Jing Zhao

Shandong Academy of Sciences, Chi-nan-shih, Shandong Sheng, China

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Publications (21)43.4 Total impact

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    ABSTRACT: Purpose: To evaluate the efficacy of a novel cyclosporine A (CsA) drug-delivery system (DDS) in the anterior chamber for suppressing the occurrence of rejection and improving the survival of corneal allografts after high-risk keratoplasty. Design: Single-center, noncomparative case series. Participants: Ninety-two eyes of 92 patients with corneal blindness who required corneal transplantation at Shandong Eye Institute from May 2003 to June 2011. Methods: The CsA DDS was implanted into the anterior chamber during high-risk keratoplasty, and subsequent therapeutic effects were evaluated. Main outcome measures: Occurrence and reversal of graft rejection within 12 months after surgery, long-term survival of corneal grafts (>12 months), biodegradation of the CsA DDS, endothelial cell density by noncontact specular microscopy, and iris status by ultrasound biomicroscopy (UBM). Results: At 6 months, the transplantation was scored as success in 81 eyes (88.0%), partial success in 7 eyes (7.6%), and failure in 4 eyes (4.3%). The mean graft survival time was 36.1 ± 17.7 months (range, 12.3-61.6 months). The carrier of the CsA DDS, polylactide-co-glycolide-co-caprolactone, biodegraded completely at 7.6 ± 4.3 months (range, 5-13 months). The density of endothelial cells was 2154 ± 230 cells/mm(2) (range, 2067-2319 cells/mm(2)) immediately after surgery and 2079 ± 156 cells/mm(2) (range, 1950-2254 cells/mm(2); P > 0.05) at 6 months. No edema of corneal stroma and iris was observed by UBM. Conclusions: The CsA DDS implanted in the anterior chamber seems to be effective for the prophylaxis of immune rejection after high-risk keratoplasty without toxicity to the cornea and the iris of patients. It can decrease the rejection episode and prolong the survival time of allografts. The anterior chamber may be a promising drug-delivery target for treatment or prevention of endothelial graft rejection after corneal transplantation.
    Ophthalmology 12/2012; 120(4). DOI:10.1016/j.ophtha.2012.09.035 · 6.14 Impact Factor
  • Jun Cheng · Xiaolin Qi · Jing Zhao · Hualei Zhai · Lixin Xie ·
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    ABSTRACT: PURPOSE: To compare the therapeutic effects of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) on patients with macular corneal dystrophy (MCD) and to analyze the risk factors of postoperative recurrence. DESIGN: Retrospective, interventional, comparative case series. PARTICIPANTS: Fifty-one patients (78 eyes) with MCD treated by PK or DALK at Shandong Eye Institute between January 1992 and December 2010. METHODS: The medical records of the patients were reviewed retrospectively. MAIN OUTCOME MEASURES: Best-corrected visual acuity, corneal endothelial density, complications, recurrence, graft survival, and risk factors for recurrence. RESULTS: Penetrating keratoplasty was performed in 57 eyes, and DALK was performed in 21 eyes. The mean follow-up time was 5.1±4.1 years (range, 1.0-18.0 years). The best-corrected visual acuity of the PK group was much better than that of the DALK group at 1, 2, 3, and 5 years. The corneal endothelial density was reduced to 1000 cells/mm(2) or less within 5 years in 21.6% (11/51) of eyes treated by PK and in none of the eyes treated by DALK. The 1-year incidence rate of complications was 21.1% in the PK group, higher than the 4.8% rate in the DALK group. At the last visit, the rate of graft clarity was 87.7% and 85.7% in the 2 groups, respectively. Ten eyes (17.5%) treated by PK had recurrent MCD, with a rate of 0.8%, 7.7%, and 40% at 1, 5, and 10 years, respectively, whereas 9 eyes (42.9%) treated by DALK demonstrated recurrence, with a rate of 14.3% and 49.5% at 1 and 5 years, respectively. The recurrence risk was higher in patients whose age was 18 years or younger at onset or younger than 30 years at surgery. The recurrence risk after DALK was 5.066 times higher than that after PK. CONCLUSIONS: Penetrating keratoplasty more often immediately improves the visual acuity of patients with MCD, but many complications seem to be inevitable, especially continuous loss of corneal endothelium. Despite poor visual acuity and recurrence after surgery, DALK may produce fewer complications overall and more durable stability of the ocular surface compared with PK. The selection of PK or DALK for MCD should depend on the actual need and situation of certain patients. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    Ophthalmology 09/2012; 120(1). DOI:10.1016/j.ophtha.2012.07.037 · 6.14 Impact Factor
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    ABSTRACT: Severe chemical burns can cause necrosis of ocular surface tissues following the infiltration of inflammatory cells. It has been shown that amniotic membrane transplantation (AMT) is an effective treatment for severe chemical burns, but the phenotypes of cells that infiltrate the amniotic membrane and the clinical significance of these cellular infiltrations have not previously been reported. The present work studies the inflammation cell traps and apoptosis inducing roles of the amniotic membrane after AMT in patients with acute chemical burns. A total of 30 patients with acute alkaline burns were classified as having either moderate or severe burns. In all participants, AMT was performed within one week of his/her injury. After 7-9 days, the transplanted amniotic membranes were removed. Histopathological and immunohistochemical techniques were used for the examination and detection of infiltrating cells, and tests for the expression of CD (cluster of differentiation)15, CD68, CD3, CD20, CD57, CD31, CD147, and CD95 (Fas) were performed. A TUNEL (TdT-mediated dUTP nick end labeling) assay was used to confirm apoptosis of the infiltrating cells. Three patients with herpes simplex-induced keratitis who had undergone AMT to treat persistent epithelium defects were used as a control group. Amniotic membrane before transplantation was used as another control. After amniotic membrane transplantation, the number of infiltrating cells in patients with severe burns was significantly higher than in patients with moderate burns or in control patients (p<0.05). Among the severe burns patients, CD15 and CD68 were widely expressed in the infiltrating cells, and CD3, CD20, and CD57 were only found in a small number of cells. Occasionally, CD31-positive cells were found in the amniotic membranes. More cells that were CD147, Fas, and TUNEL positive were found in patients with severe burns than in patients with moderate burns or in control patients. Neutrophils and macrophages were the main cells that had infiltrated into the amniotic membrane during the acute phase of healing from a chemical burns. AMT can trap different inflammatory cells and induce apoptosis of inflammatory cells in acute ocular chemical burns.
    Molecular vision 07/2012; 18:2137-46. · 1.99 Impact Factor
  • Xiaolin Qi · Lixin Xie · Jun Cheng · Jing Zhao ·
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    ABSTRACT: PURPOSE:: To analyze the clinical results and potential influential factors of modified large-diameter lamellar keratoplasty in patients with total limbal stem cell deficiency. METHODS:: Thirty-six eyes of 35 patients were included in this study. Best-corrected visual acuity, ocular surface stability, central corneal graft clarity, and postoperative complications were recorded. Related influential factors were evaluated using Cox regression analysis. RESULTS:: At the final follow-up (mean, 48.1 ± 43.2 months), 21 eyes (58.3%) had an improvement in best-corrected visual acuity of at least 1 line. Twenty-seven eyes (75.0%) had a stable ocular surface. The survival of ocular surface stability was 74.4% ± 7.4%, 58.9% ± 8.5%, 51.1% ± 9.0%, and 39.3% ± 9.2% at 1, 2, 5, and 7 years after surgery, respectively. Twenty-one eyes (58.3%) maintained a clear graft. The survival of central graft clarity was 74.4% ± 7.4%, 59.5% ± 8.4%, 55.2% ± 8.8%, and 46.7% ± 9.3% at 1, 2, 5, and 7 years after surgery, respectively. Thirteen eyes (36.1%) developed persistent epithelial defects, and immune rejection occurred in 9 eyes (25.0%). The Cox regression analysis revealed that previous eyelid reconstruction [relative risk (RR) = 0.035] and combination with subconjunctival implantation of a cyclosporine A drug delivery system (RR = 0.170) were protective factors. Preoperative persistent epithelial defects (RR = 3.443) and decreased Schirmer test (RR = 6.770) were risk factors associated with ocular surface stability. CONCLUSIONS:: The modified large-diameter lamellar keratoplasty seems to be effective in reconstructing an ocular surface with long-term stability. Improvement in tear production, reconstruction of eyelid abnormalities, and combination with subconjunctival implantation of an immunosuppressive drug delivery system can help to maintain a stable ocular surface.
    Cornea 05/2012; 32(5). DOI:10.1097/ICO.0b013e318255394e · 2.04 Impact Factor
  • Junyi Wang · Ge Zhao · Lixin Xie · Min Chen · Jing Zhao ·
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    ABSTRACT: To evaluate the therapeutic effect of deep anterior lamellar keratoplasty (DALK) in patients with herpetic stromal keratitis (HSK). Forty-three eyes belonging to 42 patients with HSK, including 22 eyes in the active phase and 21 eyes in the quiescent phase, underwent DALK at the Shandong Eye Institute from January 2006 to December 2009. All patients with active disease had received intravenous acyclovir and amniotic membrane implants prior to DALK. Herpes simplex virus type 1 (HSV-1) antigens from excised corneal buttons were detected by immunohistochemistry. The follow-up ranged from 1 to 4 years (mean, 29.1 months). Graft rejection occurred in one eye (2.3%) and was reversed. Among the other 42 survived grafts (97.7%), 37 remained clear at the last visit. The best spectacle-corrected visual acuity was 20/200 or better in 95.2% of eyes and 20/40 or better in 38.1% of eyes. Six eyes (14.0%) developed recurrent HSK, one of which received a second keratoplasty due to ineffective antiviral medication. There were no significant differences in endothelial cell density between 6 months and 12 months after the surgery. By immunohistochemistry, HSV-1 antigens were observed in the stroma of 18 of 32 corneal buttons. DALK can not only remove the corneal lesions of HSK but also reduce latent or persistent viral loads in the cornea. In eyes with active or quiescent HSK but otherwise healthy endothelia, DALK seems to be safe and promising for its favorable visual outcome, graft survival rate, and low endothelial cell loss.
    Albrecht von Graæes Archiv für Ophthalmologie 02/2012; 250(8):1187-94. DOI:10.1007/s00417-012-1947-2 · 1.91 Impact Factor
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    ABSTRACT: Hypopyon is common in eyes with fungal keratitis. The evaluation of the clinical features, culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions. The medical records of 1066 inpatients (1069 eyes) with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features, risk factors, clinical characteristics, laboratory findings and treatment outcomes. The incidence of hypopyon, the fungal culture positivity for hypopyon, risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined. We identified 1069 eyes with fungal keratitis. Of the 850 fungal culture-positive eyes, the Fusarium species was the most frequent (73.6%), followed by Alternaria (10.0%) and Aspergillus (9.0%). Upon admission, 562 (52.6%) eyes with hypopyon were identified. The hypopyon of 66 eyes was evaluated via fungal culturing, and 31 eyes (47.0%) were positive. A total of 194 eyes had ocular hypertension, and 172 (88.7%) of these eyes had hypopyon (P < 0.001). Risk factors for incident hypopyon included long duration of symptoms (P < 0.001), large lesion size (P < 0.001) and infection caused by the Fusarium and Aspergillus species (P < 0.001). The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size. Surgical intervention was more common in cases with hypopyon (P < 0.001). Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation (P = 0.002). Hypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension. About half of the hypopyon cases were positive based on fungal culture. Long duration of symptoms, large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon. The presence of hypopyon increases the likelihood of surgical intervention.
    Chinese medical journal 02/2012; 125(3):470-5. DOI:10.3760/cma.j.issn.0366-6999.2012.03.013 · 1.05 Impact Factor
  • Ge Zhao · Min Chen · Ting Liu · Shi Y Sun · Jing Zhao · Li X Xie ·
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    ABSTRACT: To investigate whether the clinical characteristics of stromal herpetic simplex keratitis (HSK) are associated with herpes simplex virus type 1 (HSV-1) antigens distribution in the pathologic cornea. Pathologic corneal buttons from 8 eyes were obtained during keratoplasty at the Shandong Eye Institute from 2006 to 2009. Immunohistochemical examination was performed to detect the distribution of HSV-1 antigens, including position, depth, and load in the cornea. Each of the 8 pathologic corneal buttons was positive for HSV-1 antigen by immunohistochemical staining, and HSV-1 antigen was detected in the corneal stroma but not in the corneal epithelium or endothelium. Combined with the clinical characteristics, it was found that the distribution depth of HSV-1 antigen in the cornea was partly related to the disease course, and the load was related to the delay time for treatment. Furthermore, HSK could be effectively cured by deep anterior lamellar keratoplasty (DALK). The distribution characteristics of HSV-1 in HSK corneal stroma supports the theory of HSV-1 latency in the cornea and guides the selection of DALK, rather than penetrating keratoplasty (PKP), for clinical stromal HSK treatment.
    European journal of ophthalmology 10/2011; 22 Suppl 7(Suppl. 7):S40-5. DOI:10.5301/ejo.5000064 · 1.07 Impact Factor
  • Xiusheng Song · Lingjuan Xu · Shiying Sun · Jing Zhao · Lixin Xie ·
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    ABSTRACT: To study the predisposing factors, clinical and microbiologic characteristics, treatment, and outcomes of pediatric microbial keratitis. The medical records of 80 eyes with (nonviral) microbial keratitis in 76 children aged 16 years or younger were retrospectively reviewed. Demographic features, predisposing factors, clinical features, etiologic microorganisms, and treatment outcomes were analyzed. Seventy-six patients met the inclusion criteria of this study, and the male to female ratio was 1.9:1. The average age of the children was 8.9 ± 5.7 years, and the mean duration of symptoms was 12.5 ± 9.8 days. The most common predisposing factor was trauma (58.8%). Thirty-nine (48.8%) of 80 cases were culture positive. Bacterial isolates were observed in 21 cases, being headed by coagulase-negative Staphylococcus, and fungi were found in 19 cases, with Fusarium sp. the predominant pathogen. Fifty-nine cases required surgery intervention. Fifty of the 58 examined eyes achieved best-corrected visual acuity of 20/200 or better at the final follow-up. The most common risk factor for childhood microbial keratitis was corneal trauma. The most frequent bacteria isolated were coagulase-negative Staphylococcus, whereas the predominant fungi isolated were Fusarium species. Early diagnosis, intensive drug therapy, and timely surgical intervention may effectively improve the prognosis of pediatric microbial keratitis.
    European journal of ophthalmology 05/2011; 22(2):136-41. DOI:10.5301/EJO.2011.8338 · 1.07 Impact Factor
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    Jun-Yi Wang · Li-Xin Xie · Xiu-Sheng Song · Jing Zhao ·
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    ABSTRACT: To identify the current indications and the trend shifts for penetrating keratoplasty (PKP) in Shandong. The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1, 2005 to May 31, 2010 were analysed retrospectively. A total of 875 patients (875 eyes) received PKP in this 5-year period, accounting for 61.6% of all corneal transplantation surgeries. The leading indications for PKP were infectious keratitis (37.1%), HSK (19.1%), keratoconus (11.2%), bullous keratopathy (8.5%), regrafting (6.7%) and corneal scarring (4.8%). The percentage of PKP for keratoconus declined year by year, whereas the percentage of bullous keratopathy had a mild annual increase. Fungal infections accounted for 65.2% of the infectious keratitis cases, remaining the leading cause of corneal infection. In addition, 54.1% of bullous keratopathy cases were associated with cataract surgery. The leading initial diagnoses associated with regrafting were infectious keratitis (38.9%), HSK (18.6%) and corneal burn (16.9%). The major causes of regrafting included graft endothelial dysfunction (39.0%), graft ulcer (28.8%) and primary disease recurrence (15.3%). Infectious keratitis remained the leading indication for PKP in Shandong, and fungal infections were still the major cause of corneal infections. There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus. Even with a decline in the overall proportion among all corneal transplantation surgeries, PKP is still the major corneal transplant choice in Shandong.
    01/2011; 4(5):492-7. DOI:10.3980/j.issn.2222-3959.2011.05.07
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    ABSTRACT: Corneal fibroblasts exhibit different phenotypes in different phases of corneal wound healing. In the inflammatory phase, the cells assume a proinflammatory phenotype and produce large amounts of cytokines and chemokines, but in the proliferative and remodeling phases, they adapt a profibrotic state, differentiate into myofibroblasts and increase extracellular matrix protein synthesis, secretion, and deposition. In the present study, the molecular mechanisms regulating the transition of corneal fibroblasts from the proinflammatory state to the profibrotic state were investigated. Corneal fibroblasts were treated with TGFbeta, a known profibrotic and anti-inflammatory factor in wound healing, in the absence or presence of trichostatin A (TSA), a histone deacetylase (HDAC) inhibitor. The results revealed that TGFbeta induced the profibrotic transition of corneal fibroblasts, including increased extracellular matrix synthesis, morphological changes, and assembly of actin filaments. Meanwhile, proinflammatory gene expressions of corneal fibroblasts were down-regulated with the treatment of TGFbeta, as confirmed by cDNA microarray, real time PCR and ELISA. Moreover, TSA reversed the TGFbeta-mediated transition of corneal fibroblasts from the proinflammatory state to the profibrotic state, as accompanied by histone hyperacetylations. In conclusion, TGFbeta suppressed the production of proinflammatory factors and enhanced the expression of matrix remodeling genes of corneal fibroblasts in the transition from the proinflammatory state to the profibrotic state, and the dual roles of TGFbeta on the phenotype regulations of corneal fibroblasts were mediated by altered histone acetylation.
    Journal of Cellular Physiology 07/2010; 224(1):135-43. DOI:10.1002/jcp.22110 · 3.84 Impact Factor
  • Ge Zhao · Shiying Sun · Jing Zhao · Lixin Xie ·
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    ABSTRACT: Acanthamoeba keratitis (AK) is a sight-threatening corneal infection, the epidemiology of which is related to the specific genotype of Acanthamoeba. In this study, the genotypes of 14 Acanthamoeba isolates, each from a patient with AK, were identified according to the highly variable DF3 region in the 18S rRNA gene at Shandong Eye Institute, PR China, from 2000 to 2009, and the clinical characteristics of these patients were analysed. All 14 amoebae were genotype T4, representing nine different DF3 sequence types, seven of which were newly identified. Cornea infestation was the main risk factor for these 14 AK patients. Amoebic cysts could be detected in all corneal scrapes. Corneal ulcers were located mainly at the corneal centre, accompanied by eye pain, and some appeared with a Wessely ring. Surgery was carried out on all patients. Acanthamoeba genotypes T4/26 and T4/27 were found to cause a more severe keratitis, whilst the others showed no significant differences in clinical characteristics. In conclusion, the majority of the keratitis-causing Acanthamoeba isolates were genotype T4, with Acanthamoeba genotypes T4/26 and T4/27 from PR China causing a more severe keratitis.
    Journal of Medical Microbiology 04/2010; 59(Pt 4):462-6. DOI:10.1099/jmm.0.016667-0 · 2.25 Impact Factor
  • Xing-feng Fang · Jing Zhao · Wei-yun Shi · Li-xin Xie ·
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    ABSTRACT: To evaluate the biocompatibility of xenogeneic acellular corneal stroma, the feasibility of tissue engineered corneal epithelial transplantation, and verify the long term survival of epithelial allograft. It was a experimental study. Porcine corneal stroma was treated by dispase followed by Triton-X-100 detergent. Treated porcine corneal stroma (group A) or fresh corneal stroma (group B) were put into the sac of rabbit cornea. Rabbit cornea without implantation of porcine corneal stroma was used as the control group (group C). Immunological rejection was evaluated in morphology, histopathology and immunohistochemistry in month 1, 3, 6. Female rabbit underwent lamellar keratoplasty (LK) using male tissue engineered corneal epithelium as donors, and immunological rejection after LK was analyzed. The corneas were collected at day 1, 3, 7, 15 and 30 after LK and evaluated by histopathology, immunohistochemistry and sex-determining region of Y-chromosome (SRY)-PCR analysis. All corneas became transparent gradually after the transplantation of treated porcine corneal stroma and were not rejected. The epithelium, stroma, endothelium, Bowman's and Descemet's membrane were preserved in all corneas of group A and B in histological observations, collagen fibers were parallel, a few keratocytes presented in the acellular and fresh corneal stromas. The corneas of group C were normal in histological sections. No significant immune rejection was noted in any of the corneas. The corneas in the study of transplantation of tissue engineered cornea epithelium recovered smoothly in 3 or 4 days, turned transparent in 15 or 20 days after surgery and were not stained by fluorescein. Well-differentiated corneal epithelium were recognized at 15 and 30 days after LK. Many keratocytes infiltrated into the scaffold. SRY-PCR analysis showed that allogenic donor corneal epithelium cells could survive in recipients after a long-term observation. Acellular porcine corneal stroma shows a satisfying biocompatibility. Tissue engineered corneal epithelium using acellular porcine corneal stroma as carrier could be used as donors for LK with satisfactory results. Donor cells have the potential to survive in recipients after long-term observation.
    [Zhonghua yan ke za zhi] Chinese journal of ophthalmology 11/2008; 44(10):934-42.
  • Xing-Feng Fang · Jing Zhao · Wei-Yun Shi · Li-Xin Xie ·
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    ABSTRACT: To compare two methods for preparing acellular corneal stroma and evaluate the possibility of culturing corneal epithelium on xenogeneic acellular corneal stroma. Experimental study, applying completely randomized design method. Dispase followed by Triton-X-100 detergent and sodium chloride SDS detergent followed by trypsinase were applied respectively to treat the rabbit cornea. The characteristics of corneal stroma and acellular status after treatment were examined with slit lamp, optical microscope and transmission electron microscope. The rabbit limbal cells were then cultured on the acellular porcine Bowman's membrane/stroma. Rabbit corneal epithelium lamella reconstructed in vitro and evaluated in morphology, histopathology and immunohisto-chemistry. Acellular corneal stroma prepared by two different methods is quite similar in morphology, being gray and opaque with visible edema and soft texture. Collagen fibers of the stroma were regularly in histopathology and ultrastructure. But the one prepared by the NaCl-SDS-Trypsinase method retained a amounts of cell debris, while there was none in the other did by Dispase-Triton-X-100 method. The limbal cells began to shift out at 24 hours after being inoculated on xenogeneic acellular corneal stroma, then attached on it, formed a confluent monolayer containing normal-appearing in 7 days. The tissue engineering corneal epithelium was cryosectioned and characterized immunohistochemically at 14 days after inoculation. Meanwhile, epithelium associated antigen CK3 in endochylema was stained. Dispase-Triton-X-100 was proved better in obtaining acellular corneal stroma. It is possible to reconstruction tissue-engineered rabbit's corneal epithelium on acellular porcine corneal Bowman's membrane/stroma.
    [Zhonghua yan ke za zhi] Chinese journal of ophthalmology 10/2008; 44(9):825-30.
  • Weiyun Shi · Ting Wang · Ju Zhang · Jing Zhao · Lixin Xie ·
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    ABSTRACT: To summarize the clinical features of immune rejection after corneoscleral transplantation. A retrospective, noncomparative, observational case series. Patients who received corneoscleral transplantation because of whole corneal ulcer or corneal perforation at Shandong Eye Institute from July 1, 2003 through July 31, 2005 were included. Fourteen patients (14 eyes) with immune rejection but not recurrence or other complications were reviewed, including ocular vision, rejection onset time, symptoms, and characteristics. The average rejection time in the 14 eyes was 35 days. The rejection arose rapidly, and the mean best-corrected visual acuity decreased to counting fingers or hand movements. Circular limbal congestion and edema developed with circuitous and dilatational vessels. Whole graft edema and Descemet membrane folds were present, but no epithelial rejection line, endothelial rejection line, or keratic precipitate were observed. The average intraocular pressure (IOP) dropped from 13.6 mm Hg to 7.4 mm Hg. Seven eyes had shallow anterior chambers (AC). Retinal and choroidal edema was observed in five eyes. The clinical features of immune rejection after corneoscleral transplantation include rapid onset of rejection, vision decrease, circular limbal congestion and edema with circuitous and dilatational vessels, whole graft edema and shallow AC, low IOP, and no rejection line or keratic precipitate.
    American Journal of Ophthalmology 09/2008; 146(5):707-13. DOI:10.1016/j.ajo.2008.05.051 · 3.87 Impact Factor
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    ABSTRACT: To analyze common pathogens of fungal keratitis and results of antifungal drug sensitivity test in Shandong Province, China and provide guidance for appropriate choice of antifungal drugs in clinic. Retrospective, noncomparative study. The pathogens isolated from 674 fungal keratitis patients between January 1, 2001 and December 31, 2006 were cultured and identified in Shandong Eye Institute, of which some common strains were tested for sensitivity to antifungal drugs. Fungi were positively cultured in 549 (81.5%) patients, in which the dominating pathogen was genus Fusarium (77.6%), with F. solani (37.3%), F. moniliforme (30.0%), and F. oxysporum (27.9%) being common species; Fusarium was mostly sensitive to natamycin, next to amphotericin B, and then to terbinafin. The second common pathogen was genus Aspergillus (10.8%), in which the main species were A. flavus (49.2%) and A. fumigatus (35.6%); Aspergillus was mostly sensitive to natamycin, next to terbinafin, and then to amphotericin B. Relatively, both Fusarium and Aspergillus were insensitive to ketoconazole, miconazole, itraconazole, fluconazole, and fluorocytosine. Fusarium is the most common pathogen of fungal keratitis, followed by Aspergillus, in Shandong Province, China. Natamycin is still the first choice in the treatment of hyphomycetic keratitis. Fusarium and Aspergillus are also sensitive to amphotericin B and terbinafin. Early diagnosis and treatments are vital to good prognosis in the treatment of fungal keratitis.
    American Journal of Ophthalmology 07/2008; 146(2):260-265. DOI:10.1016/j.ajo.2008.04.019 · 3.87 Impact Factor
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    ABSTRACT: To evaluate growth patterns of fungal pathogens in corneas and recurrence of fungal keratitis after lamellar keratoplasty (LK). Retrospective noncomparative study. One hundred seventy-four patients (174 eyes) with fungal keratitis who underwent LK at Shandong Eye Institute from January 2000 through November 2006. Medical records of each patient were retrospectively reviewed. Hyphal growth patterns in corneas were evaluated by histopathological examination. Fungal recurrence after LK was observed during the follow-up. Pathogens, hyphal growth patterns, and postoperative fungal recurrence. The pathogens were Fusarium (85.1%), Aspergillus (6.3%), Alternaria (4.6%), Penicillium (2.3%), and Candida (1.7%). Most Fusarium hyphae (91.2%) lay parallel to the corneal stromal lamellae, whereas most Aspergillus (90.9%) grew vertically. Recurrence of fungal keratitis was found in 15 patients (8.6%) after LK, and the pathogens were F. oxysporum (33.3%), F. solani (26.7%), F. moniliforme (13.3%), Aspergillus flavus (13.3%), Aspergillus fumigatus (6.7%), and Aspergillus terreus (6.7%). In cases of fungal recurrence, the majority of hyphae (80%) grew vertically. There was a higher recurrence rate in patients with vertically growing hyphae (46.2%) than in those with horizontally growing hyphae (2%) (chi(2) = 54.664, P<0.001), as well as in those with Aspergillus keratitis (36.4%) versus those with Fusarium keratitis (7.4%) (chi(2) = 10.031, P = 0.002). Reproducibility of the fungal recurrence rate was moderate in the patients with different hyphal growth patterns (kappa = 0.534) but poor in those with different fungal pathogens (kappa = -0.044). Hyphal growth patterns in corneas differ not only in the same fungal genus but also in the same species. The fungal recurrence rate after LK in patients with hyphae growing horizontally is much lower than that in those with hyphae growing vertically. Growth patterns of fungal pathogens may be an important factor for fungal recurrence after LK.
    Ophthalmology 06/2008; 115(6):983-7. DOI:10.1016/j.ophtha.2007.07.034 · 6.14 Impact Factor
  • Lixin Xie · Zhenhua Song · Jing Zhao · Weiyun Shi · Fuhua Wang ·
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    ABSTRACT: To analyze leading indications for penetrating keratoplasty (PKP) in north China and changing trends in them. We retrospectively reviewed the records of patients who underwent PKP at Shandong Eye Institute from January 1997 to December 2002. Infectious keratitis (fungal, bacterial, and acanthamoeba), herpes simplex keratitis (HSK), corneal scarring, keratoconus, bullous keratopathy, regrafting, corneal dystrophy and degeneration, and others were included in the indications for PKP. Initial diagnoses and causes of regrafting were recorded, as well as the related intraocular surgeries for bullous keratopathy. A total of 1702 patients (1702 eyes) were included in this study. The leading indications for PKP were infectious keratitis (31%), followed by HSK (18%), corneal scarring (16%), keratoconus (13%), bullous keratopathy (7%), regrafting (5%), and corneal dystrophy and degeneration (4%). Percentage of PKP for keratoconus and bullous keratopathy increased significantly during the 6 years, contrary to HSK and corneal scarring. Fungal infections accounted for 66% of infectious keratitis. Of 118 bullous keratopathy cases, 90 (76%) were associated with cataract surgery. The leading initial diagnoses of regrafting were corneal burns (25%), HSK (23%), and infectious keratitis (14%); the major causes included immune rejection (61%), graft infection (14%), and recurrence of HSK (10%). Infectious keratitis remains the most common indication for PKP in north China. Moreover, there is an increasing trend in the percentage of PKP for keratoconus and bullous keratopathy.
    Cornea 11/2007; 26(9):1070-3. DOI:10.1097/ICO.0b013e318093de07 · 2.04 Impact Factor
  • Wei-yun Shi · Ting Wang · Hua Gao · Fu-hua Wang · Jing Zhao · Li-xin Xie ·
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    ABSTRACT: To study the clinical characteristic of immune rejection after corneoscleral transplantation. A retrospective study was performed on patients received corneoscleral transplantation in Shandong Eye Institute between July 2003 and July 2005. 14 cases were included in this study. Enrollment criterion: on the 7th day postoperatively, graft was transparent; depth of anterior chamber, intraocular pressure (IOP) and B scan were normal. The time, vision, symptom, characteristic, and outcome of immune rejection were recorded. The time and incidence of immune rejection were as following: 2 cases from day 11 to day 13; 10 cases from weeks to 1 month; 1 case in 3 months and 1 case in 6 months. Vision acuity decreased from 0.05 - 0.2 to finger counting (FC) or hand motion (HM) in all of cases with immune rejection; the major manifestation of immune rejection were circular limbal congestion, edema with circuitous and dilated vessel; the other characteristics of the rejection included whole graft edema, descemet membrane folds, shallow anterior chamber; endothelial rejection line or keratic precipitate (KP). IOP reduction < 10 mm Hg was seen 12 patients. Retina and choroids edema were found in 5 patients using B scan. After the diagnosis of immune rejection was established, 7 patients were treated with anti-rejection medication within 3 days, their grafts became transparent; 3 patients were treated within 3 - 5 day after the rejection, 2 grafts became transparent, 1 graft was suffered from endothelium decompensation; 4 patients were treated 7 days later after the rejection, 1 graft became transparent, 2 grafts were suffered from endothelium decompensation and 1 eye was atrophied. After corneoscleral transplantation, the characteristic of immune rejection includes circular limbal congestion, whole graft edema, shallow anterior chamber and low IOP. Immediately anti-rejection treatment is critical for the prognosis after immune rejection.
    [Zhonghua yan ke za zhi] Chinese journal of ophthalmology 08/2007; 43(7):589-93.
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    ABSTRACT: To analyze the etiological and clinical characteristics of 1054 cases with suppurative keratitis. Medical records of 1054 inpatients with suppurative keratitis at the Qingdao Eye Hospital, Shandong Eye Institute from January 1999 to December 2004 were retrospectively reviewed for the analysis of demographic features, duration of symptoms, risk factors, previous therapy and laboratory findings. Fungal keratitis (61.9%) was the most common type in suppurative keratitis inpatients. Middle aged patients (between 41 - 50 years, 27.3%) and farm workers (82.9%) were the most common groups. Corneal trauma was noted as the most common risk factor. The positive rate of direct microscopic examination of potassium hydroxide (KOH) wet mounts was 88.7% for the diagnosis of fungal keratitis, but the positive rate of microscopic examination of Gram staining was only 43.4% in detecting bacterial keratitis. The most common type of fungi isolated was fusarium species (437 cases, 73.3%), followed by aspergillus species (72 cases, 12.1%). Pseudomonas aeruginosa was the most commonly isolated bacteria (35.7%), followed by staphylococcus epidermidis (22.5%). Fungal keratitis is the most common type in severe suppurative corneal ulcers and its incidence shows an increasing tendency progressively. As a rapid, simple and effective diagnostic method of fungal keratitis, the application of direct microscopic examination of KOH wet mounts should be used more extensively. A rapid and effective detecting technique of bacterial keratitis is required urgently.
    [Zhonghua yan ke za zhi] Chinese journal of ophthalmology 04/2007; 43(3):245-50.
  • Wei-yun Shi · Min Chen · Fu-hua Wang · Jing Zhao · Lin Ma · Li-xin Xie ·
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    ABSTRACT: To evaluate the efficacy of multilayer amniotic membrane transplantation (AMT) combined with antivirus and corticosteroid drug to treat necrotizing herpes simplex stromal keratitis. Thirteen patients (13 eyes) of necrotizing stromal keratitis were referred to Shandong Eye Institute and Qingdao Eye Hospital between January 2003 and April 2004. The course of disease was 3 - 22 months (mean 15 months). Corneal inflammation persisted and corneal ulcer progressed despite topical and systemic antiviral treatment for over 1 weeks. Multilayer amniotic membrane transplantation was performed after excluding of bacterial and fungal infection by microbiologic studies including smears and cultures of necrotic corneal tissue and confocal microscope. Topical and systemic antiviral medications were given with adjuvant corticosteroid eyedrops postoperatively. We investigated the healing of corneal ulcer and improvement of stromal edema with slit lamp biomicroscope, the integrity of corneal defect with fluorescein staining, the migration of healthy corneal epithelial cells and transformation of amniotic membrane with confocal microscopy. All patients were followed up for 3 - 13 months (mean 10 months). Corneal ulcer healed within 1 - 3 weeks postoperatively with negative fluorescein staining. Corneal stromal edema faded away within 1 month. Superficial amniotic membrane patches dissolved or shed on postoperative day 7 - 10, while the deeper grafts were adhered into the ulcer and fused with the surrounding fibroblasts. One of these grafts remained in situ more than 3 months. Confocal microscope examination indicated flat epithelial progenitor cells on the surface of residual amniotic membrane. Corneal transparence was achieved in 7 eyes, macula in 4 eyes and leucoma in 2 eyes 3 months after the operation. No recurrence of necrotizing stromal keratitis was occurred in 13 patients during the follow-up period. Multilayer AMT combined with antivirus and corticosteroid treatment is an effective method to treat necrotizing herpes simplex stromal keratitis.
    [Zhonghua yan ke za zhi] Chinese journal of ophthalmology 01/2006; 41(12):1107-11.

Publication Stats

170 Citations
43.40 Total Impact Points


  • 2011-2012
    • Shandong Academy of Sciences
      Chi-nan-shih, Shandong Sheng, China
  • 2004-2012
    • Shandong Eye Institute
      Tsingtao, Shandong Sheng, China