions of phospho-ERK1/2 and phospho- p38. Immunofluorescent staining further demonstrated that 20mg/L DHA lowered the expression levels of phospho- ERK1/2 and phospho-p38 in the corneas with suture-induced NV. CONCLUSION: Suture-induced NV in rat corneas was significantly inhibited by topical treatment with 20mg/L and 10mg/L DHA. The results suggest that the effects could be partially dependent on the DHA-mediated inhibitions of the ERK1/2 and p38 pathways.

Abstract:AIM: To investigate the expression of connexin 43 and epithelial cadherin (E-cadherin) in choroidal melanoma, to explore the clinical and pathological implications of expression of these proteins, and to determine their relations with malignant features． METHODS: The expression of connexin 43 and E-cadherin in choroidal melanoma were detected by immunohist- ochemistry and correlated with clinicopathological features. RESULTS: Positive rates of connexin 43 in choroidal melanomas and benign pigmented nevus tissues were 75% and 40% respectively with significant differences between the two groups (χ2=5.607, P=0.009). Positive rates of E-cadherin in choroidal melanomas and benign pigmented nevus tissues were 40％ and 75% respectively with significant differences between the two groups (χ2=5.214, P=0.010). Significant overexpression of connexin 43 and reduction of E-cadherin expression was associated with the invasion to the sclera, and there were respectively significant differences between without and with scleral invasion groups (χ2=2.880, P=0.040; χ2=2.778, P=0.046). Overexpression of connexin 43 were correlated with tumor cell types and the expression of connexin 43 and E-cadherin may be correlated with each other. CONCLUSION: The increased expression of connexin 43 and the decreased expression of E-cadherin may be involved in the process of invasion of choroidal melanoma. The overepression of connexin 43 and reduction of E-cadherin may contribute to the development of choroidal melanoma．

Abstract:AIM: To study the effect of the minocycline (MNC) on expression of bcl-2, bax in retinal nerve cells of rat with diabetes. METHODS: Male SD rats were randomly divided into negative control group, model control group and MNC treated group. Diabetes model was established by intraperitoneal injection of 60 mg/kg streptozotocin (STZ). The protein expressions of bcl-2 and bax in retina were detected by immunohistochemistry method. RESULTS: Compared with the negative control group, bax immunoreactive neurons in retina were increased significantly (P <0.01) in model control group. However, bax immun- oreactive neurons in retina in MNC treated group were significantly decreased (P<0.01). Compared with the model control group, bcl-2 immunoreactive neurons in retina were increased significantly(P <0.01) in MNC treated group. CONCLUSION: MNC can obviously decreased expression of bax and increased expression of bcl-2 in retina with DR. It is one of path of inhibiting impairment on retinal nerve cells with DR.

Abstract:? AIM: To investigate the expression of interleukin-10 (IL-10) and the effect of NS-398(COX-2 inhibitor) on the expression of IL-10 in fungal keratitis in rats, and analyze its effects on anti-fungus immunity. ? METHODS: Ninety Wister rats were randomly divided into 3 groups. Group A was blank control group (10 eyes). Group B was fungal keratitis group (40 eyes). Group C was fungal keratitis group treated with NS-398 (40 eyes). PAS staining, 100g/L potassium hydroxide (KOH) smear and fungal culture confirmed the successful establishment of fungal keratitis model. After the central epithelium was scraped, Fusarium solani colonies were applied and contact lens was put on the right cornea of group B and C, and plane contact lens was put on the left cornea of control eyes. Phosphate buffered saline (PBS) eyedrops were given for group B and NS-398 eyedrops for group C. The expression of IL-10 on corneas of group B and C on the 1st day, 3rd days, 7th days, and 14th days were detected by immunohistochemistry and semi- quantitative reverse transcription- polymerase chain reaction (RT-PCR). ? RESULTS: Histopathologic examination showed neutrophil infiltration and severe tissue necrosis in ulcer cornea. PAS staining confirmed the existence of hyphae and spores in the superficial layer of stroma. In the blank and control groups almost no expression of IL-10 was detected at any observing points. In group B the expression of IL-10 increased at first and decreased thereafter. Its expression also showed significant difference at any observing points (P＜0.01). Compared with group B, the expression of IL-10 in group C showed no difference on the 1stday, decrease on the 3rd day, but a significant increase on the 7th day and 14th day. ? CONCLUSION: IL-10 takes part in the occurrence and development of fungal keratitis. NS-398 can upgrade the expression of IL-10 in fungal keratitis in the later period of the ulcer. Meanwhile, pathologic observation showed a slightly corneal opacity. IL-10 may play an important role in the process of cornea anti-damage repair.

Abstract:AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-Ⅱ) were randomly assigned to propofol (n=41) and urapidil groups (n=41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P>0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO2 and intraocular pressure (IOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P<0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P>0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P<0.05), and had significant difference compared with those in urapidil group (P<0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P<0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P<0.05). The changes in these indicators between the two groups had no significant difference (P>0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.

Abstract:AIM: To evaluate the distance vision of Chinese patients with cataracts and corneal astigmatism after implantation of bilateral AcrySof toric intraocular lens (IOL) versus bilateral AcrySof spherical IOL. METHODS: This study randomized 60 patients into equal groups to receive toric IOL or spherical IOL. IOL powers targeting emmetropia were selected for 93% of toric IOL patients and for 90% of spherical IOL patients. Assessments included monocular and binocular distance vision, with and without best correction. Patients also completed surveys about their distance vision. RESULTS: Preoperatively, the two study groups were similar in age, in distance visual acuity, and in the magnitude of corneal astigmatism. At 6 months postoperative, binocular uncorrected distance vision was 0.06±0.14 logMAR in the AcrySof toric IOL group, significantly better than the 0.14±0.11 logMAR in the spherical IOL group (P<0.05). For eyes with emmetropia as a target, the equivalent of 20/20 uncorrected vision was more likely (P<0.001) in the toric IOL group (36% of eyes) than in the spherical IOL group (4% of eyes). No patients in the emmetropia/toric IOL group used distance glasses, as compared to 52% of patients in the emmetropia/spherical IOL group. All patients were satisfied or highly satisfied. Quality of distance vision was rated higher by toric IOL patients than by spherical IOL patients (P<0.05). CONCLUSION: Bilateral AcrySof toric IOL is superior to bilateral spherical IOL in providing uncorrected distance vision to cataract patients with corneal astigmatism.

Abstract:AIM: To investigate a new, safe and effective injection method for strabismus patients. Botulinum toxin type A (BTXA) was injected by pulling the extraocular muscles with a minimally-invasive technique into the ocular surface, and it was ensured that the extraocular muscles was maintained in the suspended state. METHODS: A total of 32 patients with different types of strabismus were treated at our institution from February to October 2010. A small conjunctival incision (≤2mm) was made under a microscope. The extraocular muscles were pulled out with a hook to ensure an elevated position compared with the wall of eyeball. The muscle fiber was clearly seen through the conjunctiva and BTXA was injected at a small angle under the microscope. The deviation angles before and after the injection were recorded. All patients were followed up at 5 and 30 days after the operation. Recovery was defined as abolition of diplopia in straight-ahead gaze and anteroinferior gaze and the symptoms of giddiness disappeared thoroughly. Eyeball position was essentially normal. Improvement was defined as basic disappearance of diplopia in straight-ahead gaze and anteroinferior gaze; restriction of action of paralytic muscle improved. If most of the symptoms and signs still existed and disturbed normal work and life, the treatment was determined to be invalid. The injection dose for patients of 5 to 10 prism diopter (PD), 11 to 20PD, and ≥21PD was 1u, 3u and 4u to 5u, respectively. RESULTS: Of the 32 treated patients, 11(34.4%) were cured, and 18(56.3%) were improved at 5 days after the operation; 12(40%) were cured, and 15(46.9%) were improved at 30 days. Five patients (15.6%) who had unsatisfactory response after BTXA injection at 30 days received repeated injections or underwent strabismus surgery. Ptosis was present in 2.5% of the injected eyes. No retrobulbar hemorrhage or ocular perforation was found in any eye. CONCLUSION: It is safe and efficient to inject BTXA by pulling extraocular muscles with a minimally-invasive technique under the microscope to make the muscles separated from the wall of eyeball.

Abstract:AIM: To evaluate the risk factors associated with retinal neovascularization of diabetic retinopathy in northern Chinese Han patients with type 2 diabetes mellitus (T2DM). METHODS: The clinical characteristics of 200 patients with proliferative diabetic retinopathy (PDR) and 100 age-matched healthy individuals were compared. The univariate and multivariate logistic regression analysis were performed in the patients with PDR. RESULTS: Fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), blood urea nitrogen (BUN), uric acid (UA), white blood cell count (WBC), absolute neutrophil count, hematocrit (HCT) and mean platelet volume (MPV) and mean platelet volume (MPV) were all significantly higher in patients with PDR than in the control group (P<0.05). The univariate and multivariate logistic regression analysis showed that risk factors independently associated with retinal neovascularization of DR were duration of diabetes mellitus (OR=1.112; P =0.000), BUN (OR=1.277; P=0.000), smoking (OR=3.967; P=0.000) and MPV(OR=2.472; P=0.000). On the other hand, panretinal photocoagulation was associated with reduced risk of retinal neovascularization (OR=0.983; P=0.000). CONCLUSION: Preventing and controlling T2DM in terms of risk factors, including duration of diabetes, BUN, smoking and MPV, might offer novel approaches to prevent or delay the onset of retinal neovascularization in patients with PDR.

Abstract:AIM: To report the study on radiofrequency ablation technique for eradication of palpebral margin neoplasm and its clinical effects. METHODS: One hundred and six cases with the palpebral margin neoplasm were performed surgical removal with radiofrequency ablation technique. The 1-2 months postoperative follow-up was investigated and the lost cases were excluded from statistics. The continuing follow-up lasted about 6-16months. RESULTS: One hundred cases underwent one treatment and 6 cases underwent two treatments. Six cases were missed. All the cases followed up healed well without pigmentation or scar left, nor eyelash loss or palpebral margin deformation. No case was recurrent. CONCLUSION: Radiofrequency ablation has significant efficiency in eradicating the palpebral margin neoplasm.

Abstract:AIM: To evalaute the effect of fixed-combination latanoprost 0.005%/timolol maleate 0.5% and dorzolamide hydrochloride 2%/timolol maleate 0.5% on postoperative intraocular pressure after phacoemulsification cataract surgery. METHODS: This study is a prospective, randomized, double-masked and placebo-controlled. The study included 90 eyes of 90 patients which were scheduled to have phacoemulsification surgery. Patients were randomly assigned preoperatively to 1 of 3 groups (30 eyes of 30 patients). Two hour before surgery, the patients received one drop latanoprost/timolol (group 1), dorzolamide/timolol (group 2) and placebo (group 3, control group). The IOPs were measured at preoperative and postoperative 4, 8, and 24 hours. RESULTS: The preoperative mean intraocular pressure was not statistically significant between both drug groups and control group. In group 1 and 2, the postoperative mean IOP [group1: (14.03±3.15)mmHg and group 2: (14.16±4.43)mmHg] at 24 hours were significantly lower than the control group [(16.93±3.70)mmHg, (P<0.05)]. In addition, the postoperative mean IOP of group 1 [(14.90±3.69)mmHg] at 8 hours was significantly lower than the control group [(17.70±3.89)mmHg, (P<0.05)], but there was no significant difference between group 2 [(16.16±5.23)mmHg] and control group at 8 hours (P>0.05). CONCLUSION: When compared with placebo, the use of preoperative fixed combination of latanoprost/ timolol and dorzolamide/timolol is an effective method for preventing intraocular pressure elevation in 24 hours after phacoemulsification surgery, but did not completely prevent IOP spikes.

Abstract:AIM: To assess features of cavernous hemangioma (CH) in the orbit revealed by CT and MRI and summarize prediction of preoperative CT and MRI for the adhesion degree of CH in the orbit. METHODS: A total of 97 patients with pathologically confirmed CH in the orbit were examined with axial and coronal CT scan, and axial, coronal, sagittal, and enhanced fat suppression MRI scan. CT and MRI findings and intraoperative adhesion degrees were retrospectively analyzed. RESULTS: There were 47 patients with slight adhesion, for whom CT and MRI showed round masses with well defined margins in the extraocular muscles; 14 patients with mild adhesion, for whom CT and MRI revealed irregular masses with unclear boundary between CH and the optic nerve in coronal images, and emissary veins in the posterior region of masses in contrast-enhanced images; 36 patients with severe adhesion, for whom CT and MRI exhibited an irregular or ovoid mass filling the orbital apex, or showed distorted and even spiky margins in the posterior region of masses in contrast enhanced images at the presence of a transparent triangle between the mass and the orbital apex. CONCLUSION: Preoperative CT and MRI aid in accurate diagnosis, selection of the surgical approach, and assessment of the adhesion degree and surgical risks for CH.

Abstract:AIM: To report ocular symptoms, funduscopic findings and demographic distribution of ocular toxoplasmosis in Iran METHODS: In this cross-sectional study, a total of 40 patients with ocular toxoplasmosis (24 female, 16 male) were enrolled. The distribution of symptoms and funduscopic findings were studied. RESULTS: The patients' age was in the range of 13-52 with the most common age of 19 years old. Twenty-four patients were female (60.0%). The most common presenting sign was visual loss. There was anterior chamber (AC) inflammation in 23 patients (57.5%). Vitritis was presented in 36 patients (90.0%). In 35 patients (87.5%), the retinal lesion was central. In patients with peripheral lesion, 3 patients (60.0%) had flashing vs 12.5% chance of flashing in all patients. Older patients had larger lesion (P=0.04). CONCLUSION: Ocular toxoplasmosis substantially varies among patients with different age, gender, status of immunity, site of lesion and other undetermined factors. One of ocular symptoms, flashing, may necessitate a more precise peripheral fundus examination.

Abstract:AIM: To determine the epidemiological characteristics and estimate the risk factors of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) in Shandong Peninsula of China. METHODS: The cases of T2DM admitted to Affiliated Hospital of Medical College of Qingdao University, Shandong Province, China, from January 2006 to December 2010 were retrospectively reviewed. The epidemiological characteristics of DR were estimated. The cases were divided into two groups according to degrees of retinopathy: non-DR group and DR group. Logistic regression analysis was used to study the related risk factors of DR. RESULTS: The prevalence of DR in patients with T2DM was 25.08% (834/3326). There was significant difference between the average age for men (59.08±15.43 years) and for women (62.92±18.19 years,P=0.0021). The majority of DR occurred in women (female: male ratio=1.76:1,P<0.0001). The incidence rate of DR in urban (489/834) was higher than that in rural area (345/834, P<0.0001). In 834 DR patients, the mean duration of T2DM was 8.90±4.15 years (range: 0-16 years); 440 people (52.76%) had received varying degrees of health education about prevention and primary care of DM; and 473 people (56.71%) suffered from other DM complications confirmed at the same time. In addition, the incidence rate of monocular (551/3326) and binocular retinopathy (283/3326) were statistically different (P<0.0001). Factors associated (P<0.05) with the presence of DR included old age, lower health educational level, intraocular surgery history, longer duration of T2DM, accompanying with other DM complications, no standard treatment procedure, lower body mass index (BMI) and higher fasting plasma glucose (FPG), glycated hemoglobin A1C (HbA1C), urine albumin (UA), total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C). The risk factors (P<0.05) independently associated with the presence of DR were: longer duration of T2DM, lower health educational level, higher FPG, higher UA, lower BMI and higher TC. CONCLUSION: DR is highly prevalent in the patients with T2DM in Shandong Peninsula of China. Besides blood glucose, many factors are associated with the present and development of DR.

Abstract:We describe a rapid anterior capsule contraction following phacoemulsifiction and intraocular lens(IOL) implantation in an old woman with high myopia. The patient with high myopia complicated with cataract received phacoemulc- ification and IOL implantation bilaterally .The best-corrected visual acuity (BCVA) improved from 0.1 to 0.4 in the right eye and 0.5 in the left eye 1 week after surgeries.5 weeks after surgery of the right eye and 4 weeks after surgery of the left eye, the patient complained blurred vision in the right eye. BCVA of the right eye was 0.06 and that of the left was 0.1. Slit-lamp examination revealed anterior capsule contraction in both eyes and a fully closed capsulorhexis opening in the right eye. The IOLs were centered but almost completely enclosed, with numerous linear fibrous folds radiating from the hick central fibrosis. We surgically excised the central part of the anterior capsule of the eyes with microscissors, resulting again in BCVA of 0.4 and 0.5 in the right and left eyes respectively. Anterior capsule contraction might appear much earlier than three months after phacoemulsification and IOL implantation surgery in case of high myopia complicated with cataract. Patients with high myopia receive cataract and IOL surgery should be monitored carefully for the rapid development of anterior capsule contraction.

Abstract:We present a case of circumscribed choroidal hemangioma (CCH) in Sturge-Weber syndrome in a 30-year-old woman with congenital port-wine stains on the left side of face involving the upper eyelid, cheek and the nose, and she had undergone facial hemangioma surgery 3 years ago suggestive of Sturge-Weber syndrome. She presented with a 1-month history of rapidly decreased visual acuity (VA) to counting fingers in the left eye which had no prior history of visual problem. And there was no evidence of glaucoma. At 3 months after the treatment of the standard photodynamic therapy (PDT) the VA was 20/200. For some reasons, we have no idea about the changes of tumor thickness and subretinal fluid. We confirmed the curative effect of PDT treatment for CCH because of the significantly improved VA in the bad eye.

Abstract:AIM: To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to Stevens-Johnson syndrome (SJS). METHODS: An interventional case report. RESULTS: We describe a 35-year-old Indian woman, a known case of SJS with bilateral dry eyes and corneal blindness (failed corneal graft with vascularised total corneal opacity in the right eye and non-healing corneal ulcer in the left eye). Vision was hand movement only in both eyes. The corneal ulcer healed with medical treatment resulting in vascularised total corneal opacity with no improvement in vision. OOKP was performed in the right eye and the vision was improved from hand movement to 6/6. The same vision was maintained in the right eye at the last follow-up 5 years after surgery. CONCLUSION: OOKP provides good visual rehabilitation with long-term anatomically stable prosthesis in patients with end-stage of ocular surface disorders and corneal blindness secondary to SJS.

Abstract:AIM: To describe a case in which vitrectomy was required for vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis (LCVA) for non-ischemic central retinal vein occlusion (CRVO). METHODS: Observational case report. RESULTS: A 72-year-old man complained of central scotoma in the left eye, and was diagnosed as suffering from non-ischemic CRVO. LCVA was performed in another hospital. Although favorable visual function was briefly maintained postoperatively,severe vitreous hemorrhage developed in his left eye, necessitating vitrectomy. CONCLUSION: Considering that LCVA carries a risk of serious complications, we must apply this treatment with caution, especially in ethnic groups, such as the Japanese, in whom pigmentation reacts to photocoagulation excessively.

Abstract:This is a case presentation of a very bizarre open globe trauma with anterior segment foreign body-fishing hook stuck in the cornea and iris. Complications due to this kind of eye trauma might be very hazardous and with serious impact on visual function. We are representing our approach and experience of three step management of this kind of eye injury: first-extract the foreign body, close and reconstruct the eyeball, second-fight inflammation, and third-restore the visual function by cataract surgery.