Volume 51 · Issue 09 · 2015

Eye drops are the most commonly used preparations in ophthalmology. Preservatives are usually added in order to protect eye drops against pathogenic organisms and increase the solubility of the drugs in multi-dose containers. Ophthalmologists have paid a lot of attention to the preservatives in eye drops because they remain one of the main reasons for ocular surface damage, and even may lead to serious visual impairment in patients with inappropriate use of eye drops. However, it should be noted that the dangers of preservatives become overstated nowadays. It is necessary to completely evaluate the effects of preservatives in ophthalmic preparations, so that ophthalmologists can guide patients to correctly select eye drops containing preservatives and avoid dangerous side effects, according to their eye disease situation, state of tear function and ocular surface changes, cultural background and financial income, cost and benefit and convenience of the use of drugs, and other factors. The direction of the future development in this field is to establish the clinical guideline for use of eye drops containing preservatives, carry out continuing education courses on preservatives and develop ideal preservatives. (Chin J Ophthalmol, 2015, 51: 641-644)

In the field of ophthalmology, the importance of vision is unknown, but some basic problems related to vision are rarely studied. "Exploring the Method of Correct Statistics of Eye Disease Vision Data and True and False Paracentric Dark Spots" in the Academic Debate Column of Chinese Journal of Ophthalmology, Issue 5, 2015^[1](hereinafter referred to as "Exploration") and "Discussion with the author of the article" Exploring the Method of Correct Statistics of Eye Disease Vision Data and True and False Paracentric Dark Spots ""^[2](hereinafter referred to as "Discussion") two articles, on "the nature of vision" carry on the thought-provoking discussion and discussion. The author thinks that the key of the problem lies in the understanding and understanding of "peripheral vision". In order to avoid "each speaks his own words", the main concepts involved and their interrelationships should be sorted out and clarified from the perspective of visual physiology, hoping to lead the discussion in depth and reach a consensus.

To develop and assess a new dry eye questionnaire applicable to the Chinese population.

Based on literature review and clinical practice, a dry eye questionnaire was developed and optimized to apply to Chinese dry eye patients in the language expression and culture background. Participants (78 patients with dry eye and 82 controls) completed the dry eye questionnaire and the ocular surface disease index (OSDI) questionnaire, and ophthalmic examinations were performed, including slit lamp examination, tear breakup time, fluorescein staining, Schirmer I test and meibomian gland assessment. The original questionnaire was optimized with factor analysis according to the answers from respondents and clinical evaluations. The Cronbach αand intraclass correlation coefficient (ICC) were used to evaluate the internal consistency reliability and test-retest reliability. Factor analysis was used to assess the construct validity, concurrent validity was obtained by Spearman correlation analysis, and discriminant validity was obtained by ANOVA and Wilcoxon rank sum test. Receiver operator characteristics curves were generated to identify the sensitivity and specificity of each questionnaire for diagnosis of dry eye.

The questionnaire was optimized to 12 items by factor analysis. The response rate from respondents to the dry eye questionnaire and the OSDI was 100% and 91.25%, respectively. The Cronbachαof the dry eye questionnaire and the OSDI was 0.794 and 0.925, respectively, whilst the ICC of both questionnaires was 0.99, indicating good to excellent reliability. The factor analysis suggested that these two questionnaires had good construct validity. The Spearman correlation analysis indicated that the dry eye questionnaire score correlated positively with the OSDI score(r=0.812, P<0.01)and had a greater correlation relationship with the clinical evaluations compared with the OSDI score(r for each was 0.613 and 0.605,P<0.01). The discriminant validity analysis suggested that there was significant difference in the dry eye questionnaire score between the dry eye group and non-dry eye group (P<0.01). When the dry eye questionnaire score of 7 was used as the diagnostic threshold, the sensitivity and specificity were 83.33% and 70.73%, respectively, and the area under roc curve was 0.814, which was higher than 0.772 of the OSDI (P<0.01).

The dry eye questionnaire we developed is applicable to the Chinese population with Chinese culture characteristics, high reliability, validity, specificity, and sensitivity, and holds a better diagnostic value than the OSDI for Chinese patients with dry eye. (Chin J Ophthalmol, 2015, 51: 647-654)

To describe a novel surgical technique for the treatment of large corneal perforations by using acellular multilayer of corneal stromal lenticules.

Prospective study. The acellular tissue used for the repair was harvested from myopic patients during the femtosecond laser (FS) refractive surgery. Informed consent, blood test and donor eligibility were obtained in each case. Three or four layers of lenticules were stacked up and stored at -80℃ in pure sterile glycerin. The diameter is 6.0 to 6.5 mm and central thickness was 300 to 400 µm. If the diameter of the corneal ulcer perforation was larger than 3 mm and corneal grafts were not available, we used this kind of patches to seal the perforations. It was a retrospective case series study. Five cases of corneal ulcer perforation were enrolled in this study. One was neuropathic keratitis, one was atopic keratoconjunctivitis, and the other three were fungal keratitis. Acellular multilayer of stromal lenticules were used in these cases for emergent therapy.

The sealing of the perforation and the re-establishment of the anterior chamber were achieved successfully in all the cases. For the pericentral perforations, visual recovery was achieved. And efficient palliative management was done for the central perforations.

The reported technique seems to represent a good alternative emergency procedure for the management of large corneal perforations. It is a very useful method for Chinese hospitals where the shortage of cornea donors is a very serious problem and the amount of FS surgeries are increasing. (Chin J Ophthalmol, 2015, 51: 655-659)

To detect the genotypes and in vitro antifungal susceptibility of Fusarium isolated from patients with fungal keratitis in central China.

Partial translation elongation factor (EF) 1-ɑ of 758 strains of Fusarium isolated from patients with fungal keratitis in Henan Eye Institute during 2002 to 2011 were sequenced. Species and genotypes of Fusarium were identified by conducting BLAST searches of the Fusarium ID database with partial EF1-ɑ sequences as the query. The minimum inhibitory concentrations(MIC) of vorionazole, ketoconazole, terbinafine, natamycin, 5-flucytosine, fluconazol, amphotericin B, nystatin, econazole, clotrimazole, miconazole and itraconazole to 145 isolates of Fusarium were determined by microbroth dilution method according to Clinical Laboratory Standards Institute(CLSI) M38-A program.

Among the 758 strains of Fusarium isolates, species of 653 strains were identified. 99.69% of the Fusarium strains were identified by EF1-asequences as Fusarium solani species complex (FSSC), Fusarium oxysporum species complex (FOSC) and Gibberella fujikuroi species complex (GFSC), 0.31% as Fusarium sp. Among the 653 isolates from cornea, FSSC was the predominant Fusarium, 386 isolates (59.11%), with 43 genotypes. The most common seen FSSC genotype was FSSC5-d (132/20. 21%), followed by FSSC3+ 4-eee (58/8.88%), FSSC3+ 4-ii (37/5.67%) and FSSC3+ 4-z (31/4.75%). The second complex was GFSC, 254 isolates (38.90%), with 3 species which were F.proliferatum (124 strains/18.99%), F.verticillioides (112 strains/17.15%) and GFSC(18 strains/2.76%) respectively. The third complex was FOSC, 11 (1.68%) strains, with 6 genotypes. The results of in vitro drug sensitivity test showed that Fusarium strains were sensitive to natamycin, vorionazole and amphotericin B, resistant to 5-fluorocytosine, fluconazole, nystatin, clotrimazole, miconazole. More than 50% of Fusarium strains were sensitive to econazole, ketoconazole, itraconazole and terbinafine. The MIC50 of FSSC to vorionazole, miconazole, terbinafine, Econazole and natamycin was higher than that of F.verticillioides, F.proliferatum and GFSC respectively.

The predominant Fusarium complex of fungal keratitis in central China was FSSC, followed by GFSC. 43 genotypes were included in FSSC in which the most common seen FSSC genotype was FSSC5-d, followed by FSSC3+4-eee, FSSC3+4-ii and FSSC3+4-z. GFSC contained 3 species which were F.proliferatum, F.verticillioides and GFSC respectively. Different genotypes of Fusarium from keratitis had different susceptibility to vorionazole, terbinafine, natamycin and miconazole. (Chin J Ophthalmol, 2015, 51: 660-667)

To analyze and identify the meibum from healthy individuals and patients with meibomian gland dysfunction (MGD) by gas chromatography-mass spectrometry (GC-MS).

Case-control study. The meibum from twenty healthy persons and nineteen MGD patients was separated and analyzed by GC-MS. GC conditions were: column: DB-5 MS (30 m × 0.25 mm × 0.25 μm) capillary column, carrier gas: He, flow rate: 1.0 ml/min, injection amount: 1 ml. MS conditions were: MS ionization mode: EI, electron impact source electron energy: 70 eV, ion source temperature: 200 ℃, electron multiplier voltage of 1.10 kV, solvent delay time: 1.00 min, scanning mode: San, scanning range m/z 20-500 aum. The components of meibum were identified by El mass fragmentation and the standard substance in the database. The relative content of the components was calculated by the method of chromatographic peak area normalization.

In the 39 samples that were analyzed by GC-MS, 102 chromatography peaks were separated, and 23 compounds were identified, including 3 alkanes, 4 alkenes, 2 alcohols, 1 aromatic hydrocarbon, 7 esters, 4 fatty acids, 1 amide, and 1 phenol. However, there was no corresponding physical mass library information in the remaining 79 GC peaks, and no identification could be performed. The relative concentration level of palmitic acid, stearic acid, and squalene in the MGD group was significantly lower than that in the healthy controls (U=-2.086, -2.027, -2.866, P<0.05).

Meibum has a wide variety of components, the structures are complex, and the components in different individuals vary greatly. Palmitic acid, stearic acid, and squalene levels were significantly decreased in MGD patients compared to the healthy group, suggesting that MGD is related to changes of the meibum components. (ChinJ Ophthalmol, 2015, 51: 668-672)

This study was to evaluate clinical results and complications associated with the Boston type Ⅰ keratoprosthesis implanted into complex corneal opacity.

Retrospective study. Sixty-one eyes (57 cases ) received Boston type Ⅰ KPro implantation between May 2011 and January 2013 in the Chinese PLA General Hospital, and were followed for at least 2 months (range, 2 to 27 months, mean 19 months). Indications for keratoprosthesis included thermal injury (n= 17), chemical injury (n=19), herpetic keratitis (n=8), blast injury (n=6), keratitis(n=8), antoimmune diseases (n=2) and corneal endothelial decompensation (n=9). Kpro implantation in accordance with the Massachusetts Eye Center standardized surgical approach, and routine lens removal meantime. Clinical complications and postoperative treatments were recorded.

Preoperative visual acuity were light perception to the counting figure in all the patients. Forty-seven eyes (77%) had better best correct visual acurity than counting figure and 18 eyes (30%) had BCVA better than 0.3 after implantation. Postoperative complications indluded carrier corneal melting (10 cases),retroprothesis membrane (6 cases ), glaucoma (12 cases), retinal detachment (2 cases ), choroidal detachment (1 case ), endophthalmitis (2 cases ) . Complications take symptomatic treatment, in addition to glaucoma patients and two cases of endophthalmitis patients (Evisceration), all patients can maintain the original best corrected visual acuity.

Timely examination of the KPro and replacement with donor cornea may prevent a poor outcome. Close follow-up is necessary after KPro-implantation. (Chin J Ophthalmol, 2015, 51: 673-676)

To evaluate the early clinical results of keratoconic eyes treated with transepithelial iontophoresis corneal collagen cross-linking (i-CXL) within 1 year.

Propective nonrandomized study. Twenty-three eyes of 23 patients with progressive keratoconus with minimum corneal thickness from 380 μm to 420 μm (including the epithelium) were included in this prospective, nonrandomized clinical study and treated with i-CXL. Scoring of pain and foreign body sensation, slit lamp examination, uncorrected visual acuity (UCVA) and best corrected distance visual acuity (BCVA), corneal topography, anterior segment optical coherence tomography (AS-OCT), in vivo corneal confocal microscopy and endothelial cell count were assessed before surgery and at 1, 3, 6 and 12 months (m) postoperatively. Paired t test was applied for statistical analysis.

Moderate pain and foreign body sensation were reported by most patients on postoperative Day (D) 1, but rapidly decreased and eventually disappeared on D3. Mild epithelial damage was observed on D1, and the epithelium fully recovered on D3. Improvement of UCVA and BCVA were recorded at 3 months and 12 months postoperatively. Orbscan Ⅱ corneal topography revealed the significant reductions of K_max and K_min from 3m to 12m (K_max, t=2.912, P<0.01, K_min, t=2.508, P<0.05) postoperatively while the other parameters remained stable. The K_max and K_min at 12m was (52.94±4.87) and (46.78±3.71) respectively, while the preoperative values was (54.37 ± 5.56) and (48.53 ± 3.57) respectively. Within 1m postoperatively, AS-OCT exhibited an increase of reflectance with a white line (demarcation line) in the anterior stroma, in vivo confocal microscopy also showed the significant thickening and increased connections of collagen fibers with maximal depth of about 133 μm. The corneal endothelial cell density remained stable ( t=0.915, P>0.05). None of the patients showed postoperative complications such as corneal infection, scarring, ulcer, persistent epithelial defect, etc.

Priliminary clinical results within 1 year postoperatively demonstrated the efficacy and safety of i-CXL for the management of progressive keratoconus. This technique was applicable for keratoconic eyes with minimum corneal thickness around 400 μm. i-CXL showed the advantage of short time consuming in surgery, rapid recovery and few complication, and has the potential to become a valid alternative for the treatment of keratoconus. (Chin J Ophthalmol, 2015, 51: 677-682)

To evaluate the safety, effectiveness and predictability of allogeneic corneal lens inlays in correcting hyperopia.

In this case series study. Twenty-one hyperopic patients (37 eyes) received allogeneic corneal lens inlays. The range of preoperative spherical equivalent was 3.25 to 10.00 D, and the mean value was (6.84±2.79)D. All the cases were followed up for 3 months. Uncorrected and best corrected visual acuity and refraction were compared before and after operation. Corneal topography and optical coherence tomography were performed. Ocular response analyzer was used to evaluate the shifts of corneal hysteresis.

No intraoperative or postoperative complications were found. Uncorrected distance and near visual acuities (UCDVA and UCNVA) were improved obviously after surgery UCDVA was improved from (4.64±0.25) to (4.89±0.14)(F=5.919, P<0.001), and UCNVA was improved from J4.94 to J1.18 (F=4.926, P<0.01). The UCNVA in 31 eyes (83.8%) was J1 at 3 months after surgery. Mild overcorrection was the state early after operation, and the refractive power was stable at 1 month after surgery. The average residual spherical equivalent was (-0.63 ± 0.94)D, which was improved significantly from (6.84 ± 2.79)D before surgery. There was no obvious hyperopic regression. The corneal biomechanics did not change before and after surgery.

Allogeneic corneal lens inlays can be used to correct hyperopic eyes with good safety, effectiveness and predictability. It provides a new choice for hyperopic patients. (Chin J Ophthalmol, 2015, 51: 683-688)

To evaluate the clinical outcome of the femtosecond laser-assisted cataract surgery (FLACS) in our first 300 cases.

In this retrospective study, the study group comprised 300 cases (300 eyes) in which FLACS was done. The control group comprised 300 cases (300 eyes) in which phacoemulsification was performed. The steps of the FLACS included capsulotomy, lens fragmentation, corneal incisions, and creation of incisions within the peripheral cornea to aid the correction of pre-existing astigmatism. After the FLACS, 2.2-mm coaxial micro-incision phacoemulsification and implantation of an intraocular lens were operated. The preoperative best corrected visual acuity (BCVA) and postoperative uncorrected visual acuity (UCVA), the cumulative dissipated energy (CDE) of the phacoemulsification, and the parameters of the FLACS, including the docking time, the suction time and the laser time, were recorded. The complications of the FLACS were analyzed.

The FLACS was successfully completed in 99.33% of the cases. The docking time was (24.6±16.8) sec, the suction time was (101.27±20.09) sec, and the laser time was (23.3±5.5) sec. The most common complications of the FLACS included suction break (7/300, 2.33%), subconjunctival hemorrhage (58/300, 19.33%), pupillary constriction (47/300, 15.67%), incision at a wrong site (13/300, 4.33% ), anterior capsular tag (17/300, 5.67% ), decentration of the capsulorhexis (11/300, 3.67%), failure to split the lens nucleus (5/300, 1.67%), and posterior capsular ruptures (1/300, 0.33%). The CDE was 5.52±5.18 in the FLACS group and 8.37±7.91 in the traditional phaco group (P<0.05). The UCVA was 0.12±0.08 and 0.13±0.11 at 1 month after the FLACS and traditional phaco, respectively (P>0.05).

Compared with the conventional phacoemulsification surgery, the FLACS can achieve less CDE and better early postoperative visual acuity. Long-term effects remain to be investigated. (Chin J Ophthalmol, 2015, 51:689-693)

Trauma is one of the main causes of corneal ulcer. It is estimated that the number of blindness caused by eye injuries and corneal ulcers reaches 2 million worldwide every year^[1]There are few clinical reports on delayed corneal ulcer after corneal trauma repair. At present, there is no clear definition of "delayed corneal ulcer". The author defines it in this article as: corneal ulcer that occurs after a period of time (1 month or more) without signs of infection after corneal trauma and good wound healing. This study retrospectively analyzed 6 cases of delayed corneal ulcer after corneal trauma repair admitted to Tianjin Eye Hospital from February to November 2014. All of them achieved good therapeutic results after treatment. The pathogenic factors, treatment methods and efficacy of this disease are reported as follows.

The patient was a 51-year-old male. The inferior temporal field of the right eye was occluded for 6 months and gradually enlarged. FFA in an external hospital was diagnosed as hiatus retinal detachment, and the macula was not affected. At that time, the visual acuity of the right eye was 0.8, and the epidermal pad compression operation was performed. Postoperative visual acuity declined and the retina did not recover. Two months after operation, he came to Chengdu Aidi Eye Hospital for treatment. Admission examination: No obvious abnormalities were found on general physical examination. Eye examination: visual acuity 0.15 in right eye and 2.0 in left eye. No obvious abnormalities were observed in the left eye. In the right eye, except for the flat part of the inferior temporal retina, the rest of the retina was flat and detached, and there was no obvious spherical bulge (Figure 1,Figure 2）。 Pigmentation area after proto-scleral buckling surgery can be seen above the temporal. Repeated examination of indirect mirror, front mirror and three-sided mirror did not find the exact hole. A small circular depression can be seen above the center of the right eye papilla. Suspected congenital papilla fovea. FFA examination: In the pre-arterial and arterial stages, there was no fluorescence in the recesses. With time, the fluorescence in the recesses appeared and gradually increased. After the background fluorescence and intravascular fluorescence receded in the late stage, strong fluorescence accumulated in the recesses (Figure 3）。 OCT examination of the optic papilla revealed a fissure outside the inner wall of the fovea above the optic papilla communicating with the retinal neuroepithelium (Figure 4,Figure 5）。 Diagnosis: Congenital papillar fovea with serous detachment of the retina in the right eye. Treatment: Vitreous gas injection under local anesthesia, injection of C₃F₈0.8 ml. Rest in prone position. The retina was completely flat on the second postoperative day. Vision is manual in front of the eye. Immediately close the laser around the optic papilla for 2 to 3 times, and rest in the prone position. Visual acuity gradually recovered to 0.3 1 month after surgery. The retinal reattachment was good. OCT revealed complete macular reduction. Three months after surgery, the visual acuity was 0.5 in the right eye and 1.5 in the left eye. Mild vitreous opacity, complete retinal repatch, macular repatch (Figure 6,Figure 7)。 Four months after surgery, the right eye was 0.7, and the retinal reattachment was good.

The patient was a 36-year-old male. On December 19, 2013, he went to the Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University due to visual loss in his left eye and discomfort for more than one month. The patient had a history of boxing injuries in both eyes and no history of systemic disease decades ago. Eye examination: visual acuity in the right eye was 1.0 and visual acuity in the left eye was 0.15. No obvious abnormalities were observed in the right eye. Mild conjunctival hyperemia in the left eye, nebulous edema of the cornea, medium-deep anterior chamber, brown retrocorneal precipitate (KP) (+), Tyndall sign, planktonic granules (+), round pupil, about 3 mm in diameter, sensitive to light reflection. The fundus of the eye is hazy, with a faint cup-to-disc ratio of 0.4, and the presence of macular central reflection. IOP: 15.4 mmHg (1 mmHg =0.133 kPa) in the right eye and 51.6 mmHg in the left eye. Gonioscopy showed that all quadrants of both eyes were wide angles, and no angular recession was observed. 2% carteolol hydrochloride eye drops, 0.2% brimonidine tartrate eye drops and 1% brinzolamide eye drops were administered to the left eye twice a day; Oral methazolamide tablets 50 mg, twice/d; Intravenous drip of 20% mannitol injection 250 ml, intraocular pressure fluctuated between 24.0 and 40.4 mmHg after 1 week of antihypertensive treatment once/d. ultrasound biomicroscope (UBM) examination showed that there were multiple cysts in the ciliary body of both eyes, and no ciliary epithelial hole or non-pigmented epithelial detachment was seen (Figure 1）。 Ocular B-ultrasound revealed flat retinal detachment in the left eye. After dilatation of the left eye, the trihedral mirror examination found that the peripheral retina was superficially detached from 8:00 to 12:00, and no hiatus was found. Preliminary diagnosis: Schwartz syndrome in the left eye. On January 9, 2014, the scleral surface condensation + fluid drainage + external compression of the left eye was performed under local anesthesia. Intraoperative anterior chamber puncture was performed to extract aqueous humor for later electron microscopy. Pressing the peripheral retina during operation revealed a sieve-shaped hole in the serrated edge above the nose. No intraocular pressure lowering drugs were used postoperatively, the intraocular pressure was 16.7 mmHg on day 1, the anterior chamber was clear, and the fundus examination showed complete repositioning of the retina. The intraocular pressure was 13.4 mmHg at 1 week postoperatively, and the visual acuity of the left eye was 1.0 at 20 days postoperatively. Retcam examination showed that the retina was flat and the compressed crest was high (Figure 2）。 The intraoperatively collected aqueous humor was electro-microscopically examined, and the external disc membrane of the optic cell was found, further confirming the diagnosis (Figure 3）。 Since the follow-up, the visual acuity, intraocular pressure and fundus are stable.

患者男性，44岁。因右眼视力下降半年于2014年4月14日到遵义医学院附属医院眼科门诊就诊。患者智力障碍，由其母亲代述：患者自幼视力欠佳，半年前右眼无明显诱因视力下降。否认外伤手术史，否认肝炎、结核、高血压、糖尿病史。患者幼时曾有"抽搐"发作，当时未予诊治，青春期后未再发作，家中未发现其他类似病例。全身检查：智力障碍，面部皮肤未见丘疹及结节。眼科检查：视力：右眼0.04，左眼0.1，矫正均不能提高。眼压：右眼15.3 mmHg (1 mmHg=0.133 kPa)，左眼13.7 mmHg。双眼球运动正常。睫状肌麻痹后裂隙灯检查法可见双眼前节、玻璃体无异常。右眼视乳头上、下及鼻侧边界清楚，颞侧可见一个直径约0.5 PD的黄白色病灶，表面轻度不光滑，黄斑区见黄白色点状病灶，视网膜程豹纹状（图1）。左眼视乳头边界清楚，其下方可见一直径约1.5 PD大小分叶状的黄白色病灶，病灶隆起表面小结明显呈桑葚状伴半透明外周边缘，其后血管不可见，黄斑区未见异常（图2）。FFA检查结果：双眼病灶处早期呈局限性低荧光，后期出现明显荧光素渗漏（图3,图4），右眼下方及鼻下方周边血管管壁漏荧光（图3）。辅助检查：血常规：血红蛋白96 g/L、血小板106×10⁹/L，余正常。胸部正位平片未见异常。结核菌素试验结果为阴性。MRI平扫双眼球、眼眶未见明显异常，孟氏孔区见不规则囊性肿物，双侧侧脑室扩大，左侧侧脑室壁见低信号、等信号结节（图5）。头颅CT平扫加增强扫描：双侧侧脑室扩大，侧脑室壁见多发斑点、结节状钙质密度影，边缘清晰最大者为11 mm×10 mm，孟氏孔区左旁见不规则囊实性肿物，伴钙化，增强扫描肿物不均匀强化（图6），右侧小脑半球皮层见钙质结节（图7）。双眼视乳头附近眼球壁内侧分别见一钙化灶，左眼钙化灶较右眼钙化灶大（图8）。部分脑沟及脑池增宽、加深。脑中线结构居中，脑干轮廓清楚，未见颅内血肿，颅骨未见异常。头颅平扫MRI加强化检查示：双侧侧脑室孟氏孔区见多发不均匀强化结节状影，最大者位于左侧，约22 mm×15 mm（图9），右侧小脑半球、左侧侧脑室室管膜下见结节状低信号影，双侧侧脑室稍增大，部分脑沟及脑池增宽、加深。考虑孟氏孔区室管膜下巨细胞星形细胞瘤、结节性硬化、脑萎缩。诊断：结节性硬化症合并双眼视网膜星形细胞错构瘤及室管膜下巨细胞星形细胞瘤。

The patient was a 34-year-old male. On April 18, 2014, he came to the Department of Ophthalmology of Guangxi Zhuang Autonomous Region People's Hospital due to swelling and pain in his right eye with headache for 1 day. He had a history of type 2 diabetes for 6 years, and was treated with oral hypoglycemic drugs and subcutaneous insulin. The blood sugar control was not ideal, but routine fundus examination was not performed. Eye examination: visual acuity: 1.2 in right eye and 1.0 in left eye; IOP: 7.4 mmHg (1 mmHg =0.133 kPa) in the right eye and 9.8 mmHg in the left eye. Right eye conjunctiva hyperemia +, retrocorneal deposit + + +, aqueous humor opacity + +, pupil diameter 3 mm, direct and indirect light reflection sensitivity, crystalline lens transparency. No abnormalities were observed in the anterior segment of the left eye. Fundus examination of both eyes showed that the optic papilla was light in color with clear boundaries, and the fundus was scattered with hard exudation, microangioma and flaky bleeding. The arterial and venous blood vessels were light in color and showed a creamy appearance, and the arterial and venous blood vessels could not be distinguished. After asking about the medical history, the patient had been found to have fatty liver during physical examination, and suffered from acute pancreatitis in May 2013. After conservative treatment, his condition was stable. After admission, fundus photography, OCT, FFA, blood lipid, fasting blood glucose and abdominal ultrasound were examined. The results showed that the fundus image showed pale color and clear boundary of binocular optic papilla, scattered hard exudation, microangioma and patchy hemorrhage in the fundus, pale color of arterial and venous blood vessels, showing cream appearance, and arterial and venous blood vessels could not be distinguished (Figure 1）。 The results of OCT examination showed scattered punctate hyperreflex (hard exudation) in the neuroepithelial layer of the posterior pole of both eyes; Several mass hyperreflexes in the neuroepithelial layer, followed by obvious attenuation (hemorrhage); There were no vascular reflections in the choroidal layer (Figure 2）。 The results of FFA examination showed scattered microangiomas and patchy bleeding in the fundus of both eyes to obscure fluorescence, but no non-perfusion area and strong fluorescence of neovascularization were observed, showing moderate non-proliferative diabetic retinopathy (MNPDR) in both eyes (Figure 3）。 Peripheral blood showed a severe chyloid appearance, with total cholesterol 17.5 mmol/L, triglycerides 18.6 mmol/L, and fasting blood glucose 28.98 mmol/L. Abdominal ultrasound showed fatty liver and no abnormalities in pancreas. Diagnosis: Right eye iridocyclitis; Moderate nonproliferative diabetic retinopathy in both eyes; Binocular retinal lipidemia. After the diagnosis, in addition to the treatment of iridocyclitis, blood sugar and blood lipid reduction were treated concurrently. After 2 weeks of reexamination, the triglyceride was 10.1 mmol/L, the boundary of binocular papilla was clear, the color of arterial and venous blood vessels was normal, the hard exudation and bleeding were reduced compared with before treatment, and the retinal morphology returned to normal (Figure 4）。

A 41-year-old male was seen in the Department of Ophthalmology of the Second Affiliated Hospital of Nanchang University on October 16, 2012 due to red eyes, half-month vision loss and dizziness. He had a history of chronic bronchitis for more than 20 years in the past. One month ago, he was treated in an outside hospital for cough and fever, and was discharged after his condition improved. In the past half month, my conscious vision has gradually declined, so I came to the Second Affiliated Hospital of Nanchang University for treatment. Physical examination: blood pressure 120/70mmHg, clear consciousness, thin physique, crimson face, lips and palms, correct facial features of the head, soft neck, widening of intercostal space in the thorax, scattered dry rales in both lungs, no wet rales, heart rate 80 beats/min, uniform rhythm, soft abdominal wall, no enlargement of liver and spleen, and no pathological signs in the nervous system. Eye examination: the visual acuity of the right eye was 0.1, the visual acuity of the left eye was 0.5, and the correction did not improve. IOP was 15 mmHg (1 mmHg =0.133 kPa) in the right eye and 14.5 mmHg in the left eye. There was no abnormality in the eye position, conjunctiva and sclera of both eyes were congested, blood vessels were dilated, the cornea was transparent, the anterior chamber was middle-deep, and the lens was transparent. Funduscopy showed congestion and edema of the optic head, blurred boundary, thin retinal artery, arteriovenous ratio of about 2:5, arteriovenous crossover compression sign was obvious, the retinal vein was highly dilated and dark purple, the vein diameter was uneven, and the distal vein at the arteriovenous crossover was enlarged and appeared sausage-like. Multiple scattered retinal spots and patchy hemorrhage were seen on the retina (Figure 1）。 FFA examination showed that the dye development and reflux time were significantly prolonged, the boundary of binocular papilla was not clear, the small blood vessels on its surface were dilated and fluorescein leaked, the retinal veins were generally dilated and dilated in a sausage-like manner, and a large number of scattered circular hemorrhage of different sizes were seen in the omentum to block fluorescence. In the later stage, some vein walls were stained, and the papilla was intensely fluorescent (Figure 2）。 OCT examination showed obvious thickening of the retinal nerve fiber layer around the optic papilla in both eyes. Chest X-ray showed chronic bronchitis, bronchiectasis, emphysema. White blood cells 3.61×10⁹/L, red blood cells 7.23×10¹²/L, hemoglobin 300g/L, platelets 78×10⁹/L. After consultation with the hematology department, the bone marrow image was further examined. The result was polycythemia bone marrow image, and the JAKI/V617 fusion gene was positive. Diagnosis: emphysema, secondary polycythemia with fundus alterations.

The patient was a 55-year-old female. Because of the discovery of conjunctival mass in both eyes for 2 years, he went to Tianjin Eye Hospital. There were no obvious abnormalities in the whole body examination. Eye examination: the naked eye visual acuity of both eyes was 1.0; The conjunctiva of both eyes is shown inQuintessence Picture 1； Anterior segment and fundus examination of both eyes showed no obvious abnormalities; Mild vitreous opacity in both eyes. Excision of conjunctival masses in both eyes was performed. Excised tissues were examined by immunohistochemistry: CD20 (+ +), CD79a (+), CD3 scattered cells (+), CD5 scattered cells (+), CD7 scattered cells (+), CD38 (–), CD43 (+), Ki-67 focal and scattered cells (+) (Quintessence Picture 2）。 Histopathological diagnosis: small cell B-cell lymphoma of the conjunctiva in both eyes.

The patient was a 24-year-old male. Because the right eye mass was found for 45 days, he went to Tianjin Eye Hospital. Eye examination: visual acuity in the right eye was 1.0; The bulbar conjunctiva was slightly congested, and two pink pedicled neoplasms were visible on the surface of the medial canthus conjunctiva, which were papillary and soft (Quintessence Picture 1A), a mass was seen in the upper eyelid conjunctiva, with dilated blood vessels and congested eyelid conjunctiva (Quintessence Picture 1in B); The cornea is transparent; No other obvious abnormalities were seen in the anterior segment of the eye; Fundus examination showed no obvious abnormalities. Clinical diagnosis: Multiple papilloma of the right eye.

Infectious keratitis is a serious eye disease that may cause blindness. Currently, microbial culture remains the gold standard for diagnosis of many ocular infections, but the technique is limited by low sensitivity and time consuming. Developing rapid and sensitive early diagnostic methods for infectious keratitis is important for guiding timely and effective treatment in clinical practice. Molecular diagnostic techniques use detection of specific nucleic acid sequences as evidence for presence of suspected pathogens. This kind of techniques develops very fast because of its sensitive, specific, rapid and highthroughput advantages. In this review, we highlight recent advances in the application of molecular diagnostic techniques in the diagnosis of infectious keratitis, and discuss the problems and prospects of molecular diagnosis for detecting pathogens in keratitis. (Chin J Ophthalmol, 2015, 51: 709-714)

UVA-riboflavin collagen crosslinking was introduced as a clinical application to stabilize the cornea by inducing crosslinks within and between collagen fibers. It has been shown clinically to arrest the progression of keratoconic ectasia. With further researches, the technical methods of collagen crosslinking have been improved, and the treatment range has been increased. This paper covers the researches on the innovative techniques and applications of collagen crosslinking. (Chin J Ophthalmol, 2015, 51: 715-720)