Volume 51 · Issue 10 · 2015

Uveitis, as one of the major cause of blindness worldwide, seriously harms patients' vision and quality of life. The social and economic burden caused by uveitis cannot be ignored. Remarkable achievements in basic and clinical uveitis research were gained after decades of unremitting efforts by Chinese ophthalmologists. A number of original results and breakthroughs were achieved in researches on Behcet's disease, VKH syndrome and other important types of disease that lead to blindness. We are integrating the power of the Chinese Ocular Immunology Association, conducting multi-center collaborative research, and establishing the uveitis sample bank of Chinese. We need to train more uveitis specialists in the future, establish diagnostic and treatment practices of different types of uveitis, accelerate the research on main diseases which lead to blindness, further enhance the overall level of uveitis study, and enhance China's research position in international uveitis.(Chin J Ophthalmol, 2015, 51: 721-725)

As increasingly frequent immigration in China, the prevalence of drug-resistant tuberculosis (TB) as well as special populations (acquired immune deficiency syndrome, diabetes, etc.) continue to increase, ocular tuberculosis has become an important cause of infectious uveitis. Because the clinical manifestations of this disease manifested in various forms, currently it lacks a unified reliable diagnostic criteria. Misdiagnosis could occur and cause patients' visual loss.The diagnostic criteria for tuberculous uveitis in Chinese patients, the standardized anti-TB therapy and the prevention of tuberculous uveitis in immune dysfunctionalpatients should be made and noted as early as possible by all the ophthalmologists.(Chin J Ophthalmol, 2015, 51: 726-729)

The patient was a 25-year-old male. Due to abnormal fundus found in physical examination, he went to the Department of Ophthalmology of the 401 Hospital of the People's Liberation Army. No previous symptoms of night blindness, denying the history of close marriage of parents. Eye examination: visual acuity in both eyes 1.5, normal intraocular pressure; No obvious abnormalities were observed in the anterior segment of both eyes; Dilated pupil examination fundus condition seeQuintessence Picture 1。 Objectively, the rapid dark adaptation time was 58 s, which was close to the upper limit of normal value (the normal value range was 6~60 s). No obvious abnormality was found in visual evoked potential and visual field examination. Clinical diagnosis: White dotted fundus in both eyes combined with myelinated nerve fibers in the right eye.

The patient was a 31-year-old female. He went to the Department of Ophthalmology, Affiliated Hospital of Qingdao University because of the decrease of visual acuity in his right eye for 3 years. Eye examination: the visual acuity of the right eye was 0.4, which could not be corrected, and no obvious abnormalities were found in the anterior segment of the eye; The infratemporal branch of the fundus retinal vein runs abnormally and invades the macular area (Essence Picture 1A、Quintessence Picture 1B）。 FFA examination: abnormally running retinal vein without leakage (Quintessence Picture 1C）。 OCT examination is presented inQuintessence Picture 2。 Clinical diagnosis: congenital retinal vascular abnormalities in the macular area of the right eye.

The patient was a 22-year-old male, Pakistani. Because of blurred vision in both eyes for 1 week, he went to the Department of Ophthalmology of Peking Union Medical College Hospital. Previous history of anemia. Eye examination: visual acuity in both eyes was 0.25, which could not be corrected; The intraocular pressure in both eyes was normal, and the refractive interstitial was clear; For both fundus examinations, seeQuintessence Picture 1。 Clinical diagnosis: anemia-associated retinopathy in both eyes.

The 16th National Academic Conference on Strabismus and Pediatric Ophthalmology, sponsored by Ophthalmology Branch of Chinese Medical Association, and hosted by Strabismus and Pediatric Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association and Peking University People's Hospital, will be held in Beijing from October 16 to 18, 2015. This academic conference will invite well-known experts at home and abroad to give academic lectures on basic and clinical research on strabismus, amblyopia, childhood optometry, congenital cataract, congenital glaucoma, infantile vitreoretinal diseases, childhood eye trauma, childhood hereditary eye diseases and childhood eye health care.

The Asian Association of Neuroophthalmology (ASNOS) was founded in 2002 in Tokyo, Japan. The Asian Neuroophthalmology Congress, hosted every two years by the Asian Neuroophthalmology Association, is a large-scale international neuro-ophthalmology conference, representing the highest level of basic and clinical research in neuro-ophthalmology in Asia. In previous conferences, hundreds of neuro-ophthalmology professionals from various countries conducted academic exchanges, introduced and discussed the recent international neuro-ophthalmology new technologies and academic frontiers. The Asian Neuroophthalmology Congress provides an international platform for participants from around the world to exchange ideas on cutting-edge neuroophthalmology research topics, discuss the latest advances and promote future cooperation. in Walsh in Asia, a particularly well-known and important case discussion section of the Asian Congress of Neuroophthalmology, it is very challenging to select outstanding cases with pathological findings from various countries for in-depth analysis.

The studies and clinical applications of Ranibizumab and Bevacizumab which are new anti-VEGF drugs have made significant progression on the treatment of corneal neovascularization. The effectiveness and safety of Ranibizumab compared with Bevacizumab has been the focus of the debate for scholars nowadays. Some experiments showed that the effect of Bevacizumab was better than Ranibizumab. But combined with our experiments, Ranibizumab represented the advantages of shorter effect time, stronger affinity with VEGF-A, better tolerance with repeated injections etc. So we believed that the adequate doses of ranibizumab had better effects. Its clinical application should be paid much attention. (Chin J Ophthalmol, 2015, 51: 730-733)

To observe the efficacy and safety of subconjunctival triamcinolone acetonide injections in the treatment of uveitic macular edema (UME).

A retrospective case series study. The clinical data of uveitis patients with macular edema were collected and analyzed at Peking Union Medical College Hospital from July 2009 to June 2014 with a minimum follow-up period of 6 months. The main outcome was central macular thickness (CMT) measured by optical coherence tomography at the 1st and the 3rd month after injection. The secondary outcomes included best corrected visual acuity (BCVA) at the 1st and the 3rd month, recurrence rate and intraocular pressure (IOP) within 6 months after injection.

Thirty two patients (37 eyes) were included in the study. At the 1st month after the first injection , 24 of the 37 eyes (64.9%) showed an obvious reduction of CMT (at least 20%), among them 15 eyes (40.5%) showed a total resolution. The mean CMT decreased from (498.9±211.9) μm at baseline to (392.4±232.3) μm ( t=-4.070, P<0.01). The BCVA improved in 20 eyes (54.1%) and 15 eyes (40.5%) gained more than 0.2 log MAR unit. The mean BCVA increased from logMAR, 0.45 ± 0.29 at baseline to logMAR, 0.33 ± 0.30 (t=-4.835, P<0.01). No statistically significant difference was found in mean CMT or BCVA in 23 eyes between the 1st and the 3rd month after injection. These eyes didn't receive any additional medications for improvement of the condition. Seven eyes (30.4%, 7/23) got a second injection because of relapse within 6 months after the first injection and the efficacy was good. The elevation of IOP over 21 mmHg (1 mmHg= 0.133 kPa) were observed in 9 eyes and 3 eyes after the first and the second injection respectively. All of them were well controlled by either topical IOP lowering drugs or removal of the subconjunctival TA deposition.

Subconjunctival injection of triamcinolone acetonide is an effective and safe method for uveitic macular edema. (Chin J Ophthalmol, 2015, 51: 734-738)

To investigate the clinical manifestations of syphilitic uveoretinitis in patients co-infected with human immunodeficiency virus (HIV).

Uveoretinitis patients presenting between January 2008 and December 2014 at Eye and ENT Hospital of Fudan University were collected. Patients were selected with positive serologic tests, including rapid plasma regain titer (RPR) > 1 : 8, treponema pallidum particle agglutination assay (TPPA) and human immunodeficiency virus (HIV). Other causes of uveoretinitis were excluded. Each patient underwent complete ophthalmologic examination including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, ophthalmoscopy, applanation tonometry and B-scan ultrasonography. Fundus fluorescein angiography were obtained in each case except for patients whose fundus was blurred with dense vitritis. Optical coherence tomography (OCT) was performed in selected patients. Thorough physical examination was performed simultaneously.

Twenty six patients were included in this study including 24 male (92.3%) and 2 female (7.7%). The mean age at presentation was 39.3±13.2 (range 20 to 63 years). RPR titres ranged from 1:32 to 1:512. There were 49 eyes altogether and ocular involvement was bilateral in 23 patients (88.5%) and unilateral in 3 patients (11.5%). Panuveitis was the most common ophthalmic presentation (n=39, 79.6%). Only two eyes were anterior uveitis (4.1%) and 8 eyes were posterior uveitis (16.3%). Anterior chamber cells +++ and mild to severe vitreous opacities were observed. Sixteen eyes presented with neuroretinitis (32.7%), 27 eyes had vitritis (55.1%), 5 eyes had retinochoroiditis (10.2%), 5 eyes had optic neuritis (10.2%), 5 eyes had retinitis (10.2%) including 2 eyes with necrotizing retinitis (4.1%), 4 eyes had retinal vasculitis (8.2%). Two eyes (11.5%) presented with posterior placoid chorioretinitis (4.1%) and multifocal choroiditis (4.1%). Systemic manifestations were detected. Five patients had a history of skin rash (19.2%), five (19.2%) had genital ulcers, three (11.5%) had chancre, two (7.7%) suffered from headache, two (7.7%) had a fever, one (3.8%) had oral ulcers and one patient (3.8%) lost his hair.

The clinical features are protean and lack of specificity. The most common manifestations was neuroretinitis, ususlly with vitritis. (Chin J Ophthalmol, 2015, 51: 739-745)

To study the relationship between the structure of macular central fovea and the best-corrected visual acuity (BCVA) during remission stage of Behcet's disease associated uveitis.

Retrospective case series studies. The study covered 51 patients (79 eyes) during remission stage of Behcet's disease-associated uveitis from Peking Union Medical College Hospital in a three-year period from January 2012 to January 2015. There were 40 males, 11 females with the average age of 31.5±6.9 years old (ranging from 18 to 46). All the patients received a complete set of ophthalmic examination, including BCVA, intraocular pressure, slit-lamp microscope, ophthalmoscope and frequency domain optical coherence tomography (OCT). All the eyes were divided into 4 groups according to central macular thickness (CMT) (the thick CMT group: CMT≥130 μm; the thin CMT group: CMT<130 μm) and the existence of ellipsoid zone. Group 1: thick CMT and ellipsoid (+); Group 2: thick CMT and ellipsoid (-); Group 3: thin CMT and ellipsoid (+); Group 4: thin CMT and ellipsoid (-). Sight disparity among multiple groups was tested with Kruskal Wallis, while the difference between two groups was tested with Mann-WhitneyU test. Bonferroni correction was conducted when necessary.

The mean CMT was (151.4±62.3) μm in all eyes (43 eyes in thick CMT group, 36 eyes in thin CMT group). According to grouping rule, there were 32 eyes in group 1, 11 eyes in group 2, 2 eyes in group 3 and 34 eyes in group 4. The BCVA of thick CMT group was better than that of thin CMT group (logMAR0.1 and logMAR1.0) ( z=-6.88, P<0.01). In addition, the BCVA of ellipsoid (+) group was better than the ellipsoid (-) group. (log MAR0.1 and log MAR1.0) (z=-6.60, P< 0.01).

Thick CMT and intact ellipsoid zone usually associated with relatively better BCVA in Behcet's disease-associated uveitis patients. (Chin J Ophthalmol, 2015, 51: 746-749)

To observe the peripheral retinal changes of anterior uveitis patients using ultra-wide field fluorescein angiography.

Retrospective case series study. Thirty-three eyes of 20 patients diagnosed as anterior uveitis from September to November 2013 in the ophthalmic clinic of Peking University First Hospital was included. All the patients underwent routine ocular examination, followed by ultra-wide field Fluorescein.

There were 13 male patients and 7 female patients, aged 23—66, an average of 46 years old. The anterior uveitis recurrent in both eyes in 13 patients and only one eye in 7 patients. Uveitis duration ranging from months to 30 years. Twenty eyes were at the active stage of the anterior uveitis while 13 eyes in the quiescent stage. Peripheral retinal vessels leakage was detected in 57.6% (19/33) of the eyes, among which in eyes with active disease the rate of peripheral retinal vessels leakage was 75% (15/20), and in eyes with quiescent disease the rate was 30.8% (4/13). Optic disk hyperfluorescence was found in 6 of 20 eyes with active disease. Cystoid macular edema was found in 4 eyes. In addition, peripheral retinal hyperfluorescence dot and zone were detected in 2 eyes.

Peripheral retinal vessels were detected to have inflammative leakage in patients of anterior uveitis by ultra-wide field fluorescein agiography. Peripheral retinal inflammation may still exist even in the quiescent stage of the anterior uveitis. (Chin J Ophthalmol, 2015, 51: 750-753)

To investigate the protective efficacy of leflunomide on the Lewis rats with experimental autoimmune uveitis (EAU).

Complete randomized controlled trials research. Lewis rats were immunized with interphotoreceptor retinoid-binding peptide (IRBP) in order to build the model of EAU. Rats were randomized assigned into four groups, that is control group as A, model group without leflunomide as B, model group with leflunomide administrations as C, and model group with cyclosporine A as D. Rats in group C received intragastric administration of three doses of leflunomide at 3mg/kg/d; 6mg/kg/d; 12mg/kg/d. Rats in group D received 10 mg/kg cyclosporin A were considered as a positive control. Each group has 6 to 8 rats. At the second day of immunization with IRBP, rats were intragastric administrated one time every day till day 13. Rats were investigated for EAU symptoms under slit lamp. Enucleated eyes were collected for sections with HE staining as histopathological evidences at the peak point of disease activity day 14. Treatment effectiveness was evaluated referred by Agarwal standard for clinical EAU and histopathological scoring. The expression of IL-17 in ocular sections was detected by immunohistochemistry (SP method). The expression levels of IL-17 and IFN-γ in the serum were quantified by ELISA. Intracellular expression of IL-17 in the activated CD4 + T cells was assessed by flow cytometry. Ocular of rats were harvested and mRNA expression of IL-17 and IFN-γ were quantified through RT-PCR. Continuous variables were reported as mean ± SD. The comparison among groups was done by using analysis of students't test. Nonparametric test was used in Hierarchical data comparison and multiple comparison method was Bonferroni.

The model of EAU disease was built successfully in Lewis rats. With giving IRBP for 14 days, the clinic EAU scores were lower in model rats than those without leflunomide. Moreover, the effects of leflunomide on the clinic EAU scores was dose-dependent. Comparing to vehicle-treated eyes, treatment with leflunomide significantly prevented the onset of EAU-induced ocular inflammation [1.5 (1,2) vs. 3 (3,4), P=0.0006, P<α', α'=0.05/15]. The pathological examination showed model rats eye characterized by severe inflammatory cells infiltration and all layers of retina damaged. The pathologic grade was significant higher in model group than in medium dose leflunomide. [3(3, 4) vs. 2(1,3),P=0.0014, P<α', α'= 0.05/15]. IL-17 was positively expressed in iris, ciliary and retina in model group. While, it was markedly reduced in leflunomide-treated eyes. Flow cytometry detection found that compared with normal group, Th17 cells rates in rats' spleen of model group also increased significantly (8.5%±1.3% vs. 0.5%±0.2%;t=8.057, P=0.000, P<α', α'=0.05/15). Compared with model group, Th17 cells in spleen of rats in leflunomide groups showed a decreased number by flow cytometry. And it showed dosage dependent. It was significant different between different doses leflunomide treated group compared with control group. The results showed as below, in low dose group (4.1%±0.6% vs. 8.5%±1.3%;t=6.372, P=0.01, P<α', α'=0.05/15), in medium dose group (2.8%±0.2% vs. 8.5%±1.3%;t=4.49, P=0.002, P<α', α'=0.05/15) and in high dose group (1.8%±0.2% vs. 8.5%±1.3%;t=5.743, P=0.000, P<α', α'=0.05/15). Gene expression of IL-17 and IFN-γ were markedly reduced in leflunomide-treated eyes. Leflunomide significantly decreased the serum levels of IL-17 and IFN-γ. Compared with model group, in leflunomide-treated low dosage group (0.603±0.03 vs. 0.787±0.104;t= 0.183, P=0.002, P<α', α'=0.05/15), medium dosage group (0.535±0.048 vs. 0.787±0.104;t=0.252, P=0.000, P<α', α'=0.05/15) and high dosage group (0.374±0.051 vs. 0.787±0.104;t=0.412, P=0.000, P<α', α'=0.05/15), IL-17 mRNA showed lower expression. Moreover, IFN-γ mRNA in the tissue of EAU eyes were suppressed by medium dosage leflunomide group (0.375±0.018 vs. 0.427±0.056;t=0.69, P=0.001, P<α', α'= 0.05/15) and high leflunomide dosage group respectively (0.367±0.018 vs. 0.427±0.056;t=0.077, P=0.000, P<α', α'=0.05/15) . The difference was statistically significant. All the results suggested that IL-17, which was secreted by Th17 cell, a subtype of T lymphocytes, might play an important role in the pathogenesis of uveitis.

Oral administration of leflunomide effectively suppressed IRBP-induced uveitis in rats, not only reduced exudation in iris but also alleviated the infiltration damage of inflammation cells in fundus. It might be ascribed to the effect that leflunomide could treat inflammation by down-regulating the expressions of IL-17 and IFN-γ. Therefore, it suggested that leflunomide had protective effects against EAU in Lewis rats.(Chin J Ophthalmol, 2015, 51:754-761)

To isolate and cultivate the Lacrimal gland Adenoid Cystic Carcinoma cells line, study Cancer Stem Cells properties.

Experimental study. Lacrimal gland adenoid cystic carcinoma cancer stem cells were cultivated in serum-free suspension culture and the morphological changes were observed. Cells were divided into two groups, the LACC-CSC experimental group and the LACC control group. The flow cytometry instrument was used to detect the expression of classical stem cell markers CD133 and ABCG2. Transwell chamber was used to detect the cancer stem cell aggressivity and differentiated into the vascular endothelial cells. The tumorigenic force in vitro xenotransplantation were applied.

LACC cells can grow suspensively after vaccinated in serum free medium and form tumor microspheres after 10-12 days. Flow cytometry experiments showed that the expression ratio of stem cell markers CD133 in LACC-CSC was (35.67 ± 6.86)% , significantly different to LACC with (0.46 ± 0.48)% , (t=8.867, P<0.05). Similarly ,the expression ratio of stem cell marker ABCG2 in LACC-CSC was (39.99±4.54) %, significantly different to LACC with (6.75±1.34) %,(t=-9.932, P<0.05). In vitro experiment of Matrigel invasion, LACC-CSC went through the matrigel basement membrane averagely (32.60 ± 8.79)/HP contrary to LACC with average (10.20±2.77)/HP after 24 hours, showing statistically significance(t=5.433, P<0.05) between the two groups. After training for 48 hours, the difference between two groups was still obvious (t=5.779, P<0.05) with LACC-CSC average(62.60 ± 4.83) /HP to LACC (44.00 ± 5.34) /HP. When induced by serum medium containing VEGF and bFGF, LACC-CSC grew adherent gradually and cell morphological changes occurred after continuous induction to long spindle cells. When cultured into three-dimensional matrix structure they formed vessel samples and expressed vascular endothelial marker CD31 and CD34. Transplanted tumor in vitro experiment, mice of LACC-CSC group grew tumors in 9 days with 100% tumorigenic rate, whereas LACC group 12 days with 100% tumorigenic rate.

LACC-CSC can be obtained through serum-free culture method. LACC-CSC grew suspensively and expressed classical stem cell markers. LACC-CSC were identified as cancer stem cells with stronger migration and invasion. LACC-CSC have tumorigenic force and multi-directional differentiation potential with general characteristics of the stem cell. (Chin J Ophthalmol, 2015, 51: 762-767)

To understand the distribution of visual impairment caused by trachoma in China and provide evidences for evaluation of eliminating blinding trachoma in China in the mission of Vision 2020.

Sampling study. The results from the first year 1987 and second (year 2006) national sampling surveys of disabled persons were analyzed. Chi-square test was performed using SAS 9.30 to analyze the rates of visual impairment caused by trachoma in different groups. Unifactor and multifactor analyses were applied to analyze the relevance between visual impairment caused by trachoma and risk factors, including gender and age.

The rate of visual impairment caused by trachoma was 102.01 persons/100 000 in 1987 and 17.62 persons/100 000 in 2006. The percentage of trachoma in all kinds of visual impairment was 14.25% in 1987 and 1.87% in 2006, and the difference was significant (F=1 382.6, P<0.01) . Spatial aggregation was obvious in visual impairment caused by trachoma. H-aggregation areas included Hubei, Sichuan, Anhui, Shannxi, Guizhou, Hunan provinces and Chongqing Municipality. Survival time without trachoma between 1987 and 2006 was significantly different (F=2 745.9, P<0.01) . The rate and risk of visual impairment caused by trachoma increased with age. Except the group of>85 years, the rate of visual impairment caused by trachoma in all age groups in 1987 was significantly higher than that in 2006. The risk of visual impairment caused by trachoma in 1987 was 5.8 times that in 2006. If the other risk factors were not involved, the risk in 1987 was 8.75 times that in 2006. The risk in females was twice that in males.

Both, the rate and risk of visual impairment caused by trachoma were significantly reduced in China. Impressive progresses were achieved in trachoma prevention and control. (Chin J Ophthalmol, 2015, 51:768-772)

Top ten research items that may represent the advance of ophthalmic immunology research in China in the past 5 years were voted by specialists from the Ocular Immunology & Uveitis Group of Chinese Ophthalmological Society. These researches were concentrated in the molecular genetics and immunology study on the pathogenesis of uveitis, translational research in uveitis, and novel methods of the diagnosis and treatment of uveitis. They represent the current level of uveitis research in China and enhance our clout in the field of international ocular immunology. (Chin J Ophthalmol, 2015, 51: 773-777)

Compared with general anesthesia, strabismus correction surgery under local anesthesia can complete intraoperative suture adjustment, which significantly improves the success rate of one operation^[1]。 The key of local anesthesia surgery is the inhibition of intraoperative pain. The ideal anesthesia method can not only inhibit the pain caused by pulling muscles during surgery, but also not affect the movement of extraocular muscles. In recent years, people have begun to try strabismus correction under simple topical anesthesia^[2]However, topical anesthetics have difficulty in subconjunctival penetration. Some scholars have combined subconjunctival injection anesthesia or Tenon subcapsular anesthesia to enhance the analgesic effect^[3]However, subconjunctival edema and even subconjunctival hemorrhage caused by subconjunctival anesthesia affect the visual field of surgical operation. However, traditional Tenon subcapsular anesthesia may also cause subconjunctival edema or hemorrhage due to the large dose of anesthetic drugs and the deviation of the administration position, and will also bring restriction of eye movement, which makes it difficult to adjust sutures during surgery^[4]。 We attempted to administer a small amount (1 ml) of 2% lidocaine under the Tenon capsule around the tendon, assisted by topical anesthesia, and achieved good pain suppression effect. On the other hand, monitored anesthesia care (MAC) has been applied to strabismus correction because of its effective sedative and analgesic effects. This has also become our more routine clinical practice. This article compares pain scores under modified Tenon subcapsular + topical anesthesia and MAC + topical anesthesia and is reported below.

The child was a male, 2 years old. Due to the repeated swelling of eyelids 36 days after the welding rod was pierced into the left orbit and removed, he came to the Institute of Orbital Diseases of Armed Police General Hospital on December 10, 2004. The patient was electroded while playing 36 d ago (Figure 1) Through the upper part of the left orbit, the intracranial foreign body was pulled out through the left orbit in the emergency department. He had transient limb mobility disorder and fever after operation, and was admitted to our hospital for treatment after improvement. The physical examination of the whole body showed no significant abnormalities. Eye examination: Left eye vision examination does not cooperate, there is follow-up movement. Soybean-sized breakage and scabs on the middle of the upper eyelid. The eye position is right, the upward rotation of the eyeball is limited, and the movement in other directions is in place. Exophthalmos: right eye 11 mm, left eye 16 mm, orbital distance 86 mm. Orbital CT showed a large number of high-density shadows scattered in the upper part of the orbit, surrounded by soft tissue density shadows, local bone absence at the roof of the orbit, and high-density shadows scattered in the cranium, forming a cord shape (Figure 2）。 Admission diagnosis: left orbit and intracranial foreign body residual; Postoperative removal of left orbital and intracranial foreign bodies. On December 21, 2004, the left orbital foreign body was removed under general anesthesia. During the operation, the orbital septum of the upper eyelid was cut open. The granulation tissue was organized and wrapped in the upper part of the orbit, and yellow-green pus flowed out from the organized membrane. There were more than 10 pieces of gray-black hard foreign bodies in detritus, of different sizes, which were considered to be the shedding of welding electrode coating (Figure 3）。 After removing the intraorbital foreign body, the localized absence of the orbital parietal bone was observed. In order to avoid damage to the intracranial structure or secondary cerebrospinal fluid leakage, no exploration was made above the orbital parietal bone. Postoperative orbital CT revealed a few granular high-density shadows at the top of the left orbit, and the intracranial foreign body shadows were the same as before operation. The postoperative recovery was good, the exophthalmos was 11 mm in the right eye, 12 mm in the left eye, the orbital distance was 86 mm, and the edema at the macula of the fundus resolved.

患儿男性，7岁。因左眼球突出、流脓1月余，于2014年5月28日至武警总医院眼眶病研究所就诊。患儿于2014年4月3日出现左侧龋齿（左上5）疼痛，次日晨起患儿家长发现患儿左眼肿胀，充血，遂就诊当地眼科，给予静脉抗生素治疗，病情好转。4月14日左下睑脓肿破溃流脓，切开引流并给予抗生素治疗，无明显好转，后行"鼻窦炎"手术治疗，眼部病情好转，但窦口不愈，就诊北京某医院，诊为"牙槽脓肿伴眶下间隙感染"，行左上5牙槽脓肿切开引流加龋齿根管治疗。治疗后左眶及下睑肿胀好转，但皮肤窦道仍有脓液排出。为进一步诊治遂来我院就诊。门诊以"左眶蜂窝织炎，左下睑皮肤瘘管"收入院。患者发病以来不伴发热、头痛、眼痛，大小便及睡眠正常。既往体健，无全身免疫性疾病。入院后完善各项检查，胸片示心肺膈未见异常。血常规示：白细胞：5.87×10⁹/L，中性粒细胞58.4%，均在正常值范围内。小儿生化全项示：碱性磷酸酶157 IU/L，高于正常值（正常值15~112 IU/L）；总胆固醇3.32 mmol/L，低于正常值（正常值15~112 mmol/L）；磷1.93mmol/L，高于正常值（正常值0.8~1.6 mmol/L），余各项无异常。尿常规无异常。全身查体未发现阳性体征。专科查体：左眼视力：0.8，下眼睑水肿，外翻。下睑睫毛下5 mm处可见直径4 mm的横形窦口，伴脓性分泌物排出（图1A），无异味。泪阜结膜有瘘口，泪囊区按压有脓性分泌物溢出。泪道冲洗不配合。眼位正，眼球各方向运动到位，球结膜轻充血，余未见明显异常。指试眶压正常。口腔科检查：左上5牙槽骨根部切口（图1B），位于左侧上颌骨牙槽嵴，长1.5 cm，切口尚未愈合，挤压后有少量黄白色脓液自切口处流出。左上5牙龋齿，其内可见填充材料。三维重建CT提示左上5牙槽骨根部不连续（图2A），右上5牙槽骨根部连续（图2B）。CT提示左眶下方软组织影，眶内壁、下壁骨质不连续，左侧上颌窦、中鼻道内充满软组织影，筛窦内可见同性质病变（图3A，图3B）。MRI提示左眶下部、筛窦（图4）及上颌窦黏膜异常信号影。入院诊断为：左上牙槽脓肿合并左眶蜂窝织炎，左下睑皮肤瘘管，左下睑外翻，左下睑畸形，左眼化脓性泪囊炎，左侧鼻窦炎，左侧牙槽黏膜瘘管。于2014年6月3日在全身麻醉下行左眶、副鼻窦、泪囊脓肿清创术加口腔颊部黏膜切开脓肿引流术。

The traditional view is that lacrimal duct calculi are rare in clinic, and are easily misdiagnosed and misdiagnosed^[1,2]。 In recent years, with the application of lacrimal duct endoscope^[3]People' s understanding of lacrimal duct stones is deepening, and the literature reports on lacrimal duct stones are increasing obviously, and there are literature studies on its pathogenesis factors^[4,5]It is reported, but it is clinically rare for older siblings to suffer from lacrimal canalicular stones successively. We treated two cases, and the report is as follows.

The patient was a 77-year-old female. On July 23, 2013, he was admitted to the local hospital due to a car accident injury in his left eye for 1 day. The patient was admitted to the hospital with clear consciousness and answered the questions. He reported that he was injured in a car accident 1 d before admission. At that time, he suffered multiple deep lacerations on his face and completely lost his vision in his left eye, and was diagnosed as facial avulsion injury. Damage to the left eyeball. After debridement and suture of facial avulsion, he was transferred to the ophthalmology department of Lanzhou General Hospital of Lanzhou Military Region for treatment. The patient denied trauma to other parts of the body, and denied family history and genetic history.

Uveitis is an inflammatory disease which involves the uvea, retina, retinal vessel and vitreous body. The disease mainly affects middle age and young people with a variety of clinical manifestations and is often recurrent. If not treated properly, it will cause visual impairment and even blindness. Spectral domain optical coherence tomography (SD-OCT) is a noninvasive examination which provides clear images quickly without contacting the eyes. As the development of OCT, we can obtain the sectional images with similar resolution as histological examination. Especially, when the enhanced depth image OCT (EDI-OCT) was used in clinical, the structures of choroid could also be detected. Therefore, OCT was used more and more in uveitis patients. Anterior segment OCT (AS-OCT) is used to evaluate the inflammation in anterior chamber. It also can provide the changes of iris and corneal structures during acute phase and recovery period. SD-OCT can clearly display many kinds of retinopathy in patients with uveitis including macular edema and the changes of retinal thickness. EDI-OCT can be used to observe the changes of retina and choroid at the same time. In particular, the measurement of choroidal thickness can be used to evaluate the choroidal changes and the degree of the response to treatment. Therefore, SD-OCT helps to diagnose uveitis and is easily used in the disease follow-up and treatment effect observation.(Chin J Ophthalmol, 2015, 51: 790-794)

Primary intraocular lymphoma (PIOL) is a rare and fatal ocular malignancy. The diagnosis and treatment of PIOL is usually challenging as it often masquerades as uveitis. PIOL demonstrates characteristic features on fundus autofluorescence (FAF), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). These methods although not as a basis for diagnosis of PIOL, but can be used as the evaluation of PIOL progress and prognosis. Eye tissue biopsy is the gold standard for diagnosis of PIOL. The methods to obtain ocular fluid include anterior chamber paracentesis, fine needle aspiration biopsies of the vitreous and diagnostic pars plana vitrectomy. Cytology, immunohistochemistry, flow cytometry, cytokine analysis and molecular pathology are often used in combination to improve the diagnosis rate of PIOL. While current management of PIOL mainly involves local intraocular chemotherapy, combination therapy protocol yields effective control and prevention of PIOL relapse. This article reviewed recent research progress to improve the clinical understanding of PIOL. (Chin J Ophthalmol, 2015, 51: 795-800)

This issue focuses on clinical and basic research related to ocular immunity. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Yang Peizeng.