Volume 50 · Issue 10 · 2014

The purpose of this artical is to make authors and readers master some writing and reading skills by elaborating the definition,characteristics,the comparison of style and writing technique of expert commentary.Expert commentary is journal editorial that is not only author's personal point of view,but also the collective opinions of Ophthalmology Branch of the Chinese Medical Association and editorial board of the magazine.Therefore,it should be view clear,clear-cut stand and having certain academic orientation.It is our common responsibility to promote the academic development of ophthalmology in China,by mobilizing various aspects strength,carefully written and read expert commentary.

Along with the development of cell biology and molecular biology,the application of molecular biotechnology has brought new vitality into traditional pathology.Recently,hot research topics of ocular pathology field mainly focus on diabetic ophthalmopathy,dry eye syndrome,age-related macular degeneration and ocular tumors.Base on hot research topics,we analyzed the present status and existing problems in ocular pathology field of China.

Histopathologic high risk factors are core content in the histopathologic examination of enucleated retinoblastoma.Histopathologic high risk factors indicate that the patient has high risk of tumor spreading and metastasizing and should be given systemic adjuvant chemotherapy.Therefore,histopathologic high risk factors can provide important basis for clinicians to determine treatment plan and serve as the important foundation for clinical trials and studies to validate the proposed criteria.The focus of our discussion includes three aspects as follows.How to evaluate histopathologic high risk factors? Can clinical characteristics be used to predict histopathologic high risk factors? Do histopathologic high risk factors have any hint for intra-arterial chemotherapy? The importance of evaluating histopathologic high risk factors in retinoblastoma is emphasized in this article.

The 11th National Symposium on Refractive Surgery (CSORS) and the National Optometry Standardized Diagnosis and Treatment Theory and Practice Study Class will be held in Nanchang, Jiangxi Province from November 13th to 16th, 2014. The contents of the conference included the experience and experience of excimer laser and femtosecond laser corneal refractive surgery and intraocular refractive surgery, individualized cutting technology, prevention and management of surgical complications, perioperative medication, etc.

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. 1. High-quality and influential scientific research papers. 2. The author needs to obtain the consent of the relevant journal, and there is no objection to the journal that publishes the paper for the first time and the journal that is going to be published again. The author is required to provide the republished journal with the consent of the journal for the first publication of the paper, the time of the first publication of the paper and a copy, single volume or original manuscript of the paper.

Objective To analyze the clinicopathologic characteristics of retinoblastoma spontaneous regression.Methods Retrospective case series study.The clinic and pathologic data of 52 cases of retinoblastoma spontaneous regression were analyzed retrospectively.All the cases came from 579 cases of retinoblastoma (without pre-enucleation chemotherapy) archived in Ophthalmic Pathology Laboratory of Beijing Tongren Eye Centre from Jan.2007 to Dec.2013.The analyzed factors included tumor activity,tumor invasion,and tissue changes of uveal and lens.Results In this study,the patients' average age was (14.0 ± 8.7) months.There were 33 (63.5％) male and 19 (36.5％) female patients.The rate of retinoblastoma spontaneous regression was 9.0％ (52/579),of which the rate of complete regression was 1.4％ (8/579).The most common symptom was leucocoria coupled with red eye 55.8％ (29/52).The typical clinicopathologic characteristics were as follows:(1) all or most of all tumor cells suffered coagulation necrosis and only tumor cell remains were left; (2)most eyeballs showed atrophiabulbi or phthisis bulbi; (3) severe atrophy occurred in uvea,especially in iris and ciliary body combined with pigment cells disintegrating; (4) cataract formed coupled with lens swelling,displacement,or wrapped by fibrous connective tissue; (5) in a small number of cases,there were alive tumor cells in the retrolaminar optic nerve or choroid in spite of most tumor cells had suffered regression,indicating the patients had histopathologic high risk factors and had the dispositions of tumor diffusion and metastasis.Conclusions Some untypical clinical manifestation such as leukocoria coupled with red eye or atrophia bulbi should be paid close attention.The possibility of retinoblastoma spontaneous regression should be considered.Meanwhile,some cases of retinoblastoma spontaneous regression with histopathologic high risk factors should be given post-enucleation systemic adjuvant chemotherapy combined with close observations and follow-ups.

Orbital fracture is the most common orbital trauma at present. The book "Diagnosis and Treatment of Orbital Fracture" written by Professor Xiao Lihua and Professor Wang Yi of the Institute of Orbital Diseases of Armed Police General Hospital was published by People's Medical Publishing House in June 2014. This book has 11 chapters, 470,000 words and more than 1,000 wonderful pictures. It describes in detail the clinical manifestations, imaging examinations, surgical treatment and treatment of postoperative complications of orbital fractures (especially orbital burst fractures). This book summarizes the author's decades of experience and lessons in the diagnosis and treatment of orbital fractures, and is also the accumulation of clinical practice. The content starts from clinical practice, is practical and easy to understand and read.

The book "The Essence of Tongren Corneoconjunctival Cases", edited by Professor Sun Xuguang, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University, has been officially published by People's Military Medical Publishing House. The analysis of typical cases is the starting point of understanding clinical diseases, and the understanding of difficult cases is the basis of accumulating clinical experience and establishing diagnosis and treatment ideas. Ophthalmologists should always pay attention to collecting and analyzing typical or difficult cases in clinical practice.

Objective To analyze the reasons of orbital exenteration for orbital retinoblastoma (RB) patients.Methods Retrospective case series study.Clinical records were reviewed retrospectively of 17 orbital RB patients who had undergone exenteration from November 1999 to November 2010 at Armed Police General Hospital.The clinical records included ophthalmic history,process of diagnosis and treatment,symptom and signs,surgical approach,pathological diagnosis and follow-up results.The reasons of orbital exenteration for orbital RB patients according to medical history,process of diagnosis and treatment were analyzed.Results The average age of patient was 3.2 years old.The ratio of male versusfemale was 1.1 ∶ 1.The common clinical findinds were as following:11 cases of orbital mass,7 cases of exophthalmos,6 cases with palpebral edema,4 cases of conjunctival congestion and edema with conjunctival mass,and 2 cases with orbital pain.Reasons for orbital exenteration were as following:7 patients who lost the opportunity of the treatment because of concernning about the cost of treatment and poor prognosis and caused worst outcome.Exenteration had to be done eventually.Five cases of orbital recurrence happened after enucleation.Three patients' Rb invaded into orbit after conservative treatmentintravenous chemotherapy or radio therapy alone.Two cases were misdiagnosed and mishandled causing rapidly tumor spread into the orbit.Conclusions The major reasons of orbital exenteration for orbital RB patients lies in the following:giving up treatment from patients,tumor recurrence in the orbit after enucleation,progressing of orbital RB after simple conservative treatment,misdiagnosis and mishandling to let RB invade into orbit rapidly.

Chinese Journal of Ophthalmology was founded in 1950. Over the past 60 years, it has recorded the development of ophthalmology in New China, and has become an important part of China's ophthalmology. Up to now, it has become a fine journal that represents the national level externally and guides the academic development internally. In order to meet the needs of the development of the information society and raise the awareness of serving the majority of ophthalmology colleagues,

Objective To improve pathological understanding of massive sub-retinal hemorrhage.Methods Retrospective case series study.The clinical and pathological data of 7 cases of massive sub-retinal hemorrhage which were examined in the Pathological Department of Tianjin Eye Hospital from May 1988 to April 2012 were collected.The serial section of eyeball specimens were made with HE and PAS staining.The pathological section were reviewed under the light microscope.Analysis were made again combining with patients' clinical history,imaging findings and the pathological features.Results In 7 patients,6 patients were male,1 patient was female.The age range was from 60 to 82 years old and the average age was 71.7 years old.Four cases were on the right eye and 3 cases were on the left eye.The main clinical feature was sudden loss of vision and 2 cases had acute glaucoma symptoms.Ultrasound examination showed choroidal tumor in 6 cases and retinal detachment with vitreous hemorrhage in one case.The color Doppler ultrasound examination demonstrated choroidal substantive occupying lesion in 3 cases and two of them were detected with blood flow signal.The MRI were examined in 3 cases which showed iso-high signal in T1W1 and iso-low signal in T2W1 suggesting the choroidal melanoma in 2 cases and sub-retinal hemorrhage in 1 case.Six cases were diagnosed clinically as choroidal tumor or melanoma and 1 case was diagnosed as acute angle-closure glaucoma.The enucleation were performed in 7 cases.In these cases,6 cases were diagnosed pathologically as vitreous hemorrhage,hemorrhagic RPE detachment and massive subretinal hemorrhage.The related choroidal lesions included soft drusen of Bruch membrane in 3 cases,choriocapillaris wall degeneration in 2 cases,fibrovascular membrane formation under RPE in 2 cases,choroidal chronic non-granulomatous inflammation in 4 cases,choroidal vessels wall thickening and sclerosis in 2 cases and choroidal vessels anomaly in one case.The secondary angle-closure glaucoma or angle-open glaucoma were accompanied respectively in 2 cases.Another case of 7 cases was diagnosed pathologically as the rupture of retinal macroaneurysm with massive sub-retinal hemorrhage.Conclusions Massive sub-retinal hemorrhage liked to occur in the elderly male patients.The main manifestations were sudden visual loss.A small number of patients had symptoms of acute glaucoma.Ophthalmic ultrasound and imaging characteristics were usually similar to the choroidal substantive neoplasm and were easily misdiagnosed as choroidal melanoma.Pathological examination revealed that the main reasons of massive hemorrhage were from the hemorrhagic RPE detachment and the rupture of retinal macroaneurysm.

The book "Laser Confocal Microscopy Atlas of Living Cornea" edited by Professor Sun Xuguang of Beijing Institute of Ophthalmology, Beijing Tongren Ophthalmology Center, Capital Medical University has been officially published by People's Military Medical Publishing House. The in vivo corneal laser scanning confocal microscope has a resolution of 1 μ m and a magnification of 800 times. Through non-invasive and real-time observation of corneal conjunctiva tissue, ophthalmologists can directly observe the histocytological changes of corneal conjunctiva and its many diseases from the cellular level on the living body, and dynamically understand the development and outcome of diseases,

Objective To observe and evaluate the therapeutic effect of brachytherapy for choroidal metastasis.Methods A restrospective case-series study.The data of 22 patients with 23 eyes of choroidal metastasis undergoing ruthenium 106 radioactive applicator brachytherapy were retrospectively analyzed from the Eye Center of People Hospital of Peking University from Feb.2004 and Sep.2012.Ocular tumor control,globe salvage rate and the visual acuity of the patients were observed and analyzed.Results Eighteen patients of 18 eyes were followed up.The median age of the 18 patients was 59 years and the median time of follow-up was 13 months.The remission of tumors with decreasing of subretinal fluid volume were obviously achieved and the globes were all reserved.At follow-up,13 patients' visual acuity was above or equal to 0.3,one patient's visual acuity was under 0.05,4 patients' visual acuity was between 0.05 and 0.3.Conclusion Brachytherapy was an effective option for the treatment of choroidal metastasis.

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 their full Chinese names when they first appear,

Objective To analysis the clinical and pathological characteristics of primary iris stromal cyst.Methods Retrospective cases series study.14 cases of primary iris stromal cyst which were treated in Tianjin Eye Hospital from Jan.1979 to Dec.2012 were collected.They were all proved by pathological results.Their clinical and pathological features were analyzed.Results The age of 14 patients were 5 months to 50 years old,the median is 10 years old.10 patients (71.4％) were attacked from children or adolescence,among which onset age of 8 patients were less than 1-year-old.4 patients (28.6％)occurs when they were adults.10 cases were female and 4 cases were males.10 cases were left eyes,4 cases were right eyes.All cases were unilateral involvement.In these cases,11 cases appeared as a single translucent or gray-white cystic mass on the iris surface,which 6 cases located in the inferior aspect of the iris,2 cases appeared with diffused iris cyst and another 1 case's cyst was found occasionally in the eyeball enucleating specimen.8 cases had corneal opacity or leucoma,7 cases had secondary glaucoma,and 3 cases had complicated cataract.Pathological features showed:cysts located on the iris surface or in the stroma layer.The cysts of 9 cases were constructed of non-cuticular stratified squamous epithelium cells.3 cases' cysts were constructed of lens epithelium cells and lens capsular analogical tissues,and the cysts adhesion to the lenstightly.The other 2 cysts were constructed of single or stratified epithelium cells,similar to ciliary epithelium cells.2 cases complicated with crystalline lens dysplasia,3 cases complicated with iris tissue dysplasia,2 cases complicated with ciliary cysts and 1 case had chamber angle dysplasia.Conclusions Primary iris stoma cyst is rare and it usually occurs in infant,more often in the children less than 1-year-old.Pathological examination showed that most of the cysts originated from the conjunctivaepithelium,minority cysts originated from crystalline lens epithelium or ciliary epithelium.Some cases complicated with iris,ciliary or crystalline lens malformation.

Ten researches that may represent the progresses of clinical and basic ocular pathological studies in China in the past 5 years,were voted by specialists from Chinese Ocular Pathology Group.These researches were concentrated in following 5 fields:Stem cell therapy for retinal disease,Molecular imaging approach for detection of ocular fundus disease,Pathogenesis and comprehensive therapy of ocular tumors,Study of thyroid-associated opthalmopathy and Study of diabetic retinopathy.These studies,in a certain extent,represented the current level of research and the influence of our national ocular pathology specialists in the international ocular pathology field.

The patient was a 65-year-old male. One month ago, he developed redness, swelling and pain in his right eye without obvious trigger, accompanied by headache, photophobia and blurred vision. He came to the ophthalmology department of Ezhou Egang Hospital on May 14, 2013. The patient had a history of smoking for 30 years, 3 packs a day, and frequently coughed. After admission, the physical examination showed that the visual acuity of the right eye was 0.12, the left eye was 1.0, the conjunctiva was mixed congested, the cornea was edema, the lower anterior chamber showed detritus-like deposition, and there was a raised translucent mass on the nasal side and below the iris, with new blood vessels on the surface, and there were new blood vessels running on the temporal iris surface. The lens was opaque and the retrospect was unclear (Figure 1). IOP was measured: 56 mmHg (1 mmHg =0.133 kPa) in one eye and 15 mmHg in the left eye.

The patient was a 37-year-old female. Six months ago, there was no obvious trigger for increased fluttering of dark shadows in front of both eyes, no eye redness, eye pain and visual acuity decrease. 3 months ago, the visual acuity of both eyes gradually decreased, accompanied by deformation of the right eye, and fixed occlusion of the central vision of the left eye. 2 months ago, the patient felt dry in both eyes, and the visual acuity of the right eye was 0.15, and the visual acuity of the left eye was 0.3. The basal tear secretion (Schirmer Ⅰ) test showed 2 mm in the right eye and 1 mm in the left eye. The corneal epithelium of both eyes showed filamentous objects attached, and the middle and lower parts of the cornea showed dense punctate fluorescein staining. Ocular examination: conjunctiva congestion, edema, opacity of middle and lower cornea and opacity of lens in both eyes. The patient was treated with bandage contact lens, 0.02% fluorometrolone eye drops, calf blood deproteinized extract ophthalmic gel and artificial tear.

The patient is a 31-year-old female. Due to corneal trauma epithelial implantation, she went to the Department of Ophthalmology of Peking Union Medical College Hospital in March 2014. The patient underwent binocular LASIK surgery in 2008, and was scratched by a child in 2010. The corneal subflap epithelial implantation was performed, and she underwent subflap epithelial curettage twice. Eye examination: visual acuity 0.8 in right eye and 1.0 in left eye; right corneal subflap epithelial implantation (essence picture 1), no abnormalities were found in the anterior segment and fundus of both eyes. Diagnosis: after LASIK in both eyes; Epithelial implantation under the flap of the right cornea.

A 44-year-old male was seen in the Department of Ophthalmology of Peking University First Hospital for more than 30 years due to foreign body sensation in both eyes. In the past 30 years, the patient had repeated symptoms of foreign body sensation in both eyes, red eyes and tears, and his father and sister had the same symptoms. The conjunctiva of both eyes was mildly congested, the cornea in the palpebral fissure area was stained with ribbon-like fluorescence (essence picture 1), wavy gray lines could be seen below the cornea of the left eye (essence picture 2), and a large number of microvesicles could be seen in the epithelial layer of the cornea of both eyes (essence picture 3), with the upper and lower corneas as the key, and the central area was transparent. See essence picture 4 for confocal microscopy of the cornea of both eyes. Diagnosis: Meesmann corneal dystrophy in both eyes; Dysfunction of the lamellar glands of both eyes.

Advances in animal models of retinoblastoma have accelerated the research in understanding tumor biology and assessing therapeutic modalities.At present,there are two types of models:transgenic models and xenograft models.The transgenic models have experienced a developmental process from LH-β-Tag models to conditional gene knock-out models.The xenograft models included intraocular transplantation models and subcutaneous transplantation models.The two types of RB models both have their merits and drawbacks.The combination of genetic and xenograft models in retinoblastoma research has and will help to pave way for better understanding tumor progression and searching more effective diagnosis and treatment modalities.In this review,we summarized the recent research progress in animal models of retinoblastoma and their application in assessing therapeutic modalities.

Glaucomatous optic neuropathy is among the most common causes of blindness worldwide.Elevated intraocular pressure (IOP) has long being considered to be the major risk factors for the development and progression of glaucomatous optic nerve damage.However,numerous studies have shown that a relatively large number of patients with typical glaucomatous optic neuropathy,in whom the IOP measurements have always been in the normal range (＜21 mmHg,1 mmHg =0.133 kPa).Thus,the role of IOP in the pathogenesis of POAG becomes vague and controversial.Based on prospective clinical observations,Beijing iCOP (Intracranial and Intraocular Pressure) Study has found that the orbital cerebrospinal fluid pressure (CSF-P) may be of importance for the physiology and patho-physiology of the optic nerve head and may play a role in the pathogenesis of glaucomatous optic neuropathy.A low CSF-P in the retrobulbar region of the orbit may act as the counter-pressure against IOP and theoretically have a similar effect as an increased IOP on the trans-lamina cribrosa pressure difference which may be more relevant to the glaucomatous optic neuropathy than IOP alone.Moreover,an experimental and chronic reduction in CSF-P in monkeys was associated with the development of optic nerve damage morphologically typical for glaucomatous optic neuropathy.The findings support the hypothesis the CSF-P may play a role in the pathogenesis of glaucomatous optic neuropathy.