[A new classification method of eyelid divided nevi and the effect of plastic surgical treatment]

Objective: To classify the eyelid divided nevi using a new classification method, and to observe the distribution characteristics and surgical effects of these nevi. Methods: It was a retrospective case series study. Thirty-nine cases (39 eyes) of eyelid divided nevus treated at Beijing Tongren Hospital affiliated to Capital Medical University were collected between October 2015 and January 2020. A new classification method, namely traditional classification combined with aesthetic unit classification, was used to classify eyelid divided nevi. According to different classifications, the corresponding surgical treatment methods were adopted. The distribution characteristics of different types of eyelid divided nevi were summarized, as well as the effects of plastic surgery. Results: Thirty-nine patients were affected unilaterally, including 26 females (67%) and 13 males (33%), aged (31.1±17.8) years. There were 5 cases (13%) of localized, 6 cases (15%) of a moderate range and 2 cases (5%) of a large range medial eyelid divided nevus respectively. There were 6 cases (15%) of localized and 3 cases (8%) of a moderate range central eyelid divided nevus, respectively. There were 4 cases (10%) of localized and 6 cases (15%) of a moderate range lateral eyelid divided nevus, respectively. There were 2 cases (5%) of a moderate range and 5 cases (13%) of a large range total eyelid divided nevus, respectively. Pathological results revealed 20 cases of intradermal nevus (51%), 18 cases of compound nevus (46%) and 1 case of boundary nevus (3%). After 6 months to 2 years of observation, the patients' appearance was satisfactory. The treatment results were excellent in 36 cases (92%) and good in 3 cases (8%). Even though the pigmented nevus at the eyelid margin recurred in two cases (5%), there was no recurrence after reoperation. Conclusions: Medial and moderate-range eyelid divided nevi are more common, and the traditional classification combined with aesthetic unit classification is more accurate for the classification of eyelid divided nevi. Different types of eyelid divided nevi can be treated by corresponding surgical methods with satisfactory results.

[Ultrasonic manifestations and axis length of blind microphthalmia]

Objective: To discuss the ultrasonic manifestations of blind microphthalmia, and to explore the correlation between axis length and complicity of intraocular structure of blind microphthalmia. Methods: Retrospective case series study. The data of ultrasonic imaging and axis length of 162 patients (162 eyes) with blind microphthalmia diagnosed in Tongren Eye Center, Beijing Tongren Hospital from July 2013 to July 2018 were collected. According to the degree of internal structure disorder, all affected eyes were divided into groups of the normal, the abnormal and the indistinguishable. The binocular axial length in these patients were compared. The relationship between the axial length and the age of the patients, and the structural changes of the blind microphthalmia with a basic structure were analyzed. Statistical methods were mainly performed by paired t-test, one-way linear regression analysis and one-way analysis of variance. Results: The disease was unilateral in all the 162 patients. The age ranged from 1 month to 58 years old. And 139 cases (85.80%) were under 12 years old. There were 90 males and 72 females. The mean axial length of the affected eyes (162 eyes) was (13.17±3.77) mm, while the mean axial length of the control eyes (162 eyes) was (21.85±2.01) mm. There was significantly statistical difference in the ocular size between them (t=-27.369; P<0.01). There was no significant correlation between the axial length of the affected eye and age in patients with unilateral blind microphthalmia (r=0.027; P>0.05), while there was a significant correlation between the axial length of the control eye and age (r=0.590; P<0.01). The axial length of the groups of the normal (14 eyes), the abnormal (91 eyes) and the indistinguishable (57 eyes) was (17.80±2.19) mm, (14.81±2.92) mm and (10.05±2.46) mm, respectively, and the difference was statistically significant (F=72.800; P<0.01), and there was also significant difference between the two groups (all P<0.01). Ocular ultrasonic imaging showed that 105 eyes (64.81%) had a basic ocular structure, 83 eyes (51.23%) had retinal detachment, 15 eyes (9.26%) had bulbar ossification, and 10 eyes (6.17%) had optic disc abnormality. Conclusions: Blind microphthalmia mostly has a basic ocular structure and is often associated with retinal detachment. The axial length of the affected eye is correlated with the degree of intraocular structural disorder. (Chin J Ophthalmol, 2021, 57: 825-829).

[Ocular manifestations and surgical treatment of the linear nevus sebaceous syndrome]

Objective: To report the clinical and pathological features and surgical treatment of the linear nevus sebaceous syndrome. Methods: It was a retrospective case series study. The clinical records of 11 patients (14 eyes) who were diagnosed as linear nevus sebaceous syndrome between April 2009 and February 2018 at Beijing Tongren Hospital were analyzed. Data collected included sex, age, clinical manifestations, disease site, pathological features, surgical treatment and therapeutic effects. Results: There were six males and five females, aged 6 months to 7 years (mean, 2.8 years). The nevus sebaceous was located at the head (9 patients), face (5 patients) and neck (3 patients). The most common ocular manifestations were blepharocoloboma (13 eyes) and external ocular mass (9 eyes). Surgical treatment was performed in 9 patients (11 eyes), including lid reconstruction in all these eyes, corneal and conjunctival mass resection in four patients (4 eyes), eyelid tumor resection in 5 patients (5 eyes), and symblepharon separation and conjunctival sac reconstruction in 3 patients (5 eyes). Pathological examinations of the external ocular, corneal and conjunctival masses (6 eyes) confirmed the diagnosis of complex choristoma. All operated patients had improved appearance. Conclusions: Linear nevus sebaceous syndrome has characteristic cutaneous lesions and ocular manifestations. Histopathologically, all epibulbar lesions prove to be complex choristomas. The appearance of patients with linear nevus sebaceous syndrome can be significantly improved by oculoplastic surgery. (Chin J Ophthalmol, 2020, 56: 846-852).

[Clinical features and surgical management of orbitotemporal neurofibromatosis]

Objective: To report the clinical features and surgical treatment of orbitotemporal neurofibromatosis. Methods: It was a retrospective case series study. The clinical records of 24 patients who were treated for orbitotemporal neurofibromatosis between April 2007 and July 2017 at Beijing Tongren Hospital, Capital Medical University were analyzed. Data collected included sex, age, laterality, periorbital deformities, surgical treatment, follow-up time, complication and recurrence. Results: Sixteen males and 8 females were included. Age at surgery was (15±7) years (4-30 years). All patients were unilaterally involved. Twenty-three patients (96%) had upper lid involvement and ptosis. Nine patients (38%) had lower lid involvement. Fourteen patients (58%) had lateral canthal disinsertion. Three patients (13%) had brow involvement, 10 patients (42%) had conjunctival involvement and 2 patients (8%) had lacrimal gland infiltration. All patients had tumor debulking procedure. Twenty-two patients (92%) had correction of ptosis. Fourteen patients (58%) required lid reconstruction and lateral canthus reattachment surgery. Three patients (13%) had correction of brow ptosis.One patient (4%) had skull and orbit reconstruction. The median follow-up time was 3.5 (1.0-10.0) years. All patients had improved appearance. Ptosis recurred in 6 patients, but were corrected with surgery. On the last follow-up, 7 patients were free of ptosis. In 14 patients, mild ptosis was noted, but the upper lid did not cover the pupil. In 2 patients the pupil was half covered. Only in 1 patient who had not received ptosis correction surgery the pupil was covered completely. Conclusions: The periorbital deformities of orbitotemporal neurofibromatosis include upper eyelid infiltration with ptosis, lateral canthal disinsertion and infiltration of lower eyelid, brow, conjunctiva and lacrimal gland. The appearance of patients with orbitotemporal neurofibromatosis can be significantly improved through oculoplastic surgery. (Chin J Ophthalmol, 2019, 55: 828-833).

[Computed tomography imaging parameters of 82 Chinese patients with congenital microphthalmia]

Objective: To observe computed tomography (CT) imaging parameters of congenitally blind microphthalmia in Chinese patients and to provide clinical reference data for the Chinese population. Methods: It was a retrospective study for a consecutive case series of congenitally blind microphthalmia from July 2011 to July 2013. All of the patients were diagnosed in the Ocular Plastic Department, Tongren Eye Center, Beijing Tongren Hospital. We employed multi-section helical CT imaging with a computer-aided design system to observe and measure the imaging features in 82 Chinese patients (85 eyes). The paired T-test was applied for comparing the axial lengths, transverse diameters, and vertical diameters between the both sides in patients with congenital microphthalmia. The Pearson correlation was used for analyzing the relationship between the axial length and the age of the patients. Results: In the 82 patients, the age ranged from 1 month to 40 years old. Forty-one patients were male and 41 were female. The disease was unilateral in 96.34% of the patients. The orbital cysts were observed in 12.94% of them, and 76.47% of them presented basic structures on the CT scan. The abnormalities of the lens (62.35% of the eyes) and vitreous (82.35% of the eyes) were observed. The mean maximum axial length of the affected eyes (85 eyes) was (14.52±0.56) mm and the mean axial length of the unaffected eyes (79 eyes) was (22.79±0.36) mm. There was significantly statistical difference in the ocular size between the affected and unaffected eyes (t= 1.156, P<0.001) . Conclusions: Congenitally blind microphthalmia is usually complicated with the abnormalities of the lens and vitreous. The ocular size decreases significantly. The results of the present study provide a clinical reference for evaluating congenitally blind microphthalmia.(Chin J Ophthalmol, 2018, 54: 199-204).

Functional analysis of chimeric proteins of the Wilson Cu(I)-ATPase (ATP7B) and ZntA, a Pb(II)/Zn(II)/Cd(II)-ATPase from Escherichia coli

ATP7B, the Wilson disease-associated Cu(I)-transporter, and ZntA from Escherichia coli are soft metal P1-type ATPases with mutually exclusive metal ion substrates. P1-type ATPases have a distinctive amino-terminal domain containing the conserved metal-binding motif GXXCXXC. ZntA has one copy of this motif while ATP7B has six copies. The effect of interchanging the amino-terminal domains of ATP7B and ZntA was investigated. Chimeric proteins were constructed in which either the entire amino-terminal domain of ATP7B or only its sixth metal-binding motif replaced the amino-terminal domain of ZntA. Both chimeras conferred resistance to lead, zinc, and cadmium salts but not to copper salts. The purified chimeras displayed activity with lead, cadmium, zinc, and mercury, which are substrates of ZntA. There was no activity with copper or silver, which are substrates of ATP7B. The chimeras were 2-3-fold less active than ZntA. Thus, the amino-terminal domain of P1-type ATPases cannot alter the metal specificity determined by the transmembrane segment. Also, these results suggest that this domain interacts with the rest of the transporter in a metal ion-specific manner; the amino-terminal domain of ATP7B cannot replace that of ZntA in restoring full catalytic activity.

Antagonistic effect of 3,6-dimethamidodibenzopyriodonium gluconate on lipid peroxidation in cerebral cortical neuronal cultures and rat brains during focal cerebral ischemia reperfusion

AIM

To study 3,6-dimethamidodibenzopyriodonium gluconate (I-93) antagonistic effects on lipid peroxidation in cerebral cortical neuronal cultures and rat brains during focal cerebral ischemia-reperfusion.

METHODS

Cerebral cortical neurons were cultured and rat focal cerebral ischemia-reperfusion model was established by reversible middle cerebral artery occlusion (MCAO) without craniectomy. The efflux of lactate dehydrogenase (LDH) from neurons, content of malondialdehyde (MDA) in neurons and brain homogenate, activity of superoxide dismutase (SOD) in brain homogenate, and index of cerebral edema as well as brain morphology were investigated.

RESULTS

I-93 10-40 mumol.L-1 concentration-dependently inhibited efflux of LDH and elevated levels of MDA induced by addition of H2O2(10 mumol.L-1) in vitro. I-93 0.5 mg.kg-1 improved the cerebral morphology, reduced brain edema, decreased MDA content, and enhanced SOD activity in brain homogenate.

CONCLUSION

I-93 protects neurons from H2O2-induced neurotoxicity and ischemia-reperfusion mediated damage by increasing the activity of antioxidant enzymes and suppressing the generation of lipid peroxides.

[Effects of complex of 3,6-di-(dimethylamino)-dibenzopyriodonium with praseodymium dicitrate on the syntheses of DNA, RNA, protein, nucleoprotein and ATP of leukemia L 7712 cells in mice]

The incorporations of [3H] thymidine, [3H]uridine and [3H]leucine into DNA, RNA and protein synthesis in leukemia 7712 cells were inhibited by the complex of 3,6-di-(dimethylamino)-dibenzopyriodonium with praseodymium (Pr, rare earth element) dicitrite 34 micrograms/ml for 3-24 h. The degree of inhibition increased in proportion to the incubation time. After being treated with [C17H20N2I]3[Pr(C6H5O7)2] 34 micrograms/ml for 3, 6, 12 and 24 h, the incorporation of [32P]Na2HPO4 into the nucleoprotein of leukemia 7712 cells was inhibited by 49, 57, 65 and 85%, while those into ATP were inhibited by 43, 59, 65 and 83%, respectively. The ID50 of [C17H20N2I]3[Pr(C6H5O7)2] on DNA synthesis in leukemia 7712 cells at 24 h was 22 micrograms/ml. After the complex was removed from the medium entirely, the rate of DNA synthesis decreased with time over 3-12 h. This result indicated that the inhibition mechanism was likely due to damage to the DNA template.