Volume 52 · Issue 12 · 2016

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

Secondary optic neuropathy of optic nerve abnormalities is the leading cause of persistent visual impairment. Previous ocular neuroprotection studies have proved that the nerve growth factor and other agents are of significant in the preservation of optic nerve axon and retinal ganglion cells. However, finding novel safe and effective approach as well as the appropriate applications of optic neuroprotection should be highly emphasized and would be very helpful in the treatment of optic neuropathy.(Chin J Ophthalmol, 2016, 52: 881-884)

Optical coherence tomography(OCT) had become the most important imaging technique in ophthalmology. OCT is able to segment the retinal nerve fiber layer and retinal ganglion cell layer accurately. Quantitative analysis can be performed for both layers. OCT is very important to evaluate the neuron and axon loss in optic nerve diseases diagnosis. Meanwhile, OCT has great value for differentiating glaucoma and macular diseases from optic nerve diseases. This review presented OCT application in optic nerve diseases diagnosis, differentiation diagnosis, the key points in use and the features of en face OCT and OCT angiography. It gave us suggestions that it should be pay more attention to OCT examination in diagnosis and treatment of optic nerve diseases. (Chin J Ophthalmol, 2016, 52: 885-888)

traumatic optic neuropathy (TON) is a common type of ocular trauma in clinical practice. It mainly refers to optic neuropathy caused by sudden blunt external force in the frontal and temporal regions above the orbit^[1,2]。 Its incidence rate accounts for 0.5% ~5.0% of closed craniocerebral trauma, and more than 90% of them are indirect injury of optic nerve in the intracanal segment. With the rapid development of transportation, tourism, factory and mining industries, the incidence of TON is increasing. Among the causes of TON, car accident injury occupied the first place (50% ~65%), followed by fall injury and fall injury (13% ~28%)^[3,4]。 The most common injury sites were the lateral and temporal parts of the eyebrow arch, followed by the periorbital and cranial areas. The consequences of TON are more serious, 68% ~78% of patients have no light sensation after injury^[2,3,4]。 Therefore, aggressive treatment should be given as early as possible to save visual function.

Glucocorticoid (hereinafter referred to as hormone) ophthalmic preparations are currently one of the most commonly used and effective drugs for the treatment of ocular inflammatory reaction. In corneal and ocular surface inflammatory reaction diseases, rational application of hormonal ophthalmic preparations can quickly and effectively control the inflammatory reaction and disease. However, irregular use may lead to poor curative effect and even serious side effects, such as prolonging the disease and aggravating corneal infection. It is emphasized that ophthalmologists should master the indications and usage of hormonal ophthalmic preparations, which has important clinical significance for the treatment of corneal and ocular surface diseases. Therefore, the Keratology Group of Ophthalmology Branch of Chinese Medical Association discussed and formed a consensus on the application of hormone ophthalmic preparations in corneal and ocular surface diseases, which provided a reference for clinical ophthalmologists to treat related diseases.

To study the characteristics of neurosyphilis with optic neuritis as an initial finding.

Retrospective analysis of clinical data and laboratory testing results of 16 cases (27 eyes) with optic neuritis as an initial finding of neurosyphilis from October 2010 to March 2015 in General Hospital of People's Liberation Army was made.

Six-teen patients (12 males, 4 females) were collected, the median age of patients was 47 (range 33 to 65) years ,the mean age was (49.63±9.05) years. Treponema pallidum particle agglutination assay (TPPA) analysis was positive in all of the patients and rapid plasma reagin (RPR) test was positive in 14 patients (2 patients did not test). Lumbar puncture was requested and performed for all patients. Cerebrospinal fluid (CSF) TPPA analysis was positive in 16 patients and RPR test was positive in 12 patients. The CSF white blood cell counting increased in 9 (56.3%) patients and 10(62.5%)patients presented with increased CSF protein level. Both eyes were involved in 11 patients (68.8%). Relative afferent papillary defect was positive in 11 patients. Twenty-seven eyes were affected in 16 patients, and among them 7 eyes' pupil diameter were 2.5 mm or less. Incipient visual acuity was less than 0.1 in 22 eyes. The slit lamp examination showed vitreous opacity in 12 eyes and visible cells in 6 eyes among 27 eyes. Fundus examination found that 6 eyes had papillary edema and 15 eyes had pallordisc among 27eyes. Electro-retinogram (ERG) was tested in 24 eyes, and 18 eyes were abnormal. Visual evoked potential (VEP) were performed in 26 eyes (flash VEP in 22 eyes, pattern VEP in 4 eyes), and all were abnormal. Fourteen eyes were tested by 30-2 perimetry, and 6 eyes had diffuse visual field defect, 2 eyes had peripheral visual field defect, 4 eyes had quadrant defect and 2 eyes had center scotoma. Fundus fluorescence angiography was done in 16 eyes and choroidal hyper-fluorescent dots were found in posterior pole in 4 eyes. All patients were treated with antibiotic medicines, among them 10 cases in the General Hospital, and 6 cases in the other hospitals. During 15 months follow-up after discharge, visual acuity of 17 eyes recovered to 0.5 and above.

Syphilitic optic neuritis is a condition that manifests with severe visual loss and tends to involve both eyes, Some patients have a smaller pupil diameter. Due to the particular infective routes of the disease, patients often conceal their sexual history. The manifestations of ocular syphilis are complicated and easy to misdiagnose or undiagnose. Clinical manifestations combining with the detailed history taking, serum and cerebrospinal fluid examination can guide to an accurate diagnosis and prevent from permanent vision loss. (Chin J Ophthalmol, 2016, 52: 898-904)

To analyze the correlation between retinal vascular calibers, ocular blood flow parameters and internal carotid artery stenosis and to evaluate the effect of internal carotid artery stenosis on ocular blood vessels comprehensively.

A retrospective case-control study. The clinical data of 141 patients who underwent head-and-neck computed tomography (CT) angiography examinations of the ICA were collected at Beijing Friendship Hospital, Capital Medical University from January 2014 to January 2016. According to diagnostic criteria, the patients were divided into four groups: the non-stenosis group, the mild stenosis group, the moderate stenosis group, and the severe stenosis andocclusion group. The retinal vascular caliber was measured in color fundus photograph by IVAN software. Color Doppler ultrasonography was used to measure the parameters of ocular blood flow, including the peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI). The enumeration data were analyzed with chi-square test, the measurement data were analyzed with rank-sum test, and the correlation test was performed with spearman.

The gender ratio of the patients without stenosis, mild stenosis, moderate stenosis, severe stenosis and occlusion was 12/7, 31/19, 28/25, 12/7, χ ² test was not statistically significant (χ²= 0.79, P=0.85); There was no statistically significant difference between the different groups (χ²= 0.15, P=0.68), the age of four groups were (64.1±8.3), (54.3±14.3), (68.9±11.8) and (59.1±8.0) y, respectively. In the no internal carotid artery stenosis group, the arteries diameter is (164.5±15.6) μm ,the vein diameter is (245.6±20.0) μm and the arteriovenous ratio is 0.7±0.1. There is no difference among the mild stenosis group, moderate stenosis group and the severe stenosis (χ ²_{artery calibe}r=6.92, P_{artery calibe}r=0.08; χ ²_{vein diamete}r=4.16, P_{vein diamete}r=0.25; χ ²_{arteriolar-venular ratio}=1.38,P_{arteriolar-venular ratio}=0.71) . The PSV of central retinal artery in the above groups were (14.6±3.6), (34.4±13.2), (35.7±14.6), (42.3±19.0)cm/s respectively, the data were analyzed by rank-sum test and there was a significant difference (χ²=13.44, P< 0.01) ; The PSV of the posterior ciliary artery in the above groups (17.6±6.5), (15.0±4.6), (13.4±4.3) and (11.0±3.2)cm/s respectively, the data were analyzed by rank-sum test and there was a significant difference (χ²=22.71, P<0.01) , EDV were (5.90±2.2), (5.1±2.1), (4.3±1.5) and (4.3±4.8)cm/s respectively and there was a significant difference (χ²=20.36, P<0.01) .There was a correlation between retinal artery diameter, PSV and EDV of the central retinal artery, PSV and EDV of the posterior ciliary artery and the diameter of the internal carotid artery but without linear correlation. (r_{artery calibe}r=-0.23, P_{artery calibe}r=0.01; r_{PSV of central retinal artery}= -0.29, P_{PSV of central retinal artery}<0.01;r_{PSV of posteri or ciliary artery}=-0.34, P_{PSV of posterior ciliary artery}<0.01,r_{EDV of posterior ciliary artery}=-0.35, P_{EDV of posterior ciliary artery}<0.01).

There was a correlation between retinal artery diameter, PSV and EDV of the central retinal artery, PSV and EDV of the posterior ciliary artery and the diameter of the internal carotid artery. PSV of the central retinal artery, PSV and EDV of the posterior ciliary artery changed significantly when the internal carotid artery stenosis existed. (Chin J Ophthalmol, 2016, 52: 905-910)

To investigate spectrum of causes in optic nerve subarachnoid space (ONSS) expansion by using Magnetic Resonance Imaging (MRI).

A retrospective study. Twenty-six patients (46 eyes) with ONSS expansion and 20 healthy adults (40 eyes) were recruited in Neuro-ophthalmology Department of Chinese PLA General Hospital from January, 2014 to December, 2015. The diameters were measured on the optic nerve (OND) and optic nerve sheath (ONSD) 2.4 mm behind the globe. ONSS was calculated by the formula of (ONSD-OND)/2. All participants were under went ophthalmologic examinations. The patients' clinical features, MRI and final diagnosis were analyzed. Qualitative data were compared between groups by using chi square test and quantitative data were compared by independent samplet test.

There was no statistically significant difference between ONSS group and control group with age, BMI and mean arterial blood pressure (P>0.05). Larger space was found in ONSS group with mean±standard deviation (SD) of (1.9±0.4) mm comparing to the control group with (1.2±0. 2) mm (t=2.879, P<0.01). Bilateral ONSS expansion were found in 20 patients, 15 patients (75%) with cerebral venous sinus thrombosis (CVST), 2 patients (10%) with neurosyphilis, 2 patients (10%) with peri-neuritis and 1 patient (5%) with hydrocephalus. Unilateral ONSS expansion were seen in 6 patients, 4 patients (66.7%) with compressive lesson on anterior visual pathway, 1 patient (16.7%) with fungal infection and 1 patient (16.7%) with peri-neuritis.

The CVST patients more frequently presented bilateral ONSS expansion. Unilateral ONSS expansion may indicate compressive lesions located on the anterior visual pathway. (Chin J Ophthalmol, 2016, 52: 911-917)

To investigate the temporal and spatial characteristics of retinal ganglion cell (RGC) death and axon degeneration in the rat model of nonarteritic anterior ischemic optic neuropathy (rNAION).

Experimental study. The model of rNAION was induced by directly illuminating the optic nerve head with laser, after intravenous infusion with the photosensitizing agent rose Bengal. Seventy-one SD rats were randomly divided into five groups: 1-week (n=14), 2-week (n=14), 4-week (n=15) , 8-week (n=16) model group and the normal control group (n=12). Hematoxylin and eosin (H&E) staining and morphometric measurement with FG labeling were performed to assess rNAION-indeced histologic changes in the retina at different time points. RGCs were counted on retinal flat mounts in a masked fashion. Semithin sections stained with toluidine blue and transmission electron microscopy were performed to evaluate axonal degeneration. The differences of RGC density among multiple groups were tested with one-way ANOVA while the survival rate of RGC with kruskal-Wallis.

H&E-stained retina sections of rNAION revealed RGC loss. The density of labeled RGC was (2 273±219) cells/mm² in the control group, (2 075±120) cells/mm² in the 1-week group, (1 783±143) cells/mm² in the 2-week group, (1 330±169) cells/mm² in the 4-week group and (869±301) cells/mm² in the 8-week group. There were significant differences between all pairs of groups (F=80.98, P<0.01). The impairment of RGC was aggravatedprogressively, which mainly in the upper quadrant. The survival rate of RGC was 99.9%±3.4%, 91.8%±2.9%, 72.6%±5.7%, 54.4%±7.0% and 37.5%±13.0%, respectively. There were significant differences between the 1-week and 2-week group(Z=-3.78, P<0.01), the 2-week and 4-week group(Z=-3.89, P<0.01), and the 4-week and 8-week group(Z=-3.23, P<0.01). Toluidine blue staining of the ON revealed significant demyelination 1 week after ischemic damage. Progressive axonal degeneration existed for several weeks, which mainly affected the central region of the optic nerve with extensive reactive gliosis. Ultrastructural study showed axonal edema and collapsed sheaths in the ischemic optic. Four weeks later, there were extensive axonal loss and severe glial scars.

rNAION results in regional and later RGC death. The extended period of RGC death after rNAION induction is much more longer than previously recognized. (Chin J Ophthalmol, 2016, 52: 918-923)

To evaluate the clinical application of ultra-wide-field fluorescein angiography in posterior and panuveitis patients.

It's a prospective, observational case series study. A total of 82 eyes of 42 patients conformed to the research criteria of posterior and panuveitis. Clinical examinations, conventional fluorescein angiography and ultra-wide-field fluorescein angiograms were performed for each patient. The main outcome was the detection of peripheral retinal changes by ultra-wide-field fluorescein angiography, and how these changes influenced the evaluation and management of the disease.

There were 22 male and 20 female in the 42 patients. The mean age of the patients was (43±21) years. Twelve eyes (6 patients) were diagnosed as posterior uveitis, and 70 eyes (36 patients) as panuveitis. Clinical examinations and conventional fluorescein angiography detected active inflammation in 30 eyes (37%), while ultra-wide-field fluorescein angiography identified active inflammation in 48 eyes (59%). In these 18 additional eyes (22%) with active inflammation found by ultra-wide-field fluorescein angiography, non-perfusion area was observed in 4 eyes (5%) and neovascularization was observed in 1 eye (1%). By means of ultra-wide-field fluorescein angiography, a larger area of peripheral vessel leakage showed in 10 eyes (12%) which judged as active inflammation by conventional fluorescein angiography. Additional angiographic changes showed in 46%(21/45) of the eyes with clear etiology, while only in 19%(7/37) of the eyes without clear etiology. According to these findings, treatment strategies adjusted for 12 patients.

Ultra-wide-field fluorescein angiography detected more peripheral retinal vascular pathology than conventional fluorescein angiography. The changes found in the periphery were important in the management of uveitis. (Chin J Ophthalmol, 2016, 52: 924-928)

To explore the efficacy and related risk factors on cataract surgery in Shandong province.

A total of 108 190 cataract surgeries which were reported from 17 cities of Shandong province during January 2013 to December were reviewed. The demographic information, preoperative examination, surgery related information (including date of surgery, surgical methods, and intraoperative complications), and postoperative situations (naked eye visual acuity, curative efficacy after three days, and postoperative complications) were reviewed. Wilcoxon signed-ranks, univariate and orderly multivariate Logistic regression analysis were used according to nature of the data.

There were 64 852 female patients (59.9 %) and 43 338 male patients (40.1%) in all 108 190 cases. About 36.5% patients (39 496 cases), the highest proportion, were 71 to 80 years of age, 31.26% patients (33 711 cases) were 61 to 70 years old and 13.6% patients (14 720 cases) were over 81 years old. Visual acuity increased significantly after surgery (Z=165.24, P<0.01). Simple factor Logistic regression analysis showed that preoperative corrected visual acuity less than 0.1 (OR=2.30 95%CI: 0.59 to 1.07), complications (OR=8.50,95% CI: 1.34 to 2.94), congenital cataract (OR=1.69, 95%CI: 0.22 to 0.83), extracapsular cataract extraction (OR=1.99, 95% CI:0.57 to 0.81), postoperative complications in three days (OR=7.46, 95% CI:1.77 to 2.25) were predictors of worse outcome after cataract surgery. Multivariate logistic regression analysis showed that the efficacy of cataract surgery were influenced by history of diabetes (OR=1.79, 95% CI: 0.46 to 0.71), history of hypertension (OR=3.49, 95% CI: 1.07-1.43), postoperative complications in three days (OR=3.91, 95% CI: 1.53 to 1.20) and extracapsular cataract extraction (OR=1.54, 95% CI: 0.20 to 0.66). Young male patients (OR=0.82, 95% CI:-0.28 to -0.12), normal preoperative intraocular pressure (OR=0.79, 95%CI: -0.38 to -0.10) and pupil (OR=0.42, 95% CI:-1.17 to -0.57) were predictors of better outcome.

Visual acuity improved significantly after cataract surgery in Shandong province. The efficacy of cataract surgery was influenced by many factors. It is important to control systemic diseases and to choose modern operation method. (Chin J Ophthalmol, 2016, 52: 929-935)

To observe the impact of the input temporal changes on visual cortex of rats cells and the change of the synaptic efficacy, for the study of visual developmental plasticity mechanism.

Experimental research. The brain slice of ten 14d healthy Wistar rats and ten 21d healthy Wistar rats were recorded with whole cell recording technique, using single stimulation and combined stimulate model, to observe the visual cortex of rats neurons changes in synaptic activity. Change the stimulus input sequence, and observe the visual cortex of rats changes of synaptic efficacy. Using the paired t test to compare the change of excitatory postsynaptic potential (EPSC) of visual cortex.

The difference between single stimulation and combined stimulate about EPSC was statistically significant, which was decreased (14.3±7.4) % (n=15) in single stimulation and (53.4±17.5) % (n=20) in combined stimulation for P14 rats which were long-term depression (t_s2=3.9, t_s1+s2=2.2; P<0.05) , and was increased (27.5±11.4) % (n=16) in single stimulation and (34.6±10.3) % (n=10) in combined stimulation for P20 rats which were long-term potentiation (t_s2=2.3, t_s1+s2=3.5; P<0.05) . Rats in different development period have a specific time window for input temporal changes. Combined stimulation patterns produced by the neuron cell reaction were not just an accumulation of simple response caused by single stimulation. For P14 rats, its time window was of about ±0.5ms. However, for P20 rats, scope of time window reduced to ±0.1ms.

Different development period of rats, change the stimulation pattern can cause the change of the visual cortex synapses reaction, and stimulate the temporal change within a specific time window to producenonlinear results. (Chin J Ophthalmol, 2016, 52: 936-940)

Example 1The child was a 7-year-old female. Due to the loss of vision in his left eye for nearly 2 years and exophthalmos for more than 3 months, he went to the Department of Ophthalmology of the Second Hospital of Tianjin Medical University on May 15, 2008. The child's previous systemic condition was acceptable, the development was normal, the nutritional status was acceptable, there were no obvious abnormalities in both eyes, and there was no history of orbital tumor in the family. Ophthalmological examination: the visual acuity of the right eye was 1.0, and no obvious abnormalities were found in the anterior and posterior segments; The visual acuity of the left eye was 0.1, the exophthalmos was about 1 mm, the orbital pressure was +2, and the papilla was edema. The rest of the examinations were normal. Orbital MRI showed that the anterior 2/3 of the optic nerve in the left eye was swollen, with a size of about 12 mm ×11 mm ×19 mm, T₁WI showed medium signal (Figure 1a), T₂WI is high signal. Diagnosis of left eye optic nerve glioma, to transcranial orbital resection of the tumor, later transferred to our hospital, gamma knife treatment. Four months after treatment, pain in the orbital area, visual acuity decreased to 0.01, exophthalmos significantly increased, and eyelid edema (Figure 1b), MRI showed that the tumor was larger than before treatment, about 16 mm ×16 mm ×22 mm in size (Figure 1c), intravenous drip of hypertonic fluid, oral administration of prednisone, orbital pain gradually subsided. MRI revealed tumor shrinkage after 1 year. After 3 years of ophthalmic examination, the visual acuity of the left eye was 0.02, the eyeball was 1 mm protruding from the contralateral side (Figure D), the orbital pressure was +1, the eyeball movement in all directions was unrestricted, the edge of the optic papilla was clear and light, and the central retinal artery and vein were thin (Figure 1e), MRI suggested that the tumor had shrunk more recently. MRI after 7 years showed that the tumor was significantly smaller than before treatment (Figure 1f）。

The child was a 9-year-old male. Due to the ptosis of his right eye for 1 week, he came to the ophthalmology department of Cangzhou Central Hospital in December 2012. Ophthalmic examination after admission: the visual acuity of the right eye was 1.0, the exophthalmos was 17 mm, the upper eyelid margin covered 1/2 of the pupil, the ptosis was obviously light in the morning and heavy in the evening, and the ptosis was obviously improved after rest. The visual acuity of the left eye was 1.0, the exophthalmos was 22 mm, the upper eyelid was retracted and delayed, and the position of the upper eyelid of the left eye did not change in morning light and evening weight. The corneas of both eyes are transparent, the pupils are round, about 2.5 mm in diameter, there is light reflection, the fundus examination is normal, and the intraocular pressure is normal. Eye movement is unrestricted. No obvious extraocular muscle abnormalities were found on orbital CT. Positive test for neostigmine. Whole body examination: the white blood cell count in routine blood examination was 11.85×10⁹/L. Chest CT showed right middle lobe pneumonia; The thymus gland is slightly full, and there is no exact abnormality in density. CT of the head showed no obvious abnormalities. The electrocardiogram showed sinus tachycardia, 121 beats/min, and no abnormalities in myocardial enzyme spectrum were found. Follow-up history The child had a history of fever, mild cough, no phlegm, asthma and chest pain 5 days before admission, and a history of irritability, hyperhidrosis, polyphagia, etc. Therefore, the thyroid function was checked. Thyroid stimulating hormone receptor antibody: 6.04 IU/L, free triiodothyronine: 10.26 ng/L, free thyroxine: 3.87 mg/L, thyroid stimulating hormone: 0.005 IU/L, serum total triiodothyronine: 297.2 mg/L, serum total thyroxine: 19.15 g/L, thyroid color ultrasound return: thyroid volume increased. Physical examination: Second degree thyroid enlargement, soft texture, heart rate 110 beats/min, uniform rhythm, left eye exophthalmia positive. Endocrinology consultation, Graves' disease and thyroid associated ophthalmopathy (TAO) were diagnosed clearly, and methimazole tablets and atenolol oral administration were recommended. Pediatric consultation, mycoplasma pneumonia is considered, and azithromycin is recommended for anti-inflammation. There were no abnormalities in other physical examinations of the whole body, and there were no manifestations of myasthenia gravis. Therefore, the diagnosis of ocular myasthenia gravis (OMG), Graves disease, TAO and mycoplasma pneumonia in the child was clear. Treatment with pyridostigmine bromide, prednisolone, methimazole tablets, atenolol and azithromycin was observed after 2 weeks. The height of right eyelid fissure was 10 mm and the height of left eyelid fissure was 12 mm at the time of discharge. After discharge, oral prednisone tablets, pyridostigmine bromide and methimazole were continued. After using prednisone tablets and pyridostigmine bromide for 25 days, the right eyelid fissure was stable in height, which was 10 mm, and there was no change in morning light and evening weight. Thyroid function was checked after 3 months with methylmercaptoimidazole: free triiodothyronine: 5.42 ng/L, free thyroxine: 1.25 mg/L, thyroid stimulating hormone: 0.585 IU/L, thyroid stimulating hormone receptor antibody 5.50 IU/L, and thyroid function was checked after 5 months: free triiodothyronine: 4.39 ng/L, free thyroxine: 1.02 mg/L, thyroid stimulating hormone: 1.52 IU/L. Up to the follow-up date of June 6, 2015, the ocular condition was good, myasthenia gravis did not convert to generalized form, and the thyroid function was normal.

Crouzon syndrome, also known as hereditary familial craniofacial hypoplasia, is a rare genetic disease named after the first report by French physician Crouzon in 1912^[1]。 The clinical features of the disease include craniosynostosis, mid-facial dysplasia and exophthalmos. Most ophthalmologists have insufficient understanding of this disease, which is easily neglected in clinical diagnosis and treatment. The author encountered a family with Crouzon syndrome in 2014, which is now reported as follows, and the relevant literature is reviewed to raise awareness and avoid missed diagnosis and misdiagnosis.

The patient was a 42-year-old female. Because the visual acuity of his left eye suddenly decreased for 16 h, he was seen in the Department of Ophthalmology, Affiliated Hospital of Guangdong Medical University. Systemic examination: mild elevation of blood triglycerides, mild fatty liver. Eye examination: the visual acuity of the right eye is 1.5, and the left eye is manual before the eye; IOP was 12 mmHg (1 mmHg =0.133 kPa) in the right eye and 13 mmHg in the left eye; The cornea of both eyes is transparent, the aqueous humor is clear, and the iris texture is clear. The pupil diameter of the right eye is 3 mm, and the direct response to light is normal, while the pupil diameter of the left eye is 4 mm, and the direct response to light is slow. Right fundus normal; For the left fundus, seeQuintessence Picture 1。 FFA examination: the boundary of the optic papilla is unclear, the retina is scattered with bleeding to block the fluorescence, the retinal artery is full, the venous return is slow, the temporal retina is a large capillary without perfusion area, the posterior pole capillary is dilated, and there are small non-perfusion areas in between, and the late fluorescein leakage is obvious. OCT examination is presented inQuintessence Picture 2。 Clinical diagnosis: retinal artery occlusion combined with venous occlusion in left eye.

Idiopathic intracranial hypertension(IIH) is a kind of diffuse brain swelling disease. Several causes could lead to IIH. Intracranial venous circulatory disturbance is more common. The clinical manifestations include intracranial pressure increased, headache and papilledema. Since IIH usually has serious impact on vision even blindness, the diagnosis and corresponding treatment are especially important. This review is to discuss the new insights on the therapeutic options of IIH, which cover medical treatment, weight-losing therapy, surgical treatment, interventional therapy and supportive treatment.(Chin J Ophthalmol, 2016, 52: 948-951)

The lamina cribrosa (LC) is believed to be site of injury to retina ganglion cell axons in glaucoma. The ability to visualize this structure helps us increase the understanding of pathophysiological process of glaucoma. At the same time, it is helpful in the early detection and treatment of glaucoma. While for many years the researches on the LC were essentially dependent on histology. With the development of optical coherence tomography (OCT) in recent years, it is possible to image the LC in vivo in both animals and human. This review focused on the biomechanics of optic nerve and LC, recent advances in OCT imaging of LC, imaging processing and analysis. All of these will supply the ability to diagnose and monitor glaucoma, as well as to expand our recognition of its pathophysiology. (Chin J Ophthalmol, 2016, 52: 952-956)

Pupillary examination is an important item in ophthalmology and neurology. This examination has the advantages of being convenient, non-invasive and not relying on expensive equipment. Because the size and activity of the pupil are controlled by the autonomic nervous system, pupil examination can reflect visual function information that patients cannot subjectively control. In some ophthalmic diseases, pupil changes may be the only positive sign, and pupil examination is an important objective basis for evaluating related diseases. In addition, pupil examination requires low cooperation with patients, and pupil examination is still feasible for infants, young children, the elderly and seriously ill patients. Mastering the correct method of pupil examination is of great significance to the clinical diagnosis of ophthalmic diseases.