Volume 50 · Issue 07 · 2014

The introduction of Preferred Practice Patterns (PPP) into China has given ophthalmologists in China more opportunities to acquaint themselves with international clinical guidelines for eye care,including its developing principles,methods and the application value.It had brought significant effects on the fast improvement of clinical eye care and standardization of diagnosis and treatment of eye diseases in China,and promoted the international academic exchanges.The 2nd Chinese version of PPPs translated by Prof.Jialiang Zhao was officially published in November,2013.The new version of PPP for amblyopia adopted the newest standard for grading of evidence strength and recommendation assessment,and emphasizes the practicability based on evidence.New explanations of the definition of amblyopia are added according to the recent research progresses in amblyopia.The diagnostic criteria of best visual acuity for bilateral amblyopia at different ages is given with new specifications.Comprehensive and practical suggestions on the examination methods for amblyopia are provided from the qualitative assessment of visual acuity,the choice of eye chart,to the use of cycloplegic agents.In the aspect of the treatment of amblyopia,based on the findings of recent multi-central random controlled clinical trials,not only strong recommendations are provided,but also the insufficiency of evidence supporting for some choices of therapy is pointed out.The necessity of the follow-up evaluation after the cessation of the treatment of amblyopia is emphasized too.In the aspect of the prevention of amblyopia,the new amblyopia PPP points out the importance of the early-period screening of amblyopia,and that the healthcare insurance plans should cover timely screening,treatment,and monitoring for recurrence of amblyopia.This article deciphers the essential contents of the new version of Chinese PPP for amblyopia,and aims to promote the standardization of the diagnosis and treatment of amblyopia with our ophthalmic colleagues in China.

Surgical treatments of intermittent exotropia include symmetric bilateral lateral rectus recession,symmetric bilateral medial rectus resection,asymmetric monocular lateral rectus recession and/or medial rectus resection,in which lateral rectus recession is the most common method.The maximum amount of lateral rectus recession,however,is still controversial.Bilateral lateral rectus recession 7-8 mm for 35Δ-40Δ exotropia and unilateral lateral rectus recession and medial rectus resection for exotropia larger than 40Δ are suggested by most doctor usually.But some other doctors advocated augmented bilateral lateral rectus recession (9-14 mm) for exotropia larger than 50Δ or augmented unilateral lateral rectus recession for moderate angle exotropia (30Δ-35Δ),which brought confusion in practical clinical work.In this paper,we'll focus on the amount of lateral rectus recession,and discuss several common issues related to augmented lateral rectus recession,in order to provide references for the majority of clinicians.

Objective To investigate AC/A ratio and coexisting ametropia in intermittent exotropia.To discuss the relation between AC/A ratio and the development of intermittent exotropia.Methods The medical records of 135 patients who had an exotropia were retrospectively reviewed.Patients were divided into 3 groups based on the type of ametropia:exotropia without ametropia(-0.50-+ 3.00 D between the age of 3-6 years old,-0.50-+ 2.00 D between the age of 7-40 years old),exotropia coexisting with myopia (-0.50-7.75 D)and exotropia coexisting with hypermetropia(≥ + 3.00 D of 3-6 years old,≥ + 2.00 D of 7 ～40 years old).AC/A ratios of all patients were assessed using synoptophore method.Distance and near deviations were assessed using prism cover test.AC/A ratios and deviation angles of 3 groups were compared.The relationship between AC/A ratios and ametropia/age were investigated.Results There were obvious differences in AC/A ratios (2.686 ± 1.372,1.773 ± 1.110,4.581 ± 1.552,F =36.323,P ＜ 0.001) and in near deviation angles (44.473Δ ± 19.008Δ,53.621Δ ± 20.749Δ,34.455Δ ± 13.292Δ,F =8.762,P =＜0.001) between 3 groups of patients,no obvious differences were seen in distance deviation angles(40.333Δ ± 19.474Δ,44.052Δ ± 23.722Δ,35.590Δ ± 11.143Δ,F =1.444,P =0.24).AC/A ratios were negative linear correlated with refractive powers for patients of intermittent extropia coexisting with myopia or with hypermetropia(r =0.320,P =-0.469 and r =-0.046,P =0.036,respectively).A trend of decline with age was found for AC/A ratios only in patients of intermittent extropia without ametropia(r =-0.320,P =0.019 ; r =-0.023,P =0.865 ; r =0.246,P =0.296 for the other 2 groups,respectively).Conclusions Myopia and hypermetropia,when coexisting with abnormally low or high AC/A ratio,can destroy the balance between extraocular muscles and induce exophoria to be manifest.

Objective To investigate the efficacy and safety of full-time patching therapy of anisometropic amblyopia in children aged 8-14 years.Methods It was a prospective case series study.Forty-three patients with anisometropic amblyopia without strabismus (ranged from 8-14 years,mean 10.8 years) were included in this study.All of the patients received eye patching for the entire day,29 days a month,during the first 3 months.Distance best corrected visual acuity in LogMAR units; cycloplegic refraction and contrast sensitivity function were performed on all the patients before treatment,at a month later of full-time patching therapy,and all recorded at 3 months later,and evaluation the spatial function with visual acuity,the area under the log contrast sensitivity function (AULCSF),the co-ordinates of the peak of the CSF (maximum sensitivity,Smax,and the spatial frequency at which it occurs,Fmax) and the cut-off spatial frequency.Difference amoug groups was evaluated by analysis of variance (One-Way ANOVA),and the Bonferroni test investigated the pairwise comparison of the groups.Results The degree of amblyopia and the D-value of binocular AULCSF of before full-cover treatment,after one month's and three months' full-cover treatment were-0.70 ± 0.30,-0.57 ± 0.29,-0.47 ± 0.28 and 0.78 ± 0.48,0.63 ±0.43,0.53 ±0.42,respectively,which showed statistically significant differences (F =6.406,P ＜ 0.01 ; F =3.517,P =0.028).The degree of amblyopia,the D-value of binocular AULCSF after three months' full-cover treatment had significant difference compared with those before full-cover treatment (P ＜ 0.01 ; P =0.02).There were statistically significant differences along with time in the best corrected visual acuity (BCVA) of the amblyopic eye,AULCSF and CutSF (F =6.906,P ＜ 0.01 ; F =4.016,P =0.02 ; F =5.717,P ＜0.01).The BCVA of the amblyopic eye,AULCSF and CutSF after three months' full-cover treatment had significant difference compared with those before full-cover treatment (P ＜ 0.01 ; P =0.028; P ＜0.01).However,the BCVA,AULCSF of the normal eye,and Smax,Frmax of amblyopic eye showed no statistically significant differences among groups along with time (F =0.243,P =0.785 ; F =0.265,P =0.768; F=0.949,P =0.390; F =2.934,P =0.057).Conclusions The present results show that continuous full-time patching in older children with anisometropic amblyopia improves visual acuity,and cut off spatial sensitivity with no serious complications.The use of continuous full-time patching in after-school children to improve amblyopia seems promising.

Objective To investigate the effect of superior oblique recession on the status of ocular torsion.Methods Twenty patients (31 eyes) underwent superior oblique recession for treatment of superior oblique overacting,11 cases had both eyes involvement while 9 had monocular.Objective cyclotorsion were examined pre-operation,as well as 1,30,90 days post-operation with fundus photograph.The photographs were transferred to a computer and then the fovea-disa angle (FDA) was measured by a software for drawing pictures.Subjective cyclotorsion were assessed by double Maddox rod test and synoptophore,while the binocular vision function by Bagolini glasses and Titmus.Results For 11 cases of the both eyes involvement,preoperation FDA was 9.50° ±5.12°in the right eyes,8.23° ± 3.45° in the left eyes,there was not statistically significant between two eyes (t =1.12,P =0.29).For 9 cases of the monocular eye involvement,preoperation FDA was 6.55° ±4.14°in the affected eyes,6.85° ±5.08° in the follow eyes,there was also not statistically significant between two eyes (t =0.13,P =0.90).To 1 1 cases of the both eyes involvement,the combined FDA of preoperation and 1,30,90 days after operation were 17.74° ±7.89°and 7.63 ° ± 4.28 °,6.05 ° ± 6.1 1 °,7.33 ° ± 6.17 ° respectively.The comparision of objective ocular cyclotorsion for both eyes showed significant difference pre-and post-operation(F =8.245,P ＜0.01).To 9 cases of the monocular eye involvement,the combined FDA of preoperation and 1,30,90 days after operation were 13.40° ±6.13°and 5.06° ±3.99°,3.59° ± 3.47°,5.07° ± 3.35°respectively.The comparision of objective ocular cyclotorsion showed significant difference pre-and post-operation (F =9.351,P ＜ 0.01).Four patients had subjective cyclotorsion,but it's different with objective cyclotorsion before and after surgery.8 patients' binocular vision function were ameliorated after surgery.Conclusion Recession of overaction superior oblique muscles can correct ocular incyclodeviation effectively.

Objective To offer a clue for the etiology of amblyopia by systematically comparing the macular thickness measured by optical coherence tomography (OCT) between the amblyopic eye and the fellow normal eye in patients with unilateral amblyopia.Methods Databases including Wanfang,PubMed and others were searched,and data were extracted after quality assessment,then the Meta analysis was preformed by the RevMan 5.02 software.Results Four studies using the time-domain OCT (TD-OCT) were enrolled in the analysis and all those were anisometropic amblyopic patients.The only one study showed that the foveal minimum thickness is thicker in the amblyopic eyes than the fellow ones (P =0.045).The meta analysis indicated the amblyopic eyes were 6.82 μm (P ＜ 0.05,95％ CI:2.81-10.83) thicker in the fovea (1 mm diameter region).Five trials using the spectral-domain OCT (SD-OCT) were included in the analysis.It showed no significant difference in the foveal minimum thickness between amblyopic and fellow eyes.Also,no significant difference were detected in either anisometropic or strabismic subgroup (P =0.50).Amblyopic eyes were 7.38 μm thicker in the fovea (1 mm diameter region) (P ＜0.05,95％ CI:3.13-11.63)and significant difference in the anisometropic subgroup while no significant difference in the strabismic subgroup were detected.Conclusions The macular fovea is thicker in the amblyopic eyes than the fellow ones by the use of OCT,so it is effective to measure the macular thickness of amblyopia in searching evidence for the etiology of amblyopia.

Objective To observe the spatiotemporal frequency tuning of pattern visual evoked potentials in Wistar rats.Methods Experimental study.15 Wistar rats of 8 weeks old were used in this study.Recording electrodes were chronically inserted into the skull without piercing the dura at the corresponding sites to the primary visual cortex under anesthesia.Reference electrodes were inserted into the nose bone in the same way.Pattern visual evoked potentials were recorded on the 3rd,5th,7th and 9th postoperation days.The visual stimuli were chessboard patterns with spatial frequency of 0.01,0.02,0.04 or 0.08 cpd,and temporal frequency of 1,2,4 or 6 Hz,respectively.Data were processed and statistically analyzed with Matlab and SPSS.The amplitudes and latencies of pattern visual evoked potentials under different spatial and temporal frequencies,the inter-individual variations and the repeated measurement variations were compared.Results With the increase of spatial frequencies,the P100 amplitudes of PVEPs were gradually reduced,which were (29.87 ±10.37) μV (0.01 cpd),(31.92 ±10.98) μV (0.02 cpd),(28.46 ±6.18) μV (0.04 cpd) and (20.71 ±6.54) μV(0.08 cpd),respectively,with significant difference among groups (F =3.725,P =0.018),and the P100 latencies of PVEPs were gradually elongated,which were (96.25 ± 12.12) ms (0.01 cpd),(95.73 ± 15.13) ms (0.02 cpd),(101.75 ± 8.11) ms (0.04 cpd) and (125.58 ± 18.32) ms (0.08 cpd),respectively,with significant difference among groups (F =12.187,P =0.000).With the increase of temporal frequencies,the P100 amplitudes of PVEPs were gradually reduced,which were (30.71 ± 8.25) μV (1 Hz),(29.75 ± 4.76) μV (2 Hz),(25.79 ± 8.51) μV (4 Hz) and (19.63 ± 6.00) μV (6 Hz),with significant difference among groups (F =6.115,P =0.001),and there was no change of P100 latencies,which were (102.58 ± 16.09) ms (1 Hz),(101.75 ± 10.32) ms (2 Hz),(104.25 ±12.51) ms (4 Hz) and (102.67± 13.59) ms (6 Hz),respectively,with no significant difference among groups (F =0.074,P =0.974).The inter-individual variation was the smallest under the spatial frequency of 0.04 cpd and temporal frequency of 2 Hz.The repeated measurement variations showed no significant change under tested conditions.Conclusion Under appropriate stimuli and recording conditions,PVEP can be reliably recorded in Wistar rats.The spatiotemporal frequency tuning of P100 amplitudes of Wistar rats exhibit low-pass selectivity.The spatial frequency affects the P100 latency in Wistar rat,but not so does the temporal frequency.

Objective To study changes of blood flow of ophthalmic artery (OA),central retinal artery (CRA) and posterior ciliary artery (PCA) in patients with primary retinitis pigmentosa.Methods Color Doppler flow imaging (CDIF) was used in 184 cases (184 eyes) of RP patient.The peak systolic velocity (PSV),end diastolic velocity (EDV),time-averaged maximum velocity (TAMV),pulsatility index (PI) and resistance index (RI) were measured in OA,CRA and PCA separately.Data was analyzed statistically by One-Sample T Test to compare changes of these parameters between RP and normal group.Results Concerning RP group,inOA,thePSV,EDV,TAMV[(33.05±8.62),(7.74±3.04),(14.16± 4.43) cm/s] vs normal group[(31.47±9.63),(7.11 ±2.34),(12.44 ±3.64) cm/s] were increased,the differences were statistically significant (t =-2.481,2.820,5.253,P ＜ 0.05).But the PI in OA of RP (1.87 ± 0.73) vs normal group (2.02 ± 0.71) was deceased,the difference was statistically significant (t =-2.794 ;P ＜ 0.05).Concerning RP group,in CRA,the PSV,EDV,TAMV,PI and RI [(5.30 ± 1.36),(2.11 ±0.49),(3.01 ±0.680) cm/s],[(1.05 ±0.28),(0.60 ±0.18)] vs normal group [(10.82 ± 2.97),(3.28 ±1.11),(5.50±2.06) cm/s],[(1.48 ±0.49),(0.71 ±0.08)] were decreased,the differences were statistically significant (t =-55.186,-32.015,-49.634,-20.430,-8.704,P ＜ 0.05).Concerning RP group,in PCA,the PSV 、EDV 、TAMV 、PI and RI [(7.60 ± 1.95),(2.59 ± 0.58),(4.07±1.00) cm/s],[(1.23 ±0.28),(0.65±0.80)] vs normal group[(11.61 ±3.41),(3.34± 1.25),(5.83 ± 1.91) cm/s],[(1.49 ± 0.43),(0.70 ± 0.09)] were decreased,the differences were statistically significant (t =-28.097,-17.541,-23.842,12.445,-8.720,P ＜ 0.05).Conclusions Hemodynamic abnormal changes of OA,RCA and PCA in RP patients possibly suggest the role of blood supply in occurrence or development of RP.Maintaining normal ocular blood flow may be able to offer a new way for prevention and treatment for RP.

Objective To describe the clinical features as well as mutations in 2 relative genes in 5 cases with macular dystrophies presenting with vitelliform lesions in adulthood.Methods Case control study.A total of 5 patients visited Eye and ENT Hospital of Fudan University between January and December 2012 and diagnosed with adult onset macular dystrophy were reviewed.Patient evaluation included complete ophthalmic examinations,such as optical coherence tomography,fundus photography,electrooculogram testing and fundus autofluorescence.The Best1 and peripherin/RDS genes were screened for variation by direct DNA sequencing of coding regions and intron/exon boundaries.At the same time,50 controls were screened in the same way to get comparisons.Results The age at the time of diagnosis ranged from 28 to 59 years with the average of 45 years.2 patients were affected bilaterally,while the other 3 were unilateral Attack.Moreover,vitelliform lesion and macular atrophy was found in 2 eyes separately in 1 patient.Direct sequencing of PCR products spanning all exons revealed a noval missense mutation in 1 patient:1009 G ＞ A,causing a Ala 337 Thr change in Peripherin/RDS gene exon 3,as well as a slightly reduced EOG Arden index bilaterally.There was no such change in controls.Conclusions The AVMD related with mutations in peripherin/RDS gene has its own clinical features.The mutation near the C-terminal domain of the polypeptide may play a crucial role in the development of AVMD.There is some relevance between clinical feature and genetype in AVMD.

Objective To characterize the safety profile of triamcinolone acetonide made in China (Transton) and triamcinolone acetonide acetate (Tongyong) for their ocular application.Methods Experimental study.In vitro cell viability assay was performed on 3 types of human ocular cells to evaluate the cytotoxicity of the simulated vitreal concentrations (from a 1 ∶ 15 dilution as if injected into 1.5 ml of rabbit vitreous to 1∶50 dilution as if injected into 5 ml of human vitreous) of Transton and Tongyong using MTT method.In vivo 28 guinea pigs,randomly divided into four groups,were used for evaluating either intravitreal 6 μl of the two types of triamcinolone suspension or 18 μ1 of their supernatant.Following the injections,the eyes were monitored by biomicroscopy,ophthalmoscopy,tonometry,electroretinography,and histology.The Dunnett's test was used to analyze in vitro cell viability.Paired sample t-test and Generalized Estimating Equations (GEE) were respectively used to compare electroretinography data and intraocular pressure between experimental eyes and the control eyes.Results The undiluted supernatant of Transton and Tongyong was toxic to human scleral fibroblasts when compared with their control groups(MTT values =0.046 ±0.036 and 0.044 ±0.05 versus 0.367 ± 0.106 and 0.413 ± 0.128) (P ＜ 0.01) or with the BSS group (0.368 ±0.106 and 0.441 ±0.137) (P ＜0.01).1∶15 or greater dilution of supernatant of Transton and Tongyong did not show cytotoxicity on cultured human retinal pigment epithelium cells or Müller cell (P ＞ 0.05),but 1∶15 dilution of Tongyong supematant showed cytotoxicity on the Müller cells (MTT value =0.366 ± 0.062 versus 0.417 ± 0.042 for BSS) (P =0.03).In vivo,neither intravitreal 6 μl (0.25 mg,equivalent to 4 mg in 0.1 ml for human eyes) of the suspension nor 18 μl(equivalent resultant preservative concentration to intravitreal 4 mg in 0.1 ml for rabbit eyes) of the supernatant of Transton and Tongyong showed ocular toxicity.Conclusion The equivalent dose (6 μl) to 4 mg in 0.1 ml intravitreal suspension for human eye or equivalent resultant preservative concentration to 0.1 ml intravitreal suspension for rabbit eye is found safe in guinea pig eyes.

Objective To evaluate the long-term efficacy of laser peripheral iridotomy (LPI) in preventing deterioration in eyes with pigment dispersion syndrome (PDS).Methods A cohort study.Nineteen patients with PDS were treated with LPI and followed up periodically in Beijing Tongren Eye Center from May 2006 to April 2007.One eye of each patient was chosen randomly for the study.Main investigating items included iris configuration,intraocular pressure (IOP),anterior chamber pigmentation,and visual field analysis.The average follow-up period was (6.5 ± 0.3) years.A paired sample t test was used to determine whether there is a significant difference between average values of pre-and post-LPI IOP and mean deviation of Humphrey visual field analysis in these PDS eyes.Results The average age of the 19 patients were (35.8 ±7.1) years on admission.The initial IOP of the 19 eyes was (24.7 ±2.2) mmHg(1 mmHg =0.133 kPa)before LPI.The mean deviation (MD) of Humphrey visual field analysis (VFA) were (-1.82 ± 1.26) dB(-4.34--0.28 dB).All 19 eyes had concave iris and heavy trabecular pigmentation.The iris became fiat in all PDS eyes after the laser treatment.At the last follow-up visit,the average IOP was 14.8 ± 2.0 (12-20) mmHg,which was statistically lower than that of baseline (t =11.49,P ＜ 0.01).Extent of trabecular pigmentation reduced obviously in 16 eyes.No deterioration or new visual field defect was detected in any of the PDS eyes.MD of the last VFA was-1.79 ± 1.21 (-4.39--0.21 dB).There was no statistical difference between MD of the last VFA and baseline (t =-0.26,P =0.798).Conclusion The long-term follow-up results showed that LPI prevents progression effectively in eyes with PDS.

Morquio syndrome belongs to mucopolysaccharide metabolism abnormalities, that is, type IV of mucopolysaccharidosis, also known as hereditary chondrodystrophic syndrome. A case is reported. A 20-year-old male was diagnosed with abnormal skeletal development in the local hospital, but no treatment was given. In the past 5 years, his visual acuity in both eyes decreased, accompanied by swelling, pain and headache in both eyes, and he was diagnosed with glaucoma in both eyes in the local hospital 2 years ago. The highest intraocular pressure was 43 mmHg (1 mmHg =0.133 kPa). He was treated with timolol eye drops and mannitol intravenously, and the intraocular pressure was controlled at about 23 mmHg. In the past two years, the intraocular pressure was poorly controlled by drugs, and the visual acuity decreased significantly. The parents were not close relatives, both of them were in good health, and delivered naturally at full term. His brother was 184 cm tall, without similar symptoms, and suffered from ankylosing spondylitis.

Reiter's syndrome is a special type of reactive arthritis with arthritis, urethritis and conjunctivitis as clinical characteristics. The disease was first reported by Reiter in 1916 [1]. The main manifestation of Reiter's syndrome in the eye is conjunctivitis, and keratitis is relatively rare. In 2010, a patient with Reiter's syndrome complicated with corneal ulcer was admitted to our hospital. The patient was an 18-year-old man. Because of redness and pain in both eyes for 1 month, aggravated and blurred vision for 10 days, he came to Beijing Tongren Eye Center on May 14, 2010 with the help of his parents. One month ago, the patient developed redness and pain in both eyes, swelling of knee joint and difficulty in moving both lower limbs without obvious trigger. He went to a local county hospital for diagnosis and treatment. He was given levofloxacin eye drops and oral indomethacin, but the effect was not good, and the symptoms worsened day by day. 10 days ago, the patient's visual acuity in both eyes decreased. Eye examination: the visual acuity was 0.1 in the right eye and the anterior index in the left eye; Mixed conjunctival hyperemia in both eyes, opacity in the center of the cornea, strip-shaped or disc-shaped lesions, spot-shaped staining in the right eye, fusiform ulcer in the left cornea, edema and folds in the posterior elastic layer of the cornea in the corresponding area of the lesion (Figure 1); The anterior chamber of both eyes is middle deep, the aqueous humor is clear, the pupil is round, the diameter is 3 mm, and the lens is clear; Laboratory examination showed that no pathogen was found in the scraping of corneal lesions of left eye, the bacterial and fungal cultures were negative, the amoeba culture was negative, and the detection of herpes simplex virus antibody in conjunctiva of both eyes was negative.

The patient was a 26-year-old male who came to the Department of Ophthalmology of Occupational Disease Hospital of Xinjiang Uygur Autonomous Region because of the decrease of visual acuity in his left eye for 1 year and aggravation for 2 months. The patient had no history of hereditary diseases in his family. The center of the cornea became obviously thinner, showing a special oval cone, the apex of the cone was located in the center of the cornea, the cornea became thinner towards the apex of the cone, and the cornea became thinner, with local opacity and edema (Quintessence Picture 1).

A 28-year-old male came to the Department of Ophthalmology of the General Hospital of the People's Liberation Army because of filamentous keratitis after LASIK in both eyes. He dropped a large amount of topical anesthetic (promecaine hydrochloride) into both eyes by himself, resulting in corneal ulcers in both eyes. Intraocular pressure in the right eye was measured as Tn; The left eye was T +2; the cornea of both eyes was conjunctival, a large number of new blood vessels grew in, and the internal structure of the remaining eyes could not be seen. Clinical diagnosis: drug toxic keratitis caused by topical anesthetic drugs in both eyes. The left eye glaucoma valve implantation combined with Boston type Ⅰ artificial cornea implantation was performed. The postoperative visual acuity of left eye was 0.2 in the naked eye and 0.6 (-2.00 DS) in the corrected visual acuity.

Highly myopic strabismus,also known as ‘heavy eye syndrome' or ‘myopic strabismus fixus',is an acquired restrictive strabismus occurred in patients with pathologic myopia.Patients often manifest extreme esotropia,hypotropia and restrictive ocular motility.Recession of medial rectus and resection of lateral rectus,even dis-insertion of medial rectus surgery often have limited effect in the severe high myopia strabismus,and susceptible to recur postoperatively.In the European strabismus meeting of 2001,Yokoyama first proposed a new surgical idea,he suggested to union the lateral rectus and superior rectus together,and use it as a muscle pulley to push the herniated eyeball back into the muscle cone.After that,a series of studies focused on the specific surgical operation methods.The objective of this article is to review recent research progress of highly myopic strabismus surgery,in order to give some recommendations for the improvement of surgical treatment.

Avian influenza virus (AIV) has caused several outbreaks in humans,leading to disasters to human beings.The outbreak of H7N9 avian influenza in China in 2003 re-attracted our close attention to this disease.More and more evidences demonstrated that eye is one of invasion portals of AIV,leading to conjunctivitis.The current studies showed that only subtypes H7 and H5 could cause severe systemic infections.Abundant distribution of α-2,3 siliac acid receptor in conjunctiva and cornea as well as specific activiation of NF-κB signal transduction pathway by subtype H7 virus may contribute to the ocular tropism of the virus.These studies suggest that avian influenza conjunctivitis should be considered as a differential diagnosis during influenza epidemic seasons,and eyes should be well protected for disease control personnel when handling avian influenza epidemics.This review focused on AIV conjunctivitis and the molecular basis of ocular tropism.

The preoperative examination of strabismus includes two aspects: perceptual function examination and motor function examination. The former includes visual acuity, refraction and binocular monopic function examination; The latter includes strabismus degree measurement, eye movement examination, traction test, etc. At present, some ophthalmologists in China still use Hirschberg test, arc field meter or synoptic machine method to measure strabismus degree in clinical examination of strabismus, but the methods and principles of measuring strabismus degree by using triangular prism commonly used in the world, such as triangular prism plus alternating covering method, triangular prism corneal mapping method (Krimsky test) and simultaneous prism cover test, are not sufficiently grasped and understood, and some matters needing attention in the process of using triangular prism examination are not clear. The clinical examination of horizontal strabismus combined with vertical strabismus, dissociative vertical deviation, extraocular muscle paralysis or non-common strabismus caused by mechanical restriction is often inadequate and comprehensive, which affects the rational surgical design; In addition, the evaluation of head position of strabismus patients and the examination of binocular monoscopic function before and after surgery may also be inaccurate.Therefore, it is necessary to further strengthen the study of basic theory of strabismus specialty and the training of clinical skills of ophthalmologists in grass-roots hospitals, standardize the clinical examination of strabismus, and gradually improve the overall level of strabismus diagnosis and treatment in China.

In order to timely report and publicize domestic innovative research trends, promote the dissemination of new technologies and new achievements, and enhance domestic and foreign exchanges, this journal continued to open the "Research Letter" column in 2014. Submission requirements: (1) Contents: cutting-edge innovative research and discoveries that are in the near future and cannot yet form a complete treatise, but have relevant data and scientific significance; (2) Style: Four-paragraph essay format, with Chinese and English titles and narrative Chinese and English abstracts (English abstracts will be available internationally through the Medline database). Articles published in this column focus on the rapid dissemination of research information and trends, and have the advantages of publicity and first release at home and abroad (different from publishing complete research articles). Ophthalmologists are welcome to contribute enthusiastically.

Sponsored by the Ocular Trauma Group of Ophthalmology Branch of Chinese Medical Association, hosted by Shenzhen Eye Hospital and co-organized by Shenzhen Medical Doctors Association, the 20th National Symposium on Ocular Trauma will be held in Shenzhen Qilin Villa Conference Center (No.4599 Qinyuan Road, Xili, Nanshan District) from October 30th to November 2nd, 2014.

In order to use the terminology and its abbreviations in this field more conveniently and concisely, this journal specifically publishes some foreign language abbreviations which are well-known and recognized. Authors can directly use the following abbreviations in the abstract and text without giving their full names when writing articles. For unpublished terms, please write the full Chinese name when it first appears, and write the full foreign name and its abbreviation in parentheses, such as tumor necrosis factor (TNF).

According to international practice and the actual situation in China, for papers that meet the following conditions, the Chinese Medical Association series journals allow and accept the republication of relevant papers of the same research in different languages.

If the topic involved in the thesis is a national or ministerial or provincial fund or key project, the name of the fund project should be indicated with "Fund Project:" as the logo at the foot of the front page of the article, and the project number should be indicated in parentheses. The name of the fund project shall be filled in according to the official name stipulated by the relevant departments of the state, and a number of funds shall be listed in turn, separated by ";". All fund projects must be accompanied by copies of certificates.

The 19th National Ophthalmology Conference and the 17th Asian-African Ophthalmology Conference are scheduled to be held in Xi' an from September 17th to 21st, 2014. At that time, more than 1,000 famous international and domestic ophthalmologists will give special reports on new technologies, new knowledge and new experiences in ophthalmology development. Ophthalmologists from all over the country and Asian and African countries will gather at this event to exchange and share the latest research results in ophthalmology and visual science with domestic colleagues. The conference will also hold a large-scale exhibition of ophthalmic medical devices and drugs. The organizing committee of the conference welcomes ophthalmologists from all over the country to actively contribute to the conference. The relevant matters are hereby notified as follows: Meeting time: registration from September 17th to 18th, academic activities such as study group meetings, conferences and continuing education classes from September 18th to 21st; Venue: Xi'an Qujiang International Conference Center; Conference languages: Chinese and English.

Ophthalmic pathological technique is the most important component of pathological diagnostics. The book "Ophthalmic Pathology Filming and Cell Culture Technology" edited by Professor Zhuo Yehong, chief technician of Zheng Jianke and doctoral supervisor of Sun Yat-sen Ophthalmology Center of Sun Yat-sen University, was published by Guangdong Science and Technology Press in 2014. This book consists of 5 chapters and 36 sections, with a total of 107 color drawings and explanations. The main contents include: (1) routine film making techniques of human and several animal eye pathology; (2) Special staining and histochemical staining; (3) Immunohistochemical techniques; (4) Molecular biology technology; (5) Human eye tissue cell culture technology, including in vitro culture technology of 14 normal cells of human eye and 2 most common malignant tumors in the eye.

1. Statistical symbols: According to the relevant provisions of GB3358-1982 "Statistical Terms and Symbols", all statistical symbols are printed in italics. Commonly used: (1) The arithmetic mean of the sample is in English lowercase face (the median is in M); (2) Standard deviation is lowercase s in English; (3) Standard misuse of English lowercase sx; (4) t test is lowercase t in English;

Chinese Journal of Ophthalmology is a professional academic journal of ophthalmology sponsored by Chinese Medical Association. It targets ophthalmologists as the main readers, reporting leading scientific research achievements, clinical diagnosis and treatment experience in the field of ophthalmology, and basic theoretical research that has a guiding role in ophthalmology clinics and is closely integrated with ophthalmology clinics. The purpose of this journal is to implement the principles and policies of the Party and the state on health work, implement the principle of combining theory with practice, popularization and improvement, reflect the significant progress of clinical and scientific research in ophthalmology in China, and promote academic exchanges in ophthalmology at home and abroad.