Acute dacryocystitis is an ocular disease that most often results from an acute attack of chronic dacryocystitis, which manifests as redness, swelling and pain in the lacrimal sac area. Chronic Lymphocytic Leukemia (CLL), on the other hand, is a malignant hematologic disease originating in hematopoietic tissues with diverse biological features and clinical outcomes. Although there is no direct pathophysiologic correlation between these two diseases, in the present case, we identified a patient with CLL with acute dacryocystitis as the first symptom. The aim of this study was to investigate a case of CLL with acute dacryocystitis as the first symptom, and to comprehensively analyze this disease by reviewing the previous literature, to explore the possible underlying pathogenesis and the thoughts that this case brings to our clinical diagnosis and treatment ideas. This case report was in concordance with the Declaration of Helsinki and with the informed consent of the patient.
Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is a systemic condition characterized by the infiltration of IgG4-positive plasma cells and elevated serum IgG4 levels. The ocular manifestations of this disease can involve the lacrimal gland, orbital fat, infraorbital nerves, extraocular muscles, and eyelids, often accompanied by inflammatory and fibrotic processes. At the molecular level, IgG4-ROD is associated with the interaction of various immune cells and cytokines, including Th1, Th2, Treg, and Tfh cells, as well as the cytokines IL-4, IL-13, and TGF-β. These molecules collectively contribute to the pathogenesis of IgG4-ROD by promoting B cell activation and IgG4 production, as well as facilitating the development of fibrosis. Diagnosis is primarily based on histopathological features, while treatment typically involves glucocorticoids and immunosuppressive agents aimed at controlling immune-mediated inflammation and fibrosis, alleviating symptoms, and preventing organ damage. As our understanding of the molecular pathogenesis of IgG4-ROD deepens, treatment strategies are expected to be continuously refined to offer patients more precise and effective therapeutic options. This article summarizes and elucidates the key molecules and signaling pathways implicated in the pathogenesis of IgG4-related eye diseases, and reviews the interplay between autoimmunity and fibrosis, as well as their transformations, from a molecular perspective.
Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is a systemic condition characterized by the infiltration of IgG4-positive plasma cells and elevated serum IgG4 levels. The ocular manifestations of this disease can involve the lacrimal gland, orbital fat, infraorbital nerves, extraocular muscles, and eyelids, often accompanied by inflammatory and fibrotic processes. At the molecular level, IgG4-ROD is associated with the interaction of various immune cells and cytokines, including Th1, Th2, Treg, and Tfh cells, as well as the cytokines IL-4, IL-13, and TGF-β. These molecules collectively contribute to the pathogenesis of IgG4-ROD by promoting B cell activation and IgG4 production, as well as facilitating the development of fibrosis. Diagnosis is primarily based on histopathological features, while treatment typically involves glucocorticoids and immunosuppressive agents aimed at controlling immune-mediated inflammation and fibrosis, alleviating symptoms, and preventing organ damage. As our understanding of the molecular pathogenesis of IgG4-ROD deepens, treatment strategies are expected to be continuously refined to offer patients more precise and effective therapeutic options. This article summarizes and elucidates the key molecules and signaling pathways implicated in the pathogenesis of IgG4-related eye diseases, and reviews the interplay between autoimmunity and fibrosis, as well as their transformations, from a molecular perspective.
Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is a systemic condition characterized by the infiltration of IgG4-positive plasma cells and elevated serum IgG4 levels. The ocular manifestations of this disease can involve the lacrimal gland, orbital fat, infraorbital nerves, extraocular muscles, and eyelids, often accompanied by inflammatory and fibrotic processes. At the molecular level, IgG4-ROD is associated with the interaction of various immune cells and cytokines, including Th1, Th2, Treg, and Tfh cells, as well as the cytokines IL-4, IL-13, and TGF-β. These molecules collectively contribute to the pathogenesis of IgG4-ROD by promoting B cell activation and IgG4 production, as well as facilitating the development of fibrosis. Diagnosis is primarily based on histopathological features, while treatment typically involves glucocorticoids and immunosuppressive agents aimed at controlling immune-mediated inflammation and fibrosis, alleviating symptoms, and preventing organ damage. As our understanding of the molecular pathogenesis of IgG4-ROD deepens, treatment strategies are expected to be continuously refined to offer patients more precise and effective therapeutic options. This article summarizes and elucidates the key molecules and signaling pathways implicated in the pathogenesis of IgG4-related eye diseases, and reviews the interplay between autoimmunity and fibrosis, as well as their transformations, from a molecular perspective.
Lacrimal tumors are a relatively rare disease of the lacrimal system and are often malignant. According to the literature, more than 55% of lacrimal tumors are malignant tumors. If the tumor cannot be completely removed or has already metastasized, it may increase the recurrence rate and mortality rate. Therefore, in clinical practice, if a case of a mass in the lacrimal sac is encountered, a thorough examination should be performed, such as orbital ultrasound scan, CT and MRI with or without contrast enhancement, and endoscopic examination of the lacrimal duct, if possible. The condition should be fully assessed to design a reasonable surgical approach and the extent of surgical resection. Preoperative biopsy is only recommended in cases of obvious exophytic or ulcerative lesions. For potentially malignant lesions, it should be removed as completely as possible, and rapid frozen section biopsy can be performed during surgery to guide the scope of the excision . If the lesion is large or the condition is complex, a single incision through the skin or endoscopic approach may not be able to completely remove it, and an combined approach can be used to obtain a good view and fully dissect and separate the lesion for appropriate resection. This article reports two cases of lacrimal tumor resection performed through a skin incision combined with an endoscopic approach, one of which had a postoperative pathological diagnosis of benign papilloma and Long-term follow-up is planned. The other case was a nasal sinus NUT cancer. NUT cancer is a rare highly malignant tumor with an unclear pathogenesis. Once diagnosed, the patient was advised to seek treatment in the oncology department as soon as possible, and we will continue to follow up with the patient.
Objective To explore the factors of macular edema after por-ogenous retinal detachment and its influence on visual vision. Methods A total of 180 (180 eyes) patients with rhegogenous retinal detachment admitted to our hospital from January 2021 to March 2023 were selected. 180 patients were classified without macular oedema (142 eyes) or (38 eyes) based on the optical coherence tomography (OCT) 1 month after surgery. Electronic medical records was collected for clinical data, and underwent ophthalmic examination for mean visual field defect (MD), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT), and observed maximum systolic flow velocity (PSV), peak end diastolic flow velocity (EDV), and mean flow rate (MV). Structural equation models were constructed to analyze the effects of the occurrence of macular edema after pore-derived retinal detachment, and stratified regression was used to analyze the BCVA expression levels of different pathological features. Results After treatment, the serum total bilirubin (TB) content and peripheral neutrophil, lymphocyte ratio (NLR), best corrected visual acuity (BCVA) between the two groups (P <0.05). Diabetes mellitus, ocular artery systolic maximum flow velocity (OA-PSV), peak ocular artery end-diastolic flow velocity (OA-EDV), ophthalmic artery mean flow velocity (OA-MV), central retinal artery systolic maximum flow velocity (CRA-PSV), peak central retinal artery end-diastolic flow velocity (CRA-EDV), mean central retinal artery velocity (CRA-MV), maximum posterior ciliary artery systolic flow velocity (SPCA-PSV), and posterior ciliary short artery end-diastolic flow velocity (SPCA-EDV) are all macula Independent risk factors for oedema (P <0.05). The structural equation model was constructed. The various indicators of the model were good, and the convergent validity and combined reliability of the model were good. The nerve fiber layer, ganglion cell layer, inner tuxform layer, inner core layer and outer tuxform layer were all affected (P <0.05). Conclusion Elevations of diabetes mellitus, OA-PSV, OA-EDV, OA-MV, CRA-PSV, CRA-EDV, CRA-MV, SPCA-PSV, and SPCA-EDV are risk factors for postoperative macular edema in patients with pore-origin retinal detachment, which should be noted in clinical studies.
Objective To observe and analyse the related factors and treatment effects that affect the clinical treatment of lacrimal duct injury due to trauma . Methods A retrospective analysis was conducted on the clinical data of 347 patients (347 eyes) with traumatic lacrimal duct injury treated at the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2024, all of whom underwent lacrimal duct ligation and reconnection surgery, with a tear duct drainage tube inserted. The postoperative follow-up results were recorded, and the causes of injury, surgical time, method, and success rate were statistically analyzed to investigate the relationship between the degree of injury, surgical time, and method, and success rate . Results The data showed that the causes of injury were avulsion injuries in 82 cases (23.6%), fractures in 150 cases (43.2%), damage in 64 cases (18.3%), burns in 44 cases (12.6%), and other injuries in 7 cases (2.3%); the locations of injury were workplaces in 201 cases (58%), homes in 42 cases (12%), traffic accidents in 76 cases (22%), schools in 24 cases (7%), and other locations in 4 cases (1%); and the time after injury was within 7 days in 280 cases (80.8%) and more than 7 days in 67 cases (19.2%). The distal group had 164 cases (47.3%), the middle group had 126 cases (36.2%), and the proximal group had 57 cases (16.5%). All 347 cases were successfully treated with lacrimal duct anastomosis, nasolacrimal duct dilation, and insertion of lacrimal duct drainage tubes. The success rates of lacrimal duct anastomosis in the proximal, middle, and distal groups were 93.6%, 89.7%, and 87.6%, respectively. At one-month follow-up, the lacrimal duct re-establishment rate was 91%, the three-month rate was 83%, the six-month rate was 77%, and the main complications were postoperative tearing 78 cases (22.5%) and scarring of the anastomosis site 26 cases (7.5%) Conclusion Patients with traumatic lacrimal canaliculi injury need to analyze the cause of injury, the characteristics of injury, the severity, the best one-stage surgical treatment, the clinical treatment effect is better.
Objective: Studies on whether air pollutants are associated with age-related cataracts are limited, and previous findings have been inconsistent. The aim of this study was to evaluate the relationship between multiple atmospheric pollutants and age-related cataracts.Methods: A two-sample Mendelian randomization (MR) design was employed, utilizing summary statistics from independent genome-wide association studies (GWAS) from Asian and European populations. Data on atmospheric pollutants included PM2.5, PM2.5-10, PM10, nitrogen dioxide, and nitrogen oxides. The primary analytical method was the inverse variance weighted (IVW) approach, complemented by various sensitivity analyses. Heterogeneity among single nucleotide polymorphisms (SNPs) was assessed using Cochran's Q test, and SNP outliers were removed using the MR Pleiotropy Residual Sum and Outlier (MR PRESSO) method. Potential pleiotropy among SNPs was examined via the MR Egger intercept test, and a "leave-one-out" sensitivity analysis was conducted to assess if the MR study results were influenced by any single SNP.Results: Among the five atmospheric pollutant characteristics studied, we found that in the Asian population: nitrogen dioxide (IVW method: OR = 1.03, 95% CI: 1.00 - 1.06, P = 0.026) was associated with an increased risk of age-related cataracts; in the European population: PM2.5-10 (IVW method: OR = 1.35, 95% CI: 1.12 - 1.62, P = 0.002) was associated with an increased risk of age-related cataracts. All sensitivity analyses further supported these associations.Conclusion: Environmental levels of PM2.5-10 and nitrogen dioxide have a significant causal relationship with the increased risk of age-related cataracts. These findings provide scientific evidence for the prevention and management of age-related cataracts and the formulation of public health policies.
This article reports the clinical presentation, ophthalmologic examination, and imaging features of a 5-year-old girl with Dandy-Walker syndrome (DWS). She underwent partial resection of an arachnoid cyst in the posterior cranial fossa after the diagnosis of DWS. However, her visual acuity continued to deteriorate after the surgery, and the ophthalmologic follow-up revealed progressive thinning of the retinal nerve fibers layer (RNFL), suggesting that the intracranial pressure (ICP) had not yet been effectively controlled, and the damage to the optic nerve was further developing. However, due to the special pathological changes of DWS, MRI and routine lumbar puncture was not able to exactly identify the supratentorial ICP, subsequent ICP measurement through the lateral ventricle confirmed that increased ICP was still existed. After performing a right ventriculoperitoneal shunt, the child's binocular vision improved, and the thickness of the RNFL in both eyes remained stable.Current treatment modalities for DWS include cystectomy, cerebrospinal fluid shunt and endoscopic third ventriculostomy. The measurement of postoperative ICP in DWS patients is complicated, because there may be a significant pressure gradient between the supratentorial and infratentorial regions, which is not accurately reflected by lumbar puncture manometry, and intraventricular manometry is much more invasive. Ophthalmologic examinations including progressive decrease in RNFL thickness, optic disc edema, and abnormal retinal vascular morphology are required to provide evidences of increased ICP. These examinations are noninvasive, simple, and repeatable. They are an effective means of assessing ICP, and are recommended to be included in the routine management of ICP in patients with DWS after surgery.
