Intraocular Hypertension Research Articles

Neuroprotective effects of DAAO are mediated via the ERK1/2 signaling pathway in a glaucomatous animal model

Neuronal excitotoxicity caused by over activation of N -Methyl-D-Aspartate (NMDA) receptors is an important risk factor for the retinal ganglion cells (RGCs) death in glaucoma. D-serine played a role as a key co-agonist for NMDA receptor activity and neurotoxicity. Our previous studies have demonstrated that increased D-serine and serine racemase (SR) expression in the retina of the chronic intraocular hypertension (COH) model were detected. D-amino acid oxidase (DAAO) treatment significantly increased RGCs survival in the glaucomatous eyes. However, the molecular mechanism remains unclear. In the present study, we investigated the extracellular signal-regulated protein kinase1/2 (ERK1/2) signaling pathway involved in DAAO neuroprotective effects on RGC survival and explore the effect of inhibited ERK1/2 phosphorylation on RGC survival and Müller cell activation in a COH rat model. We found that ERK1/2 phosphorylation and p38 kinase (p38) phosphorylation increased in the COH model, while c-Jun N-terminal kinase (JNK) phosphorylation didn't change. DAAO treatment induced ERK-1/2 MAP kinase phosphorylation and its upstream regulator, p-MEK increased in the COH model. The increased p-ERK was mainly located in retinal Müller cells. In contrast, p-JNK and p-p38 protein expression was not significantly different under these conditions. Quantitative analysis of RGC survival by fluorescent labeling and TdT-mediated dUTP nick-end labeling (TUNEL) assays confirmed that p-ERK1/2 inhibition by PD98059 attenuates DAAO-mediated reductions in RGC apoptosis. Additionally, p-ERK1/2 inhibition induced elevated glial fibrillary acidic protein (GFAP) expression in Müller cells in the COH model. Together, these results suggest that the ERK1/2 signaling pathway is involved in DAAO's neuroprotective effects on RGC survival.

Whether lowering intraocular pressure is needed for thyroid associated ophthalmopathy with intraocular hypertension

Patients with thyroid associated ophthalmopathy often have elevated intraocular pressure. Patients and doctors are often confused about whether intraocular hypertension in thyroid associated ophthalmopathy needs to be lowered. There are several theories on the possible causes of this kind of increased intraocular pressure: restriction and compression of the globe by fibrotic and enlarged rectus muscles, increased episcleral venous pressure resulting from orbital congestion and venous outflow obstruction, and increased resistance to trabecular outflow. In addition, the patient's eye position and the device for measuring intraocular pressure also have great impacts on the accuracy of intraocular pressure measurement. At the same time, there are very few patients with thyroid associated ophthalmopathy combined with primary glaucoma. Therefore, whether patients with elevated intraocular pressure need to be treated depends on the specific clinical manifestations of the thyroid associated ophthalmopathy. Intraocular pressure of most patients can be lowered by active treatment for thyroid associated ophthalmopathy; antiglaucoma medical therapy may be necessary for patients whose intraocular pressure cannot be lowered; only very few cases of glaucoma require antiglaucoma drugs or surgery. (Chin J Ophthalmol, 2019, 55:811-813).

Melatonin and the control of intraocular pressure.

Melatonin is not only synthesized by the pineal gland but by several ocular structures. This natural indoleamine is of great importance for regulating several eye processes, among which pressure homeostasis is included. Glaucoma, the most prevalent eye disease, also known as the silent thief of vision, is a multifactorial pathology that is associated to age and, often, to intraocular hypertension (IOP). Indeed IOP is the only modifiable risk factor and as such medications are available to control it; however, novel medications are sought to minimize undesirable side effects. Melatonin and analogues decrease IOP in both normotensive and hypertensive eyes. Melatonin activates its cognate membrane receptors, MT1 and MT2, which are present in numerous ocular tissues, including the aqueous-humor-producing ciliary processes. Melatonin receptors belong to the superfamily of G-protein-coupled receptors and their activation would lead to different signalling pathways depending on the tissue. This review describes the molecular mechanisms underlying differential functionalities that are attributed to melatonin receptors. Accordingly, the current work highlights the important role of melatonin and its analogues in the healthy and in the glaucomatous eyes, with special attention to the control of intraocular pressure.

Analysis and management of intraoperative and early postoperative complications of bag-in-the-lens intraocular lens implantation in different age groups of paediatric cataract patients: report of the Giessen Paediatric Cataract Study Group.

To report the rate and management of intra- and early postoperative complications of bag-in-the-lens intraocular lens (IOL) implantation technique for cataract treatment in paediatric patients of different age groups. Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany. Retrospective non-randomized consecutive case series. Ninety eyes of 60 paediatric cataract patients were enrolled to this retrospective non-randomized observational consecutive case series single-centre study. All patients underwent cataract surgery with bag-in-the-lens IOL implantation between January 2008 and December 2018, performed by two experienced surgeons. The entire cohort was divided into four age groups: first - 0-<3months, second - 3-<12months, third - 12-<36 and fourth - >36months-17years of age. The intra- and postoperative complications were based on the clinical records. The description of management of complications related specifically to bag-in-the-lens IOL technique was based on the 39 consecutive cases operated since 1 Jan 2016 by one single surgeon that were all video documented. The early postoperative period was defined as 12months after surgery. Overall, there were 27 unilateral and 33 bilateral surgical cases of 24 female and 36 male children. The mean age at surgery was 45.25months (range 1-200months). The most common intraoperative events were vitreous prolapse and anterior capsule rupture with 28.9% and 13.3%, respectively. Within 12months of follow-up, five eyes (5.6%) were re-operated because of visual axis reo-pacification (VAR). Intraocular hypertension was diagnosed in seven eyes (7.8%), including two cases that required surgical treatment. In all cases with intra- and early postoperative complications related specifically to bag-in-the-lens technique, it was possible to manage them and successfully implant bag-in-the-lens IOL. Implementation of bag-in-the-lens technique in the treatment of paediatric cataract was associated with a relatively low rate of intra- and postoperative complications, including rare cases of VAR. The correct management of complications related specifically to bag-in-the-lens IOL implantation technique shall to be considered during the learning curve.

HLA-DPA1 gene polymorphism in primary glaucoma.

To explore the association between human leukocyte antigen (HLA)-DPA1 gene polymorphism and primary glaucoma. Six single nucleotide polymorphisms (SNPs) were genotyped in 51 patients and 51 healthy controls through Polymerase Chain Reaction (PCR). The possible association between HLA-DPA1 gene mutation and primary glaucoma was detected using the t-test and the Chi-square test. Rs1676486 genotype had a significant genetic correlation. Rs3753841 and rs12138977 genotypes had a higher minor-allele frequency in control group. The CT + CC genotype frequency of rs12138977 showed a significant genetic correlation in both case group and control group. Moreover, the rs12138977 polymorphism and corneal thickness had little influence on the occurrence of primary angle-closure glaucoma (PACG). Also, the main risk factors for PACG were intraocular hypertension and short axial length. The HLA-DPA1 gene polymorphism may be related to the severity of PACG.

Prevalence of increased intraocular pressure in patients with Graves' ophthalmopathy and association with ophthalmic signs and symptoms in the north-west of Iran.

IntroductionGraves’ ophthalmopathy (GO) is the most common extra-thyroidal manifestation of Graves' disease and is characterized by multiple ocular symptoms such as eyelid retraction, lid lag, proptosis, elevated intraocular pressure (IOP) and ultimately loss of vision. We aimed to investigate the prevalence of increased IOP in Graves' patients and association with ophthalmic signs and symptoms in north-west of Iran.Materials and methodsThis descriptive cross-sectional study recruited 93 patients with GO who were diagnosed based on clinical and laboratory examinations. A complete ocular examination and IOP measurements on forward gaze were performed using Goldman applanation tonometer.ResultsIn this study, 93 patients with GO were evaluated from 2016 to 2017. Among these patients, 67 (72.05%) were female and 27 (27.95%) were male. The most common complaints of patients were lid retraction (62.36%), puffy eyelids (58.06%) and proptosis (46.23%), respectively. The duration of disease was 0–24 months in most patients. Most subjects were at grade 3 according to NOSPECS classification. Nine patients (9.6%) had an IOP greater than or equal to 21 mmHg. The mean IOP in subjects was 16.61±3.42 mmHg. The mean IOP in males and smokers was significantly higher than that of females and nonsmokers. The mean IOP increased significantly with a higher grade of disease, duration of disease, age and smoking.ConclusionsAccording to the results, females comprised the majority of the study population, while ocular complications were more prevalent among males. The highest IOP was seen in old cases of GO. The most prevalent ocular signs in patients were eyelid retraction and periorbital edema. The least prevalent sign was glaucomatous optic neuropathy. In this study, the prevalence of intra-ocular hypertension was higher than that of the general population, especially in males, old cases with a drug history of antithyroid medication and smokers.

Clinical study on the timing of preoperative application of conbercept in proliferative diabetic retinopathy

Objective To observe the best time of application of conbercept before vitrectomy for proliferative diabetic retinopathy (PDR). Methods The data of 75 eyes of 75 cases of proliferative diabetic retinopathy who underwent vitrectomy from May 2017 to Jul. 2018 were retrospectively analyzed. All cases were divided into two groups randomly. Group A , 38 eyes of 38 cases, received intravitreal injection of Conbercept at 7 days before operation, and group B, 37 eyes of 37 cases, received intravitreal injection of Conbercept 3 days before operation. The operation time, intraoperative and postoperative complications and the visual acuity at 6 months postoperatively were observed and compared between the two groups. Results Postoperative visual acuity of the two groups were significantly improved (t=8.854, P=0.000). Postoperative recurrence of vitreous hemorrhage occurred in 1 eye (2.6%) of group A and 7 eyes (18.9%) of group B (P=0.028). Postoperative intraocular hypertension occurred in 5 eyes (13.2%) of group A and 7 eyes (18.9 %) of group B, the difference was not statistically significant (χ2 =0.463, P=0.496). The difference were not statistically significant between the two groups in operation time, intraoperative retinal hemorrhage, iatrogenic tear incidence, silicone oil or gas tamponade rate (P=0.502, 0.518, 0.304, 0.444, 0.720). Conclusion Application of Conbercept before vitrectomy can improve the visual acuity for patients with PDR. The incidence of vitreous hemorrhage in patients applicated of Conbercept at 7 days before vitrectomy can reduce the incidence of vitreous hemorrhage than that in patients applicated of Conbercept at 3 days. Key words: Conbercept, intravitreal injection; Retinopathy, proliferative diabetic; Vitrectomy

Observation on postoperative intraocular pressure after microinvasion vitrectomy combined with cataract surgery

Objective To observe the intraocular pressure after microinvasion vitrectomy combined with phacoemulsification. Methods A prospective case-contral study.The data of 126 eyes of 126 cases of vitreoretinal diseases and cataract from Aug. 2016 to Dec. 2017 were divided into two groups randomly. The combined group, 36 eyes of 36 cases, underwent microinvasion vitrectomy combined with phacoemulsification and intraocular lens implantation. The control group, 90 eyes of 90 cases, underwent simple microinvasion vitrectomy. The intraocular pressure at 7 days after operation was observed and compared between the two groups. Results The intraocular pressure of the combined group were (12.5±3.2) mmHg, (13.5±3.7) mmHg, (11.6±4.0) mmHg, (10.4±2.9) mmHg(1 mmHg=0.133 kPa) before and 1, 3 and 7 days after operation, that of the control group was (12.6±3.4) mmHg, (13.9±4.2) mmHg, (12.4±3.8) mmHg and (13.1±2.7) mmHg, respectively. The intraocular pressure of combined group at 7 days after operation was lower than that of control group, the difference was statistically significant (t=4.964, P=0.0001), and the difference was not significant in other time points between the two groups (P>0.05). The intraocular pressure fluctuation in combined group at 7 days after operation was lower than that in the control group, the difference was statistically significant (t=3.298, P=0.0013). The incidence of intraocular hypertension (8.3%) and the incidence of introcular hypotension (5.6%) in combined group were lower than those in the control group (22.2%, 26.7%). The difference were statistically significant (χ2=4.1022, 3.8673, P=0.0428, 0.0492). Conclusion Microinvasion vitrectomy combined with cataract surgery is helpful to stabilize intraocular pressure in patients with vitreoretinal diseases and cataract. Key words: Surgery, cataract; Vitrectomy, microinvasion; Pressure, intraocular; Diseases, vitreoretinal

Marine-Steroid Derivative 5α-Androst-3β, 5α, 6β-triol Protects Retinal Ganglion Cells from Ischemia⁻Reperfusion Injury by Activating Nrf2 Pathway.

High intraocular pressure (IOP)-induced retinal ischemia leads to acute glaucoma, which is one of the leading causes of irreversible visual-field loss, characterized by loss of retinal ganglion cells (RGCs) and axonal injury in optic nerves (ONs). Oxidative stress and the inflammatory response play an important role in the ischemic injury of retinal and optic nerves. We focus on 5α-androst-3β, 5α, 6β-triol (TRIOL), a synthetic neuroactive derivative of natural marine steroids 24-methylene-cholest-3β, 5α, 6β, 19-tetrol and cholestane-3β, 5α, 6β-triol, which are two neuroactive polyhydroxysterols isolated from the soft coral Nephthea brassica and the gorgonian Menella kanisa, respectively. We previously demonstrated that TRIOL was a neuroprotective steroid with anti-inflammatory and antioxidative activities. However, the potential role of TRIOL on acute glaucoma and its underlying mechanisms remains unclear. Here, we report TRIOL as a promising neuroprotectant that can protect RGCs and their axons/dendrites from ischemic–reperfusion (I/R) injury in an acute intraocular hypertension (AIH) model. Intravitreal injection of TRIOL significantly alleviated the loss of RGCs and the damage of axons and dendrites in rats and mice with acute glaucoma. As NF-E2-related factor 2 (Nrf2) is one of the most critical regulators in oxidative and inflammatory injury, we further evaluated the effect of TRIOL on Nrf2 knockout mice, and the neuroprotective role of TRIOL on retinal ischemia was not observed in Nrf2 knockout mice, indicating that activation of Nrf2 is responsible for the neuroprotection of TRIOL. Further experiments demonstrated that TRIOL can activate and upregulate Nrf2, along with its downstream hemeoxygenase-1 (HO-1), by negative regulation of Kelch-like ECH (Enoyl-CoA Hydratase) associated Protein-1 (Keap1). In conclusion, our study shed new light on the neuroprotective therapy of retinal ischemia and proposed a promising marine drug candidate, TRIOL, for the therapeutics of acute glaucoma.

Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases.

To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital. The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative best-corrected visual acuities (BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed. A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73% (2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1d, 1wk, and 1mo post-surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12% (171/4151) had posterior capsule rupture, 0.79% (33/4151) had iris or ciliary body injury, and 0.048% (2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38% (182/4151) had cornea edema, 7.78% (323/4151) had intraocular hypertension, 0.096% (4/4151) had IOL toxicity syndrome, 0.28% (12/4151) had retained lens cortex, and 0.048% (2/4151) had hyphema. The delayed discharge rate was 0.82% (44/4151) and the unplanned re-admission to the hospital was 0 (0/4151). The patient satisfaction rate was 91.42% (3795/4151). Day-case cataract surgery is safe and effective with good prospects for development.

Cyclophotocoagulation combined with panretinal photocoagulation for the treatment of neovascular glaucoma

Objective To evaluate the clinical efficacy of cyclophotocoagulation combined with panretinal photocoagulation (PRP) through 23 G minimal incision for the treatment of neovascular glaucoma. Methods A prospective study. Twenty-four eyes of 24 patients with neovascular glaucoma underwent cyclophotocoagulation combined with PRP through 23 G minimal incision. The patients were followed up for 12 months. Results The IOP were normal in 21 patients at the end of follow-up. Three eyes with intraocular hypertension were controlled after cyclophotocoagulation again. The postoperative IOP and types of anti-glaucoma drugs at all follow-up time point were significantly lower than those preoperatively (all P=0.000). The difference in BCVA was not significant between before and after surgery(χ2=1.491, P=0.684). The main complications were hyphema, inflammatory reaction and temporary intraocular hypertension, which were controlled after medication. Conclusion Cyclophotocoagulation combined with PRP through 23 G minimal incision for the treatment of neovascular glaucoma is effective and safe. Key words: Cyclophotocoagulation; Photocoagulation, panretinal, minimal incision; Glaucoma, neovascularization

A Novel Synthetic Steroid of 2β,3α,5α-Trihydroxy-androst-6-one Alleviates the Loss of Rat Retinal Ganglion Cells Caused by Acute Intraocular Hypertension via Inhibiting the Inflammatory Activation of Microglia.

Neuroinflammation has been well recognized as a key pathological event in acute glaucoma. The medical therapy of acute glaucoma mainly focuses on lowering intraocular pressure (IOP), while there are still scarce anti-inflammatory agents in the clinical treatment of acute glaucoma. Here we reported that β,3α,5α-trihydroxy-androst-6-one (sterone), a novel synthetic polyhydric steroid, blocked neuroinflammation mediated by microglia/macrophages and alleviated the loss of retinal ganglion cells (RGCs) caused by acute intraocular hypertension (AIH). The results showed that sterone significantly inhibited the morphological changes, the up-regulation of inflammatory biomarker ionized calcium-binding adapter molecule 1 (Iba-1), and the mRNA increase of proinflammatory tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) induced by lipopolysaccharide (LPS) in BV2 microglia and RAW264.7 macrophages. Moreover, immunofluorescence and western blotting analysis revealed that sterone markedly abrogated the nuclear translocation and phosphorylation of nuclear factor-κB (NF-κB) p65 subunit. Furthermore, sterone significantly suppressed the inflammatory microglial activation and RGCs’ reduction caused by retinal ischemia/reperfusion (I/R) injury in a rat AIH model. These results suggest sterone may be a potential candidate in the treatment of acute glaucoma caused by microglial activation-mediated neuroinflammatory injury.

Efficacy of trabeculectomy in acute angle-closure glaucoma patients with sustained intraocular hypertension

Objective To evaluate the efficacy of trabeculectomy in primary acute angle-closure glaucoma patients with sustained intraocular hypertension. Methods The data of 82 eyes of 79 patients of primary acute angle-closure glaucoma from Mar. 2016 to Oct. 2017 were analyzed retrospectively. The patients were divided into two groups: the observation group, 41 eyes of 40 patients, with IOP ≥40 mmHg and lasted for more than 3 days after conventional treatment and the control group, 41 eyes of 39 patients, with IOP<40 mmHg. The two groups were treated with trabeculectomy. The follow up time was 3 months. The surgical efficacy and postoperative complications were compared and analysed. Results The improved, unchanged and decreased rate of visual acuity in observation group at 3 months postoperatively were 78.05%, 17.07% and 4.88%, the difference were not statistically significant between the two groups (Z=1.620, P=0.110). The postoperative IOP of the two groups significantly decreased (P<0.05). The incidence of intraocular hypertension of observation group was higher significantly than control group at early stage after operation(χ2=4.100, P=0.042). The differences of IOP between the two groups was not statistically significant at 3 months postoperatively(t=1.309, P=0.194). Postopertive complication rate of observation group was 36.6%, and the control group was 7.3%.The difference between the two groups was statistically significant(χ2=10.250 P=0.001). Conclusion Trabeculectomy is safe and effective for primary acute angle-closure glaucoma patients with sustained intraocular hypertension, the complications should be treated actively. Key words: Glaucoma, angle-closure, acute, primary; Intraocular hypertension, sustained; Trabeculectomy

The impact of laparoscopic surgery in Trendelenburg position on intraocular pressure

Background Patients′ intraocular pressure (IOP) significantly increase during laparoscopic surgery in Trendelenburg position, and the resulting intraoperative intraocular hypertension may be related to postoperative visual loss (POVL). Objective To review the impact of laparoscopic surgery in Trendelenburg position on IOP to let the practitioners aware of the association between intraocular hypertension and POVL. Content One of the major causes for POVL is ischemia in optic nerve following reduction of ocular perfusion pressure (OPP) because of the increase of IOP. Animal studies prove that persistently increased IOP leads to damages in the retina. Patients often receive the laparoscopic surgery in Trendelenburg position, and low OPP and high IOP are commonly seen in this situation. In addition to the body position, the increase of IOP can also be a consequence of hypercapnia following CO2 inflation in the abdominal cavity, and may be affected by anesthetics, duration of the surgery, blood pressure, obesity and gender, etc. Several procedures have been performed to alleviate the increase of IOP, such as, intermittent shift the Trendelenburg position into supine position and intraoperative pharmacological intervention. Trend POVL is rarely seen in laparoscopic surgery, but severely compromises patient′s life quality if happens. Cautions should be taken to carefully monitor IOP in the patients with risk factors for POVL during laparoscopic surgery in the Trendelenburg position. Key words: Intraocular pressure; Laparoscopic surgery; Trendelenburg position

"PI-less DMEK": results of Descemet's membrane endothelial keratoplasty (DMEK) without a peripheral iridotomy.

To assess Descemet's membrane endothelial keratoplasty (DMEK) without performing a peripheral iridotomy (PI) prior to or during surgery ("PI-less DMEK"). This retrospective study included consecutive patients that underwent PI-less DMEK by a single surgeon (E.L) between February 2016 and February 2017 at the Rabin Medical Center, a Tertiary Hospital. Intraoperative and postoperative complications were assessed. Thirty-one patients, mean age 75.9 ± 7.9 years with 58.1% female were included. Leading indications for surgery were pseudophakic bullous keratopathy (18/31) and Fuchs' endothelial dystrophy (9/31). Preoperative best-corrected distance visual acuity was 1.13 ± 0.59 logMAR (~6/80 Snellen). For 12/31 that had postoperative endothelial cell count measurements, cell loss was 49 ± 20%. Intraoperative complications included anterior chamber (AC) hyphema during graft insertion requiring reinsertion (n = 1), and minor hyphema from the main corneal incision (n = 1). Partial slit lamp gas evacuation was performed in all patients 1.5 h postoperatively. Postoperative complications included partial graft detachment requiring rebubbling (n = 5), self-resolving minimal peripheral graft detachment (n = 5), uncontrolled intraocular hypertension requiring trabeculectomy in a patient with a history of medically controlled glaucoma (n = 1), postoperative cystoid macular edema that resolved medically (n = 1) and graft failure 5 months postoperatively (n = 1). No patients developed pupillary block. Excluding graft failure (n = 1), preoperative amblyopia (n = 2) and premature loss to follow-up (n = 1), final corrected distance visual acuity was 0.18 ± 0.14 logMAR (~20/30 Snellen) with 44.4% reaching 6/7.5 (Snellen) or more. PI-Less DMEK is a safe, technically easy, and effective modification that avoids the time and complications associated with performing a PI before or during surgery.

XEN gel stent to treat intraocular hypertension induced by Dexamethasone‐implant intravitreal injections: about 5 cases

XEN gel stent to treat intraocular hypertension induced by Dexamethasone‐implant intravitreal injections: about 5 cases

Comparison on the efficacy of two methods of laser capsulotomy for the treatment of after-cataract

Objective To compare the clinical efficacy of two methods of laser capsulotomy for the treatment of after-cataract. Methods Clinical data of 108 eyes of 108 cases with after-cataract was retrospectively analyzed. All cases were randomly divided into 2 groups. Group A, 54 eyes received Q pattern posterior capsulotomy with Nd: YAG laser. Group B of 54 eyes received cross silkworm etched posterior capsulotomy. The intraocular pressure, visual acuity, muscae volitantes accidence and treatment consuming-time were compared between two groups. The follow-up time was 1 month. Results The visual acuity of two groups improved after treatment (group A: Z=-6.415, P=0.000; group B: Z=-6.408, P=0.000). At last following time, the difference of visual acuity was not statistically significant between the two groups(t=-0.590, P=0.610). The treatment consuming-time of group A was shorter than that of group B(t=29.067, P=0.000). The incidence rate of high intraocular pressure in group A was lower than that of group B (χ2=4.800, P=0.030). The incidence rate of muscae volitantes in group A was lower than group B(χ2=8.020, P=0.000). Conclusion Q pattern posterior capsulotomy with laser for the treatment of after-cataract can reduce incidence rate of intraocular hypertension and muscae volitantes with less consuming-time. Key words: After-cataract; Capsulotomy, posterior capsule, laser; Observation, comparison

Decreased d-Serine Levels Prevent Retinal Ganglion Cell Apoptosis in a Glaucomatous Animal Model.

The purpose of this study was to determine d-Serine and d-Serine synthetase serine racemase (SR) expression and whether decreased d-Serine expression has protective effects on retinal ganglion cells (RGCs) in a glaucomatous animal model. The rat chronic intraocular hypertension (COH) model was generated as a glaucomatous animal model by cauterizing three episcleral veins. Quantitative analysis of RGC survival was determined by the counting of retrograde FluoroGold-labeled RGCs. The level of d-Serine in the retinas and aqueous humor was determined by Ultra High Performance Liquid Chromatography coupled to triple-quadrupole Mass Spectrometry (UHPLC-MS/MS). Retinal expression of serine racemase (SR) protein was determined by immunohistochemistry and Western blot analysis. The TUNEL assay was used to detect cell apoptosis. The content of d-Serine increased significantly in the glaucomatous retina of the COH model 2 weeks after surgery compared with the control retina. d-Serine synthetase SR expression in the right glaucomatous eye increased slightly after surgery compared with that in the left control eye and remained at this high level for 6 weeks after surgery. SR-positive cells were located mainly in the ganglion cell layer (GCL) of the retina. d-Amino acid oxidase (DAAO) treatment significantly increased RGC survival in the glaucomatous eyes, and the TUNEL assay was used to confirm that DAAO reduced the number of TUNEL-positive cells in glaucomatous eyes. However, excess d-Serine could not exacerbate RGC loss in the COH model. Increased d-Serine and SR expressions in the retina of the COH model were detected. DAAO treatment significantly increased RGC survival in the glaucomatous eyes. These results suggest that decreased d-Serine expression has protective effects on RGCs.

Outcome and Prognostic Factors of Phacoemulsification Cataract Surgery in Vogt-Koyanagi-Harada Uveitis

To investigate visual outcome and prognostic factors following cataract surgery in patients with Vogt-Koyanagi-Harada (VKH) disease. Retrospective, interventional case series. The history, clinical characteristics, best-corrected visual acuity (BCVA), full-field electroretinogram (ERG), intraocular inflammation, complications, and extraocular manifestations were analyzed retrospectively. One hundred and forty-eight male (214 eyes) and 138 female (194 eyes) VKH patients with complicated cataract were included. Surgery was performed on 352 eyes after complete control of intraocular inflammation for at least 3months. In another set of 56 eyes, surgery was done 1month after intraocular inflammation control. There was no difference in postoperative complications or BCVA between these 2 groups. The main complications after surgery were hyphema, ocular hypertension, and moderate anterior chamber reaction. Average preoperative visual acuity was 0.08. At last visit, BCVA was improved in 405 eyes (99.3%). The preoperative BCVA, treatment delay after disease onset, preoperative intraocular hypertension, and iris synechiae were associated with final visual outcome. Other parameters such as postoperative inflammation, IOL type, and presence of extraocular VKH features did not affect final BCVA. Poor visual acuity was caused by optic nerve atrophy, choroidoretinal neovascularization, and subretinal fibrosis. Poor postoperative BCVA was associated with an abnormal preoperative ERG profile. Phacoemulsification and IOL implantation in VKH patients can be safely and successfully performed in quiet eyes even after 1month following the last signs of inflammation. Visual prognosis was associated with preoperative BCVA, treatment delay after disease onset, preoperative intraocular hypertension, iris synechiae, and presence of preoperative ERG abnormalities.

Cytomegalovirus keratitis.

Cytomegalovirus (CMV) keratitis, albeit an uncommon manifestation of this ubiquitous pathogen, can lead to devastating ocular morbidity. Timely diagnosis and appropriate treatment are also unfortunately uncommon. The purpose of this review is to discuss recently published literature regarding the epidemiology, pathophysiology, diagnosis, and therapy of CMV keratitis. Classic clinical presentations of CMV keratitis are known; however, current investigations further elucidate characteristics of typical versus atypical disease. Ongoing research stems beyond utilizing PCR analysis towards targeted diagnostic studies with advanced imaging modalities as well as modern genotyping techniques. Strong clinical acumen combined with appropriate handling of these modern technologies are proving invaluable for rapid diagnosis and treatment of this virulent pathogen. The current recommended treatment for CMV keratitis is systemic ganciclovir. Astute clinicians must consider this diagnosis in any patient with keratitis, anterior uveitis, and intraocular hypertension. Novel diagnostic techniques should be combined with clinical exam findings to accurately and efficiently diagnose, treat, and monitor progression.