Volume 41 ·  Issue 12 ·  2005

Glaucoma is a common and irreversible severe blinding eye disease, and genetic factors play an important role in the occurrence of glaucoma.The completion of the Human Genome Project and the application of related molecular genetics techniques in the field of glaucoma research have made important progress in the etiology research of glaucoma.At present, it is difficult to predict the important influence of new research results on the prevention, early diagnosis and treatment of glaucoma, but it has caused a series of questions worth thinking about, which may indicate the change trend of glaucoma genetics research.

Recently, a new definition and classification system for primary angle closure glaucoma (PACG) has been put forward internationally. It is emphasized that the definition of glaucomatous optic neuropathy should be the same as that of primary open angle glaucoma. Patients who have not yet developed glaucomatous optic nerve damage but have acute attack or chronic angle-anterior iris adhesion are renamed as primary angle closure. Although this new classification system has been adopted by American Academy of Ophthalmology and Southeast Asian Glaucoma Society, there has been great controversy about whether this definition and classification system should be adopted in China. The author aims to explain the background of this classification system, discuss the benefits and existing problems of the new definition, so as to communicate with the majority of ophthalmologists.

At present, problems such as improper use of statistical analysis and low level of scientific research design are widely existed in ophthalmology scientific research. The root cause is that researchers themselves pay insufficient attention to statistics or even have biased understanding. Therefore, first of all, we should eliminate the misunderstanding of researchers in statistics concept, fully realize that statistics is a part of researchers' overall scientific research quality, and should not rely on the cooperation with statistics experts alone. Secondly, we should pay attention to the study of statistics knowledge and the improvement of practical application ability. Statistics is not only one of the foundations of evidence-based medicine, but also an important prerequisite for sustainable development of scientific research, so it should be paid attention to by ophthalmologists.

Objective to identify the pathogenic genes of autosomal dominant familial open-angle glaucoma (GZ.1) and explore its pathogenic mechanism.Methods Whole genome scanning, linkage analysis and direct nucleotide sequencing were used to screen the pathogenic gene mutations in GZ.1 family, and further in vitro gene transfection technique was used to observe the expression, distribution and effect of mutant gene on apoptosis in trabecular cells.Results All patients in GZ.1 family had heterozygous mutation of Pro370Leu in exon 3 of myocilin gene (16/16), but no mutation was detected in normal people (0/8). After transfection of wild-type and mutant myocilin genes in trabecular cells in vitro, it was confirmed by immunoblotting that the extracellular secretion of mutant myocilin protein in culture supernatant was significantly reduced compared with wild-type; The results of fluorescence immunohistochemistry confirmed that wild-type myocilin protein showed a dot-like and diffuse distribution in trabecular cells; Pro370Leu mutant myocilin protein exists in the cytoplasm in the form of accumulates; The percentage of apoptotic cells in the mutant transfected group was slightly higher than that in the wild-type transfected group and the control group by flow cytometry. Conclusion The mutant (Pro370Leu) myocilin gene is the pathogenic gene of GZ.1 family, and the mutant (Pro370Leu) myocilin protein exists in the form of accumulation in trabecular cells, which may be caused by protein misfolding and may induce apoptosis in trabecular cells.

Objective to investigate the inhibitory effect of RNA interference technique on the proliferation of human ocular fascial sac fibroblasts cultured in vitro.Methods Chemically synthesized siRNA targeting IKK-β was used to transfect human ocular fascial sac fibroblasts cultured in vitro.Meanwhile, siRNA which had no effect on any gene was used as negative control.The expression level of IKK-β mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR) technique and the expression level of IKK-β protein was detected by immunoblotting.The transfection concentrations of siRNA were set to 5, 10, 25, 50, 100 and 200 nmol/L respectively.The inhibitory effect of siRNA on fibroblasts was detected by tetramethylazo salt method 48 h after transfection. Results After transfection of siRNA targeting IKK-β, the expression levels of IKK-β mRNA and protein in fibroblasts were inhibited.The proliferation of fibroblasts was inhibited at various transfection concentrations (5, 10, 25, 50, 100 and 200 nmol/L) (P<The inhibition rate was 10.72%, 23.35%, 30.84%, 51.25%, 50.06% and 49.63%, respectively, and the maximum inhibition rate was reached at 50 nmol/L. Conclusion the siRNA transfection targeting IKK-β can reduce the expression level of IKK-β and inhibit the proliferation of human eyeball fascial sac fibroblasts cultured in vitro.

Objective to observe the treatment effect and influencing factors of acupuncture combined with 5-fluorouracil (5-FU) injection on early and middle stage dysfunctional filter vesicles after trabeculectomy for glaucoma.Methods Thirty-four eyes (40 eyes) of glaucoma patients with dysfunctional filter vesicles were treated with acupuncture combined with 5-FU subconjunctival injection within 2~8 weeks after surgery. Among them, 14 eyes were treated with repeated acupuncture combined with 5-FU injection, and followed up for 3 months after acupuncture. Results The types of failed filter vesicles after surgery and early failed filter vesicles were: 23 eyes with low-flat limited hypertrophic congestion, 13 eyes with cystic type and 4 eyes with pouchy-drooping congestion. The appearance of filter vesicles after acupuncture was: 26 eyes with mild bulging diffusion, 9 eyes with multi-cavity or thin wall, and 5 eyes with limited hypertrophic or no filter vesicles. Compared with that before needling, the difference was statistically significant (P<The 3-month survival rate of filtered vesicles after needling was (87.51±5.23) % (survival rate ± standard error). Logistic regression analysis showed that the type of glaucoma, the history of intraocular surgery and the age of patients had no effect on the effect of needling. The effect of needling was poor in patients with longer interval after surgery (P =0.046), but the intermediate effect time was t =5.9 (weeks). Subconjunctival hemorrhage was observed in 6 eyes during needling, but no complication was observed after surgery. Conclusion Needling combined with 5-FU injection is an effective, safe and simple method for the treatment of failed filtered vesicles after trabeculectomy and early failed filtered vesicles. Most of the filtered vesicles with risk factors need repeated needling and 5-FU injection, and the effect was poor in patients with long interval after surgery, and the possibility of success at 6 weeks was close to 50%.

Objective to evaluate the difference of visual quality between air-permeable rigid contact lens (RGPCL) and frame glasses in correction of keratoconus. Methods 27 cases (54 eyes) with mild, moderate and severe keratoconus were observed by computer-aided corneal topography, subjective wavefront aberration and contrast sensitivity meter. Results The overall mean myopia and astigmatism of 30 eyes with mild, 13 eyes with moderate and 11 eyes with severe keratoconus were (6.92±3.66) and (5.75±1.85) respectively. The naked eye visual acuity of 66.6% of the affected eyes was ≤0.15 and 96.3% of the affected eyes was ≤0.3. The corrected visual acuity was ≥0.6, 59.3% wore frame glasses and 100.0% wore RGPCL; The corneal topography showed that astigmatism was basically eliminated (<0.75 D), and the surface morphology became spherical and regular.The total wavefront aberration and the aberration of each order of keratoconus increased significantly with the deepening degree of keratoconus lesion. The wavefront aberration of RGPCL was significantly lower than that of naked eyes, and the difference of RMS was statistically significant (P<0.01), the total RMS decreased from 3.63 μ m to 1.39 μ m, the second-order RMS decreased from 2.64 μ m to 0.81 μ m, the total higher-order RMS removing the second-order decreased from 2.35 μ m to 1.10 μ m, and the third-order RMS decreased from 1.78 μ m to 0.68 μ m, the most remarkable. The contrast sensitivity and glare contrast sensitivity curve of RGPCL in the whole frequency band, especially in the middle and high frequency bands, are significantly higher than that of frame glasses. Conclusion Corneal irregular astigmatism caused by corneal protrusion deformation is the main reason of low visual function and increased aberration in keratoconus, and frame glasses often cannot be corrected. Wearing appropriate RGPCL can effectively bridge with lacrimoscope to reshape a new smooth central optical interface, so it can effectively eliminate corneal astigmatism, reduce aberration, improve visual acuity and contrast sensitivity curve, obviously improve visual quality, and make patients quickly return to normal study and life.

Objective to explore the construction method of three-dimensional solid model of compound orbital fracture and the computer-aided design and manufacture (CAD/CAM) of orbital fracture repair and reconstruction. Methods Twelve patients with complex orbital fracture from August 2003 to March 2004 were selected in the Department of Ophthalmology of Shanghai Ninth People's Hospital for orbital spiral CT examination. Firstly, the CT data were entered into a computer for 3D solid modeling, and the fractured bone fragment was moved, rotated and reduced by self-developed computer-aided surgical navigation software, and the movement amount of the bone fragment in each axial position was recorded for surgical navigation. Secondly, the orbital volume was calculated, and the difference of orbital volume between the two sides was compared, which provided a reference for the volume of implanted material required during surgery. Finally, a rapid prototype was made to simulate the operation. All patients underwent orbital reconstruction and functional reduction of eyeball, and were followed up for 3~9 months after surgery to evaluate the curative effect. Results The computer-aided design and manufacturing system of orbital fracture repair and reconstruction operation ran well as a whole, the function of the system application software met the design requirements, the interactive operation was convenient and practical, the measurement results were stable and reliable, Computer-aided design and manufacture of orbital fracture surgery was realized.All 12 patients achieved satisfactory results after surgery: the fractured orbit was well reduced, the invagination and downward movement of the eyeball were corrected, diplopia and eye movement restriction were significantly improved, and no visual loss or loss occurred. Conclusion The computer-aided design and manufacture system of orbital fracture repair and reconstruction surgery can provide important reference for orbital surgery, improve the curative effect and reduce the risk.

Objective to investigate the clinical efficacy of the new Smart PLUG lacrimal embolism in the treatment of intractable dry eyes. Methods 43 patients (72 eyes) with intractable dry eyes who were treated with artificial tears from July 2004 to October 2004 were treated with the new Smart PLUG lacrimal embolism. The symptoms of dry eyes were investigated by questionnaires 3 days before operation and 1 week and 3 months after operation. Slit lamp microscopy, corneal fluorescein staining, tear film rupture time (BUT), Schirmer Ⅰ test (STⅠ) and conjunctival imprinted cytology (IC) were performed at the same time to observe the clinical efficacy. Results In the questionnaire, the most common complaints of dry eyes were dryness, foreign body sensation, visual fatigue and eye redness. The above symptoms were significantly reduced or even disappeared after operation. Compared with before operation, 37 cases (62 eyes) with fluorescein staining corneal epithelium punctate staining disappeared, and tear river line was obviously formed at the lower eyelid margin. Compared with before operation, BUT and STⅠ were significantly increased and prolonged. Conclusion Lacrimal embolization with Smart PLUG embolization can improve the clinical symptoms, increase the volume of tear fluid on the surface of eyeball and improve the stability of tear film in patients with intractable dry eye. It is one of the effective methods for treating intractable dry eye.

Objective to investigate the clinical effect of optical keratoplasty after therapeutic keratoplasty with cryopreserved donor corneas in patients with severe fungal keratitis. Methods Thirty-five patients (35 eyes) with severe fungal keratitis from May 1995 to May 2002 in Sir Run Run Shaw Hospital were selected. After at least 6 months of therapeutic keratoplasty with cryopreserved donor corneas, optical keratoplasty was performed. If complicated with cataract, extracapsular cataract extraction and intraocular lens implantation were performed simultaneously. The complications, postoperative visual acuity, rejection and graft transparency of the affected eyes were observed. Results 18 eyes of 35 eyes underwent simple optical keratoplasty, and 17 eyes underwent extracapsular cataract extraction and intraocular lens implantation simultaneously. The surgical procedure was smooth. After 6.8~36.8 (15.7±7.6) months of follow-up, 32 eyes had graft transparency, 3 eyes had graft opacity due to rejection. The best corrected visual acuity of 24 eyes was equal to or better than 0.4, 32 eyes were equal to or better than 0.1, 3 eyes were lower than 0.1. No other complications were observed in 35 eyes during and after surgery. Conclusion After therapeutic keratoplasty of cryopreserved donor corneas in severe fungal keratitis eyes, optical keratoplasty was performed again, with fewer postoperative complications, and can maintain higher graft transparency and ideal visual acuity.

Objective to investigate the clinical efficacy of multi-layer amniotic membrane transplantation combined with antiviral drugs and glucocorticoids in the treatment of stromal necrotic herpes simplex keratitis (HSK). Methods Thirteen patients (13 eyes) with stromal necrotic HSK were selected from January 2003 to April 2004 in Qingdao Eye Hospital of Shandong Ophthalmology Institute. The course of disease was 3~22 months, with an average of 15 months. After systematic local and systemic antiviral drugs for more than 1 week, the inflammatory reaction of cornea was prolonged, and the corneal ulcer continued to expand or develop into deep stroma. Bacterial or fungal infection was excluded by corneal scraping microscopy, necrotic tissue culture or confocal microscopy, and multi-layer amniotic membrane transplantation was performed. The healing of corneal ulcer and the resolution of stromal edema were observed by slit lamp microscopy, the healing of corneal epithelium was observed by fluorescein sodium staining, and the outcome of corneal epithelium and amniotic membrane was examined by confocal microscopy. The follow-up time was 3~13 months, Results the corneal ulcer healed in 13 patients at 1 to 3 weeks after operation, and the staining of fluorescein sodium was negative; The corneal stromal edema resolved completely 1 month after surgery, and the surface amniotic membrane was autolytic or exfoliated 7~10 days after surgery; The inner amniotic membrane was close to the corneal ulcer surface, and gradually dissolved and absorbed, and the longest in-situ time reached 3 months after surgery. The tissue structure of amniotic membrane was still observed by confocal microscopy, and it was covered with flat keratoid epithelial cells. At 3 months after surgery, the cornea returned to transparency in 7 cases, pannus in 4 cases, leukoplakia in 2 cases, and the ocular surface recovered to stability. No recurrence of HSK was observed in 13 patients during the follow-up period. Conclusion Multilayer amniotic membrane transplantation combined with antiviral drugs and glucocorticoids is an effective method for the treatment of stromal necrosis HSK.

Objective to analyze the effect of rhodopsin protein kinase (ROCK) inhibitor Y27632 on proliferative vitreoretinopathy (PVR) in rabbits. Methods Rabbit retinal pigment epithelium (RPE) cells were cultured. The effects of Y27632 on the formation of smooth muscle actin (SMA) pressure fibers in RPE cells were detected by phase contrast microscopy and immunofluorescence staining. The effects of Y27632 on the contraction strength and proliferation of RPE cells were detected by type Ⅰ collagen gel contraction test and thiazole blue (MTT) test in vitro. A rabbit PVR model was established by 6th generation rabbit RPE cells. 50 μ mol/L Y27632 was administered intravitreously once a week for 28 days to evaluate the in vivo effect of the drug according to the incidence of traction retinal detachment. Visual electrophysiology and histological examination were performed to analyze the toxicity of the drug. Results 50 μ mol/L Y27632 destroyed the formation of α-SMA pressure fibers in rabbit RPE cells and weakened the contraction force produced by RPE cells (P<0.01); The proliferation of RPE cells was not affected by Y27632. The incidence of traction retinal detachment was decreased in the Y27632 group (P<Conclusion The specific ROCK inhibitor Y27632 can reduce the contractility of RPE cells and prevent the development of PVR in rabbits. It has no obvious side effects and may be an effective method for preventing and treating PVR.

Objective to investigate the effects of different intensities of periodic extraocular negative pressure suction on the ultrastructure of rabbit retina. Methods New Zealand white rabbits were divided into control group and experimental group. The experimental group was respectively placed with modified excimer laser in situ keratomileusis negative pressure suction ring on the limb of rabbit cornea and sclera. The extraocular negative pressure increased to (200 ± 20) mm Hg (experimental group Ⅰ), (300 ± 20) mm Hg (experimental group Ⅱ), (400 ± 20) mm Hg (experimental group Ⅲ) and (500 ± 20) mm Hg (experimental group Ⅳ) at a rate of 100 mm Hg (1 mm Hg =0.133 kPa) every 3 s. The instant intraocular pressure was 35, 45, 55 and 75 mm Hg, respectively. After maintaining for about 5 s, the pressure was released to 0. The above operation was repeated for 10 cycles after 1 min interval, and the experiment was done once every other day. After 2 weeks, the ultrastructure of rabbit retina in different parts was observed by electron microscope, and the differences between the experimental group and the control group were compared. Results There was no significant change in the ultrastructure of rabbit retina in experimental group Ⅰ and the control group Conclusion Periodic extraocular negative pressure aspiration at different endpoints has different effects on the retinal ultrastructure. There is basically no effect at less than 45 mm Hg, some effect at about 55 mm Hg, and obvious destructive effect at more than 75 mm Hg.

Uveitis is an inflammatory reaction occurring in intraocular tissues and is one of the common ocular diseases causing blindness worldwide. Its etiology and clinical types have changed in recent years, and the research of pathogenesis has made great progress. Some new diagnostic techniques, immunosuppressants and biological agents have improved the therapeutic effect of uveitis.

The Chinese Journal of Ophthalmology was founded on October 1, 1950 with the celebration of the first anniversary of the birth of New China. It has been more than half a century since now. The older generation of journal runners have experienced the hardships of founding, the helplessness of suspending and the joy of resuming; After entering the 21st century, the new generation of journal runners kept pace with the times, created new situations and made gratifying achievements. In order to commemorate this unforgettable day, Chinese Journal of Ophthalmology held the "Celebration of the 55th Anniversary of the Founding of Chinese Journal of Ophthalmology and the 12th Plenary Meeting of the Editorial Committee" in Tianjin on September 7, 2005. More than 100 editorial members attended the meeting, including Bai Xizhong, Vice President of Chinese Medical Association, Han Xiaoming, Deputy Secretary General of Chinese Medical Association, Yan Ming, Editor-in-Chief of Chinese Medical Association Magazine, and Jiang Yongmao, Vice President of Chinese Medical Association Magazine, were invited to attend the meeting. The meeting was chaired by Zhao Jialiang, Editor-in-Chief of Chinese Journal of Ophthalmology and Zhao Hongmei, Director of Chinese Journal of Ophthalmology Editorial Department, respectively.

In order to reflect the innovative scientific research achievements and clinical experience of ophthalmology in China as soon as possible, this journal has opened up a "fast track" to publish excellent academic papers in 2002. It simplifies the procedure from review to formal publication of papers and shortens the publication cycle. In view of the increasing number of authors applying for the "fast track" at present, the editorial board of this journal has supplemented and improved the specific conditions for applying for the "fast track" on the basis of the operation of some time ago, and reiterated the relevant regulations of the "fast track" once again, so that academic papers with innovative content can be published as soon as possible.

The National Eye Plastic and Cosmetic Surgery Progress Study Class jointly organized by Beijing Tongren Eye Center of Capital Medical University and the editorial department of Chinese Journal of Ophthalmology is scheduled to be held in Beijing from April 9 to 16, 2006. This class will be given by well-known experts with rich clinical experience in ophthalmoplastic surgery and cosmetology from Beijing Tongren Hospital of Capital Medical University. The lectures include congenital malformations and defects, such as ptosis, small palpebral fissure, no eyeball, orbital bone development deformity, etc. Ocular tissue defects and morphological deformities caused by trauma, such as orbital fracture, canthal angle displacement, orbital depression, symblepharon, etc.; Repair of eyelid defects after resection of ocular tumors and eye cosmetics, such as double eyelid, eyelid bag, correction of blepharidal laxity and eyebrow ptosis, etc.

Oride Medical Investment Group is a large-scale professional medical investment group jointly invested by Oride Medical Investment Group and Hengyu Wanjia Group in the United States, and supported by Margaret International Medical Foundation and Dean's Decision Research Center. Since 2004, the Group has implemented the "108 Plan", which plans to invest RMB 1 billion in China within five years to build eight large-scale modern intelligent eye chain hospitals integrating medical treatment, scientific research, health care and academic exchanges. Zhanjiang Aolide Eye Hospital, with a business area of more than 20,000 square meters, is now open for business; Hospitals in Guangzhou, Huizhou, Shaoguan and other places are under construction. With the approval of the relevant state authorities, the Group is now open to recruit professional medical care and management talents in ophthalmology nationwide.

Approved by China Association of Science and Technology, the 6th International (Shanghai) Ophthalmology Conference and the 6th International (Shanghai) Optometry Conference will be held in Shanghai Exhibition Center from April 14th to 17th, 2006, jointly sponsored by Ophthalmology Branch of Shanghai Medical Association, Ophthalmology Branch of Six Medical Associations in East China, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, Optometry College of Wenzhou Medical College and China International Science and Technology Conference Center.

In order to improve the level of microcomputer visual field detection and reading for clinical ophthalmologists and technicians, as well as the diagnosis level of glaucoma and various eye diseases, and promote the in-depth development of ophthalmology, a modern microcomputer visual field detection and reading class sponsored by the editorial board of Chinese Journal of Ophthalmology of Chinese Medical Association and co-organized by Ophthalmology Branch of Shenzhen Medical Association and Shenzhen Eye Hospital will be held in Shenzhen, Guangdong Province from December 15 to 20, 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. Since the 1970s, the advent, development and application of computer automatic visual field meter have significantly improved the sensitivity of visual field examination,

Patient Ling, female, 10 years old, came to the clinic in August 2002. Her visual acuity in both eyes decreased for half a year, and she had no discomfort such as red eyes and eye pain. She was diagnosed with refractive error in both eyes in the local hospital. She came to our hospital for optometry and glasses. The naked visual acuity of both eyes was 0.5, and the corrected visual acuity was 1.0. The cornea of both eyes was transparent, the aqueous humor was clear, the pupil was round, sensitive to light reflection, the lens was transparent, and there was no abnormality in the left fundus of the eye. After the mydriasis of the right eye, a large area of grape string-shaped nasal retina with different sizes and dark red hemangioma was seen, and the tumor surface was covered with white glial fibers (Figure 1). Fluorescein fundus angiography showed that the early tumor site was masked fluorescence, and the fluorescence of the tumor site gradually increased in the venous phase, showing snowflake-like high fluorescence. The upper half of the late hemangioma was strong fluorescence, and the lower half was masked fluorescence, showing the characteristic "cap-shaped fluorescence" (Figure 2). There was no leakage during the angiography. The distal end of the hemangioma was a large area without perfusion. There was no skin or central nervous system hemangioma in the whole body, and there was no similar disease in the family.

A 58-year-old male patient came to our hospital on February 22, 2002 due to exophthalmos for 10 months and visual acuity decrease for 8 months. He had a history of hyperthyroidism for 2 years, and had been treated with oral drugs (specific name and dose unknown), 131I and radiotherapy 7 times. Before January 2002, the thyroid function was checked to be normal (specific value unknown). In May 2001, the patient had exophthalmos and was diagnosed with thyroid-associated ophthalmopathy (TAO) in another hospital. He was treated with oral high-dose glucocorticoids, and the total amount of prednisone was about 1575 mg, gradually decreasing. No abnormalities were found in the whole body examination in our hospital this time. Ocular examination: the visual acuity of the right eye was 0.1 in the naked eye and 0.5 in the left eye, both of which could not be corrected. Eye movement normal; The bulbar conjunctiva was congested and edema (+), and the attachment of the medial and external rectus muscles was congested obviously; Exophthalmos: 22 mm in right eye, 22 mm in left eye, orbital distance 109 mm; Orbital pressure (+ +), palpation (-). CT examination showed hypertrophy of extraocular muscles. Clinical diagnosis: thyroid-related ophthalmopathy; Severe exophthalmos; Hyperthyroidism.

Organophosphorus poisoning is a common acute toxic disease in most primary hospitals. A set of scientific and perfect treatment methods are needed to rescue organophosphorus poisoning. Among them, atropinization is one of the important indicators for its observation. However, most emergency department doctors often pay more attention to the observation of vital signs and neglect the treatment of ocular symptoms. Now, 2 patients with organophosphorus poisoning transferred from other hospitals to our department were successfully rescued by atropinization, but caused acute angle-closure glaucoma attack in both eyes and led to blindness. The report and analysis are as follows.

True microphthalmos refers to a rare eye disease in which the eyeball stops developing after the embryo cleft is closed, resulting in a significantly smaller eyeball volume than normal without other ocular deformities. The axial length of the eye is 14.0~20.5 mm, the visual acuity is lower than normal, and most of them are highly hyperopic in both eyes. Because the anteroposterior diameter of the eyeball is shorter than normal, the transverse diameter of the eyeball and the corneal diameter are normal or smaller, the volume of the eyeball is small, about 2/3 of that of a normal eye, but the volume of the lens is normal. After middle age, patients may develop glaucoma secondary to the progressive shallowness of the anterior chamber with stenosis or closure of the chamber angle, and some patients may be accompanied by uveal leakage and non-rhegmatogenous retinal detachment, resulting in severe visual impairment [1]. During his further study at Beijing Tongren Ophthalmology Center of Capital Medical University in 2000, the author treated a patient with typical microphthalmos secondary to glaucoma complicated with uveitis leakage. The clinical diagnosis and treatment process is analyzed and reported as follows.

The patient was a female, 1 year old and 7 months old, who was admitted to our hospital on July 30, 2002 due to swelling and bulging of the lower eyelid of her right eye for 17 months. Since the birth of 2 months, the mother found that the lower eyelid of her right eye was swollen, but she did not pay attention to it. The swelling of the posterior lower eyelid gradually aggravated, there was a "tumor" touch, no local redness and pain in the eye, no general fever, etc. The child was delivered naturally at full term, and was in normal health. The mother was healthy during pregnancy, and there was no history of taking medication. There were no patients with similar eye diseases in the family. The whole body examination of the child showed no abnormalities, and the nutritional development was good, and there were no nodules and caffeina spots on the skin of the whole body. Eye examination: Binocular vision examination was not cooperative, and no abnormalities were found in the anterior segment and fundus examination of both eyes. The right lower eyelid was subcutaneously palpable with a painless mass of 2.5 cm ×2.0 cm size, soft texture, clear boundary, deep and in the orbit. The eyeball was displaced upward, and the lower orbital edge was obviously displaced downward, resulting in enlargement of the orbital cavity. The mass did not increase when the head was lowered or crying, no pulsation, and there was no local redness and swelling of the skin. The preauricular and submandibular lymph nodes were not swollen (Figure 1). No abnormalities were found in routine hematuria examination, coagulation test, routine blood examination, chest fluoroscopy and electrocardiogram on admission. CT orbital plain scan (window width 350, window flat 50, layer thickness 3 mm, layer distance 3 mm) showed that the right orbital cavity was enlarged, the infraorbital wall was compressed and moved downward, and an oval "fat"-like density shadow was seen below the right eyeball, about 3.0 cm ×3.0 cm ×2.5 cm, with a CT value of-108 Hu. The size of both eyeballs was normal, the eye ring was not thickened, there was no abnormal density shadow in the bulb, the optic nerve and all extraocular muscles were normal, and there was no abnormality in the left orbit (Figure 2).

Shock wave eye injury is a kind of eye injury that has attracted much attention at present, and its visual impairment is especially obvious after injury. So far, the mechanism of shock wave eye injury is still unclear, and many experimental studies have focused on the changes of choroid after injury [1-5]. However, the changes of choroid seem to be insufficient to explain the severe visual dysfunction after injury, so we conducted this experimental study and report as follows. 1. MATERIALS AND METHODS 1. Animal selection and preparation before injury: 20 adult gray rabbits, 6 months old, male or female, weighing 2.5 kg. The right eye was the experimental eye. The right eyelid was retracted under 1% tetracaine surface anesthesia with a palpebral opener, the accessory eyelid was cut off, and the rabbit frame was fixed. 2. Shock wave and injury: Shock wave was produced by shock tube, and the shock wave value and action time were recorded by electronic sensor. The peak positive pressure value was (300 ± 28) kPa, and the duration was (8.0 ± 0.6) ms. It was 1 cm away from the cornea of the experimental eye, and the injury was injured in the positive direction. 　　

meropenem (meropenem) is a new generation of broad-spectrum and high-potency carbapenem antibiotics. The antibacterial spectrum and antibacterial activity of domestic meropenem are basically the same as those of foreign countries, and it has strong antibacterial activity against most common pathogenic bacteria of bacterial endophthalmitis [1,2]. In the retinal toxicity study, we observed that there were no abnormal changes in electroretinogram, light microscope and electron microscope after intravitreal injection of domestic meropenem 1.25 mg in rabbits [3]. We used high performance liquid chromatography (HPLC) to observe the changes of drug concentration in aqueous humor and vitreous body after injection, and calculated the pharmacokinetic parameters, which provided experimental basis for rational intraocular drug use.

In recent years, Ophthalmology Societies in the United States, Europe and Asia-Pacific have successively formulated clinical guidelines for glaucoma in China, which have been used in 1987 for many years<Preliminary Suggestions for Early Diagnosis of Primary Glaucoma>, this recommendation can no longer meet the requirements of guiding domestic glaucoma clinical work, and China urgently needs modern glaucoma clinical work guidelines suitable for national conditions. In view of this, the Glaucoma Group of Ophthalmology Branch of Chinese Medical Association held a working meeting of all the members of the group in Dongguan City, Guangdong Province from July 29 to 30, 2005. After open, *, free, rigorous and serious discussion, a consensus was reached, and a consensus was agreed to formulate the clinical work guidelines for glaucoma in China according to the American Preferred practice pattern (PPP) (2005).<China Glaucoma Clinical Work Guidelines>(abbreviated as the Guidelines) are published as follows.

Hyperocular pressure has always been considered as an important mechanism of optic nerve damage in glaucoma, but it has been found that even if intraocular pressure is well controlled in some patients with glaucoma, it can't prevent further optic nerve damage. Optic nerve atrophy caused by glaucoma is not only the compression atrophy of optic nerve caused by hyperocular pressure, but more research results show that optic nerve change in glaucoma is an optic neuropathy, and there are many causes, but all of them are manifested as the death of optic ganglion cells [1]. This death process of optic ganglion cells is a slow apoptosis process, which can be divided into two stages: the first stage is the cell damage caused by ischemia and hypoxia; The second stage is that the damaged degenerative cells release harmful substances, which cause matrix changes and damage.The researchers hope to gain a deep understanding of the inducing factors leading to optic ganglion cell apoptosis, the conduction pathways and action sites of related factors, so as to provide a therapeutic basis for protecting optic nerve, so as to develop corresponding factor antagonists leading to optic nerve cell apoptosis according to the interactions and conduction pathways between various pathogenic factors.