Volume 52 · Issue 10 · 2016

This issue focuses on the clinical and basic research of ocular pathology and ocular tumors. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Li Bin.

Impression cytology (IC) has been widely used as a method for evaluating the ocular surface and superficial cells layers in the diagnosis and follow-up after treatment of several ocular surface tumors of both epithelial and melanocytic origin. Compared with exfoliative cytology with spatula, IC is less traumatic to the patient's eye. It provides a precise location of the area being studied and allows accurate observation of the cells the way they exist in vivo. The additional advantage of IC is the preservation of limbal stem cells responsible for continuous corneal epithelium renewal. In certain cases, ophthalmologists may prefer interventions less invasive than surgical biopsy such as impression cytology for both initial diagnosis and therapeutic monitoring of the treatment for ocular surface lesions. The purpose of this article is to comment the effect for the diagnosis and management of ocular surface tumors and to discuss the requirement for further investigation on the subject.(Chin J Ophthalmol, 2016, 52: 721-723)

As an indispensable professional, ophthalmic pathology plays an important role in the development of the ophthalmology. With the worldwide attention and promotion of precision medicine and the rapid development of modern medical testing technology, the development of pathology is facing the challenges of survival and development opportunities. We discuss the relationship between the development of pathology and the precision medicine to explain that the precise pathological diagnosis is the basis of the implementation of precision medicine. Ophthalmic pathology workers should be the first to improve the accuracy of the diagnosis of ocular diseases, in order to play a greater role in the future of precision medicine in the diagnosis of pathology. (Chin J Ophthalmol, 2016, 52: 724-727)

The management of retinoblastoma (RB) has dramatically changed over the past two decades. The introduction of chemotherapy has transformed treatment algorithms completely. Chemotherapy is currently used as a first line approach for children with RB and can be delivered by intravenous, intra-arterial and intravitreal routes. However, there still remains some controversy on the treatment of advanced RB, especially in eyeball salvage. This article described domestic and international approaches to eyeball salvage treatment. We would like to further discuss our opinion on the management of advanced RB based on our clinical experience for attracting more clinical concern on this issue. Many factors should be considered when choosing the appropriate conservative therapy. The choice of eyeball salvage treatment not only depends upon the tumor staging and laterality but also upon compliance and economic factors. Doctors and parents should not blindly pursue eye saving. However, there are still cases where enucleation is definitely the treatment of choice. (Chin J Ophthalmol, 2016, 52: 728-732)

Corneal transplantation is one of the important eyesight restoration surgeries in ophthalmology, which has the characteristics of both ophthalmic microsurgery and transplantation, so the probability of complications is high^[1]In particular, penetrating keratoplasty is a full-thickness keratotomy with high surgical risk. Common complications after corneal transplantation include poor incision healing, graft infection, increased intraocular pressure, recurrence of primary disease, immune rejection, etc. In recent years, with the improvement of microsurgery technique, the success rate of surgery has increased significantly, but the postoperative failure rate is still higher than that of other anterior segment surgery^[2]The main reason is that the standardization and accuracy of perioperative and postoperative long-term medication can directly affect the success or failure of surgery and the long-term survival of corneal grafts. At present, there is no standard of medication for corneal transplantation in China, which leads to great differences in perioperative medication by different hospitals and doctors, which affects the rapid and healthy development of corneal transplantation surgery. Therefore, the Keratology Group of Ophthalmology Branch of Chinese Medical Association organized relevant experts to discuss and formulated a consensus on the medication of corneal transplantation in China, which can be used for reference by domestic doctors engaged in the diagnosis and treatment of corneal transplantation.

We aimed to identify and describe the clinical and histopathologic characteristics of conjunctival neoplasms.

Retrospective case series study. We collected and analyzed the clinical and histopathologic data of the conjunctival neoplastic specimens including the age, gender, and histopathologic diagnosis of all patients obtained from Beijing Tongren Eye Center between October 2003 and October 2015. All the pathology diagnosis results were divided into two categories which were benign and malignant tumors, according to Shields histopathological classification methods and the pathology diagnosis results in our department. All cases were divided into four groups as 0-17 years old, 18-39 years old, 40-59 years old, aged 60 and above. The chi-square test was used for statistical analysis.

Of the 2 053 cases, 1 025 were males and 1 028 were females (male∶female=1∶1). 1660 cases (80.9%) were benign and 393 cases(19.1%) were premalignant or malignant. The average age at diagnosis was 30.5 years for benign lesions and 53.3 years for premalignant and malignant lesions, which was significant different (P<0.01). The most common benign lesions were nevus, cysts, dermoids and dermolipomas, inflammatory granulomas and squamous cell papillomas. The most common premalignant and malignant tumors were CIN, melanomas, lymphomas and squamous cell carcinoma. The constitution of males and females of cysts, squamous cell papillomas, primary acquired melanosis, CIN and lymphomas were significant different (P<0.01). Moreover, the most common benign and malignant neoplasm were dermoids and dermolipomas, melanomas respectively in group under 18 years old. And nevus and lymphomas were the most common benign and malignant tumors respectively in patients between 18 and 39 years old. While cysts and CIN were the most common benign and malignant tumors respectively in cases over 40 years old.

The majority of tumors of the conjunctiva were benign, with the young people being most. The premalignant and malignant tumors were more frequent in the elderly. Nevus and CIN were the most common benign and malignant tumors, respectively.(Chin J Ophthalmol, 2016, 52: 738-744)

To evaluate the efficacy of large spot indirect ophthalmoscopy laser alone or combined with systemic chemotherapy in the treatment of early and middle stage retinoblastoma.

Retrospective series case study. Clinical data of 21 patients (22 eyes) who were diagnosed as retinoblastoma (RB) in Peking University People's Hospital from March 2009 to August 2014 were collected. Medical and family history, ocular ultrasound, orbital and cranial MRI or CT examination of RB Children were detailed recorded. Ocular examination and laser treatment were performed under general anesthesia, once every 3-4 weeks until the tumor was under control. The observation period was at least 3 months after the last treatment. The ocular examination included intraocular pressure measurement, anterior segment and fundus examination and the fundus photography with Retcam. Laser therapeutic instrument was large spot indirect ophthalmoscopy laser of 810nm wavelength.

Of the 21 children, 16 were male and 5 were female. The range of age was 3 to 82 months averaged 17.3 months. Among 22 eyes, four with small tumor, eight with medium tumor, and ten with large tumor. Two eyes underwent laser treatment only and 20 eyes underwent laser treatment combined with systemic chemotherapy. During the average observation period of 33.9 months, 15 tumors were treated successfully, but 7 failed. The total success rate was 68.2%. The number and success rate of small, medium and large tumor eyes were 4 (100%), 5 (62.5%) and 5 (50%), respectively. There was one case of tumor brain metastases, and the classification of contralateral eye of the child was E phase. Complications: Iris burns happened in one eye, obvious vitreous proliferation in one eye and mild vitreous hemorrhage occurred in two eyes, which did not affect the treatment of laser. However, obvious tumor hemorrhage happened in two eyes and affected laser therapy. There was no complicated cataract, iatrogenic retinal hole and tumor intravitreal implant caused by laser blasting effect.

Indirect ophthalmoscope laser in 810-nm diode laser with large-spot alone or combined with systemic chemotherapy may be effective treatment for retinoblastoma in earlier than stage C of international classification. It is suitable for large and multiple retinoblastoma.(Chin J Ophthalmol, 2016, 52: 745-748)

To analyze features of retinal and scleral infiltration of uveal melanoma.

It was a retrospective case series study. The pathological and clinical data of 102 cases of uveal melanoma were analyzed retrospectively, which were collected between Jun. 2001 and Apr. 2013 in Beijing Tongren Hospital, Capital Medical University. The tumor shape, size, cell types, retinal and scleral invasion were recorded and analyzed. The relationship between retinal invasion and scleral invasion was analyzed by trend Chi-square test.

There were 44 male patients and 58 female patients with an average age of 45.6±12.4 (range from 15 to 78 years old) in 102 cases. As for tumor size, there were 68 (66.7%) large size tumors, 27 (26.5%) medium size tumors and 7(6.8%) small size tumors; As for cell types, 76 (74.5%) were spindle cell, 6 (5.9%) were epithelioid cell, 16 (15.7%) were mixed cell, and 4 (4.0%) were others; As for tumor location, there were 3 (2.94%) ciliary body melanoma, 28 (27.5%) ciliary body and anterior choroid melanoma, and 71 (69.6%) choroid melanoma. Eighty-six cases (84.3%) showed retinal invasion, in which there were 20 cases of outer nuclear layer invasion (19.6%), 12 cases of inner nuclear layer invasion (11.8%), 30 cases of ganglion cell layer invasion (29.4%), and 24 cases of inner limiting membrane invasion (23.5%). Fifty-five cases (53.9%) showed scleral invasions, in which there were 11 cases (68.8%) of no retinal invasion, 13 cases of outer nuclear layer invasion (65.0%), 5 cases of inner nuclear layer invasion (41.7%), 15 cases of ganglion cell layer invasion (50.0%) and 11 cases of inner limiting membrane invasion (45.8%). In 76 spindle cell cases, the scleral invasion rate of different retinal invasion degree were 72.7% in 8 cases of none retinal invasion, 71.4% in 10 cases of outer nuclear layer invasion, 62.5% in 5 cases of inner nuclear layer invasion, 53.9% in 14 cases of ganglion cell layer invasion and 47.1% in 8 cases of inner limiting membrane invasion. No significant relationship was found between retinal and scleral invasion (γ=-0.21,P=0.127) .

With the increase of scleral invasion, the retinal invasion decreased. However, the correlation show no statistical significance.(Chin J Ophthalmol, 2016, 52: 749-754)

To observe the characteristics of pterygium with in vivo confocal microscopy (IVCM) and understand pterygium activity with the density of inflammatory cells, formation of new blood vessels, and the number of activated keratocytes within the stroma.

A prospective case-controlled study. Thirty-six pterygia from 28 patients were analyzed in this study. A pterygium activity score was obtained by summing four scores of ocular discomfort, pterygium hyperemia, keratitis, and the presence of Fuchs patches. Among them, the low activity of pterygium (PAS score less than 3 points) appeared in 12 eyes and high activity of pterygium (PAS score ≥ 4 points) in 24 eyes. All Patients underwent pterygium IVCM quantitative analysis by observing the boundaries between the pterygium and the adjacent cornea, the density of goblet cells and dendritiform inflammatory cells and Fuchs patches. The correlation of pterygium activity between IVCM and PAS with slit lamp was analyzed with Spearman correlation analysis.

The presence of inflammatory cells, numerous blood vessels, and irregular boundary between the cornea and the pterygium with infiltration of hyper-reflective cells in the adjacent corneal epithelium were signs observed with IVCM associated with pterygium activity. With IVCM technique, epithelial cells, goblet cells, and dendritiform inflammatory cells of various sizes were observed within the pterygium epithelium.The active (PAS ≥4) pterygium showed irregular boundaries between the pterygium and the adjacent cornea (score, 0.84±0.51) comparing with inactive subjects (score 0.23±0.12, t=2.68, P=0.009). Fuchs patches were observed as islets of hyper-reflective polygonal cells in front of the pterygium head with blurred boundary. The score (0.75±0.25) in active group showed significant changes as compared with normal subjects (0.23±0.12, t=3.79, P=0.001). The score of dendritiform inflammatory cells, activated keratocytes, and goblet cells in active group were 2.75±0.76, 1.92±0.68, and 2.08±0.42, which were significantly higher than those in inactive group (1.25±0.55, 0.50±0.25, 1.15±0.32, P=0.035, 0.030, <0.01). There was significant positive correlation between IVCM activity and traditional slit lamp PAS.

Quantitative analysis of dendritiform inflammatory cells, vascular proliferation and activated keratocytes of pterygium by IVCM may be a reliable evaluation method to evaluate the activity of pterygium.(Chin J Ophthalmol, 2016, 52: 755-763)

To analyze the clinical features and pathological classification of chlidren's ocular tumors.

Retrospective case series study. Five hundred and four cases (506 eyes) of ocular tumor with biopsy-proven in children below 14 years old between January 2002 and December 2014 from Tianjin Eye Hospital were performed to retrospectively investigated the lesion location, clinical features and histopathologic classification of these lesions.

Of 504 cases there were 246 boys (248 eyes) and 258 girls (258 eyes) patients. The mean age at diagnosis was 6.4 years, ranged from 4 months to 14 years. Of 328 cases (65.1%) of eyelid and ocular surface, 2 cases (0.6%) were malignant tumors and other tumors were all benign tumors. The leading four tumors were corneal dermoid, dermoid cysts, nevus and pilomatricoma. Of 123 cases (24.4%) of orbital tumors, 13 cases (10.6%) were malignant tumors and other tumors were all benign tumors. The leading four tumors were dermoid cysts, lymphangiomas, hemolymphangioma and venous hemangioma. Of 53 cases (10.5%) of intraocular tumors, 41 cases (77.4%) were malignant tumors which were all retinoblastoma.

Most of children's ocular tumors were congenital and embryonic tumors. The most common ocular tumors of 504 children patients were from eyelid and ocular surface. Corneal dermoid and dermoid cysts were the most benign ones. Retinoblastoma and rhabdomyosarcoma were the most malignant ones.(Chin J Ophthalmol, 2016, 52: 764-768)

To observe the clinical and pathological features of uveal metastatic carcinoma.

It was a retrospective case series study. The clinical manifestation, growth pattern, tumor types and relative pathological features of 13 patients visiting from January 1980 to December 2014 with uveal metastatic carcinoma in Tianjin Eye Hospital were analyzed retrospectively.

There were 13 cases, 6 cases of male and 7 of female. Age was from 37.0 to 66.0 years old. The mean age was 52.1 years old. all cases were monocular. There were 5 cases with right eye and 8 cases with left eye. Among 13 cases, 10 tumors were in posterior choroid, one tumor was in anterior choroid and ciliary body, 2 tumors were in the iris. There were 5 patients with lung cancer, 4 patients with breast cancer, 1 patient with prostate cancer, 1 patient with thyroid cancer and 1 patient with esophageal cancer. The primary tumor wasn't found in 1 patient. The rapid decrease of visual acuity showed in 10 patients with posterior choroidal metastatic carcinoma, 8 of them accompanied with extensive retinal detachment and 6 of them had secondary glaucoma. The multiple gray-white nodule or pink cauliflower mass on the papillary margin of iris were showed respectively in 2 patients with iris metastatic carcinoma. The pathological examination found that posterior choroidal metastatic carcinoma mainly located in temporal or nasal side choroids in 10 cases, among them, local or diffuse flat choroidal masses showed in 6cases, extensive mass involving choroid and ciliary body showed in 1 case, large nodular or globular choroidal mass showed in 2 cases, choroidal mass surrounded the optic disc in 1 case, optic nerve invasion showed in 3 cases and extraocular or orbital invasion showed in 3 cases. The scleral and subconjunctival invasion showed in 1 case of anterior choroid and ciliary body metastatic carcinoma.

Uveal metastatic carcinoma manifested various growth pattern, the rapid decrease of visual acuity, flat or nodular choroidal solid mass, secondary retinal detachment and glaucoma were common clinical features. Some cases might invade extraocular or orbital tissue. (Chin J Ophthalmol, 2016, 52: 769-774)

To study the clinical and pathological features and surgical outcome of eyelid/conjunctival amyloidosis.

It was a retrospective case series study. The clinical and pathological records of 11 patients who were diagnosed as eyelid/conjunctival amyloidosis and had surgical treatment between February 2007 and October 2015 at Beijing Tongren Hospital were analyzed. Routine pathological examinations and Congo red staining were performed. All of the 11 patients received surgical treatment. Seven patients with ptosis underwent surgical excision and ptosis repair. One patient with lower eyelid mass underwent surgical excision and reconstruction of the lower eyelid. One patient with upper eyelid mass underwent surgical excision. Two patients with conjunctival mass underwent surgical excision.

In the 11 patients, 6 were male and 5 were female. The mean age was 31 years old, median age was 21 years old, and the range of age was13-59 years old. Eight cases presented as eyelid thickening and nodular growth of the conjunctiva, and 7 of them had ptosis. One case presented as tumor of the upper lid. Two cases presented as conjunctival masses at the semilunar fold. None of the patients were found to have systemic involvement. All of the 11 cases received surgical treatment including excision of the lesions and correction of ptosis when necessary. Pathological examinations confirmed the diagnosis of amyloidosis. Follow up time was 1-9 years. Nine cases were stable, 1 case had progression in the conjunctival lesion and 1 case was lost to follow up.

Eyelid/conjunctival amyloidosis usually present as mass or diffuse thickening of the eyelid/conjunctiva. The outcome of surgical treatment was satisfying.(Chin J Ophthalmol, 2016, 52: 775-779)

A 14-year-old child came to the Department of Ophthalmology of Beijing Children's Hospital affiliated to Capital Medical University for the first time because of 3 d of visual loss in his left eye and 1 d of disappearance. The child was diagnosed with non-Hodgkin lymphoma (NHL) (T lymphoblastic type) 11 months ago, and 9 courses of chemotherapy ended 2 months. Physical examination: Left forehead near the midline, vertically arranged 4~5 soybean-sized light red rash, itchy feeling, slight pain (Figure 1), and no obvious abnormalities were observed in the rest. Eye examination: Visual acuity: 1.5 in right eye, no light sensation in left eye. IOP: 17 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye. The corneal reflection of both eyes is in the right position, and the movement in all directions is unlimited. The anterior segment of both eyes was roughly normal under the slit lamp microscope. Round pupils in both eyes, normal direct and indirect response to light in the right eye, dilated and fixed pupil in the left eye, relative afferent pupillary disorder in the left eye (relative afferent pupillary defect, RAPD). Mild papilledema on the right side was seen in the fundus of the eye; The papilla of the left eye is highly raised with unclear boundaries. A lot of deep bleeding can be seen on the surface of the papilla and the surrounding retina, with tortuous and thickened veins, scattered small patches and flame-like bleeding of the retina, and macular edema (Figure 2）。 Orbital MRI: bilateral optic nerve thickening, left optic nerve diameter approximately 5.7 mm, peripheral meninges thickening, rough edges, bilateral muscle cone intra-fat body point linear enhancement. The left eye papilla protrudes into the vitreous body. Cranial MRI (Figure 3): No placeholder seen. PET-CT examination showed that the left maxillary sinus and posterior ethmoid sinus were thickened on the left side with mild abnormal increase in fluorodeoxyglucose (FDG) metabolism. Considering the possibility of inflammation, the left optic nerve was thickened, the posterior wall of the left eye ring was thickened, and there was no obvious abnormality in FDG metabolism, so secondary inflammatory lesions were considered. Laboratory tests: varicella zoster virus (VZV) IgG (+), IgM (+). Bone marrow puncture examination: No naive lymphocytes were found. Herpetic optic neuritis is not excluded as the cause of visual loss in children.

The patient was a 28-year-old male. Due to the redness and swelling of his left eye for 20 days after the fall, he went to the Institute of Orbital Diseases of Armed Police General Hospital on November 14, 2014. The patient accidentally fell on a bicycle 20 days ago, and his left eye was pricked by a branch. He pulled out the branch that pierced the upper lid of his left eye by himself. After the injury, the visual acuity of the left eye decreased, and the exophthalmos was accompanied by conjunctival congestion and edema. He had debridement and suture of eyelid wounds and anti-inflammatory treatment in the local area, and his condition improved but the redness and swelling did not heal. Post-admission examination: the best corrected visual acuity of the left eye was 0.1, the upper lid was congested and swollen, slightly drooped, and the healed skin wound was visible on the outside of the double lid folds of the upper lid. The eyeball was slightly displaced internally, but could not turn externally, and the movement in other directions was obviously limited. Congestion and edema of the temporal bulbar conjunctiva, prolapsing outside the palpebral fissure. The left eye protrudes 5 mm from the contralateral (Figure 1）。 Finger test orbital pressure (+ +). Inferior corneal leukoplakia. The pupils are slightly dilated, and the direct and indirect light reflections are dull. Left frontal, eyelid and facial sensation is dull. No positive signs were found in other ocular and systemic examinations. CT examination (Figure 2) suggest diffuse soft tissue shadows on the lateral side of the left orbit, with unclear boundaries, indistinguishable from the lateral rectus muscle, and spreading to the apex of the orbit. Intracranial strip-shaped low-density shadows are located behind the supraorbital fissure and paracavernous sinus. MRI examination revealed T of intraorbital soft tissue lesions₁and T₂The weighted images are all medium signals, rough edges, T₁Weighted image enhanced lipid suppression imaging can be significantly enhanced. Intracranial strip-shaped space-occupying lesions in T₁and T₂The weighted images are all low signal shadows, not enhanced (Figure 3）。 Clinical diagnosis: left intracranial foreign body residual, left orbital soft tissue injury with foreign body residual, left eye exposure keratitis, left eye traumatic pupillary paralysis, left trigeminal nerve hypoesthesia.

The patient was a 61-year-old male. He was admitted to hospital for more than 50 days due to eye grinding and eye pain in his left eye. More than 50 days ago, my left eye was accidentally scratched by a branch. I went to a local hospital and was diagnosed as "left eye keratitis". Bacterial culture of corneal scraping showed: Pseudomonas aeruginosa (+). I was given systemic and local antibiotics for more than 50 days, and my condition gradually worsened. The patient's left eye grinding and eye pain were intolerable, so he came to the First Affiliated Hospital of Dalian Medical University for treatment and asked for left eyeball enucleation. The patient was diagnosed and treated in this hospital 30 years ago due to "iron chisel injury to his left eye". He complained that he was diagnosed with "penetrating injury to his left eye, foreign body in his left eyeball, and retinal detachment of his left eye" at that time, and underwent surgical treatment (details unknown). After operation, his left eye had no light sensation and the appearance of his eyeball was normal. Ophthalmic examination: visual acuity of right eye 0.8, intraocular pressure 15 mmHg (1 mmHg =0.133 kPa), no abnormalities were found; There was no light sensation in the left eye, the conjunctiva was highly mixed and congested, new blood vessels were visible in the corneal limbus, and a gray-white deep ulcer was visible below the nose in the center of the cornea, about 4 mm ×4 mm in size. The center of the ulcer was nearly perforated, the surrounding cornea was infiltrated, the rest of the cornea was edema, the cornea was stained with blood, and the intraocular structure was not visible (Figure 1), normal intraocular pressure. Diagnosis: Bacterial corneal ulcer in left eye, hyphema, old ocular trauma. After completing the ophthalmological and systemic examinations, enucleation of the contents of the left eye combined with implantation of prosthetic ophthalmic platform was performed under local anesthesia on October 11, 2014. During the operation, the cornea was cut along the limbus, but no lens and vitreous body overflow were observed. The ciliary body was separated in the whole circumference. The ciliary body was tightly connected with the sclera and could not be separated. The whole circumference raised gray-white sclerotic tissue was seen at the serrated margin of the ciliary body, and a gray-white sclerotic object with a complete cap shape was taken out (Figure 2), with two small holes about 1 mm in diameter visible at its posterior pole. During the operation, the intact pigment membrane was closely adhered to the sclera, and the pigment membrane was removed and implanted into the prosthetic eye platform. Postoperative pathological report: A semicircular cystic tissue was submitted for examination, with a size of 1.8 cm ×1.8 cm ×1.2 cm, and the surface was gray and smooth; The cut surface is gray and white, with calcification; The wall thickness is 0.2~0.3 cm, and the inside of the sac is gray and smooth. Microscopically, focal fibrous tissue hyperplasia and hyaline degeneration were observed, and bone cells and trabecular bone formed, with vascular adipose tissue between trabecular bone. Pathological diagnosis: ossification of ocular contents, fibrous tissue hyperplasia and hyaline degeneration (Figure 3）。

The patient was a 26-year-old female. Due to double vision with alternating inward deviation for 1 year, he went to the Optometry Hospital affiliated to Wenzhou Medical University on September 28, 2011. The patient developed diplopia symptoms without inducement 1 year ago, and then his family found that his eye position was inwardly deviated, denying the past history and family history. Ophthalmological examination: naked visual acuity of 0.1 and corrected visual acuity of 1.0 (-3.00 DS) in the right eye and naked visual acuity of 0.1 and corrected visual acuity of 1.0 (-3.00 DS) in the left eye. No obvious abnormalities were observed in the anterior and posterior segments of both eyes. The eyeball moves normally in all directions, and the oblique angle is equal in all directions. Corneal light mapping: +10°, prism plus alternating covering examination: +20 near^△, Distant +20^△。 Visual machine examination: subjective oblique angle +20°, objective oblique angle +20°. Stereoscopic examination: random point stereogram TNO: none; Titmus stereoscopic diagram: greater than 800 arc seconds; Visual function meter OPTEC3500: greater than 400 arc seconds. Worth 4 Point Light Check: 5 Point Near, 5 Point Far. Neurological and systemic examinations showed no obvious abnormalities. Preliminary diagnosis: (1) acute common esotropia; (2) Refractive error in both eyes. "Right medial rectus recession" was performed under local anesthesia on 29 Sep 2011, with a right medial rectus recession of 4.0 mm. On the first day after surgery, I complained that there was no double image of near object, and the double image of far object was better than before. 33 cm corneal photometry was used to check the eye position correctly, and the distance and near of the eye position of both eyes were alternately covered, which showed mild slight movement from inside to middle.

The patient was a 27-year-old male. Because the visual acuity of his left eye decreased for 1 month, he went to Tianjin Eye Hospital. Eye examination: naked visual acuity was 1.0 in the right eye and 0.1 in the left eye (no improvement in corrected visual acuity); Anterior segment examination of both eyes was roughly normal; No obvious abnormalities were observed in the right fundus, but in the left fundusQuintessence Picture 1。 OCT examination is presented inQuintessence Picture 2。 Clinical diagnosis: inner retinal sublimiting membrane hemorrhage in left eye.

The patient was an 18-year-old female. Because of the black shadow floating in front of his left eye for half a month, he went to Beijing Aier Yingzhi Eye Hospital. Hospitalized 3 months ago in an external hospital with suspected viral encephalitis. The patient had eaten tapeworms for weight loss. Eye examination: visual acuity was 1.5 in both eyes; IOP was 18 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye; No abnormalities were observed in the anterior segment of both eyes; Right fundus normal; Left fundusQuintessence Picture 1。 B-ultrasound examination: follicular image of the vitreous cavity of the left eye. Clinical diagnosis: left eye cysticercosis.

The diagnosis of keratoconjunctival tumors were mainly relied on the examination of the slit lamp microscope and histopathology till now. Making an accurate diagnosis to ocular surface tumor in time was very important for deciding the treatment method and evaluating the prognosis. In recent years, in vivo confocal microscopy (IVCM) has been used in ophthalmic clinical diagnosis as a new evaluation method. It was easy to detect cytological characteristics of ocular surface diseases safely in vivo. More and more researches results have shown that IVCM could provide powerful supports to the diagnosis and management of keratoconjunctival tumors, especially for the pigmented tumors and ocular surface squamous neoplasia. In this paper, the applications of IVCM for diagnosing keratoconjunctival tumors were reviewed. (Chin J Ophthalmol, 2016, 52: 789-793)

As the results of both environmental and genetic factors, myopia is one of the most popular refractive errors in the world. In recent years, progressive achievements have been made in genome-wide association study (GWAS) of myopia and refractive error. A lot of susceptibility loci and regions have been found, which means the researches on genetic basis of myopia and refractive error entered a new stage. This review summarized the main advances, and indicated the possible directions of genetic studies of myopia and refractive error in the future. (Chin J Ophthalmol, 2016, 52: 794-800)