Volume 43 ·  Issue 12 ·  2007

Since the 21st century, orbitoplasty in China has been developed greatly, but there is still a big gap compared with developed countries. Therefore, we should pay attention to the diagnosis, treatment and prevention of orbital deformity, master the correct time and technique of orbitoplasty, and carry out the research of orbital repair materials and tissue engineering bone construction; At the same time, we should fully understand the characteristics of orbital reconstruction surgery, pay attention to the standardized training of orbital surgeons and strengthen the basic and clinical research of orbital reconstruction surgery, so as to improve the development level of orbital reconstruction surgery in China.

The craniofacial development of normal children depends on the growth and development of the orbit, while the enlargement of the bony orbital cavity is related to the development of the eyeball. At present, many scholars in China have a lot of debate about the choice of the timing of orbital implant surgery in children with enucleated or no eyeball during development. Some scholars believe that the earlier the implant surgery, the better, while others believe that a fixed size orbital implant cannot stimulate the development of the orbit to the normal level, and the possibility of second or third surgery is bound to be faced with the development of children. According to the influence of children's orbital, eyeball development and orbital volume loss on orbital development, this paper discusses the choice of the timing of orbital implant surgery in children during development.

Objective to investigate the clinical efficacy of periocular superficial muscle aponeurosis system (SMAS) flap combined with hard palate mucosa transplantation in the repair of moderate and severe full-thickness eyelid defects. Methods 26 cases (26 eyes) with full-thickness eyelid defects larger than or equal to 1/2 of the total length of eyelid were treated with hard palate mucosa transplantation to replace the posterior layer of eyelid, i.e. tarsal plate and palpebral conjunctiva layer; The anterior layer of the eyelid, i.e. the skin and muscle layer, was repaired by SMAS flap with abundant blood supply around the ocul.Five patients were followed up with orbicularis oculi pedicle flap, five patients were superficial temporal artery flap, seven patients were superficial eyebrow flap, and nine patients were double pedicle orbicularis muscle flap of upper eyelid cutaneous orbicularis muscle.

Objective to analyze the clinical characteristics of patients with moderate to severe Marcus-Gunn syndrome, and to explore and evaluate the effect of surgical therapy. Methods The clinical characteristics of 33 patients with moderate to severe Marcus-Gunn syndrome admitted to Sun Yat-sen Ophthalmology Center of Sun Yat-sen University from July 1997 to July 2003 were analyzed. All patients underwent unilateral levator palpebroidectomy combined with ipsilateral frontal muscle flap suspension for blepharoptosis, and evaluated the postoperative effect. Results All patients had blepharoptosis and jaw movement blink volume greater than 2 mm before surgery, no family history, no obvious gender difference (male: female =16:17), and the left eye (22 cases) was more than the right eye (11 cases). After surgery, 26/33 patients were satisfied, 3/33 cases were satisfied, 1/33 cases were unsatisfied, and 3 cases were lost to follow-up. Conclusion Patients with moderate to severe Marcus-Gunn syndrome need surgical correction of blepharoptosis.

Objective to investigate the lacrimal duct obstruction after naso-orbital ethmoid (NOE) fracture and analyze the relationship between lacrimal duct obstruction and fracture type.Methods The lacrimal duct obstruction of patients with NOE fracture hospitalized in the Department of Ophthalmology of the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2000 to January 2005 was retrospectively analyzed.The fractures of the collected patients were classified according to Markowitz's NOE fracture classification method; Combined with clinical manifestations, lacrimal duct examination and dacryocystography to evaluate the lacrimal duct condition, compared the incidence of lacrimal duct obstruction after fracture; The relationship between lacrimal duct obstruction and fracture type was analyzed.Results 63 cases of 101 NOE fractures had lacrimal duct obstruction, including 39 cases (61.90%) of nasolacrimal duct obstruction and 12 cases (19.48%) of lacrimal duct obstruction; There were 7 cases (11.11%) of lacrimal sac defects, 5 cases (7.94%) of lacrimal point atresia or absence, 16 cases of type Ⅰ NOE fracture, the incidence of lacrimal duct obstruction was 25%, 37 cases of type Ⅱ fracture, the rate of lacrimal duct obstruction was 54.05%, 48 cases of type Ⅲ fracture, the rate of lacrimal duct obstruction was as high as 81.25%. Conclusion Lacrimal duct obstruction is a common clinical manifestation of NOE fracture, among which nasolacrimal duct fracture is the most common cause of lacrimal duct obstruction.

Objective to investigate the clinical significance of CT images and computerized orbital Volume measurement program in evaluating and predicting the changes of orbital Volume after repairing large-scale orbital fractures with tunneled porous polyethylene implant material (MCI). Methods Sixteen patients with single large-scale orbital fractures underwent MCI implantation with complete data before and after surgery were collected. The changes of orbital Volume before and after surgery were retrospectively and quantitatively analyzed by computer Volume program, and the exophthalmos before and after surgery was measured by Hertel exophthalmometer. The mean time from injury to surgery was (17.4±10.0) d, and the mean follow-up time was 9 months. Results CT images after surgery showed that all patients had good MCI position in the anterior and middle segments of the orbit. The orbital Volume of injured eyes before surgery [(28.16±4.32) cm3] was statistically significant compared with that of contralateral healthy eyes [(23.94±3.47) cm3] (t =3.044, P<0.01); There was no statistically significant difference in orbital volume after surgery (t =0.069, P>0.05). The change of orbital volume before and after surgery was correlated with the degree of enophthalmos before surgery (r =0.715, P<0.01). To relieve enophthalmos 2 mm, surgical recovery of orbital volume was required to 2.86 cm3. Conclusion Objective measurement of orbital volume by computer can predict the severity of orbital fracture and possible enophthalmos after trauma. When large-scale orbital fracture causes orbital volume change, surgical treatment by MCI within the indication range is an effective method to reconstruct the orbit. CT images and computerized orbital volume measurement program can provide important data for surgery.

Objective to evaluate the safety and effectiveness of dual-channel micro-incision phacoemulsification combined with foldable intraocular lens implantation for cataract extraction; Methods Thirty-five cataract patients (35 eyes) were randomly divided into two groups to undergo surgical treatment, group one (15 cases) was treated with Thinoptx intraocular lens, group two (20 cases) was treated with Acri.Smart intraocular lens. Corneal curvature values before and 1 month after surgery; Results There were no significant differences in preoperative intraocular pressure (15.9±3.3), (15.2±2.7) mm Hg (1 mm Hg =0.133 kPa), intraocular pressure (17.3±1.9), (15.6±3.2) mm Hg), preoperative expected diopter (-0.51±0.13), (-0.55±0.13) D, preoperative actual diopter (-0.55±0.50), (-0.48±0.40) D), preoperative corneal curvature (-0.72±0.6, -0.91±0.7) and 1 month postoperative corneal curvature (-0.73±0.6, -0.64±0.5) between the two groups (P>0.05). Conclusion Dual-channel micro-incision phacoemulsification

Objective to investigate the clinical effect and safety of photodynamic therapy (PDT) in the treatment of solitary choroidal hemangioma. Methods Five patients with solitary choroidal hemangioma were diagnosed by fundus examination, fluorescein fundus angiography (FFA) and color ultrasound Doppler (CDI) examination. Among them, 4 patients were accompanied by exudative retinal detachment and macular edema. The best corrected visual acuity of patients was 0.02~0.8, the maximum thickness of tumor was 2.8~5.4 mm, and the maximum diameter was 6.5~12.5 mm by CDI. After PDT treatment, the follow-up time of patients was 13~56 weeks. Results After one PDT treatment, the exudative retinal detachment was completely absorbed, and the visual acuity was stable and improved. At the final follow-up, the best corrected visual acuity of patients was 0.2~0.9. Conclusion PDT is effective and safe in the treatment of solitary choroidal hemangioma, especially choroidal hemangioma located in macula, which can make the tumor atrophy and preserve or improve the visual acuity of patients.

Objective to investigate the clinical characteristics of Best patients with vitelloid macular dystrophy (BVMD). Methods The clinical data of 10 cases (20 eyes) with BVMD from January to December 2006 were retrospectively analyzed, including fundus examination, fluorescein fundus angiography (FFA) and coherence optical tomography (OCT) images. Results Among 10 cases (20 eyes), 3 cases (3 eyes) had stage Ⅱ lesions, the onset age was 9-18 years old, and the Best corrected visual acuity (BCVA) was 0.5-0.8. The retinal pigment epithelium (RPE) -choroidal capillary complex was thickened, bulged and signal enhanced by OCT. 2 cases (2 eyes) were stage Ⅱa, the onset age was 9-18 years, and the BCVA was 0.5-0.6. Irregular strong and weak fluorescence lesions were observed by FFA. OCT examination showed that the RPE-choroidal capillary complex was thickened, bulged, and signal enhanced, piled into a cone shape, with substance accumulation underneath it accompanied by serous retinal detachment (RD), and the neurosensory layer was lifted. Two cases (4 eyes) were stage III, the onset age was 11~29 years old, and the BCVA was 0.4~1.0. FFA examination showed fluorescence shielding below the fluid level, and window-like defect was seen above due to RPE atrophy; OCT examination showed normal upper RPE with serous RD, lower RPE-choroidal capillary complex widened, signal enhanced, and neurosensory layer lifted. Six cases (11 eyes) were stage IV, the onset age was 9-44 years old, and BCVA was 0.05-0.7. FFA examination showed typical fluorescence leakage (stage IVC) or fluorescence transmission (stage IVA) or fluorescence spot staining of fiber mass (stage IVB); OCT detection showed continuous interruption of RPE, which may be accompanied by macular edema (stage IVc), atrophy and thinning of RPE-choroidocapillary complex (stage IVa) or widening, and signal enhancement (stage IVb). Conclusion FFA and OCT detection results of BVMD support the hypothesis that vitelloid substances accumulate at or below RPE level, and the typical image features of BVMD are important to evaluate the treatment and prognosis of patients.

Objective to investigate the clinical characteristics and surgical efficacy of ciliary epithelial tear complicated with retinal detachment.Methods the clinical data of 16 patients (17 eyes) with ciliary epithelial tear complicated with retinal detachment.Results 16 patients (17 eyes) with blunt ocular contusion and ciliary epithelial tear complicated with retinal detachment.All patients underwent extrascleral cryo-silicone external compression-cerclage, of which 13 eyes underwent subretinal fluid and 4 eyes underwent vitreous cavity injection.The retinal reposition and visual acuity were improved to varying degrees.Conclusion Ciliary epithelial tear complicated with retinal detachment mostly occurred after blunt ocular contusion and mostly located in the upper nasal quadrant. Ultrasound bioscopy, anterior chamber gonioscopy and indirect ophthalmoscopy combined with scleral compression are beneficial to the diagnosis, and the success rate of scleral buckling is high.

Objective to investigate the characteristics of retinal topological projection distribution in normal human visual cortex detected by functional magnetic resonance (fMRI), and to explore the anatomical characteristics of functionally localized V1/V2 boundary. Methods Three healthy volunteers, aged 25-30 years old, right-handed, were used as experimental subjects. The visual stimulation occupied 12 degrees of view, and the checkerboard with contrast ratio close to 100% was used, and the average brightness of black and white checkerboard was used in the background, including cyclic expansion or contraction ring stimulation and clockwise or counterclockwise rotation wedge stimulation. GE Signa VH/I 3.0 TfMRI scanner was used. The functional images were obtained by GRE-EPI BOLD scan sequence, perpendicular to the coronal position of the talus fissure, and 3D-SPGR sequence was used to obtain high-resolution anatomical structure data in the sagittal position. AFNI software was used for data analysis, and Freesurfer software was used for segmentation, expansion, incision and flattening of the cortex. Results (1) When the ring stimulation expanded from the center to the periphery, the posterior occipital lobe of the visual cortex to the anterior part of the talus fissure was excited successively, and there was cortical amplification effect; (2) Wedge-shaped stimulation revealed that the polar angle coordinate direction of V1 region was opposite to the visual field, and the polar angle coordinate direction of adjacent functional regions was opposite; (3) The functionally localized V1/V2 boundary is located near the top of the cerebral gyrus. Conclusion Phase-encoded visual stimulation is an effective means to obtain the topological projection of visual cortex and retina. The anatomical features of functionally localized V1/V2 boundary support the hypothesis of optimal connection of white matter fibers.

Objective to investigate the distribution of bacterial genera and drug susceptibility of bacterial endophthalmitis, and to provide evidence for clinical diagnosis and treatment.Methods 728 samples of aqueous humor and vitreous body submitted to Beijing Tongren Ophthalmology Center from January 1999 to December 2006 were identified by routine bacterial culture and drug susceptibility test by paper diffusion method; Results Among 728 samples of aqueous humor and vitreous body, 160 samples were positive for bacterial culture, with an average positive rate of 22.0%; A total of 168 strains of bacteria were cultured, including 96 strains of Gram positive cocci (57.1%), 18 strains of Gram positive bacilli (10.7%), 2 strains of Gram negative cocci (1.2%) and 52 strains of Gram negative bacilli (31.0%). The main isolates were 36 strains of Staphylococcus epidermidis (21.4%), 19 strains of Staphylococcus aureus (11.3%) and 15 strains of Pseudomonas aeruginosa (8.9%). The susceptibility rate of Gram positive cocci to vancomycin was 93.4% (85/91), 84.4% (81/96) to levofloxacin, 88.2% (45/51) to levofloxacin, 76.9% (40/52) to ofloxacin and 75.0% (39/52) to ciprofloxacin.

Orbital development is directly related to the development of eyeball, and the retardation of eyeball development and the absence of eyeball caused by various reasons in the development period will lead to the delay of orbital development, which will affect the development of craniofacial bone and ultimately lead to facial deformity of patients. Therefore, how to take into account the orbital development of children while actively treating the affected eyes has been a difficult point in ophthalmology. Traditional treatments include placing increasing prosthetic eyelets, implanting fixed-size prosthetic eyelets, transplanting dermal fat sheets and embedding balloon-like water-injected dilators, all of which are difficult to achieve satisfactory results. Recently, the emergence of tissue osmotic pressure-dependent self-expanding dilators has provided new choices for patients and doctors. This paper summarizes the effects of abnormal eyeball on orbital development, as well as various methods and recent advances in promoting orbital development.

This issue focuses on ocular trauma and ocular plastic surgery, and specially invites Fan Xianqun to write an expert review "Problems and Countermeasures of Orbital Plastic Surgery". Orbitoplasty is to reconstruct, repair and reconstruct orbital deformities caused by trauma, inflammation, tumor and congenital abnormalities, so as to correct the appearance, improve the appearance and restore the function. In recent years, due to clinical needs, technological progress and the spread of knowledge of ophthalmoplasty, the development and popularization of orbitoplasty surgery have been promoted.

The tear film is located on the surface of the cornea and plays an important role in maintaining the metabolism, protection and physiological function of the corneal epithelium. The tear film provides a normal humid environment for the corneal epithelium, thus reducing blinking and friction during eyeball rotation, and provides a smooth refractive surface for the cornea. The corneal perception is necessary to maintain the normal corneal physiological function, and the blinking reflex and normal tear secretion are affected by the corneal perception.

Pterygium is a common ocular surface disease in which fibrovascular tissue proliferates from the conjunctiva to the cornea, which not only affects the appearance, but also may damage the visual function. The etiology is unclear. The main treatment is surgical resection, but the postoperative recurrence rate is high. At present, scholars most believe that neovascularization is involved in the formation, development and postoperative recurrence of pterygium.

A 39-year-old female patient was admitted to the Department of Ophthalmology of Eye, Ear, Nose and Throat Hospital of Fudan University on October 25th, 2006. The visual acuity of her left eye gradually declined and the visual field was defective for 6 months.

The 12th Congress of Chinese Ophthalmological Society was held in Zhengzhou International Convention and Exhibition Center from August 29th to September 2nd, 2007. The scale of The conference was unprecedented, with nearly 7000 attendees. The contents of The conference were rich and colorful, and The new knowledge, new technology, new equipment, new ideas and new strategies of ophthalmology were integrated into one, and The platform of exchange between domestic and foreign countries, basic and clinical, academic exchange and commercial exhibition, professional knowledge and popular science education was established.