Volume 47 · Issue 03 · 2011

The picture essence column of Chinese Journal of Ophthalmology is very popular with the majority of ophthalmology readers, because it is short and exquisite. Although it only has a few lines of text introduction, it also provides more detailed medical history, eye examination and other information. The published pictures reflect the word "essence", the lesions are clearly displayed, and the images are beautifully printed, so that readers can increase their perceptual understanding of some difficult and rare diseases in a very short time. We are enthusiastic readers of this column.

Objective In recent years,a lot of achievements on the basic research of ocular disease have been made in our country, however, among these basic research works, few were finally become a agent or device to be applied in the clinic. The concept of "translational medicine", i.e. "from bench to bedside" research should be strongly advocated to catalyze the medical applications of basic research on ocular disease. For doing better this way, we suggest to do more research work of originality, to persevere the a meaningful research work and to cooperate well with biomedical enterprise. Meanwhile, we emphasize the importance of the reverse translational way, i. e. ," from bedside to bench" not only because of the limited resources including financial resources and research facility,but also for improving the efficiency of the basic research of ocular diseases in China.

Objective To culture human retinal capillary endothelium cells(HRCECs) in vitro and explore the effect of rAAV2-PEDF on proliferation of HRCEs. Methods Retinas were digested by 2. 5%trypsin and 0.1% collagenase Ⅰ in order. The isolated cells were cultured on fibronectin-coated dishes in media of human endothelial-sFM basal growth medium (HE-SFM BGM) with 10% fetal bovine serum,insulin-transferin-selenium (ITS) and endothelial cell growth factor (ECGF). The cultured cells were identified by anti-factor Ⅷ related antigen though immunohistochemistry stain. The effect of hypoxia induced by CoCl2 on proliferation of HRCECs was assessed by MTT assay. After rAAV2-PEDF were transfected into HRCECs, the EGPF positive cells were observed by laser confocal scanning microscop, the protein expression of PEDF were detected by Western blot, and the proliferation of HRCECs were checked by MTT assay. Flow cytometry was used to analyze the apoptosis of HRCECs. Results Cultured HRCECs attached in the bottom of dishes in 48 h-72 h and grew to confluence in 2 weeks after seeding. HRCECs were with a positive brown staining for factor Ⅷ. EGPF positive cells were seen under laser confocal scanning microscop after 48h of rAAV2-EGFP transfection. The expression level of PEDF protein was higher in experimental group than in control group. The results of MTT assay showed the numeric value OA was 0.085±0.021 in normal group and 0.166±0.024 in hypoxia group(t =3.938,P＜0.05). In normal oxygen condition, the numeric value OA was 0.171±0.011 in normal control group, 0.178±0.016 in rAAV2-EGFP treated group, and O. 169±0.017 in rAAV2-PEDF treated group(F=0.01 ,P＞0.05). In hypoxia condition, the numeric value OA was 0.166±0.013 in CoCl2 treated group, 0.155±0.012 in CoCl2 + rAAV2-EGFP treated group, and 0.116±0.015 in CoCl2 + rAAV2-PEDF treated group. In normal oxygen condition, the ratio of apoptosis was 2. 3% in normal contral group,and 3. 3% in rAAV2-EGFP treated group,and 1.7% in rAAV2-PEDF treated group. In hypoxia condition, the ratio of apoptosis was 3.6% in CoCl2 treated group,6.7% in CoCl2 + rAAV2-EGFP treated group, and 36. 4% in CoCl2 + rAAV2-PEDF treated group.Conclusions PEDF gene can stably express in HRCECs after rAAV2-PEDF transfection and can obviously inhibit proliferation of HRCECs in hypoxia.

Objective To observe the inhibit effect of (pro)renin receptor siRNA on mice retinal neovascularization, and investigate its possible mechanism. Methods Experimental study. 72 new born C57BL/6J mouse were randomly divided into six groups: group A to group E were exposed to hyperoxia, and then returned to normoxia to induce retinal neovascularization. Group A were treated with PRR siRNA plasmid, group B with control plasmid, group C with PRR siRNA and Losartan, and group D with Losartan.Group E were not treated. Group F was control group. Mouse were sacrificed at postnatal day 17, retinal perfusion stretched preparation and HE dyeing method were used to observe the status of retinal neovascularization. PRR expression and the activation of extracellular regulated protein kinases 1/2(ERK1/2) were detected by Western Blot. And Real Time PCR was used to detect the expression of transforming growth factor-β1 (TGF-β1) in group A, B, E and F. Analysis of one way variance (LSD) was used and statistical difference was considered significant at a P value less than 0. 05. Results The mouse treated with PRR siRNA, Losartan and combind therapy could significantly reduce retina neovascularization and vessel leakage compared with oxygen-induced retinopathy group and control plasmid group. Average counts of vascular endothelial cells which break through the inner limiting membrane performed at postnatal day 17 in PRR siRNA group (4. 47 ± 1.96), Losartan group (5.94 ± 2. 54) and combind therapy group(4. 49 ± 2. 53)were significantly lower than oxygen-induced retinopathy group (32. 73 ± 6. 38) (P＜0. 05) and control plasmid group(21.04 ±5. 39). Western Blot showed that PRR protein express in hyperxia induced group was significantly higher than normal (P=0. 007). After treated with PRR siRNA or combind therapy, the expression of PRR protein was significantly lower than hyperxia induced group (P＜0. 05). There are no significantly differences between control plasmid group, Losartan group and hyperxia induced group (P＞0. 05). The activated ERK1/2 lever in hyperxia group was significantly higher than normal (P=0. 003).After treated with PRRsiRNA, Losartan or combind therapy, activated ERK1/2 lever was significantly lower than hyperxia induced group (P＜0. 05). And the effect of PRR siRNA group and combind therapy group seems more obviously, compared with Losartan group, the difference was significantly (P＜0. 05). Real Time PCR showed that the lever of TGF-β1 in hyperxia group was significantly higher than normal (P=0. 001). After treated with PRR siRNA, the TGF-β1 was significantly reduced (P=0. 004), and there was no significantly difference between control plasmia group and hyperxia induced group (P=0. 222) .Conclusions PRR combined with prorenin or renin could activate ERK1/2 signal transduction passageway,and promote cell proliferation, differentiation and migration, thus promote retinal neovascularization. PRR siRNA could obviously reduce PRR expression, inhibit ERK1/2 signal transduction passageway activation,and diminish retianl neovascularizatior.

Objective To study the influence of the ectopic synapse for electrophysiological characteristics modification in ON retinal bipolar cells (ON-RBCs) of RCS rat. Methods Immunofluorescence of the retinal frozen section was taken in P60 d, P90 d of RCS rat(RCS) and control rat (CTR) with the anti-mGluR6 and anti-Synaptophysin, Lucifer Yellow staining solo ON-RBCs was taken in all the group. The whole cell recording was performed in the retinal slice of P60 d, P90 d in RCS and CTR. The modification of the passive membrane properties and the outward currents properties in RCS-ON-RBCs, CTRON-RBCs and CTR-OFF-RBCs were observed. Results RCS-ON-RBCs stretched out the ectopic neurite in different direction and the activity of synapse could be detected around the ectopic neurite. From Pn6Od,passive membrane properties of RCS-ON-RBCs kept immature,The RMP in RCS-ON-RBCs and CTR-ON-RBCs were (-61.8±3.07) 、(-50.44±1.36)mV and (-63.1±2.59)、(-48.37±3.69) maV when P60 d and P90 d, there ware significantly higher than CTR group(t=2. 191,2.435,5. 817,6. 912;P＜0. 05). The IR in RCS-ON-RBCs and CTR-ON-RBCs were (323.3±42.6)、 (337.6±71.3) MΩ and (321.2±-58.6)、 (340.3±62.8) MΩ when P60 d and P90 d, there ware significantly higher than CTR group(t=3.561,1.987,5.211,4.034;P＜0.05). Outward currents were recorded when giving hyper-and depolarized voltage steps. In retinal degeneration, the amplitude of outward currents in RCS-ON-RBCs is significantly different with CTR-ON-RBCs (t=5.561,6.341; P＜0. 05) or CTR-OFF-RBCs (t=5.357,6.997; P＜0. 05). Conclusion The ectopic neurite from RCS-ON-RBCs has the possibility for translating the signal. In retinitis pigmentosa, the modification of electrophysiology characteristics in RCS-ON-RBCs was significantly different with CTR-ON-RBCs and CTR-OFF-RBCs. Influence with the ectopic neurite is the possible cause.

Objective The purpose of this research is to find the law of neovascular endothelial cell migration and transition through repressing the expression of Twist in mouse's retinal neovascularization with RNAi, and get a new target of inhibit retinal neovascularization. Methods Oxygen-induced retinopathy (OIR) was produced in new bom C57BL/6J mice by exposing postnatal day 7 (P7) pups to 75% oxygen for 5 days. P12 pups were injected 1 μl pTwist. siRNA plasmid solution or 1 μl negtive siRNA plasmid solution into vitreous cavity. Eyeballs were enucleated for Evans blue angiography, histopathologic examination,neovascular endothelial cell counting, immunohistochemistry and Real-Time PCR. Results Observed by light microscopy retinal neovascularization, the number of vascular endothelial cells per eye were 0.34±0.11,32.73±6.38, 4.56±2.02 and 20.17±6.49 in the normal control group, hyperoxia group,Twist plasmid group and the control plasmid group. Mouse retinal Evans blue perfusion and HE staining of paraffin sections showed that retinal vascular leakage, tortuous and angiogenesis significantly reduced in Twist plasmid group compared with hyperoxia group. Endothelial cell count was significantly decrease in Twist plasmid group. Both immunohistochemistry and real time PCR proved that Twist and vimentin expression in hyperoxia group were significantly higher than that of Twist plasmid group ( F=27.214,31.211 ;P＜0.05). Conclusion As mice retinal neovasculars growth, Twist may play important roles as a cell transition regulatory factor. Repressing Twist with RNAi, we can repress cell transition and inhibit retinal neovascular.

Objective To investigate the changes of the asphericity (Q-value) of the posterior corneal surface with different corneal diameters after corneal refractive surgery. Methods One hundred and fifteen myopic eyes of 115 subjects undertaken corneal refractive surgery (59 LASIK and 56 EPI-LASIK)were enrolled in this prospective study. The Q-value of the posterior corneal surface for patients with different corneal diameters (6, 7, 8 and 9 mm ) was measured with Pentacam pre-and post-operatively. The correlations between Q-value, Q change (△Q), and the mean preoperative spherical equivalent refraction (SE), central corneal thickness (CCT), central ablation depth (AD) and AD/CCT were investigated.Results The mean Q-value of the posterior corneal surface in 115 preoperative eyes with corneal diameters at 6, 7, 8 and 9mm was 0.08±0.16,-0.05±0.13,-0.15±0.12 and-0.26±0.11, respectively.The Q-value had a statistically significant positive shift 1 month after surgery in eyes with 6, 7 and 8 mm corneal diameters ( LASIK: t6mm=-2.076, P=0.042; t7mm=-2.873, P=0.006; t8mm=-2.180, P=0.033;EPI-LASIK:t6mm=-2.859,P=0.006;t7mm=-3.901,P=0.000;t8mm=-3.510,P=0.001 ).The mean Q-value diminished significantly 6 months compared to I month after surgery, and had an obvious tendency back to its preoperative level. No statistically significant correlation between Q and SE or CCI was found in the preoperative eyes. Also, no correlation between △Q and SE, CCT, AD and AD/CCT was found after surgery. Conclusions The shape of the posterior corneal surface in myopic eyes was more prolate as corneal diameter increased, which was similar to the anterior corneal surface. The posterior cornealsurface showed central flattening and peripheral steepening (oblate shift) at early stage either post-LASIK or post-EPI-LASIK, and then returned to its original state over time.

Objective To report the clinical manifestations and results of carotid artery color Doppler imaging (CDI) of ocular ischemic syndrome (OIS). Methods It was a retrospective case series study. Consecutive patients suspected with OIS were retrospectively studied from 1995 to 2009. We evaluated all patients with medical history, visual acuity, slit lamp, direct and indirect funduscopy, Fundus fluorescence angiography. CDI for internal carotid artery (ICA), Diagnostic Cerebral Angiography and magnetic resonance imaging were also performed. Results 17 patients (20 eyes) with OIS were studied,13 males and 4 females. The age range of patients was 46 to 83 years old (median 70). 13 right eyes and 7 left eyes (3 bilateral) were involved. (1) Symptoms: 70.6% (12/17) of the patients complained of visual decrease. 17.6% (3/17) had history of repeated amaurosis fugax (transient monocular visual loss); 11.8%(2/17) patients presented with floaters. The course before the first presentation was 2 days to 6 years (median 3 months). (2) Visual Acuity(VA): among the 20 involved eyes, the best corrected VA ＜0.05 in 3 eyes (15.0%); 0.05 to ＜0.3 in 7 eyes (35.0%); 0.3 to ＜0.7 in 7 eyes (35.0%); ≥0.7 in 3 eyes (15.0%). (3) Fundus manifestations: 15.0% (3/20) eyes had cotton-wool spots; 25.0% (5/20) had retinal hemorrhages; retinal arterioles and vein became narrow; venous beading could be seen in severe cases. 30.0% (6/20) had microaneurysms in mid-peripheral area. The pressure of central retinal artery decreased; 25.0% (5/20) had optic disc or retinal neovascularization; 10.0% (2/20) had iris neovascularization. 5.0% (1/20) had neovascular glaucoma; 5.0% (1/20) had optic atrophy. (4) Fundus fluorescence angiography: arm-retinal circulation time prolonged to 14. 5 to 39. 9 seconds, (median 20.9 seconds). The retinal and choroidal circulation time was also prolonged. The wall of artery and venous could be staining. Hyperfluorescence dots indicating microaneurysms could be seen in the mid-peripheral area. Arterio-venous shunts, non-perfusion area and the leakage of new vessels were observed in some cases.(5) Internal carotid artery CDI examination: The ipsilateral ICA of the 19 involved eyes (another patient with pulseless disease had abnormal subclavial arterial flow) showed completely occluded in 5 cases (26.4 %),＞80.0% to 95.0% stenosis in 7 cases(36.8%), 52.0% to 80.0% stenosis in 7 cases(36.8%). Among the 14 contralateral eyes of the same group of patients, CDI showed stenosis of 80.0%, 70.0%, 60.0%,50.0% and 40.0% in 5 eyes, whereas no fundus abnormal was found. Peak of systolic velocity (PSV):Among the 20 involved eyes of the 17 patients, PSV of the ipsilateral ICA was undetectable in 8 cases which occluded completely or stenosis severely. Among the ipsilateral ICA of the other 12 eyes, 11 cases showed abnormal PSV; PSV increased to 92 to 524 cm/s in 9 cases and decreased to41 cm/s in 1 case. The blood flow of subclavial artery reduced to 20 cm/s in one patient with pulseless disease. The blood flow of subclavial artery reduced to 20 cm/s in one patient with pulseless disease. Conclusions The patients with OIS are usually older than 60 years of age. It is a chronic disease with unnoticed symptoms. The clinical manifestations may include: amaurosis fugax (transient monocular visual loss), hypoperfusion retinopathy and ischemic optic neuropathy. Internal carotid artery severe stenosis or occlusion are the most frequent cause of this disease. CDI is the best safe, reliable and non-invaded method for carotid artery examination.

Objective To search for the characteristics of MFS in corneal morphology and thickness. Methods Twenty-four patients (48 eyes) with MFS and 24 healthy age- and gender-matched volunteers (48 eyes) were recruited in this clinical prospective, and comparative series study. Firstly,biomicroscopic examination and Type-A ultrasonometry was conducted to search for ectopia lentis and axis length. Secondly, the corneal morphologic parameter[including the height of anterior and posterior surface,the centre corneal curvature, the mean astigmatism in the 3.0-mm central zone (Mean A), the mean simulated astigmatism (Sim A) , the mean keratometry in the 3.0-mm central zone (Mean K), the mean simulated keratometry (Sim K), the 3.0-mm zone irregularity (3.0ZI), the 5.0-mm zone irregularity (5.0ZI) ,corneal thickness index (CTI)] and thickness (at the central location and at eight midperipheral locations) were obtained by the the autorefractometer and the Orbscan Ⅱ Z corneal topography. Last, the statistics method including Crosstabs, One-way ANOVA, student-t test and discriminant analysis were applied and the correlations were established. Results There is no statistically significance between MFS group and control group in ages (38 ±7) and (37 ±8) years, gender (8/16) and (9/15), and axis length (23. 12 ±1.06) mm and (24. 26 ±2. 96) mm (age x2=0.091 ,P=0.763 ;gender t=0.324, axis length t=1.976,P ＞0.05). Flat cornea ratio (66. 7% and 12. 5%) and topography of the oval (25.0% and 16. 7%),irregular bow-shaped (41.7% and 37.5%) and irregular-shaped (12. 5% and 8. 3%) were increased significantly in patients with MFS. The corneal topography(MFS/control) showed that there are statistically significance in the thinnest thickness of cornea (489. 8 ± 42. 9) μm and (544. 8 ± 25.7) μm, Mean K (40.60±1.30) Dand (42.80± 1.40) D, Sim K (40.50±1.30) D and (42.80±1.20) D, Sim A(1.08 ± 0.86)D and (0.91 ±0.46) D, CTI 1.57±0.24 and 1.21 ±0.14, 3.0ZI (1.76±0.96) D and (1.54 ±0.82) D, and 5.0ZI (1.91 ± 1.26) D and (0.92 ±0.68) D(thinnest thickness t=6. 996, Mean K t=2. 554, Sim K t=3.326, Sim A t=2. 324, CTI t=3. 116,3. 0Z1 t=2. 686,5. 0ZI t=3.768, P ＜0.05), while no statistically significance in the Mean A between the MFS (1.11 ± 0.89) D and control group (0.99 ±0.49) D(Mean A t=1.898 ,P=0.08) ;except for temple inferior, the significant decrease of pachymetry (including the center and the seven midperipheral locations) appeared in the MFS group compared with the control group. Conclusion The characteristic of MFS in corneal topography is that corneal axial refractive power descends and corneal thickness decreases.

Objective To evaluate the clinical features, diagnostic methods and treatment of extraocular extension of choroidal melanoma. Methods It was a retrospective case series study. The records of 12 consecutive cases with extraocular extension of choroidal melanoma confirmed by pathologic examination were analyzed with special attention to the case histories, clinical manifestations, imaging findings, treatment and follow up results. Results Four patients were misdiagnosed as glaucoma. Another 4 patients were confirmed the diagnosis of melanoma and 3 of them received the operations of transscleral local resection. The common clinical manifestations included: impaired vision, exophthalmos,blephroptosis, limited ocular motility, conjunctival hyperemia, and increased ocular or orbital pressure, etc.Characteristic sign was raised mass on the surface of sclera. All cases underwent orbital MRI preoperatively,6 underwent ocular B-scan echography, and 6 underwent orbital CT scanning to evaluate for extraocular extension of tumor. Typical ultrasonography revealed the discontinued ocular wall and an intraocular mass with a continuous hypoechoic extraocular mass. In some cases the extraocular mass showed hypoechoic with medium echo area. CT scan showed a well-defined homogeneous intraconal mass connecting with intraocular lesion in 6 cases, which could infiltrate eye or optic nerve. The MR signal features of intraocular tumors with extraocular extension showed 4 patterns in all patients. The typical pattern was the tumor showed hyperintensity on T1 and hypointensity on T2-weighted image. The maximum diameter of extraocular tumor was measured over 4 mm in 9 cases. MRI was useful for demonstrating multiple extraocular lesions, remote metastatic lesion or micro extraocular tumor, of which minimal diameter was 3 mm in our cases. Orbital exenteration was performed in 11 cases and ocular enucleation with excision of extraocular tumor was in 1 cases. Microscopic examination showed the epithelioid-cell-type tumors were the most common. The tumor extended out of the eye by three types of way in our cases. Follow-up ranged from 1 to 5 years in 8 cases,who underwent chemotherapy, radiotherapy or interferon. Six cases had no recurrences and general health.Death and metastasis was respectively recorded in one case. Conclusions Delayed treatment could induce the growth of choroidal melanoma to the stage of extraocular extension, which has few specific clinical manifestations. The combination of multiple imaging examinations was helpful for the correct diagnosis.Surgical operation with adjunctive therapies could partly reduce recurrence and metastasis of melanoma.

Objective To explore the methods to establish a xenografted model of mebomian gland carcinoma in nude mice, then find the best method to establish the animal model. The last purpose of this study was to establish a suitable animal model for clinic therapy and basic research of mebomian gland carcinoma. Methods Small pieces of mebomian gland carcinoma tissue from four patients were transplanted subcutaneously in the flanks of eight nude mice through a skin incision. Nature of transplantation tumor including formation, growth and size were observed. The transplanted tumors were stained with hematoxylineosin,Sudan Ⅲ and Immunohistochemistry. Results The human mebomian gland carcinoma tissue can survived in nude mice. The pathologic examination revealed that the transplanted tumor was arranged in mass. The tumor cells were round or multisided. The proportion of the nuclei and cytoplasm was imbalance.Nuclear division could be easily observed. The test of Sudan Ⅲ was positive. Immunohistochemical observation: the results showed that both CK and EMA were positive. Conclusions The subcutaneously xenotransplanted tumor model of human mebomian gland carcinoma with tissue explant in nude mice was successfully established. The transplanted tumor maintained the properties of human mebomian gland carcinoma.

Objective To investigate the effects of hyperosmotic stress on rabbit ocular surface and mucin 5AC (MUC5AC) expression. Methods Experimental study. Eighteen New Zealand white rabbits were randomly divided into three groups with equal number as hyperosmolar saline solution (HOSS,500 mmol/L) group, normal saline (NS, 308 mmol/L) group and blank control group respectively. In HOSS and NS groups, the HOSS and NS eye drops were instilled on bilateral eyes six times every day for 14 days. On day 0, 7 and 14, Schirmer Ⅰ test and tear break-up time (BUT) were measured and conjunctival impression cytology specimens were collected. On day 7 and 14, cornea and conjunctiva were harvested for Hematoxylin and Eosin (HE) staining, scanning and transmission electron microscopy observation and conjunctival TUNEL examination. On day 14, the conjunctiva were also harvested for immunology histological staining and western blot to evaluate the expression of MUC5AC. Results In HOSS group, the BUT on day 7 and 14 was (7.6±2. 5) and (7.0±2. 3) s respectively which was significantly shorter than the (10.3±2. 5) s on day 0(t=5. 800,4. 950; P ＜ 0.01), and also significantly shorter than the BUT in NS and control groups (F=8.030, P ＜ 0.01). But the Schirmer Ⅰ test value did not change obviously in and between all those three groups. The mean conjunctival goblet cell (GC) density in HOSS group on day 7 and 14 was (19.5±16.6) and (32.3±18.2) cells/mm2 respectively which was also significantly lower than the (75.7±43.4) cells/mm2 on day 0 (t=5.319,2. 970; P ＜ 0.05). However the GC density did not change obviously in other two groups with time. After instillation of HOSS for 14 days,subepithelial inflammatory cell infiltration was showed on conjunctival tissue specimens and decreased epithelial layers and evident desquamation were found in the cornea specimens by the HE staining. Under the electron microscope, decreased microvilli and loosened intercellular junction in the superficial epithelium and increased autophagic vesicles in basal epithelium were observed in the cornea in HOSS group; and decreased microvilli and mucous granules were found in the conjunctiva in HOSS group. Obvious TUNEL positive staining was showed in the conjunctiva in the HOSS group. Also the MUC5AC immunology histological staining and western blot indicated decreased MUC5AC protein expression in HOSS group. Conclusion Hyperosmotic stress destroyed the structure of ocular surface epithelium, induced the decrease of conjunctival goblet cell density and MUC5AC expression, and led to the decreased tear film stability.

A 14-year-old male patient came to the Department of Ophthalmology of Naval General Hospital on July 15, 2009 due to red left eye accompanied by periorbital redness, swelling and pain for 1 d. The patient felt discomfort in his left eye without obvious trigger 1 d before the visit, and quickly appeared congestion, red, swelling and pain in his eyelids, no change in vision, no fever or headache, etc.

The patient was a 4-year-old female who came to Beijing Tongren Eye Center for treatment because of "oblique eye found for 4 years and aggravated for 1 year". Two months after birth, she found that her eyes were oblique to the left and her head was tilted to the left shoulder. The local hospital diagnosed her as strabismus. There was no diplopia, blurred vision and exophthalmos.

Two patients with secondary keratoconus after laser in situ keratomileusis (LASIK) were treated with riboflavin ultraviolet corneal collagen crosslinking therapy. The report is as follows.

Multiple buried papilla drusen in family members are relatively rare clinically. A pair of twin sisters with buried papilla drusen were treated in our hospital in July 2009. The diagnosis and treatment are reported as follows.

A 25-year-old male patient went to the Department of Ophthalmology of Eye, Ear, Nose and Throat Hospital affiliated to Fudan University on March 26, 2009 due to painless blurred vision in his right eye for 11 days. The patient had driven continuously on the expressway for 5~6 hours 11 days ago, and suddenly felt blurred vision in his right eye while bathing that night, accompanied by mild headache, without ocular congestion and edema.

The patient was a 28-year-old male who came to the Department of Ophthalmology of Xijing Hospital of the Fourth Military Medical University on April 13, 2010 due to decreased visual acuity and night blindness for 2 years. The family history was denied. Ocular examination showed that the visual acuity was 0.05 in the right eye (uncorrectable) and 0.12 in the left eye (corrected visual acuity was 0.2). Anterior segment examination of both eyes showed no obvious abnormality; See Essence 1 for fundus conditions.

Diabetes mellitus causing long term disturbed glucose metabolism could result in tissue injury and multiple complications. According to recent studies, diabetes mellitus might be regarded as one of the risk factors of age related macular degeneration (AMD). Diabetes mellitus affects the incidence and progression of AMD through altering hemodynamics, increasing oxidative stress, accumulating advanced glycation end products, etc. By studying epidemiological investigation and basic research on this subject comprehensively, it is required to review the correlation between diabetes mellitus and AMD.

Pseudoexfoliation syndrome, which represents the most commonly identified specific cause of open-angle glaucoma, is a kind of clinically systemic disease. Why there are so much xfoliative material deposited in the anterior chamber? Where did xfoliative material come from? The pathogenesis is never be confirmed exactly, though there are so many theories described by investigators. In recent years, in order to survey and evaluate the changes of the materials of the aqueous humor of patients with the Pseudoexfoliation syndrome, many investigators had done more works. This review will give a summarization of these findings.

Allograft corneal transplantation is currently the most effective and optimum method to treat corneal disease, however it is the immune rejection that the main reason for graft edema caused by vascularization and inflammation of the cornea and surgical failure after transplantation. Corneal endothelial cells occupy a crucial position as immune privilege and the primary barriers for maintaining normal physiological function of eye. In this paper, the various stages (recognition, response and reaction of immune system) of corneal endothelial changes in the morphological and biological characteristics had been presented after allograft corneal transplantation.

Diplopia is a common complaint in ophthalmology, while extraophthalmoplegia is a common cause of diplopia. Among them, extraophthalmoplegia caused by idiopathic extraophthalmomyositis of unknown cause is easily ignored by us. If the disease cannot be diagnosed in time, the treatment of the disease may be delayed.

In order to comply with the development trend of network and digitalization of journals and provide high-quality services for authors and readers, the Journal of Chinese Medical Association has developed a remote manuscript management system. The system is designed according to the business requirements of manuscript processing process, editing and processing specification, manuscript review system and management specification of Chinese Medical Association series magazines. It adopts advanced database and network technology, and has strong data processing and analysis ability. The remote manuscript management system will assist authors, editors, manuscript review experts, editorial board members, finalization meeting experts, editor-in-chief and other related personnel to carry out manuscript business processing in a multi-in-one manner, solve the need of the editorial department for manuscript networked process management,

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

Sponsored by the Chinese Medical Association, this journal was founded on October 1, 1950, and is now a monthly magazine. The editorial committee is composed of more than 100 well-known ophthalmologists across the country. Currently Editor-in-Chief Zhao Kanxing, Deputy Editors-in-Chief Wang Ningli, Sun Xinghuai, Yin Zhengqin, He Shouzhi, Yao Ke, Cui Hao, Hui Yannian, Ge Jian, Xie Lixin (Academician of Chinese Academy of Engineering), Li Xiaoxin, and Director of Editorial Department Huang Yibin. For many years, the circulation, influencing factors, total citation frequency and other indicators of this journal have been ranked first among the domestic professional journals.

The 13th National Conference on Cataract and Intraocular Lens will be held in Ningbo, Zhejiang Province from June 2 to 5, 2011. This conference was sponsored by the Cataract Group of Ophthalmology Branch of Chinese Medical Association, and hosted by Zhejiang Medical Association and the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University.

The donation signing ceremony of "Chinese Medical Association Ophthalmology Branch Santian Pharmaceutical Ophthalmology Medical Cattle Scholarship" co-sponsored by Chinese Medical Association Ophthalmology Branch and Japan Santian Pharmaceutical (China) Co., Ltd. was held in Beijing on January 22nd. The signing amount of this scholarship is RMB4.5 million (2011-2013).

Corneal disease is one of the main eye diseases causing blindness at present. According to statistics, there are more than 7 million blind people in China, of which about 8% are caused by corneal disease. The only hope for blindness caused by corneal disease is corneal transplantation. However, due to the lack of donor corneas, only 8,000 corneal transplantations are performed in China every year, and millions of patients can only pray for light in the dark. Therefore, early intervention for corneal diseases is crucial. "Protect the eyes and cherish the cornea" has become the focus of general concern in the society. In order to advocate the majority of ophthalmologists to pay attention to the prevention and treatment of corneal diseases, Chinese Journal of Ophthalmology of Chinese Medical Association and Xingqi Pharmaceutical Co., Ltd. jointly held the 2010 Xingqi "Cherish Cornea" Cup prize-winning essay contest.

The 14th National Academic Conference on Strabismus and Pediatric Ophthalmology, organized by the Strabismus and Pediatric Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, will be held in Jinan, Shandong Province in early June 2011. This conference will focus on the clinical and basic research of strabismus and amblyopia, childhood refractive error, cataract, glaucoma, ocular trauma, fundus diseases, ocular tumors, hereditary eye diseases and other childhood eye diseases. Now we call for papers on the above academic contents.

The 2011 "3rd Chinese Congress of Research in Vision and Ophthalmology (CCRVO) and Graduate Tutor Forum" will be held at Sofitel Chongqing Shenji Hotel from March 31 to April 313, 2011. The conference was sponsored by the Ophthalmology Branch of Chinese Medical Association and hosted by the Third Military Medical University. This conference will extensively exchange the basic research progress of ophthalmology and vision science, and conduct in-depth discussions around today's frontier hot issues. Conference theme "Communication and Innovation".

Following the successful two "Chinese Ophthalmology Youth and Middle-aged Forum" held by the editorial board of Chinese Journal of Ophthalmology of Chinese Medical Association in 2009 and 2010, at the request of the majority of ophthalmologists, the "3rd Chinese Ophthalmology Youth and Middle-aged Forum (with Organizing Meeting)" sponsored by this journal will be held in Xiamen, Fujian Province from July 1 to 4, 2011. The content of this forum integrates the rational application of ophthalmic drugs and the promotion of new technologies and new equipment, focusing on comprehensively improving the diagnosis and treatment level of ophthalmologists. At that time, the academic leaders of ophthalmology in China (the editorial board of this journal) will be invited to give wonderful special speeches, and well-known young and middle-aged experts in ophthalmology will be invited to carry out academic discussions and experience exchanges on hot topics related to ophthalmology. Taking the forum as the main form and the academic debate as the leading thought, this paper focuses on highlighting the development potential of young and middle-aged physicians, strives to introduce the old and innovate, and gives full play to the academic guiding role of this journal.

The 17th National Academic Conference on Ocular Trauma, Ocular Plastic Surgery and Orbital Disease and the 5th National Orbital Disease Study Class, sponsored by the Ocular Trauma-Orbital Disease-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association and the Orbital Disease Research Institute of Armed Police General Hospital, will be held in Kunming in March 2011. At that time, well-known experts and scholars in the field of ocular trauma, eye plastic surgery and orbital disease in China will gather in Kunming to share successful experiences with fellow ophthalmologists all over the country; At the same time, well-known domestic manufacturers are invited to display related products.

Approved by China Association for Science and Technology, it is co-sponsored by Ophthalmology Branch of Shanghai Medical Association, Ophthalmology Branch of six medical associations in East China, Hunan, Hubei, Henan and Hebei, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, School of Optometry of Wenzhou Medical College and China International Science and Technology Conference Center of China Association for Science and Technology; The 11th International Conference on Ophthalmology and Optometry (COOC2011) jointly organized by Eye, Ear, Nose and Throat Hospital affiliated to Fudan University and China International Science and Technology Conference Center will be held at Shanghai Everbright Convention and Exhibition Center from April 8 to 10, 2011.