Jing Zhao

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

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Publications (13)40.48 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. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
    Ophthalmology 12/2012; · 5.56 Impact Factor
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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; · 5.56 Impact Factor
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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; · 1.75 Impact Factor
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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. · 1.93 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 01/2012; 18:2137-46. · 1.99 Impact Factor
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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:S40-5. · 0.91 Impact Factor
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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. · 0.91 Impact Factor
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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. · 2.30 Impact Factor
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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 03/2010; 224(1):135-43. · 4.22 Impact Factor
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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. · 4.02 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. · 4.02 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. · 5.56 Impact Factor
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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. · 1.75 Impact Factor

Publication Stats

91 Citations
40.48 Total Impact Points

Institutions

  • 2012
    • Shandong Academy of Sciences
      Chi-nan-shih, Shandong Sheng, China
  • 2011–2012
    • Renmin University of China
      Peping, Beijing, China
  • 2010–2012
    • Shandong Eye Institute
      Tsingtao, Shandong Sheng, China