Table of Content

16 October 2013 Volume 27 Issue 5

  

Articles

Resection of tumors at the tongue base and the hypopharynx by Da Vinci robotic system assisted with CO2 laser (2 cases report)

XU Li, CHEN Wei, JI Jun-feng, XU Feng-lei, WANG Qiu-ping

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  1-3.  doi:10.6040/j.issn.1673-3770.1.2013.005

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 Objective    To investigate the application of Da Vinci surgical system (DVSS) assisted with CO2 laser in the surgical treatment of tumors at the hypopharynx and the tongue base. Methods    Clinical data of two cases of tumors at the hypopharynx and the tongue base, which were surgically removed by Da Vinci surgical system assisted with CO2 laser, were reviewed. Advantages and disadvantages of such approach were discussed. Result    With DVSS and CO2 laser, two tumors were successfully removed without any complication. Conclusion    DVSS assisted with CO2 laser is recommended in the surgical treatment of tumors at the tongue base and the hypopharynx due to such advantages as satisfying exposure, small trauma, convenient manipulation, few complication and rapid recovery. 

Th17/Treg cell ratio in the peripheral circμlation of human laryngeal squamous cell carcinoma.

LIU Fang1, LAI Jian-xin1, LI Rui-yu1, LI Guan-zhen2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  4-7.  doi:10.6040/j.issn.1673-3770.0.2013.220

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Objective    To investigate Th17 /T regulatory (Treg) cell ratio in laryngeal cancer. Methods    The two T cell subsets were determined in the peripheral blood of 33 patients with laryngeal squamous cell carcinoma (LSCC) and 15 healthy volunteers by flow cytometry.  Results    Compared with the healthy controls, patients had a significantly (P＜0.01) higher proportion of both Th17 and Treg cells. Higher frequencies of Treg cells and lower frequencies of Th17 cells were found in patients with lymph node involvement. Moreover, in patients without lymph node involvement, the ratio of Th17/Treg was significantly higher than that in patients with lymph node involvement. Conclusion    Our results suggested a counter regulation of Th17 and Treg cells may be involved in the development and progression of LSCC.

Comparison of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent  chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A meta analysis.

XU Yuan-yuan, ZENG Quan, HONG Su-ling, HU Guo-hua

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  8-14.  doi:10.6040/j.issn.1673-3770.0.2013.176

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Objective    To evaluate the efficacy and treatment toxicity of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy compared with concurrent chemoradiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma. Methods    The search strategy included Pubmed(1978-2013), Embase(1978-2013),the Cochrane Library, China National Knowledge Internet Web (1978-2013), Vipbrowser Database(1978-2013) and Wanfang Database(1978-2013). We also searched reference lists of articles as a complement. RCTs that compared neoadjuvant chemotherapy followed by concurrent chemoradiotherapy(IC+CCRT) with concurrent chemoradiotherapy(CCRT) alone in locoregionally advanced nasopharyngeal carcinoma were included. After study selection, two reviewers assessed and extracted data independently. Meta-analysis was performed by using the RevMan 5.1.0.software. Results    Four studies were included in immediate result of treatment evaluation: compared with CCRT, IC+CCRT got more complete response of cervical lymph nodes［OR=2.53, 95%CI(1.44,4.44)］, but had no significant difference between the two groups in the CR of primary lesions (P＜0.05). Five studies were included in the short-term efficacy evaluation: compared with the CCRT, IC+CCRT got more complete response of primary lesions and cervical lymph nodes ［OR=1.07, 95%CI(1.02,1.14)］, ［OR=1.11, 95%CI(1.02,1.21)］. Six studies were included in 2 years overall survival evaluation: there had no significant difference between the two groups (P＞0.05). There were no treatment-related deaths in both groups of six studies. Ten studies were included in treatment toxicity evaluation: Risk ratios of ［OR=1.57, 95%CI(1.24,1.98)］, ［OR=1.34, 95%CI(0.91,1.96)］, ［OR=1.13, 95%CI(0.95,1.34)］, ［OR=0.99, 95%CI(0.72,1.37)］. were observed for leucopenia, dermatitis, mucositis, and gastrointestinal toxicity during the treatment. Conclusion    The neoadjuvant chemotherapy followed by concurrent chemoradiotherapy can improve the shortterm efficacy of treatment but increases the treatment toxicity in local advanced nasopharyngeal carcinoma, and it cannot improve the immediate result and 2-year survival.

Change of ECAP thresholds in children with cochlear implant

TIAN Ying， JI Xu， ZHANG Tao， YANG Ning， HUI Lian， JIANG Xue-jun

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  15-18.  doi:10.6040/j.issn.1673-3770.0.2013.080

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Objective    Using the neural response telemetry (NRT) software, to investigate the change of the thresholds of electrically evoked compound action potentials at different time points after cochlear implantation. Methods    33 Nucleus CI24R(CA)cochlear implant children participated in this study. ECAPs were recorded intraoperatively and 1,1.5,2,4,6 months after surgery. Results    Typical ECAPs were recorded in 154 electrodes in all 165 testing electrodes(93.3%). No. 1,7,11,17,22 electrodes were tested for each patient.The initial stimulated ECAP thresholds were the lowest. The ECAP thresholds of the same electrode increased during subsequent mapping session, and there were significant differences among different sessions. Conclusion    ECAPs is very useful in adjusting the stimulation parameters for cochlear implant and can maximize the individual performance with the device, especially in young children.

Endoscopic  eustachian  tube  dilated  catheter  for   chronic  secretory  otitis  media  in  13  cases

HAN Kai-liang， KONG Juan， SONG Zhong-yun， WANG Guang-yuan

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  19-21.  doi:10.6040/j.issn.1673-3770.0.2013.221

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Objective    To  investigate the methodology and efficacy of  endoscopic  eustachian  tube  dilated  catheter  for  chronic  secretory  otitis  media.  Methods    13  patients  with  chronic  secretory  otitis  media  were  performed eustachian  tube  dilated  catheter   placement to  the  isthmus  by   endoscopy.  The dilated catheter  had been prelumed and dilted for two  minutes.  After the  auripuncture，the tympanic was washed  by  hexadecadrol.  Then the tympanic wound has deen embrocated  with  mitomycin  C  spongio-golatine  for  five  minutes.   Results    All patients were successfully operated and  were followed up  for 4 to 5  months.  The fullness disappeared in 11 cases and types “A” tympanograms were found in all the ears. The pure-tone average of hearing thresholds were significantly improved with an average elevation of 10 to 20 dB. No  complications, such  as  middle  ear  infection, bleeding, tympanosclerosis or  tympanic  effusion  were  found  by  endoscopy.  Stuffied  turgidity  and  mild hearing disorder  occurred  in  2  cases  of  anaphylactic  rhinitis while no sever tympanic effusion.  Conclusion    The treatment of endoscopic  eustachian  tube  dilated catheter for  chronic  secretory  otitis  media is safe and easy for operation, in addition, it results in good effect and less injury.

Diagnosis and treatment of secondary posterior semicircular canal benign paroxysmal positional vertigo

SUN Xiang1, YU Ya-feng2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  22-23.  doi:10.6040/j.issn.1673-3770.0.2013.031

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Objective    To investigate the diagnosis and treatment of secondary benign paroxysmal positional vertigo (BPPV). Method    We reported six cases of secondary posterior semicircular canal benign paroxysmal positional vertigo. The diagnosis was based on history and nystagmus induced by Dix-Hallpike test. Results    Six cases of inner ear disease associated with the posterior semicircular canal benign paroxysmal positional vertigo was diagnosed by Dix-Hallpike test. There were three cases of sudden deafness, two cases of Meniere's disease and one case of vestibular neuronitis, respectively. Vertical torsional nystagmuses were induced in all the patients. Conclusions    Secondary benign paroxysmal positional vertigo is rare in clinic, and posterior semicircular canal was involved mostly. It can be diagnosed and cured by the Dix-Hallpike test and Epley manipulative method.

Clinical analysis of positional vertigo

WANG Ning-ning, LI Yong-tuan

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  24-27.  doi:10.6040/j.issn.1673-3770.0.2013.070

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Objective    To investigate the better schema of diagnosis and treatment for positional vertigo. Methods    The clinical features and treatment effectiveness of 233 positional vertigo patients were reviewed. Results    In 233 cases, there were 226 benign paroxysmal positional vertigo, 1 atlantoaxial dislocation, and 6 central vertigo, including 1  Arnold-Chiari malformation, 2 multiple-sclerosis lesions, 2 cerebellar lacunar infarction, and 1 cerebellar hemorrhage. Within 182 cases of posterior semicircular canal BPPV, 129 cases were cured (70.88%), 39 cases improved (21.43%), and 14 cases ineffective (7.70%) after the manipulative treatment. In 44 cases of other types of semicircular canal BPPV, there were 24 cured cases  (54.54%), 13 improved cases (29.55%), and 7 ineffective cases(15.91%). The patient of Arnold-Chiari malformation was cured by neurosurgery. The atlantoaxial dislocation case was treated with neck traction and the patients with multiple-sclerosis lesions and cerebellar lacunar infarct or haemorrhage were improved by neurological treatment. Conclusions    Proper diagnosis and treatment is the key to treat positional vertigo.

Effects of Wnt3a on utricle hair cells regeneration in vitro

LI Shu-na1, MA Yong-ming1, QIAN Wei1, Vincent Lin2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  28-31.  doi:10.6040/j.issn.1673-3770.0.2013.062

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Objective    To investigate the effects of cranial WNT signal pathway combined with DMSO on regeneration of mouse utricle hair cells in vitro. Methods    40 mice were divided into 8 groups randomly. In 1st part: Utricles were treated with 4mmol/L neomycin, then cultured in culture medium with different concentration of Wnt3a (0, 25, 100, 200ng/mL) for 1day. After that, β-catenin, hair cell cilia and nuclei were labeled with immunofluorescence staining. In 2nd part: Utricles were treated with 4mmol/L neomycin, and then cultured in culture medium with 25ng/mL Wnt3a for 6day. After that, utricles were cultured in control and culture medium with 50μmol/L DAPT, 0.1%DMSO, 50μmol/L DAPT+25ng/mL Wnt3a respectively. 10μmol/L Brdu was added in culture medium in every phase in this part. After culturing, Brdu, Myocin7a and nuclei were labeled with immunofluorescence staining. Results    In 1st part, β-catenin was expressed in support cell cytoplasm in 25ng/mL Wnt3a group, but not in 0, 100, 200ng/mL Wnt3a groups. β-catenin positive cells were calculated and compared with other groups. There was significant difference between 25ng/mL Wnt3a group and other groups (0, 100, 200ng/mL)(P<0.01). In 2nd part, Myosin7a positive cells were identified in DMSO group. There was no Myosin7a positive cells but Brdu positive cells in other groups. Myosin7a positive cells were calculated and compared with other groups. There was significant difference between DMSO group and the control, 50μmol/L DAPT, 50μmol/L DAPT+25ng/mL Wnt3a groups(P<0.01). Conclusion    Wnt3a combined with DMSO promotes transdifferentiation to hair celllike cells in utricle by activating cranial WNT signal pathway.

Repair of acoustic nerve injury by bone marrow NTCSCs transplantation in rats

ZHANG Ying-ying, LIANG Geng-tian, LIU Li, LU Ling, LIU Jin-yan

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  32-36.  doi:10.6040/j.issn.1673-3770.0.2013.117

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Objective    To observe the effects of nerve tissue committed stem cell (NTCSCs) transplantation in rats with injury of acoustic nerve. Methods    Bone marrow NTCSCs, transfected by green fluorescent protein (EGFP) gene, were transplanted into the left ear cochlea modiolus of rats  with specific coiling neuronal  injury, while the right ears were treated as self control with injection of same volume of PBS solution.  Group A, a control group, as well as other all the experimental groups, including group B, C, D, and E, were injected with the same volume of PBS solution. The cochlear axial slices were observed under fluorescence microscope after HE staining. The survivorship, distribution and expression of NTCSCs were observed. The threshold of ABR and DPOAE amplitude changes were detected at 1 week, 2 weeks and 1 month respectively after the injection. Results    Bone marrow NTCSCs transfected by green fluorescent protein (EGFP) gene in the  cochlear slices of the group C were dispersed in the lacouna of the tympanic canal of cochlea, while NTCSCs were dispersed in the basal membrane and Corti′s organ in the group D, butaggregated in the group E with two or three cells and its location was close to the basal membrane and Corti′s organ, which showed good distribution and tendency of migratory behavior. As the time of bone marrow NTCSCs transplantation going by, the number of Nestin (+) cells significantly increased (P<0.05) while Myosin Ⅶ a (+) showed no significant change in the number of cells (P>0.05). Meanwhile,  the threshold of ABR and  DPOAE amplitude all improved significantly(all P<0.05). Conclusion    Bone marrow NTCSCs transplanted to cochlea could gradually differentiate into spiral ganglion neuron (SGNs), which  plays a role in repairing the damage of auditory nerve.

Ventage location in cerebrospinal fluid rhinorrhea under endoscopy in 16 cases

WU Da-hai, QIN Jie, GUO Xiao-hong, LI Shu-hua

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  37-40.  doi:10.6040/j.issn.1673-3770.0.2013.136

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Objective    To analyze the sites of cerebrospinal fluid rhinorrhea (CFR) via endoscopic treatment. Methods    A total of 16 patients with CFR were included in the retrospective analysis. Preoperative endoscopy, multi-slices spiral CT (MSCT) and 3D reconstruction, and SPECT/CT fusion imaging were performed to determine the ventage location which was analyzed and compared with the surgical findings. Results    14 patients showed bone changes of the skull based on CT imaging and 3D reconstruction. 15 patients had abnormally concentrated radionuclide activity from base of the skull to the nasal part on SPECT/CT fusion imaging. Cerebrospinal fluid (CSF) leakage could be observed in 4 cases via endoscopic examination. And site in 15 cases proved surgically could be shown by the above examination in localization of the sites of CSF leakage. Only one case, which had a different site surgically proved different from pre-operative examination, was diagnosed as cerebrospinal fluid otorrhea (CFO). Conclusion    Pre-operative endoscopy, multi-slices spiral CT (MSCT) and 3D reconstruction, and SPECT/CT fusion imaging can effectively identify the ventages in surgical treatment of CFR, and lay the foundation for successful diagnosis and treatment. But it is necessary to pay attention to the possibility of CFO when treating CFR.

Transnasal endoscopic optic nerve decompression in traumatic optic neuropathy

LIU Ding-rong, SHI Yu-yong, LIU Gui-ling, LIAO Xing-chun

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  41-43.  doi:10.6040/j.issn.1673-3770.0.2013.115

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Objective    To review the effect of optic nerve decompression by the endoscopic technique in traumatic optic neuropathy. Methods    Fifteen patients (15 eyes) with traumatic optic neuropathy who were treated with large dose of glucocorticoid in 2 days but were inefficacious were undergone endoscopic optic nerve decompression. The days from injury to surgery were 3 to 32 days. Among them, 4 cases were in 4 to7days and 11 cases were >7days. 10 eyes were with light perception or higher grades pre-operation and 5 eyes were with no light perception. Results    All patients were followed up for 1more than 3 months. Nine of 15 eyes had improvements in visual acuity with the total effect rate 60%. One of 5 eyes with no light perception had raises in visual acuity (20%). Eight of 10 eyes with light perception or higher grades had improvements (80%). Conclusion    Endoscopic optic nerve decompression is an appropriate technique for patients with traumatic optic neuropathy.

Maxillary sinus irrigation in treating fungal ball maxillary sinusitis under endoscopic sinus surgery

SHEN Zhi-hao1, WU Su-juan1, ZHANG Wei-tian2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  44-46.  doi:10.6040/j.issn.1673-3770.0.2013.153

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Objective    To investigate the clinical efficacy of endoscopic sinus surgery in combination with intra-operative irrigation in treating patients with fungal ball maxillary sinusitis. Methods    Fiftyfive patients with fungal ball maxillary sinusitis were treated by endoscopy in our department from December 2009 to December 2012 .They were randomly divided into two groups. Twenty seven patients were treated with endoscopic middle nasal meatus approach (group A) and 28 were treated with middle nasal meatus approach in combination with intra-operative sinus irrigation（group B）. Results    Followed up for at least 6 months, no complications happened in two groups. There were 21 patients in group A were cured and 6 recurred, and there were 28 patients in group B were cured without recurrence. The therapeutic effect of group B was significantly better than that of group A. Conclusion    Middle meatus approach surgery in combination with intra-operative sinus irrigation is more effective than pure endoscopic middle meatus approach in treatment of fungal ball maxillary sinusitis.

Research on the upper airway structure of children with sleep apnea hypopnea syndrome by magnetic resonance imaging examination

LIU Wen-jun1, TONG Lei1, LIU Fu-xue2, MEI Xu-bin1, LI Min1, QIU Jie1, WANG Guo-hua1, WU Yi-ping1, CHEN Zheng-gang1

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  47-51.  doi:10.6040/j.issn.1673-3770.0.2013.232

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Objective    To discuss the characters of children upper airway structure with sleep apnea and hypopnea syndrome (OSAHS) by magnetic resonance imaging (MRI) examination. Methods    30 primary snoring (PS) and 30 OSAHS children were recruited from the pool of patients evaluated at Qingdao Municipal hospital, and 30 normal children were selected as controls. They were performed space measurement and soft tissue measurement respectively with MRI examination. Results    ① For space measurement, significant differences of nasopharynx airway, oralpharynx airway, palatopharyngeal airway and oblique diameter of the airway were detected among the three groups (P＜0.05). ② For soft tissue measurement, no significant difference of the crosssection area of the tongue was found (P＞0.05). The cross-section area of the adenoid was bigger and the length of the adenoid was longer in the OSAHS group than in the PS and control groups (P＜0.05). The cross-section area of the bilateral tonsils in the OSAHS and PS groups were bigger than in the control group(P＜0.05). Conclusion    MRI examination can be used as a primary method for diagnosis of children sleep order.

Effect of enlarged adenoid on tooth maxillofacial development in children

YANG Rong1, ZONG Tao1, FU Zhen-xia2, SUN Ya-nan1, LU Jin-fa1

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  52-54.  doi:10.6040/j.issn.1673-3770.0.2013.131

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Objective    To observe the clinical features of tooth maxillofacial development in children with  enlarged adenoid. Methods    Craniofacial morphology was studied by computerized cephalometric analysis in 68 children with adenoid hypertrophy (A/N≥0.71). The patients were divided into three groups: group A (25 patients aged 3 to 4 years, course of 2-3 years), group B (27 patients aged 5 to 6 years, course of 2-4 years) and group C(16 patients aged 7 to 8 years, course of 3-5 years). 20 healthy children were enrolled (3-8 years old) as the control group. Results    Compared with the control group, the ANB angle and the up and down central incisor angle were reduced in groups A, B and C(P<0.01), while ANB, FH -MP, Y axis Angle, and ABSequivalent PNS values were increased (P<0.01). Compared with group C, ANB, FH-MP, Y axis Angle, and ABS-PNS equivalent were decreased and the tooth angle were increased in group A (P<0.05). In group C, SNB value was decreased and L1-NB increased compared with the control group(P<0.05), but the two had no significantly differences between the rest groups. Conclusion    Adenoid hypertrophy can result in a great impact on children′s dental maxillofacial growth which is more obvious with an increase of the course.

Effect of UVB on glycoprotein nonmetastatic melanoma protein b in human retinal pigment epithelium cells.

SI Yan-fang, FAN Xu, GUAN Juan, ZHOU Li, ZHAO Juan

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  55-58.  doi:10.6040/j.issn.1673-3770.0.2013.150

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Objective    To investigate the effect of ultraviolet b (UVB) on glycoprotein nonmetastatic melanoma protein b (GPNMB) in human retinal pigment epithelium (RPE) cells. Methods    MTT assay was used to determine the effect of UVB on RPE cell survival rate. The effect of UVB on GPNMB in RPE cells was detected by RT-PCR and western blot. Results    MTT assay showed that RPE cells were damaged by UVB irradiation at 100 μW/cm2 for 2 h and the number of apoptotic cells significantly increased. The results of RT-PCR and western blot demonstrated that the expression of GPNMB in RPE cells markedly enhanced after UVB irradiation. Conclusion    UVB irradiation could suppress the survival rate of RPE cells and promote the expression of GPNMB in RPE cells.

Blue-on-yellow perimetry in twenty-four degrees of youth with myopia

ZHAO Jun, CHEN Yao, QIN Jian-min

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  59-61.  doi:10.6040/j.issn.1673-3770.0.2013.092

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Objective    To investigate performance characteristics of blue-on-yellow perimetry in 24 degree in young people with different degrees of myopia and to investigate its related factors. Methods    109 21-30 year-old patients (160 eyes) were performed blue and yellow perimetry in 24 degree using automated perimetry application Humphery750 II-i computer center 24-2 blue-yellow perimetry testing procedures. The patients were divided into the emmetropia, low myopia, moderate myopia and high myopia groups. The five blue-on-yellow visual indices were compared and the influencing factors，including mean sensitivity，four quadrant retinal light sensitivity, range of each eccentricity average retinal light sensitivity, mean visual field defect values(MD), and pattern standard deviation(PSD) were analyzed. Results    The differences of  MS， MD and PSD values in central 24 degree of between four groups had statistically significant difference(F=21.449, 13.191, 6.854； with P=0.000, 0.000 and 0.000， respectively), except the low myopia and moderate myopia group (P=0.326, 0.370, 0.268). Each group in each quadrant retinal light sensitivity difference was statistically significant (F=14.803, 26.163, 15.035, 14.276; P=0.000, 0.000, 0.000, 0.000), except the low myopia and moderate myopia group(P=0.360, 0.192, 0.083, 0.323). Eccentricity range of retinal light sensitivity difference was statistically significant between groups (F=9.849, 14.460, 14.143, 13.959, P=0.000, 0.000, 0.000, 0.000 ), except the low myopia and moderate myopia group(P=0.272, 0.262, 0.776, 0.968). Myopia degrees with an average retinal light sensitivity and an average visual field defect value was negatively related (r=-0.528, -0.441, P<0.01), myopia and mode standard deviation was positively related (r=0.336, P<0.01). With the deepening of myopia, the various eccentricity retinal sensitivity downward trend increases (-0.392, -0.461, -0.437, -0.436, P<0.01). Conclusion    Retinal light sensitivity values of mean visual field defect, pattern standard deviation (PSD) is influenced by the degree of myopia in each quadrant of the average retinal light sensitivity with asymmetry and with the growth in the degree of myopia showed downward trend by myopia center 24 degree blue and yellow perimetry. With the increasing of eccentricity, the average retinal light sensitivity of the peripheral portion significantly decreases with the degree of myopia growth downward trend.

Clinical analysis of cavernous sinus vascular malformation with the primary symptom in the eye

ZHAO Li-juan, ZHANG Jing

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  62-64.  doi:10.6040/j.issn.1673-3770.0.2013.028

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Objective    To improve the understanding of cavernous vascular malformation with the primary symptom in the eye by the clinical analysis and avoid misdiagnosis. Methods    Through the analysis of two cases of the same ocular symptoms in different position, we presented an overview of this disease. Results    The 2 cases were misdiagnosed as  ocularmotor paralysis and conjunctivitis. By the orbital CT and digital subtraction angiography, we found that they were caused by cavernous vascular malformation. The patients accepted arterio-venousembolization, and eye symptoms were significantly relieved. Conclusion    It is necessary to enquire the detail medical history and improve auxiliary examination to diagnose cavernous vascular malformation with the primary symptom in the eye.

Vitrectomy in treating idiopathic macular epiretinal membrane

LIU Min1, GUO Jian-lian1， ZHANG Hua2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  65-67.  doi:10.6040/j.issn.1673-3770.0.2013.141

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Objective   To evaluate the effect of pars plana vitrectomy with inner limiting membrane (ILM) peeling and intravitreal triamcinolone acetonide (TA) injection in treatment of idiopathic macular epiretinal membrane(IMEM). Methods      Patients were recruited from ophthalmic center from January 2011 to March 2013. Totally, 27 eyes (27 consecutive patients) with IMEM who underwent standard three-port pars plana vitrectomy and epiretinal membrane peeling were observed. Each patient received 4mg TA intravitreal injection at the end of the surgery. All the patients were examined by visual acuity (VA), fundus color photography, and optical coherence tomography (OCT) before and after the treatment. VA was adopted 5 points record； fundus color photography and OCT were taken as usual way．The mean of VA was(4.15±0.32) and the mean of macular thickness was(498±132)μm before the treatment. All the patients were followed-up 3 to 20 months (mean(10±7)months). Results       VA improvement was achieved in 14 eyes(51.85%)，  meanwhile， 9 eyes(33.33%)were stable and 4 eyes(14.81%) were worse． The mean VA increased from (4.15±0.32)to(4.52±0.29)post-operatively， the difference was statistically significant(t＝3.28, P＜0.05)． Simultaneously, metamorphopsia of 13 eyes disappeared, of 10 eyes alleviated and of 4 eyes aggravated. Mean macular thickness decreased from(498±132)μm to(296±114)μm post-operatively， the difference was statistically significant(t＝6.468， P＜0.01). The OCT and fundus photography showed that all the MEM had disappeared. No MEM recurrence and endoephthalmitis were observed during the follow-up periods.  6 eyes(22.22%)had retinal hemorrhage intra-operatively. 7 eyes(25.92%) had cataract improvement and 4 eyes(14.81%) had secondary higher intraocular pressure post-operatively. Conclusion       Pars plana vitrectomy with inner limiting membrane (ILM) peeling and intravitreal TA injection is successful in treating IMEM.

Riboflavin/UVA-induced corneal crosslinking in the treatment of fungal corneal ulceration

CUI Chang-xia1, ZHU Wei2, ZHANG Chun-xiao3, LI Zhi-wei3

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  68-70.  doi:10.6040/j.issn.1673-3770.0.2013.260

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Objective      To observe the safety and efficacy of riboflavin/UVA-induced corneal crosslinking in the treatment of fungal corneal ulceration. Methods      21 fungal ulceration patients underwent corneal crosslinking, followed by local anti-fungus medication. Slit-lamp and OCT were used to observe the healing process and the inflammation signal. Results       The ulceration disappeared and inflammation signal decreased in all the patients after crosslinking treatment. Among them, 5 recovered within 1 week, 11 recovered within 2 weeks, 4 healed within 1 month and one case was noneffective. No corneal crosslinking-related complication was observed. Conclusion       Corneal crosslinking combined with local anti-fungus medication can effectively treat fungal corneal ulceration.

Exotropic drift and binocular alignment after surgery for intermittent exotropia in children

GENG Xing1, ZHAO Shu-jing1, WANG Li-hua2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  71-73.  doi:10.6040/j.issn.1673-3770.0.2013.001

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Objective      To investigate exotropic drift and binocular alignment in children with intermittent exotropia 1 year after surgical correction. Methods      The records of 120 children aged 2 to 15 years undergoing surgical correction for intermittent exotropia from October 2009 to November 2011 were retrospectively reviewed in the Eye Center of Shandong Provincial Hospital Affiliated to Shandong University. The patients were divided into BLR-rec group (bilateral lateral rectus recession, 66 cases) and R&R group (unilateral lateral rectus recession combined with a medial rectus resection, 54 cases) according to the different surgical procedures. Prism and alternate cover test were used to measure the deviation of the patients, at both distance (6m) and near (33cm) with fixation on accommodative targets, with appropriate spectacle correction when required at follow-up periods of the postoperative 1-3 days, 6 weeks and 1 year. Results       The difference of the undercorrection rate between the two groups was significant at postoperative 1-3 days(P=0.023), but there were no significant differences in the success rate and overcorrection rate(P>0.05). There were no significant differences in the success rate, overcorrection rate and undercorrection rate between the two groups at postoperative 1 year(P>0.05). There were no significant differences in the following covariables to exotropic drift: age at initial surgery, initial refractive error, corrected vision, angle of strabismus before surgery, and whether accompanied by oblique muscle surgery. Conclusion       There was a trend of exotropic drift within one year after BLR-rec or R&R surgical correction in children with intermittent exotropia. 

Application of trianglar function method to calculate intra ocular lens power after myopic laser in situ keratomileusis

WEN Hua-ming1, LI Hai-xiang2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  74-76.  doi:10.6040/j.issn.1673-3770.0.2012.119

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Objective      To expound the calculation principle of the intraocular lens power after LASIK surgery with triangular function method, and to preliminarily verify its feasibility and accuracy. Methods      Corneal refractive diopter of 20 patients was calculated with clinical history method, corneal front surface curvature method and triangular function method. We re-measured the ocual axial length and calculated the IOL power with Hollady formula. Results       There were significant differences (P<0.05) among three Results  of corneal refractive diopter and IOL power. There were no significant differences (P>0.05) between the clinical history method and triangular method, but both of them had significant differences (P<0.05) compared with  corneal front surface curvature method. Conclusion       The triangular method may accurately calculate the curvature radius of the corneal surface after LASIK surgery, and it only demanded to know the pre-operative corneal curvature and the surgery parameters. The triangular method is more simple and practical than the clinical history method, but its real effect in clinical practice needs to be verified.

Correlation between cataract phacoemulsification with intraocular lens implantation and age-related macular degeneration

ZHANG Ai-hui1， ZHU Ling1, ZHANG Jin-zhi1， ZHANG Wei2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  77-83.  doi:10.6040/j.issn.1673-3770.0.2013.033

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Objective      To explore the ratio of age-related macular degeneration(AMD) after cataract phacoemulsification with intraocular lens(IOL)implantation, and analyze the influencial factors of postoperative visual acuity and operational effects on AMD. Methods      300 eyes of cataract phacoemulsification combined with IOL implantation from January 2009 to February 2012 in our hospital were retrospectively analyzed. The uncorrected visual acuity, anterior and posterior segment were checked on 1 day, 1 week, 1 month and 3 months postoperatively and the best corrected visual acuity (BCVA) was examined when necessary. BCVA of all patients were examined 3 months after the operation. The visual acuity, complications and fundus check were recorded. Fundus fluorescein angiography (FFA) was performed when patients were diagnosed or suspected as AMD. Indocyanine green angiography (ICGA) and/or optical coherence tomography (OCT) should be examined if needed. The association studies were performed with SPSS 13.0. Results       1. On day 1 postoperative, there were 45 eyes (15.00%) with BCVA ＜ 0.3 and 255 eyes (85.00%) with BCVA ≥ 0.3. 3 months operative, there were 18 eyes (6.00%) with BCVA ＜ 0.3 and 282 eyes (94.00%) with BCVA ≥ 0.3. 2. After the operation, there were 215 eyes with normal fundus, 56 eyes with AMD, 13 eyes with diabetic retinopathy, 7 eyes with high myopia retinopathy; 3 eyes with retinal vein occlusion; 2 eyes with retinal pigment degeneration, 2 eyes with optic atrophy, 1 eye with macular hole and 1 eye with epiretinal membrane of macular. 3. After cataract surgery, AMD was common in early and intermediate stage but rarely in advanced stage. However, the postoperative visual acuity was better than the preoperative. 4. Before cataract surgery, there were 11 eyes which were diagnosed with cataract and AMD. Except 1 eye developed from early AMD to intermediate stage, the rest did not change obviously after the operation.  The difference was not significant (χ2＝0.234, P=0.890). Conclusion       AMD is the main fundus disease which affects later vision restoration after cataract phacoemulsification and IOL implantation, followed by DR and high myopia retinopathy. The ratio of AMD is 18.67%, which can be commonly noted in early and intermediate stage after cataract surgery. Cataract operation shows no significant effect on the development of AMD but improves the visual acuity.

Systematic review of surgical treatment for primary angle-closure glaucoma accompanied with Cataract

SHI Shao-dan1, LIU Jing2, ZHANG Wei2, ZHANG Han2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  84-90.  doi:10.6040/j.issn.1673-3770.0.2013.023

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Objective      To make an evidence-based assessment oo the surgical treatment for primary angle-closure glaucoma accompanied with cataract. Methods      According to the evidence-based principles,  studies published in the English language in PubMed, EMBASE, and Cochrane Library, as well as those in the Chinese language in journals of Chinese Periodical Fulltext Database and Chinese Bio-medicine Database, from Jan. 2005 to Jul. 2011, were searched and selected. Outcome measures consisted of visual acuity, intraocular pressure(IOP), success rate of controlling IOP, progression in visual field loss, Thickness of retinal nerve fiber layer (RNFL), goniosynechia, UBM, complications, et al. Results       Ten articles in English and thirteen articles in Chinese were eligible, in which eleven were in gradeⅠ-Ⅱ, seven were in grade Ⅲ, and five were in grade Ⅳ. The interventions included LPI,SPI, ECCE, Phaco，Phaco-GSL，Phaco+SPI, PhacoTrab+IOL and trabeculectomy. Conclusion       Evidence-based medicine assessment suggested that phacoemulsification could be the good choice in the surgical treatment for PACG accompanied with cataract. Randomized controlled trials of large samples and multi-center study are needed. Meanwhile, damage of optic nerve and long-term follow-up on postoperative intraocular pressure should be investigated in the further research.

Advances in study of traditional Chinese medicine on age-related macular degeneration

SHAO Yan1, XU Xin-rong2

J Otolaryngol Ophthalmol Shandong Univ. 2013, 27(5):  91-94.  doi:10.6040/j.issn.1673-3770.0.2013.059

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Age-related macular degeneration (AMD) is main irreversible blindness of eye disease to the aged. In recent years, wet AMD drug treatments have made a certain progress, but many problems still need to be studied more deeply, and dry AMD is lack of effective treatments. Quite a few researches of traditional Chinese medicine (TCM) preventing and treating AMD have been reported, and display certain advantages. In this article, new progresses about the prevention and treatment of TCM in AMD are summarized.