Volume 40 ·  Issue 12 ·  2004

At present, there are still many patients with ocular atrophy or corneoscleral staphyloma due to severe ocular trauma, malignant tumor, severe retinochoroidopathy and congenital developmental abnormalities, and finally they often need eyeball enucleation to improve their appearance. After eyeball enucleation, if no intraorbital implant (prosthesis) is implanted in the muscle cone, the superior orbital depression will appear after wearing the prosthetic eye. The correction of the superior orbital depression should not be corrected by enlarging the prosthetic eye. An excessively large prosthetic eye not only affects the mobility of the prosthetic eye, but also causes the lower eyelid to fall and the lateral canthus ligament to relax over time. In addition, because the prosthesis is not implanted in the muscle cone, the soft tissue accumulates on the orbital floor due to gravity, which further aggravates the deformation of the superior orbital depression, and the shape of the conjunctival sac also changes, causing the inferior fornix to become shallow, the upper fornix to tilt backward and upward, and the prosthetic eye is easy to slip off or cannot be placed. That is, it constitutes the so-called "anophthalmic orbital syndrome".

Objective to investigate the methods of diagnosis and differential diagnosis of ocular adnexal mucosa associated lymphoid tissue (MALT) lymphoma and lymphoid tissue reactive hyperplasia.Methods 29 cases of ocular adnexal MALT lymphoma and 8 cases of lymphoid tissue reactive hyperplasia.Results the clinical manifestations of 29 cases of ocular adnexal MALT lymphoma and 8 cases of lymphoid tissue reactive hyperplasia were similar, but the difference was not significant. Immunoglobulin light chain kappa or lambda restriction in 11 cases; Among the 8 cases of lymphoid tissue reactive hyperplasia, 7 cases expressed both B cell markers and T cell markers, and the T cell markers were>30%; kappa and lambda negative; Conclusion Immunohistochemistry and molecular biology are helpful in the differential diagnosis of MALT-type lymphoma and lymphoid tissue reactive hyperplasia (Chinese Journal of Ophthalmology, 2004,40:795-799)

Objective to explore an effective and safe surgical correction method for orbital and periorbital fibrous dysplasia and its deformity.Methods 10 patients with orbital and periorbital fibrous dysplasia were treated by surgery, and the location, extent and shape of the lesions were determined according to the cranial X-ray film, two-dimensional CT and three-dimensional CT before surgery. Different surgical resection and reconstruction schemes were designed according to different situations.The lesions were completely or partially resected through scalp coronal incision, intraoral incision and lower eyelid margin incision respectively; The orbit was repaired with autologous cranial plate or inner plate, mandibular outer plate, Medpor and individualized prosthesis. Results in 10 patients, 4 cases were completely resected, 6 cases were incompletely resected, 2 cases were repaired with autologous cranial plate, 2 cases were repaired with Medpor, 1 case was repaired with mandibular outer plate, 4 cases were repaired with titanium mesh and individualized prosthesis, and the results were satisfactory.Conclusion Surgical treatment of orbital fibrous dysplasia can achieve satisfactory results under the condition of adequate preoperative design and strict prevention of complications. (Chinese Journal of Ophthalmology, 2004, 40: 800-803)

Objective to investigate the efficacy of orbital apex decompression in the treatment of traumatic orbital apex syndrome.Methods 11 patients with traumatic orbital apex syndrome were treated with different surgical approaches according to different injured sites in the orbital apic.5 cases were treated by frontal approach.6 cases were treated by pterional approach.The evaluation criteria of postoperative visual acuity were divided into 5 grades:blindness, photosensitivity, anterior manual movement, anterior numeration of fingers and visual acuity chart symbols.The postoperative visual acuity increased by 1 grade was effective, otherwise it was ineffective. Five patients with residual visual acuity had visual acuity improved to varying degrees; Conclusion Orbital apical decompression is an effective method for the treatment of orbital apical syndrome, which can treat patients with brain injury simultaneously. The postoperative recovery effect is closely related to the operation time, operation method and nerve injury degree after injury. (Chinese Journal of Ophthalmology, 2004, 40: 804-807)

Objective to investigate the efficacy of krypton laser low energy photocoagulation in the treatment of age-related macular degeneration (AMD) complicated with choroidal neovascularization (CNV). Methods 17 cases (17 eyes) with wet AMD were diagnosed with subfoveal CNV by fluorescein fundus angiography (FFA) or indocyanide green angiography (ICGA). The patients aged from 50 to 74 years, with an average of 61 years, were treated with low energy photocoagulation with krypton laser in the central dark spot of the corresponding visual field in the macular lesion area. Those with active CNV were treated with photocoagulation again 4 weeks after operation. The visual acuity, anterior segment, fundus and visual field of each patient were examined before treatment and at the follow-up visit, and fundus photography, FFA and ICGA were examined. The patients were followed up regularly for 1 to 8 years, with an average of 3.5 years after operation. Results There was no immediate visual acuity decline in all the treated eyes after operation, and local bleeding and exudation resolved significantly. FFA examination confirmed that CNV was closed or reduced, and leakage decreased. There was no recurrence in 9 patients after more than 3 years of follow-up. The visual acuity of 6 eyes improved after operation, the visual acuity of 8 eyes remained unchanged, and the visual acuity of 3 eyes decreased. There was no obvious change in the central dark spot after visual field review. Conclusion The application of krypton laser low energy photocoagulation in the treatment of AMD patients with subfoveal CNV has the advantages of good curative effect and less recurrence. (Chinese Journal of Ophthalmology, 2004, 40: 808-811)

Objective to investigate the clinical efficacy of multifocal intraocular lens implantation. Methods 196 patients (255 eyes) with senile cataract were randomly divided into experimental group (121 eyes with multifocal intraocular lens) and control group (134 eyes with monofocal intraocular lens) for phacoemulsification and intraocular lens implantation. Results Three months after surgery, 107 eyes with naked eye distance visual acuity ≥0.5 and 27 eyes with naked eye distance visual acuity ≥1.0 in the experimental group had no significant difference compared with the control group (P>0.05); In the experimental group, 93 eyes had myopia ≥0.5 and 22 eyes had myopia ≥1.0. The experimental group was significantly better than the control group (P<1 month after operation, 6 eyes with asymmetric position of intraocular lens loops in the experimental group did not affect the visual acuity recovery; The degree of corneal astigmatism of surgical origin was 0.31 D. 33.3% of the patients in the test group wore glasses while reading, and 90.0% of the control group wore glasses while reading. The symptoms of postoperative visual abnormalities were not obvious in both groups; Conclusion Multifocal intraocular lens implantation can not only restore good naked eye distance vision, but also improve the naked eye near vision; The operation was safe, reliable and without special complications. (Chinese Journal of Ophthalmology, 2004, 40:812-815)

Objective to investigate the long-term effect and safety of excimer laser in situ keratomileusis (LASIK) in the treatment of ultra-high myopia (equivalent spherical degree>-10.00 D). Methods 99 cases (173 eyes) with ultra-high myopia were corrected by LASIK. The preoperative diopter was-10.00~ -23.50 D, with an average of (-13.7±3.6) D (equivalent spherical degree), among which 41 eyes were above-15.00 D. Slit lamp microscope, three-sided mirror fundus examination, ORBSCAN Ⅱ anterior segment analysis system, intraocular pressure, A-ultrasound, corneal thickness measurement, computerized optometry, mydriasis and subjective optometry were routinely examined. The follow-up was over 18 months. Results 148 eyes (85.6%) had naked eye visual acuity ≥0.5 at 18 months postoperatively, and 147 eyes (84.4%) had optimal corrected visual acuity higher than or equal to the preoperative best corrected visual acuity. In 109 eyes (63.0%), the percentages of preoperative diopters below-14.75 D and above-15.00 D and within ±1.00 D were 73.5% (97 eyes/132 eyes) and 29.3% (12 eyes/41 eyes) respectively. The posterior surface of the cornea moved forward after operation, and the distance between the apex of the posterior surface and the ideal spherical surface was (0.069 ± 0.031) mm at 3 months and (0.065 ± 0.025) mm at 18 months, both of which were greater than (0.029 ± 0.010) mm before operation; Conclusion LASIK is effective and safe in the correction of ultra-high myopia, and caution should be followed in the selection of surgical indications. For those with too high refractive power and thin corneal thickness, LASIK should be carefully performed, and other methods such as lens refractive surgery or combined surgery should be considered. (Chinese Journal of Ophthalmology, 2004, 40: 816-818)

Objective to investigate the clinical diagnostic effect of two-step polymerase chain reaction (PCR) technique in the rapid detection of pathogens of infectious keratitis and endophthalmitis.Methods The corneal scrapes or tears of 51 patients with infectious keratitis and the vitreous fluid of 16 patients with endophthalmitis from September 2001 to May 2002.First, the pathogens were detected by multiplex polymerase chain reaction (MPCR) technique, and then the species of pathogens were detected by specific polymerase chain reaction (SPCR). The time required by PCR and microbial culture, the positive rate and the coincidence rate with clinical diagnosis were compared.Results Among 67 specimens, 52 (77.6%) were positive by MPCR (8 were positive for two pathogens). Among them, 28 (25.0%) were positive by SPCR, and 7 (25.0%) were Staphylococcus aureus, Streptococcus pneumoniae or Pseudomonas aeruginosa; The positive rate of bacteria and fungi (58.2%) was higher than that of microbial culture (χ 2=13.50, P<The coincidence rate of clinical diagnosis of infectious keratitis with laboratory detection was 54.8%. Conclusion Two-step PCR method has the advantages of rapid detection of pathogens and high positive rate, which is helpful for rapid etiological diagnosis of infectious ophthalmopathy. (Chinese Journal of Ophthalmology, 2004, 40: 819-823)

Objective to preliminarily locate the pathogenic genes of a family of autosomal dominant congenital cataract (ADCC). Methods The data of a family of ADCC were collected, and the appropriate short tandem repeat polymorphism markers (STRP) were selected near the known pathogenic genes and loci of congenital cataract, and the linkage analysis was performed on a family of ADCC. The LOD values were calculated by log-dominance scoring (LOD) using Mlink software.Results In the STRP, the maximum LOD values of D17S805, D17S1294 and D17S1293 linked to pathogenic gene loci were 2.03, 2.49 and 2.22 respectively (recombination rate θ =0). Conclusion The pathogenic genes of this ADCC family were preliminarily localized on the 17th chromosome pair; CRYBA1 gene is a candidate gene. (Chinese Journal of Ophthalmology, 2004, 40:824-827)

Objective to study the pathogenic genes of simple lens ectopia in China and determine the gene mutation.Methods A family with simple lens ectopia was studied clinically and pedigree analysis.The venous blood of 7 patients and 3 healthy members of the family was collected and genomic DNA was extracted. After the chromosome locus of the pathogenic gene was determined by linkage analysis, the exon of fibrillin (FBN) 1 gene was amplified by polymerase chain reaction (PCR), and the pathogenic gene mutation was determined by direct sequencing.The population analysis was carried out by PCR and restriction endonuclease method.Results The missense mutation in exon 6 of FBN1 gene of patients with simple lens ectopia occurred, and the guanine at position 640 of cDNA was replaced by adenine (G640A); The corresponding glycine was changed to serine (G214S), and the EagⅠ endonuclease site disappeared after the mutation. The mutation was not found in healthy members and 50 normal persons in the family. Conclusion The new mutation of FBN1 gene G640A (G214S) is the pathogenic gene mutation of simple lens ectopia in this family. (Chinese Journal of Ophthalmology, 2004, 40: 828-831)

Objective to investigate the effect of basic fibroblast growth factor (bFGF) on Ca2+ transduction in human lens epithelial cell line-B3 (LEC-B3). Methods Human LEC-B3 was subcultured, and 10 μ g/L bFGF, 10 mmol/L caffeine, 10 mmol/L ryanodine, 50 mmol/L procaine and 0.5 mmol/L genistein were added to the thawed third generation cells under laser scanning confocal microscope. The changes of intracellular Ca2+ concentration were observed by observing the relative fluorescence intensity in real time. Results 10 μ g/L bFGF could rapidly increase the concentration of Ca2+ in human LEC-B3 with or without Ca2+ and Mg2+ in the extracellular fluid, and the duration was basically the same; When the extracellular fluid contained 1 mmol/L ethylene glycol, diethyl ether and tetraacetic acid without Ca2+ and Mg2+, the concentration of Ca2+ in human LEC-B3 was higher. The combined action of 50 mmol/L procaine and 10 mmol/L ryanodine with 10 μ g/L bFGF showed that the concentration of Ca2+ in human LEC-B3 increased, but it was lower than that of 10 μ g/L bFGF alone; 10 mmol/L caffeine and 0.5 mmol/L genistein can significantly reduce the effect of additional 10 μ g/L bFGF on increasing the concentration of Ca2+ in human LEC-B3, especially the latter. Conclusion bFGF mainly causes the increase of Ca2+ concentration in human LEC-B3 by activating the signal transduction pathway of tyrosine protein kinase; Inositol 1,4,5-triphosphate receptor and ryanodine receptor channels play a certain role; Ca2+ is mainly derived from intracellular Ca2+ release. (Chinese Journal of Ophthalmology, 2004, 40:832-835)

Surgery is one of the main methods for treating orbital diseases. On the basis of analyzing the medical history, clinical symptoms and signs, MRI, CT and B-mode ultrasound are the main methods for diagnosing orbital diseases, which can accurately identify and locate the diseases before surgery, and promote the continuous improvement of surgical methods. The author retrospectively analyzed the clinical data of 229 patients with orbital diseases who underwent MRI, CT and B-mode ultrasound imaging in our hospital, aiming to explore the clinical significance of modern imaging examination in choosing surgical methods and approaches.

Radiotherapy (radiotherapy) for intraocular and orbital tumors is a major advance in the field of ophthalmology and radiation oncology. Reese and his assistant began to apply it to the treatment of ophthalmic tumors in 1976. After nearly 40 years of development, it has been developed as an affiliated specialty of ophthalmology in many medical centers around the world. Radiotherapy can be used not only for the treatment of orbital and intraocular tumors, but also for the treatment of inflammatory diseases.

In order to improve the level of clinical ophthalmologists and technicians in microcomputer visual field detection and reading, as well as the diagnosis level of glaucoma and various eye diseases, and to promote the in-depth development of ophthalmology, the editorial board of Chinese Journal of Ophthalmology decided to hold a study class on modern microcomputer visual field detection and reading in Shenzhen, Guangdong Province on December 20-26, 2005. Visual acuity (visual acuity) and visual field are the two most important aspects of visual function, and the visual field measures visual function outside the macular region.

After three years of investigation and industry analysis, combined with the development status of China's medical industry, American Aolide Medical Investment Group and the "Chief Think Tank of Hospital Management"-Dean's Decision Research Center plan to invest 1 billion yuan in China within five years to build eight chain eye hospitals, so that more patients with ophthalmic diseases in China can enjoy international medical services. The plan has now been implemented. At present, six hospitals in Guangdong Province are located in six cities: Guangzhou, Zhanjiang, Zhongshan, Meizhou, Shaoguan and Huizhou. The investment targets outside the province are Beijing and Shanghai. At present, the first hospital has settled in Zhanjiang and will open for trial operation at the end of this year, with a business area of 22000m^2. It is the largest ophthalmology hospital in western Guangdong.

On the eve of the 9th National Ophthalmology Conference of Chinese Medical Association, the third working meeting of the 11th editorial board of Chinese Journal of Ophthalmology was held in Wuhan on September 9th, 2004. Members of the editorial board, foreign editorial board members and staff of the editorial department who attended the meeting gathered together to analyze the achievements and shortcomings of running the magazine in the past two years.

A 28-year-old male was seen in our hospital on April 10, 2000 due to the progressive decline of visual acuity in his left eye for 10 months. The patient denied any other medical history. No abnormalities were found in the whole body examination. Ophthalmological examination showed that the visual acuity of his right eye was 0.7, but no improvement in correction. The visual acuity of the left eye was 0.06, and there was no improvement after correction.

A 41-year-old male was admitted to hospital on March 25, 2003 due to exophthalmos for more than 6 months after surgery of space-occupying lesions in the right orbit. The patient underwent "lateral orbitotomy to remove tumor from the right eye" in September 2000 due to "space-occupying lesions in the right orbit". The postoperative pathological diagnosis was unknown.

A 57-year-old male was admitted to the hospital on February 16, 2001 due to repeated redness and pain in both eyes for 37 years and aggravated for 2 days after left eye trauma. 37 years before admission, the patient's left eye was injured by canal slag, which caused penetrating injury in the left eye. At that time, he was debrided and sutured, and his left eye lost vision.

alveolar soft part sarcoma (ASPS) is a malignant tumor with alveolar-like structure that occurs in soft tissues. It mostly occurs in the limbs, and it is very rare to occur in the orbit [1]. In the past 10 years, a total of 2 cases of orbital ASPS have been treated in our department, which are reported as follows.

A 67-year-old male came to our hospital on June 26, 2003 because his visual acuity gradually declined for half a year after cataract extraction in his right eye.9 years ago, the gonioscopy of both eyes showed N1~ N2, and the iris root was slightly swollen, with an incident angle of about 20 °; The C/D value of the papilla under the direct ophthalmoscope of small pupils in both eyes was about 0.5; the prone test of dark chamber was negative in both eyes, and the C value of intraocular tonomography was low; Visual field examination of right eye nasal defect, left eye centripetal reduction, so in our hospital diagnosed as binocular mixed glaucoma.

Lyme disease can cause systemic multi-system lesions. The main ophthalmopathy related to Lyme disease is uveitis. In 1999, a case of Lyme disease with acute multifocal ischemic choroidal lesion (AMIC) was diagnosed and treated in our ophthalmology department. The report is as follows.

severe acute respiratory syndrome (SARS) is an acute respiratory infectious disease caused by novel coronavirus, with high fever as the first symptom and progressive pneumonia infiltrating X-ray imaging changes in both lungs [1, 2]. At present, rational use of glucocorticoids is one of the recognized routine treatment principles for this disease.

familial subepithelial corneal amyloidosis (FSCA), also known as gelatinous drop-Like corneal dystrophy (GDCD), was first reported by Nakaizumi [1] in Japan in 1914. It is a rare anterior corneal dystrophy, which belongs to autosomal recessive inheritance (human Mendelian hereditary disease classification number is 204870) [2, 3]. There are sporadic cases in other countries and regions [4, 5]. At present, there is no complete report of this disease in China. Recently, a case of FSCA was admitted to our hospital. Reviewing foreign research literature and combining our experience in diagnosis and treatment of this disease, the characteristics of FSCA are analyzed.

Congenital aniridia is a congenital genetic disease, which is relatively rare in clinic.Two families with this disease were diagnosed in our hospital in July 2002, and the report is as follows.

With the support and organization of relevant departments, the Keratology Group of Ophthalmology Branch of Chinese Medical Association organized relevant experts to formulate the "Access Standard for Corneal Transplantation" and "Access Standard for Eye Bank" after many discussions, in order to standardize the work of corneal transplantation and eye bank in China and promote the healthy development of these two works. These two drafts are now published, hoping to attract the attention of ophthalmologists and ophthalmology institutions across the country, and put forward suggestions and revisions.