Volume 51 · Issue 12 · 2015

This issue focuses on clinical and basic research related to neuroophthalmology. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Wei Shihui.

Purpose IgG4-related ocular disease is a chronic systemic disease with lymphocyte abnormal. The lacrimal glands, extraocular muscles and infraorbital nerve were often involved which was often the first symptom of systemic disease. While ophthalmologists did not know this disease well. They usually misdiagnosed it as idiopathic inflammatory pseudotumor, thyroid-associated ophthalmopathy etc, which resulted in delayed treatments. Here pathogenesis, clinical features and treatment methods of IgG4-relative ocular disease were described in order to improve awareness of this ocular disease, reduce clinical misdiagnosis, improve disease prognosis and standardized treatment. As the incidence of this disease increased in recent years, it is very necessary to improve awareness of the disease for ophthalmologists.(Chin J Ophthalmol, 2015, 51: 881-884)

Anti-vascular endothelial growth factor (VEGF) therapy has recently become the first-line treatment for wet age related macular degeneration, macular edema secondary to diabetic retinopathy and retinal vein occlusion, retinopathy of prematurity and neovascular glaucoma. It is worth thinking about whether laser photocoagulation still has its therapeutic value in these diseases. The purpose of this article is to discuss the role of laser photocoagulation in the anti-VEGF therapy era. And the article also discussed the combined treatment strategy in order to avoid clinical errors and to provide a new insight for prevention and treatment of ocular neovascular disease in the future.(Chin J Ophthalmol,2015,51: 855-887)

Keratoplasty is a kind of healthy corneal tissue to replace the patient's turbid, degenerate, infected cornea, to achieve the treatment of corneal diseases, improve the eyesight, restore the anatomical structure and improve the appearance^[1]。 According to different surgical methods, it can be divided into penetrating keratoplasty with full-thickness transplantation, lamellar keratoplasty (full lamellar and partial lamellar), corneal endothelial transplantation (with and without posterior corneal stroma) and other transplantation methods. In recent years, with the active promotion of the Keratology Group of Ophthalmology Branch of Chinese Medical Association, keratoplasty has been continuously promoted. The number of hospitals carrying out keratoplasty in China has increased significantly compared with before, and the number of various kinds of keratoplasty has also increased significantly. According to statistics, the number of corneal transplantations completed every year in the country is about 5 000. Especially the deep lamellar keratoplasty and corneal endothelial transplantation carried out in recent years, the good clinical results prompted their extensive development, but the learning curve of these two surgical methods is long, and the surgical experience and perioperative management of the surgeon are higher requirements.

With the emergence of various macromolecular ophthalmic biological agents, vitreous injection has become an important and even the only effective treatment for many fundus diseases. However, as far as the national ophthalmology industry as a whole is concerned, there is no unified and authoritative quality control standard for intravitreal drug injection, especially on some key issues involving the injection process and quality (such as staffing, equipment guarantee, drug dispensing, injection technology and post-injection follow-up, etc.), there has never been a consensus. The increasing frequency of intravitreal injection in retinopathy and its potential risks, and even the pressure on ophthalmologists caused by potentially blinding infections, all highlight the importance and urgency of quality control. In view of the work foundation of ophthalmology colleagues in major provincial and municipal hospitals and everyone's recognition of the importance of quality work, it is ripe to introduce a unified quality control standard for intravitreal drug injection.

The child was a female, 8 years old. Because of poor vision in his right eye, he went to the Department of Ophthalmology of Peking Union Medical College Hospital. Eye examination: naked eye vision is manual in front of the eye in the right eye and 1.0 in the left eye; The anterior segment of both eyes was normal. A red tumor body, about 2.5 PD in diameter, can be seen in the middle periphery of the upper temporal of the right fundus, which is connected to the thick and tortuous retinal blood vessels, and the retina around the tumor body is scattered with yellow-white exudation; The organic membrane of the vitreous body from the superior temporal of the optic papilla to the tumor body occludes the macular area (Quintessence Picture 1）。 FFA examination: the tumor body is rapidly filled with fluorescence in the arterial phase, and laminar flow can be seen in the vein connected to it; In the arteriovenous phase, the tumor body and the arteries and veins connected to it were completely filled; Tumor fluorescence continues to enhance and leak in middle and late stages, and extensive retinal hyperfluorescence can be seen (Quintessence Picture 2）。 No abnormalities were observed in the fundus of the left eye. Clinical diagnosis: Von Hippel's disease in the right eye.

The patient was a 44-year-old male. He went to Tianjin Eye Hospital because of visual acuity decrease in his left eye and visual object deformation for one and a half months. Eye examination: the visual acuity of the left eye is 0.4, which cannot be corrected; There was no obvious abnormality in the examination of the anterior segment of the left eye; For fundus examination, seeA in 1 of Quintessence Pictures。 The left eye OCT examination was performed using the American Optovue RTVue XR100-2 OCT instrument, as shown inB of 1 in Quintessence Picture。 Ultrasonography of the left eye with MD-2300 A/B ultrasound apparatus revealed a moderately echoic protuberance of the macular retina with a rough surface. Clinical diagnosis: Vitreomacular traction syndrome in the left eye.

To investigate the clinical features of ocular syndromes in patients with neurobrucellosis.

This is a retrospective series case study. The clinical data of 5 patients with neurobrucellosis, who were treated in Department of Neurology, Beijing Tongren Hospital, Captical Medical Uinversity, from May 2009 to January 2015, were collected. Their epidemiological information, clinical manifestation, laboratory and radiologic examination, therapy and prognosis were analyzed.

Among the five patients, there were 3 males and 2 females, and their ages ranged from 20 to 67 years. The median age was 25 years. All patients had ever exposed to sheep. 1 patient lived close to a slaughterhouse and 2 patients lived in epidemic areas of brucellosis. 5 patients presented with binocular vision loss, 8 eyes with fundus edema, 3 patients with ophthalmoplegia;4 patients with fever,4 patients with headache,3 patients with neck stiffness,1 patient with movement and sensation disorders. Cerebrospinal fluid (CSF) pressure elevated, white cell number and protein increased with glucose reduction were detected respectively in 3 cases. While, CSF chloride decreased in 2 cases. Serum agglutination test for brucella was positive in 5 patients. Serum brucella culture was positive in 1 patient and CSF brucella culture was positive in 1 patient. Brain magnetic resonance imaging (MRI) showed that the optic nerve was involved in 3 patients,the meninges were involved in 1 patient and the brain white matter was involved in 1 patient. The combination of rifamycin, tetracycline, ceftriaxone sodium or quinolone were given to all patients and showed appreciated effects.

The clinical features of ocular syndromes are atypical in patients with neurobrucellosis. Vision loss and ophthalmoplegia are more common to be seen. Neurobrucellosis should be considered when patients with ocular signs and other system symptoms without a definite diagnosis. (Chin J Ophthalmol, 2015, 51: 896-900)

To explore the predictive value of the prognosis and outcome for optic neuritis (ON) and neuromyelitis optica (NMO) by investigating the levels and variation of CXCL12, PDGF and CXCL14 in CSF of patients with ON and NMO.

Retrospective study. Thirty-five patients with ON, 10 patients with NMO and 10 patients with cerebral venous sinus thrombosis (CVST) were scheduled in the research unit from September 2012 to September 2013 in Neuro- Ophthalmology Department of PLA General Hospital. Clinical data and cerebrospinal fluid (CSF) parameters were collected. CXCL12, PDGF and CXCL14 concentrations were measured in CSF using enzyme linked immunosorbent assay (ELISA). The CXCL12, PDGF and CXCL14 levels in CSF were compared by using ANOVA in different diseases with different phases and recurrent cases found by MRI. Multiple comparisons were used by LSD method. The comparison of positive rate for MRI in ON different phases was used by exact probability. Meanwhile, correlation analysis was conducted between CXCL12, PDGF, CXCL14 and white blood cells (WBC), IgG and protein in CSF.

Compared with NMO group (3.69±0.35, 2.04±0.24, 7.05±0.94), the CXCL12, PDGF and CXCL14 levels in CSF were higher in ON (4.39±0.51, 2.51±0.39, 8.65±1.55) and CVST(4.84± 0.49, 2.79±0.47, 10.53±1.11) group (F=14.593, 10.060, 10.003,P<0.001, <0.001, <0.001), especially the CXCL12, PDGF and CXCL14 levels in CSF of CVST group patients were higher than that in ON group. Among them, the CXCL12 and PDGF levels in CSF were higher in acute phase of ON (4.63±0.50, 2.65±0.40) and CVST(4.84±0.49, 2.79±0.47) group than stationary phase of ON (4.13±0.39, 2.34±0.32) group ( F=8.823, 4.906, P=0.001, 0.012). In addition, 28 of 35 ON patients were conducted the cerebral or orbital magnetic resonance imaging (MRI). The result showed that the CXCL12 and PDGF levels in CSF of patients with positive finding in MRI (3.96±0.30, 2.23±0.16) were higher than those patients with negative finding in MRI (4.64±0.42, 2.62±0.42) (t=- 4.754, - 2.977, all P<0.01). Besides that, there was higher correlation between the CXCL12 level and PDGF in CSF (P<0.01).

Reduced concentration of cytokine that promoted remyelination such as CXCL12 and PDGF in cerebrospinal fluid of the ON and NMO patients may predict a bad myelin regeneration. (Chin J Ophthalmol, 2015, 51:901-906)

To report the clinical characteristics, neuto-imaging and prognosis of cavernous hemangioma of the optic chiasm.

Retrospective data analysis was conducted in 8 patients from Beijing Tongren Hospital and Beijing Tiantan Hospital. Patients' clinical characteristics, neuroimaging and prognosis were assessed.

There were eight patients aging from 16—58 years old including 3 females and 5 males. The median age was 39.5 years. From the time of onset to diagnosis, the shortest time was 25 days and the longest was 2 years and 4 months. Clinical characteristics of 8 cases were analyzed. Among 8 cases, 3 patients had acute course, 3 patient had chronic course with acute exacerbation and 2 patients had chronic course. All patients presented with decreased visual acuity and/or visual field defect and 3 cases had headache. The most common initial manifestation was decreased visual acuity and/or visual field defect (4 cases). Only 4 cases were diagnosed cavernous hemangioma of the optic chiasm before surgery. The hemangioma was total resected in 6 patients and other two got partly removed. Visual function was improved in 4 cases after surgery. MRI showed mixed signal.

All patients presented decreased visual acuity and/or visual field defect, often accompanied with headache. It can be misdiagnosed at early stage. MRI may be helpful to the diagnosis. Complete resection at early stage may improve the visual function. (Chin J Ophthalmol, 2015, 51: 907-911)

To tell the difference of Bcl-2 and Bax expression on the retina between the ocular ischemic syndrome group and the sham group.

Experimental study. To establish the ocular ischemic syndrome model by bilateral common carotid arteries obliteration (BCCAO) in BN rats. Twenty BN rats were divided into two groups randomly: 12 in the model group and 8 in the sham group. In model group, midline incised in the neck and bilateral common carotid artery obliterated. While in the sham group, midline incised in the neck with no obliteration. Pupillary reflex were detected in both groups. After 1 month, rats underwent fundus fluorescein angiography (FFA) examination. Optical coherence tomography (OCT) was used to measure and tell the retina thickness difference in both groups. Expression of Bcl-2 and Bax on rat retina and change of the Bcl- 2/Bax ratio were detected by immunohistochemical staining. Chisquare test was used for classification variable, two independent samples T test was used for quantitative data.

Compared to the sham group, only 1 eye of BCCAO group maintained its direct pupillary reflex, other eyes of the group appeared either lost or weakened their direct pupillary reflex. However, all rats in the sham group maintained their pupillary reflex. FFA showed that in the BCCAO group, retinal circulation time was significantly longer than it was in the sham group (aterial phase:t=6.19,P<0.01; arteriovenous phase:t=8.24,P<0.01; venous phase:t=2.73,P<0.05). And in the model group, the background choroidal patchy hypofluorescence and typical arterial forward phenomenon in the early phase of arterial time were observed. OCT showed that in the model group, an obvious decrease of the thickness of neuroepithelial layer of retina was observed, which was (195.67±8.84) μm in the model group and (219.31± 6.92) μm in the sham group. It had statistically significant difference ( P<0.05). Immunohistochemical staining results showed imbalance of Bcl- 2, Bax expression on rat retina. Compared with the sham group, expression level of bax which was (5.67±0.84) μm in the model group was significantly increased ( P<0.05) , while it was (2.34 ± 0.57) μm in the sham group. There was no significant difference ( P>0.05) in Bcl- 2 expression in both groups, which was (5.61±0.98) μm in the model group and which was (5.63±0.88) μm in the sham group. And Bcl-2/Bax ratio was observed statistically significant decreased ( P<0.05) in the BCCAO group compared with that in the sham group, which was (1.01 ± 0.23) in the model group, and which was (2.47±0.47) in the sham group.

BCCAO of rats lead to the injury of retina function, diminish of retinal thickness, imbalance of Bax and Bcl-2 expression. (Chin J Ophthalmol, 2015, 51: 912-917)

To evaluate the incidence of acute-onset endophthalmitis after clear corneal phacoemulsification and to report its clinical features, microbiology, and therapeutic efficacy.

It was a retrospective case series study. Medical records were reviewed for all patients diagnosed with acuteonset postoperative endophthalmitis from 2006 through 2013 associated with cataract surgery at Shandong Eye Institute of China.

The 8- year frequency of acute- onset endophthalmitis after clear corneal phacoemulsification was 0.13%. The mean time between cataract extraction and endophthalmitis onset was 6 days (median, range 1 to 37 days). Endophthalmitis onset occurred within 7 days in 57.1%. The incidence was significantly higher in summer (0.25%) than in other seasons seasons (F=8.61, P=0.05). The incidence in diabetes was 0.06% , and in non-diabetic patients was 0.16% (F=1.51, P=0.23). There were no significantly difference (F=0.003, P=0.422, ) in the endophthalmitis rates between those with capsular rupture (0.24%)and those without (0.13%). Three of the 21 cases (14.3%) were cured by antibiotic agents only. Antibiotic irrigation of the capsular bag was taken in 8 patients (38.1%). Six patients (28.6%) had both antibiotic irrigation of the capsular bag and intravitreal injection of the antibiotics and the other 4 patients (19.0%) were cured by vitreous surgery. Cultures were positive in 33.3% of cases with aqueous humor samples and in 16.7% of cases with vitreous biopsy. The culture isolates showed Staphylococcus species in 2 eyes, while Pseudomonas paucimobilis, Corynebacterium xerose, Neisseria mucosa and Enterococcus faecalis in 1 eye respectively. Sixteen patients (76.2%) achieved a final visual acuity of 20/40 or better. Five (23.8%) had worse than 20/40 to better than 20/200. No eyes were eviscerated.

Early recognition and appropriate treatment are the most important factors in the successful management of endophthalmitis. (Chin J Ophthalmol, 2015, 51: 9/8-923)

To evaluate the effectiveness and safety of a single thermodynamic treatment system (LipiFlow) for meibomian gland dysfunction (MGD).

Retrospective series case study. Forty- eight subjects with meibomian gland dysfunction were analyzed before and after 12 minutes LipiFlow system treatment. All subjects were examined before, 4 weeks and 12 weeks after this treatment. Subjective symptoms, lipid layer thickness (LLT), expressible meibomian gland, tear break-up time, meibomian gland assessment and ocular surface staining were measured. Statistical analysis was performed using SPSS 11.5 software. Analysis included those independent sample two-tailed t-tests for comparison of the mean change from baseline to 4 weeks and baseline to 12 weeks after Lipiflow treatment. Statistically significant difference was based on α=0.05 ( P<0.05).

A total of 48 cases completed the 12-week follow-up. MGD patients with LipiFlow treatment had a significant reduction in the Ocular Surface Disease Index (OSDI) scores with 45.36±19.34 before treatment, 23.82±11.94 at 4 weeks (t=2.009,P=0.035) and 25.66±14.12 at 12 weeks (t=1.976P=0.038). LipiFlow resulted in a higher number of expressible glands from 2.91±1.13 (baseline) to 6.27±2.37 (4 weeks,t=3.505,P<0.001) and 5.15±2.08 (12 weeks,t=2.004,P= 0.027) and change of secretion quality from 6.18±2.48 (baseline) to 13.55±3.46 (4 weeks,t=2.698,P=0.005) and 12.67±3.41 (12 weeks,t=2.403,P=0.009). In addition, a single thermodynamic treatment increase the LLT from (42.13±9.67)nm (baseline) to (59.02±16.39)nm (4 weeks,t=2.971,P=0.002) and (54.65±12.52)nm (12 weeks,t=2.021,P=0.021). The rate of partial blink was relieved from 0.37±0.30 (baseline) to 0.15±0.14 (4 weeks,t=3.428,P=0.035) and 0.12±0.13 (12 weeks,t=1.986,P=0.026). BUT was increased from (4.73± 2.34)s (baseline) to (9.32 ± 2.18)s (4 weeks,t=3.385,P<0.001) and (9.91 ± 3.01)s (12 weeks,t=3.253,P< 0.001). There were no unanticipated or serious device-related adverse events reported. Compared with baseline, there was no statistically significant difference in BCVA, corneal staining and intraocular pressure (P=0.141, 0.376, 0.421).

The LipiFlow system was a safety and effectiveness treatment of MGD in the 12-week study. (Chin J Ophthalmol, 2015, 51: 924-931)

The patient was a 19-year-old male. On January 7, 2014, he went to the Department of Ophthalmology, Beijing Friendship Hospital affiliated to Capital Medical University due to blurred vision in both eyes for 10 years. The patient developed dry mouth, polydipsia, polyuria, and emaciation without obvious trigger at the age of 4 years old. He had been seen in another hospital, and his blood glucose was 20.2 mmol/L, urine glucose (+ + + +), urine ketone body (-), fasting C-peptide 0.3 ng/ml (0.8~4.2 ng/ml), and insulin was checked<5 u IU/ml (2-23 u IU/ml), Insulin-related antibodies unknown. Has been diagnosed as "type I diabetes" and given insulin therapy. When the patient was 6 years old, he developed enuresis, increased urine output, clear urine as water, and nocturia 3 to 4 times/day. Water restriction and vasopressin test indicated "central diabetes insipidus". B-ultrasound revealed: double pelvic ureterosis. MRI of the head showed that the posterior pituitary lobe was short, and the T1 signal was not clearly displayed. Lumbosacral X-ray showed discontinuity of the vertebral lamina below sacral 1, which was diagnosed as "spina bifida occulta". The patient's pure tone audiometry showed high-frequency hearing loss. The patient delivered naturally at term, and the mother had no history of special infection or medication during pregnancy. The patient had no special genetic history in the family, denied consanguinity, father was healthy, the patient's mother had suffered from meningioma, which had been surgically removed, poor memory, and no limb mobility disorder. Ophthalmological examination: visual acuity in the right eye 0.1 (no improvement in corrected visual acuity), visual acuity in the left eye 0.1 (no improvement in corrected visual acuity), intraocular pressure in the right eye 12 mmHg (1 mmHg =0.133kPa), intraocular pressure in the left eye 11 mmHg, no abnormalities in the anterior segment of both eyes, atrophy of optic nerves in both fundus, thin retinal arteries, and poor macular reflection in both eyes (Figure 1）。 Dynamic visual field examination indicated: binocular tube vision; Electrophysiological examination showed that both eyes of graphic VEP were extinguished. Diagnosis: Wolfram syndrome (i.e. diabetes insipidus-diabetes-optic atrophy-hearing loss syndrome), also known as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness) syndrome.

患者女性，52岁。因左眼酸痛半个月，加重伴左侧头痛、视物不见1 d，于2014年2月15日至江苏省常熟市第二人民医院眼科就诊。眼科检查：右眼视力0.5、左眼光感。右眼角膜透明，前房浅，房水闪光（-），瞳孔圆、居中、直径3 mm、对光反应灵敏，晶状体轻度混浊，眼底视盘界清，C/D 0.3，视网膜平伏。左眼结膜混合性充血，角膜水肿，前房浅，瞳孔散大、直径约7 mm。眼压：右眼19 mmHg (1 mmHg=0.133 kPa）、左眼指测T+2。超声生物显微镜检查：前房中央深度右眼1.77 mm，左眼1.72 mm；右眼颞上方房角关闭，其余部位房角裂隙状开放；左眼颞侧房角裂隙状开放，其余部位房角关闭。否认药物过敏史，全身检查未见皮疹及色素沉着等改变。临床诊断：急性闭角型青光眼左眼发作期，右眼临床前期。入院后应用甘露醇、马来酸噻吗洛尔滴眼液、硝酸毛果芸香碱滴眼液降眼压，口服醋甲唑胺片50 mg，每日2次。角膜水肿消退后左眼视力达到0.5，检查视野：右眼平均变异-1.76 dB，模型标准变异2.75 dB；左眼平均变异-3.61 dB，模型标准变异2.86 dB。2月21日行左眼小梁切除术，术后头孢呋辛钠1.5 g静脉滴注，每日1次，连续5 d；地塞米松磷酸钠注射液5 mg静脉滴注，每日1次，连续6 d；妥布霉素地塞米松滴眼液、普拉洛芬滴眼液滴术眼，左眼眼压稳定于14~18 mmHg。于3月3日行右眼激光周边虹膜切开治疗，过程顺利，见房水顺利自后房由激光切开孔流入前房，前房加深，但激光切开孔周围色素脱落较多。右眼滴妥布霉素地塞米松眼液、普拉洛芬眼液抗炎，眼压维持在14~20 mmHg。3月7日诉右眼红痛、眼痒，检查右眼结膜混合性充血，角膜水肿，瞳孔散大直径约7 mm，右眼眼压58 mmHg，左眼眼压17 mmHg。应用甘露醇、马来酸噻吗洛尔眼液、硝酸毛果芸香碱眼液降眼压，口服醋甲唑胺50 mg，每日两次。次日晨右眼眼压20 mmHg，出现双手掌，双足掌，口唇起疹，瘙痒感明显，停用醋甲唑胺，应用甲基强的松龙40 mg静脉滴注，每日2次；口服盐酸左西替利嗪片5 mg，每日1次，抗过敏治疗2天后皮疹继续进展蔓延至四肢、躯干、颈部、面部，融合呈紫癜样改变，双手及双足部出现水疱并逐渐加重，尼氏征（＋）。复查血常规：白细胞计数5.3×10⁹/L，中性粒细胞比例78.2%，淋巴细胞比例11.8%。复查肝、肾功能及电解质未见异常。转皮肤科治疗。血培养阴性。皮肤表现继续加重，甲基强的松龙增加至60 mg静脉滴注，每日两次，根据病情逐渐减量，治疗2周后双足部和双手部皮肤水疱、渗出逐渐减轻，皮肤结痂干燥并逐渐裂开脱落（图1）。出院后醋酸泼尼松片10 mg口服2周。出院2个月后皮肤紫癜样改变消退，遗留色素沉着。

The child was a female, 1 year old. Due to the displacement of his right eyeball for more than 2 months, he was hospitalized in the Institute of Orbital Diseases of Armed Police General Hospital on February 4, 2013. The patient has developed right upward eyeball displacement since December 2012 (Figure 1), gradually aggravated, denied the history of ocular trauma, performed orbital CT examination, found right orbital tumor, admitted for treatment. The child had a full-term cesarean section, no abnormalities in the development process, and was in good health in the past. There were no obvious abnormalities in the whole body examination after admission. Ophthalmology: Right eye: visual acuity examination does not cooperate, eyelid is slightly swollen, the lower part of the orbit can be palpable with a mass, the texture is tough, the eyeball is obviously displaced upward, the conjunctiva is congested, the finger test orbital pressure (+), and the rest of the examination does not cooperate. Left eye: eye movement can chase objects, but the rest of the examination does not cooperate. Orbital CT revealed a massive soft tissue density shadow below the right orbit, no normal inferior rectus muscle structure, and the tumor spread to the orbital tip (Figure 2）。 Orbital MRI revealed: mass-like abnormal signal shadow under the right orbit, medium signal in T1 and medium signal in T2, and non-uniform enhancement of tumor after injection of booster. Orbital color Doppler ultrasound showed that there was a hypoechoic mass below the right eyeball, about 3.3 cm ×2.0 cm ×1.3 cm in size, with clear boundaries, uniform internal echoes, and scattered strong echoic spots. Color Doppler blood flow examination showed that there was a rich blood flow signal in it, and spectral Doppler examination showed that it was low impedance spectrum.

患者女性，13岁。因发现双眼眼压高5年余，右眼加重1年，于2014年2月11日至华中科技大学同济医学院附属同济医院眼科就诊。患者于2008年6月无明显诱因出现双眼红，无流泪畏光，无明显眼痛，于当地医院检查发现右眼眼压42 mmHg （1 mmHg= 0.133 kPa），左眼眼压32 mmHg，考虑为"双眼继发性青光眼"，予以酒石酸溴莫尼定滴眼液（爱尔兰艾尔建公司）等药物治疗，未见明显好转，于2008年7月在当地医院行双眼掺钕钇铝石榴石激光虹膜周边切除术，术后予以酒石酸溴莫尼定滴眼液、布林佐胺滴眼液（英国爱尔康公司）等治疗，术后每半年复查一次眼压，控制尚可。1年前患者右眼眼压再次升高（维持在30 mmHg以上），药物调整为布林佐胺滴眼液右眼每日2次、曲伏前列素滴眼液（美国爱尔康公司）双眼每晚1次。右眼眼压控制不理想，遂于2014年2月来我院就诊，入院检查：视力右眼-11.00 DS-0.25 DC×135°→0.8，左眼-9.5 DS-1.25 DC× 40°→1.0；非接触式眼压计（non-contact tonometer，NCT）测眼压右眼28 mmHg，左眼16 mmHg（左眼停用曲伏前列素滴眼液后次日眼压可升至30 mmHg以上）；双眼眼睑无水肿及畸形，结膜无充血，角膜透明，未见明显角膜后胚胎环，角膜后沉积物（-），房水清，闪光（-），右眼1~3点钟、7~8点钟、9点钟、10~11点钟方位及左眼3点钟、7~8点钟方位周边虹膜与前方角膜内皮粘连，双眼周边前房最深处大于1个角膜厚度，双眼虹膜基质可见不同程度萎缩（图1），以右眼虹膜萎缩较重，右眼下方虹膜可见激光周边切除孔；双眼瞳孔直径约3 mm，形态欠圆，对光反射灵敏，晶状体透明，晶状体中央前表面可见虹膜色调毛刺状虹膜残膜（右眼较严重，20余颗），玻璃体未见明显混浊；眼底：C/D右眼0.8 （图2A）、左眼0.3（图2B），余双眼眼底未见明显异常。角膜内皮细胞计数：右眼3 322个/mm²、左眼3 649个／mm²，双眼内皮细胞形态均匀规则。视野检查提示右眼上方视野呈弓形缺损，左眼视野基本正常。UBM检查提示双眼虹膜基质部分萎缩变薄，局部周边虹膜与前方角膜相连（图3）。患者自幼高度近视，未发现牙齿、心脏等其他部位畸形。入院初步诊断为Rieger异常、双眼先天性青光眼、屈光不正。于2014年2月25日全身麻醉下行右眼小梁切开术，术后患者右眼眼压降至正常（15 mmHg左右），左眼继续用曲伏前列素滴眼液控制眼压。术后1个月患者复诊测眼压（NCT：右眼12.5 mmHg，左眼15 mmHg），术后3个月患者复测眼压（NCT：右眼13 mmHg，左眼14.5 mmHg）。

Neuromyelitis optica (NMO) is a kind of demyelinating disorder that preferentially affects the optic nerves and spinal cord and results in permanent vision loss. There is no effective treatment so far. In recent years, monoclonal antibodies (mAbs) have been applied in a number of clinical drug trials and basic researches in NMO therapy due to its specificity and uniformity. Phase I clinical study found that, symptoms significantly improved in some patients after mAbs treatment. This review will expound the therapy classification, mechanism of action and clinical results involving mAbs, and provide reference for the clinical treatments of NMO.(Chin J Ophthalmol, 2015, 51: 942-945)

Optic neuritis(ON) is one of common neuro-ophthalmologic diseases which cause vision loss in young and middle-aged population. There are obvious differences in the incidence and the epidemiological characteristics among different countries and regions. A number of studies on ON have been carried out at home and abroad. In China, it is still lack of multi-center, prospective, large sample epidemiological studies so far. This paper reviews the epidemiological characteristics of ON through the related domestic and overseas literatures. (Chin J Ophthalmol, 2015, 51: 946-949)

DNA methylation is a major event of epigenetic modifications. In the presence of DNA methyltransferases (DNMT), the addition of methyl groups from cytosines can impact gene expression and alter cell and organism function. Methyl groups of CpG sites in the promoter can directly interfere with binding of transcription factors to their recognition cis elements or, on the other side, can facilitate interaction with a family of methyl-binding proteins and result in gene silencing. Analysis of DNA methylation includes genome-wide DNA methylation assessment, analysis of gene-specific DNA methylation and finding of new DNA methylation sites. The implication of DNA methylation has been suggested with the pathogenesis of retinoblastoma, uveal tract melanoma and ocular surface tumor. We focus on the progresses of DNA methylation on ocular tumors in this article. (Chin J Ophthalmol,2015,51: 950-954)

optic neuritis (ON) generally refers to various inflammatory reaction lesions involving the optic nerve. It is the blinding optic nerve disease most vulnerable to young and middle-aged people. In the 2014 expert consensus ON the diagnosis and treatment of ON proposed by the Neuroophthalmology Group of the Ophthalmology Branch of the Chinese Medical Association, ON was classified into idiopathic ON, infectious and infection-related ON, autoimmune optic neuropathy and other unclassified ON.^[1]。 The most common of these is idiopathic ON, also known as demyelinating ON. Classification of demyelinating ON: (1) idiopathic demyelinating ON (IDON), also known as classical multiple sclerosis-related ON (MS-ON); (2) neuromyelitis optica-related optic neuritis (NMO-ON); (3) Other central nervous system demyelinating diseases associated ON. A large number of literatures have confirmed that compared with Caucasians, the incidence of neuromyelitis optica (NMO) in Asians is much higher than that of multiple sclerosis (MS). Similarly, the incidence of NMO-ON was also higher than that of MS-ON.

Bloody tears are symptoms of bloody tears coming out of the eyes^[1,2]。 It is not uncommon in clinical work, but because the amount of blood and tears shed by most patients is not large and the color is light, it is often not taken seriously. There are many causes of blood and tears, and the symptoms of blood and tears caused by different causes are also very different. Most patients show blood in tears, and only a few patients show blood. In recent years, reports on blood and tears have increased gradually at home and abroad^[1,2,3]However, due to the complex and diverse causes of blood and tears, the pathogenesis is still unclear, and the diagnosis and treatment are difficult, which often causes trouble for clinicians. It is helpful to understand the etiology, pathogenesis and diagnosis and treatment of blood tears in clinical diagnosis and treatment and further research.