Volume 47 · Issue 08 · 2011

Ophthalmic plastics and orbital diseases have developed rapidly as a young branch of ophthalmology in recent years. The current situation and development of ophthalmic aesthetics,plastics and orbital surgery are discussed in this paper. The functional reconstruction and appearance rehabilitation are both important to the ophthalmic plastic surgery. Although the ophthalmic plastics and orbital surgery started late in China,it developmented rapidly. The development of this branch is based on innovative research,active interdisciplinary,medical-engineering cooperation and academic exchange. However,there are still some problems about ophthalmic plastics and orbital surgery in China. To promote the development of ophthalmic plastic and orbital surgery,we should regulate the training of ophthalmic plastic surgeons,and pay attention to the clinical translational research.

Blepharoptosis is one of the most common oculoplastic problems. There has been an ongoing debate regarding the choice of appropriate surgical approach and time for congenital blepharoptosis.This paper addresses several common misunderstandings regarding the diagnosis and treatment of blepharoptosis,as well as emphasizes the importance of the classification and preoperative evaluation of the blepharoptosis. Furthermore,some personal viewpoints on the choices of appropriate surgical approach and time for blepharoptosis are mentioned,which might initiate scientific argument and discussion to reach a consensus on the standardization of diagnosis and management of blepharoptosis in China.

Although corticosteroid therapy remains the mainstream of various treatment procedures in traumatic optic neuropathy,some patients are still unable to benefit by this procedure. Therefore,optic nerve decompression has become an important choice for treating traumatic optic neuropathy. However,several problems have been raised on optic nerve decompression,such as who is suitable for this operation;as well as when to do and how to do this operation. The answers to these questions are controversial. We systematically review the current clinical evidence,and suggest that surgical decompression is indicated in cases with late onset and progressive visual loss;it is not indicated in primary complete loss of vision.Furthermore,it has been recommended that an adequate decompression requires the addition of an optic nerve sheath incision to the osseous optic canal,and it must be undertaken within seven days after the injury.

Objective To evaluate the outcomes of the clinical application of three-dimensionally preformed titanium mesh plates for posttraumatic complex orbital bone fracture reconstruction. Methods Thirteen patients (13 eyes) manifested with complex orbital fractures (including orbital-zygomatic- maxillary bone fracture in 6 patients,nasal-orbital-ethmoid bone fracture in 5 patients and complex multiple periorbital bone fracture in other 2 patients ) underwent the reconstructive surgery by using three-dimensionally preformed titanium mesh plates. Eight cases underwent high density porous polyethylene implantation simultaneously. Evaluation of enophthalmos,eyeball movement,and orbit CT scan were taken pre- and post-operatively. Results The average enophthalmos was (3.9 ± 1.7 ) mm and the position of the affected eyeball was( 3. 1 ± 2. 6)mm bellow the contralateral side preoperatively. Twelve patients suffered from eyeball movement restriction,including grade Ⅰ in 4 cases,grade Ⅱ in 7 cases and grade Ⅲ in 2 cases. During the 3 to 6 months post operative follow-up,enophthalmos was completely corrected in 10 patients while the other 3 patients had residual 1.0 mm enophthalmos. The affected eyeballs were repositioned in 8 cases and 3 cases had residual 1 mm lower position and 2 cases with a 1 mm higher positioned eyeball. Eye movement was not restricted in 8 patients,whereas 3 patients had grade Ⅰ movement restriction and 2 patients had grade Ⅱ movement restriction. There were no rejection,infection and other complications during follow-up.Conclusions Three-dimensionally preformed titanium mesh plates can be used to reconstruct posttraumatic complex orbital bone fractures in order to improve the orbital volume and to correct enophthalmos effectively.

Objective To evaluate the clinical features,diagnostic methods and treatment of intraorbital nonmetallic foreign body injuries. Methods In a retrospective study,the records of 25 consecutive cases with nonmetallic foreign bodies in the orbit confirmed by surgery were analyzed with special attention to the types of injury,history,clinical manifestations,imaging findings,treatment and follow-up results. Results Among 25 cases with nonmetallic foreign bodies,23 cases were caused by trauma,including 11 cases with wooden bodies,3 cases with glass,grease,or stone,2 cases with plastic pen point,and one case with firecrackers. The remaining two cases had iatrogenic foreign bodies. The distinctive clinical manifestation was the periorbital fistula recorded in 11 (44%) cases,mostly in patients with wooden foreign bodies. The CT findings were different in various foreign bodies. The wooden foreign bodies showed low density in the acute stage and the density increased gradually from the acute to the chronic stage. CT images with lower windows could distinguish a wooden foreign body better. The grease was seen as low density mimicking orbital fat on CT. The stone or glass showed as masses with high density. Wooden foreign bodies displayed low signals on both MRI T1- and T2-weighted images. The surrounding pus was seen as a ring with high signal on T2-weighted images. The inflammatory infiltration showed marked enhancement. The grease displayed high signal on both T1- and T2-weighted images and showed lower signal than that of the fat. All patients underwent surgical removal of retained foreign bodies and the surrounding decomposed tissues. The infected wounds were not sutured at one stage operation. After follow-up for 6 months,all wounds healed normally and all patients recovered well No complications were encountered.Conclusions There are various types of intraorbital nonmetallic foreign bodies. The clinical manifestations of these different foreign bodies are complex. CT is the preferred examination for this condition. With the combination of correct diagnosis,proper surgical skills,and complete removal of foreign bodies and surrounding decomposed tissues,nonmetallic foreign bodies can be treated efficiently.

Objective To investigate the therapeutic procedures and their efficiencies for the treatment of congenital microphthalmos during or after the developing period. Methods It was a retrospective case series study. Eighteen cases with congenital microphthalmos,aged less than 12 years,underwent self inflating osmotic hydrogel expanders. Among them,11 cases were treated by implantation with sphere self-inflating hydrogel expanders into the retrobulbar space and 5 cases had implantations into the conjunctival socket The remaining 2 cases were treated with implantation of injectable self-inflating hydrogel pellet expanders. Twenty eight cases with congenital microphthalmos,aged more than 12 years,accompanied with other deformities,were treated with proper reconstruction surgery. Fourteen cases were treated with medial canthoplasty,12 caseswere treated with medial and lateral canthoplasty,3 cases were treated with ptosis correction and medial or lateral canthoplasty and 2 cases with socket reconstruction. T-test was used for the comparision between groups. Results Sixteen cases obtained satisfactory results without any complications. In one case,the hydrogel expanders migrated inferiorly in the orbit and underwent adjustment In another case,although the hydrogel expander prolapsed from the socket,the socket was still expanded. In the developing period,the length of palpebral fissure was ( 15.83 ± 1.87 ) mm before the operation,and that made much wider after the operation (18. 67 ± 1.74) mm. There were statistically significant differences between them ( t = -4. 029,P = 0. 01 ). The height of palpebral fissure was ( 1.33 ±0. 67) mm and (6. 00 ± 0. 58 ) mm before and after the operation,respectively,which were statisfcally significant (t = -5. 813,P =0. 00). Patients who aged more than 12 years and underwent eyelids and eye socket reconstruction,also obtained satisfactory appearance. Conclusion Patients with congenital microphthalmos could obtain the development of orbit and satisfactory appearance by reconstruction treatment according to different period of development.

Objective To introduce the procedure of balloon dacryocystoplasty and to evaluate its effectiveness and complications as the treatment of congenital nasolacrimal duct obstruction after a previous unsuccessful surgery. Methods Prospective case series. Balloon dacryocystoplasty was performed under general anesthesia in 50 eyes of 31 children with congenital nasolacrimal duct obstruction following previous unsuccessful surgery in Beijing Children's Hospital between May 2008 and October 2009. A probe was introduced through the punctum into the inferior meatus of the nasal cavity. A deflated balloon catheter was introduced anterogradely and the balloon was inflated several times to perform the dilation of the nasolacrimal duct. Treatment success was defined as absence of epiphora and mucous discharge,negative results of fluorescein dye disappearance test(FDDT) and the unobstructed irrigation of the lacrimal system during the follow-up period of 4 - 17 months after tube removal. Results Successful operation was reported in 44 of 50 eyes ( 88.0%;95% confidence interval 85.5% - 96. 9% ). Forty of 50 eyes were FDDT 0 - 1(80. 0% ). Major complications included epistaxis (10 eyes,20. 0% ) and lacrimal duct laceration (2 eyes,4. 0% ). Conclusion Balloon dacryocystoplasty is a safe,simple and effective procedure for congenital nasolacrimal duct obstruction following previous unsuccessful surgery without disturbing the anatomy of normal lacrimal drainage system.

Objective To observe the expression and distribution of CD44,CD133,and ABCG2 in orbital adenoid cystic carcinoma (ACC) and investigate their correlations with pathological type and prognosis. Method Two steps method of immunohistochemical staining was employed in 33 cases of paraffin embedded surgical specimens of human orbital ACC,5 cases of recurrence samples,3 cases of an excised lacrimal gland caused by neither inflammation nor tumor diseases,and 6 cases of xenograft tumors in nude mice. A retrospective analysis was performed on the clinical material of these patients,which were collected from Jan. 1991 to Mar. 2009. Results The positive rate of CD44 was 54. 5% ( 18/33),with 76. 9% (10/13) in solid type and 40. 0% (8/20) in adeno-tubiform type. There was no statistically significant difference between them (P = 0. 072). In solid type the positive expression cells were often located at the marginal part of the cancer nest. In the adeno-tubiform type,positive cells were often located at the outer layer of the tubiform structure ( myoepithelial cells). CD44 was also expressed in normal tissues.The positive rate of CD133 was 57.6% (19/33),with 76. 9% (10/13) in solid type and 45.0% (9/20)in adeno-tubiform type. There was no significant difference between them (P =0. 087). CD133 antigen was expressed in either the cytoplasm or nucleus,or expressed in both the cytoplasm and nucleus. The positive rate of ABCG2 was 21.2% (7/33),with 30. 77% (4/13) in solid type and 15.0% (3/20) in adenotubiform type. There was no significant difference between them ( P = 0. 393 ) . Many positive cells surrounded the vessels in tumor tissues. There were no significant differences between different prognosis groups of these surface phenotypes. The correlative analysis results of three surface phenotypes showed that CD44 + cells have positive correlation with CD133 + cells ( Spearman,rs = 0. 416,P = 0. 016 ). In six transplanted tumors of nude mice,the number of positive cases for CD44 +,CD133 + and ABCG2 + was 1,1 and 4 cases,respectively. Conclusions The expression of CD44,CD133 and ABCG2 in ACC may influence the progress of ACC. However,they cannot be used as the markers for the evaluation of the prognosis of this tumor.

Objective To investigate the characters of multifocal electroretinogram (mfERG) in different grades of diabetic macular edema defined by optical coherence tomography ( OCT). Methods MfERG and OCT were performed in 57 eyes of diabetic macular edema (DME) patients and 35 eyes of the control group. According to the macular thickness measured by OCT, eyes with DME were divided into three groups: mild, moderate and severe DMEs. Results In mild DME, the response densities of N1 were attenuated in ring 4[ ( 14. 67 ±4. 91 )nV · deg-2 ] to ring 5[ ( 11.65 ±3. 89)nV · deg-2 ] respectively (t=2. 179,2. 529; P ＜ 0. 05 ). The latencies of P1 was prolonged significantly in ring 3 [ (40. 61 ± 4. 10 ) ms ](t = -2. 133 ,P＜0. 05). In moderate DME , the response densities of P1 and N1 were attenuated in ring 1[ (149.50 ±29.01)nV · deg-2], ring 2[ (59.33 ±25.96) nV · deg-2], ring 3[(41.83 ±9.78) nV ·deg-2 ], and ring 5 [ ( 22. 00 ± 5. 52 ) nV · deg-2 ] respectively ( t = 3. 610,2. 168,2. 627,3. 445; P ＜0. 05). The latencies of P1 and N1 were prolonged significantly in ring 3 [ (42. 86 ± 4. 72 ) ms ], ring 4[ (44. 33 ±5.56)ms], ring 5[ (46. 31 ±4.72)ms] (t= -3. 150, -3.210, -3.968;P＜0.05) and ring 3[(23.05 ±3.06)ms], ring 4[ (22.41 ±3.36)ms] (t= -2.845, -2.098;P＜0.05) respectively. In severe DME. The response densities of P1 and N1 were attenuated in ring 1 [ ( 110. 00 ± 20. 68 ) nV ·deg-2 ], ring 2 [ (62. 40 ± 27.90) nV · deg-2 ], ring 3 [ ( 39. 20 ± 19.65 ) nV · deg- 2 ], ring 5 [ (21.60 ±11. 12)nV · deg-2] (t =7.135,1.782,2.214,2.609;P ＜0.05) and ring 1[(41.63 ±39. 17) nV ·deg-2], ring 3[ (16.63 ±5.81)nV · deg-2], ring 4[(11.20 ±7.42)nV · deg-2], ring 5[(9.05 ±4.63 ) nV · deg-2 ] ( t = 2. 714,2. 282,2. 736,2. 858; P ＜ 0. 05 ) respectively. The latencies of P1 and N1 were prolonged significantly in ring 1 [ (35. 12 ±8.44)ms], ring 3[ (40. 44 ±2. 10)ms], ring 4[ (42. 80 ±3.74)ms] (t=3.426,-2.710,-3.120;P＜0.05) and ring 4 [ ( 23. 36 ± 4. 05 ) ms ] (t= -2.572;P＜0. 05) respectively. Conclusion As the progress of DME, the thickness of macular fovea had significant correlation with responses of multifocal electroretinogram in patients with moderate or severe DME. MfERG combined with OCT can evaluate the changes of morphology and local retinal function in macula area objectively and quantitatively.

Objective To analyze the tomographic features of branching vascular networks and polypoidal lesions in patients with polypoidal choroidal vasculopathy (PCV) by spectral domain optical coherence tomography (SD-OCT). Methods It was a retrospective case series study. Retrospective review of 63 eyes of 54 patients with PCV identified with indocyanine green angiography (ICGA). Tomographic features of branching vascular networks and polypoidal lesions on SD OCT,ICGA and fluorescein angiography were analyzed. Results Both branching vascular network and polypoidal lesions were found in 45 eyes on ICGA,branching vascular network only was found in 8 eyes and polypoidal lesions only in 10 eyes. Retinal pigment epithelial detachment (RPED) was found in all 53 eyes with branching vascular networks on SDOCT. Thirty-eight eyes had areas of moderate reflectivity of branching vascular network between the fluctuating retinal pigment epithelium and Bruch membrane. Fifteen eyes had moderate reflectivity of branching vascular network and/or hemorrhage between high doom-like RPED and incomplete Bruch membrane. Solitary pelypoidal lesions in 28 patients showed local moderate reflectivity between the RPE and Bruch membrane on SDOCT. Other aggregate polypoidal lesions in 27 patients showed moderate reflectivity between high doom-like RPED and incomplete Bruch membrane. Conclusion The vascular abnormalities of PCV identified with ICGA were visualized on SD-OCT images as areas of moderate reflectivity between RPE and Bruch membrane.

Objective To map the gene mutation responsible for autosomal dominant inherited congenital anterior polar cataract in a Chinese family. Methods Peripheral blood samples were collected from the members in this congenital cataract family. DNA was extracted from the blood samples. A genescan was performed using approximately 400 microsatellite markers (ABI). Linkage analysis was processed to define the region of mutated gene. High density primers labeled with fluorescent stain for the positive region were adopted for fine targeting and haplotype analysis was performed. Mutation detection was carried out by sequencing candidate genes. Results The maximum two-point LOD score was obtained at D21S1252,Zmax = 3. 23 ( θmax = 0. 00). After fine targeting and haplotype analysis,the mutated gene was located within a 18. 47 cM region between D21S263 and D21S266 on chromosome 21q22.11 -q22.3. Direct sequencing of the candidate gene revealed a G→ A transition in exon 3 of CRYAA. Conclusion The present study has identified a missense mutation in CRYAA associated with congenital anterior polar cataract in a Chinese family.

Objective To investigate the differential expression of complement C4b and transthyretin in proliferative vitreoretinopathy (PVR). Methods It was a controlled experimental study.Human vitreous samples of 5 patients with PVR were analyzed by using two-dimensional gel electrophoresis and mass spectrometry,and the results were compared with those from normal control vitreous obtained from donor eyes. An in vivo model of PVR was created by intravitreous injection of cultured rabbit retinal pigment epithelial (RPE) cells. The vitreous of PVR models were analyzed by enzyme linked immunosorbent assay (ELISA) to confirm the proteomic results from the PVR patients. Results Seventy nine various proteins were expressed differently between PVR and normal vitreous,among which nine up-regulated proteins including complement C4b,transthyretin (TTR),and 7 albumins were identified by mass spectrometry. The up-regulation of complement C4b and TTR in PVR patients was also confirmed by ELISA. The concentration of complement C4b and TTR in normal vitreous were(20. 18 ± 1.97)mg/L and (88.58 ± 8.84)mg/L respectively,in PVR patients were ( 38.1 ± 5.79) mg/L and ( 112.57 ± 6.. 89 ) mg/L repectively,difference significantly between these two groups ( C4b: t = 11. 54,TTR: t = 9. 24;P ＜ 0. 05 ). Conclusions Differences of complement C4b and TTR expression were observed between PVR and normal vitreous. These results have lead to the assumption that there is a connection between elevated concentrations of both complement C4b and TTR and the pathogenesis of PVR and further studies on the functions of these proteins are required.

Objective To assess the standardization of meta-analyses reports on eye diseases published in Chinese journals in recent ten years. Methods Meta-analyses manuscripts on eye diseases published in Chinese-language journals from January 2000 to September 2010 were retrieved through the following databases: Wanfang Data,VIP Information,CNKI and Chinese Bio-medicine Database,along with manual database search. The manuscripts translated from foreign-language meta-analyses reports or repetitive publications were excluded. All enrolled manuscripts were then analyzed item by item according to the checklist of QUOROM statement and MOOSE guidelines. Results 50 manuscripts were finally enrolled into the present quality appraisal study,including 32 meta-analyses manuscripts of randomized control trail (RCT) studies and the other 18 meta-analyses manuscripts of observational studies. Out of the 32manuscripts evaluated with QUOROM statement,only 8 (25.0%) manuscripts included flow chat describing the process of selection,18 (56. 3% ) manuscripts included sensitivity analyses and 9 (28. 1% ) included bias evaluation part. Out of the 18 manuscripts evaluated with MOOSE guidelines,only 6 (33.3%)included comprehensive relative literatures search strategy,4 (22. 2% ) included sensitivity analyses and 8(44. 4% ) included bias evaluation section. Conclusion The standardization of meta-analyses reports on eye diseases published in Chinese journals needs to be improved.

The orbitocranial communication vegetative foreign bodies that enter the cranium from the orbit will not only cause damage to intraorbital tissues such as optic nerve and orbital innervation nerve, but the retention of foreign bodies will inevitably cause local tissue inflammation, infection and fistula formation, and even cause serious intracranial infection. It is very important to perfect the diagnosis and removal of foreign bodies as soon as possible. However, because the foreign bodies are imprisoned at the orbital tip, partly located in the orbit and partly located in the cranium, they are prone to fracture and incomplete removal when removed, and may cause complications such as injury of important intracranial structures, especially large blood vessels, which is a difficult problem in ophthalmology and neurosurgery, and there is no certain mode of diagnosis and treatment. In recent years, we have successfully diagnosed and treated 3 cases, which are reported as follows.

Pituitary stroke is a clinical syndrome caused by pituitary hemorrhage or infarction, which mostly occurs in pituitary adenomas, and is characterized by sudden headache, acute visual impairment, external ophthalmoplegia, and disturbance of consciousness [1]. Because the clinical symptoms of patients are atypical, and many pituitary adenomas, especially non-functional adenomas, are misdiagnosed, pituitary stroke is easily misdiagnosed.

A 51-year-old female patient suffered from painless vision loss in her right eye for 1 year. One year ago, the patient had blurred vision, no redness, pain, vision deformation, headache, nausea, vomiting and other discomfort in her right eye without obvious external cause, which was not paid attention to and was not diagnosed and treated. In the past year, the blurred vision progressively worsened, and there was no other eye discomfort. On August 18, 2010, she came to the outpatient clinic of the First Affiliated Hospital of Wenzhou Medical College, and underwent ocular B-ultrasound examination, which showed that the nasal ciliary body of her right eye occupied space (Figure 1). She was proposed to be diagnosed with "ciliary body tumor of her right eye and cataract of her right eye", and surgical treatment was recommended.

A 67-year-old male went to the ophthalmology department of our hospital on March 18, 2010 due to flying mosquito sensation in both eyes for 1 week. No abnormalities were found in the physical examination. Ocular examination: visual acuity in both eyes 0.8, no obvious refractive abnormalities. IOP: 19.7 mm Hg (1 mm Hg =0.133 kPa) in the right eye and 19.1 mm Hg in the left eye. No abnormalities were found in the conventional slit lamp microscopy and direct ophthalmoscopy. Ocular B-ultrasound examination (Figure 1): a small amount of thin and weak dot-like echoes in the vitreous cavity of both eyes. Longitudinal scan of the right eye at 7 o'clock showed that there was a localized bulge in front of the globular wall in the middle periphery of the eyeball, with smooth edge, moderate echo intensity, poor mobility, and negative posterior motion. A small amount of weak echoes were seen between the echo band and the globular wall, and the bulge height was about 1.4 mm.

Co-infection refers to the infection of more than one microorganism, which is less common; In February 2009, a patient with infectious keratitis caused by Candida combined with bacteria after plant trauma was diagnosed and treated in Tianjin Medical University Ophthalmology Center. A 62-year-old male was admitted to the Ophthalmology Center of Tianjin Medical University in February 2009 due to foreign body sensation after right eye trauma and visual acuity decrease for 3 months. He complained that his right eye was scratched by barley husk when he was working in farming 3 months ago. He was diagnosed as a corneal foreign body in another hospital, and was treated with antibacterial drug eye drops in the emergency department. After that, the foreign body sensation in the eye and blurred vision gradually worsened. He went to another hospital many times and continuously used a variety of antibacterial and antifungal drugs, but the details are unknown.

The patient was a 23-year-old female who came to Beijing Institute of Ophthalmology on July 26, 2010 due to the decrease of visual acuity in both eyes for 1 and a half years after laser in situ keratomileusis (LASIK). Six years ago, the patient was diagnosed with granular corneal dystrophy (GCD) in both eyes in another hospital, with a clear family history (her father suffered from the same disease). One and a half years ago, she underwent LASIK operation in a local hospital due to myopia. The refractive power was unknown, and the operation went smoothly. The naked visual acuity before operation was 0.7 in the right eye and 0.6 in the left eye, and the naked visual acuity was 1.2 in the right eye and 1.0 in the left eye 1 week after operation. Diffuse opacity under the corneal flap was found in both eyes at the follow-up visit 3 months after operation, and diffuse lamellar keratitis (DLK) was diagnosed in the local hospital. After 2 months of treatment with glucocorticoids and antibiotics, there was no improvement. The patient stopped the treatment spontaneously, and the corneal opacity aggravated, and the visual acuity gradually decreased.

The patient was a 24-year-old female who came to the Department of Ophthalmology of Southwest Hospital affiliated to the Third Military Medical University on January 8, 2011 due to the gradual decline of visual acuity in her left eye for half a year. There was no history of similar diseases and genetic diseases in her family, and no past history. Eye examination: The best corrected visual acuity was 0.9 in the right eye and manual in the left eye. When the eye position was one eye fixation, the opposite eyes were exotropic 30°, and no obvious abnormality was found in the anterior segment examination; Vitreous opacity in both eyes (+ +); The left fundus is shown in the essence pictures 1~6. Clinical diagnosis: Morning glory syndrome with retinal detachment in the left eye.

Computer-aided surgical navigation system,which is a combination of computer technology and medical imaging,is one of the most popular and developing fields in recent years. The navigation system is aimed to improve the accuracy and security of the surgery by pre-operative planning,intra-operative navigation and post-operative evaluation. This paper introduces the essential elements,fundamental principles,and implementation steps of the navigation system;further reviews its usefulness and progress in orbital fractures reduction,orbital tumor surgery and orbital decompression.

In recent years,accompanying with the development of principles of minimal invasion and engineering technology,vitreoretinal surgery has entered the new era of minimally invasive surgery with the launching of micro-incision vitrectomy represented by 25G and 23G. This paper reviews the history and development of micro-incision vitrectomy,analyzes the technical features of various types of micro-incision vitrectomy,introduces the related surgical indications,and discusses the advantages and disadvantages of micro-incision vitrectomy.

Lacrimal duct catheterization has a history of more than 100 years [1], and the insertion materials have experienced the evolution of wire, strip and tube made of pig bristles, ponytails and bird feathers to metal, plastic, latex and other materials. By the end of the 20th century, with the use of special lacrimal duct drainage tube and special catheterization tool, and the common application of lacrimal duct laser technology, endoscopic technology and nuclear magnetic magnetic technology, it marked the beginning of modern lacrimal duct catheterization [2].

In recent years, domestic epidemiological survey data show that the detection rate of amblyopia in China is obviously higher than expected, and the results of similar international epidemiological surveys even report that the detection rate of amblyopia in China is as high as 11.8%. Some research results show that the detection rate of amblyopia in children aged 4~6 years decreases exponentially with the increase of age. The high detection rate of amblyopia leads to the expansion of diagnosis, and the phenomenon of excessive treatment seriously impacts the medical standards and order, and causes huge waste of health resources, which brings burden and even harm to related children and families<Age factor should be paid attention to when diagnosing amblyopia, and operable reference data or guidelines need to be supplemented in the definition, classification and diagnosis and treatment guidelines of amblyopia. Because of the constant consultation and questions, our group conducted a population-based epidemiological investigation of children's vision in China, and reached this consensus after many years of practice and full discussion with reference to the research results and monographs of pediatric ophthalmology abroad.

In view of the limited investment in medical security in China, the reform of medical system in China is trying to explore a high-quality and efficient medical service mode, so as to facilitate the people, reduce the cost and make patients the ultimate beneficiary.In terms of payment system, diagnosis related groups (DRGs) based on the payment is an international trend [1-2]; clinical pathway (CP) refers to the use of a standardized, comprehensive and multidisciplinary process to adjust medical behavior for a specific group of patients, according to the time-based or treatment result-based process established in advance in order, to achieve the predetermined treatment result within the specified time, and by establishing a set of standardized treatment mode, it finally plays the role of standardizing medical behavior, reducing variation, reducing cost and improving quality [3].

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

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 a 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.

According to international practice and the actual situation in China, for papers that meet the following conditions, the Chinese Medical Association series journals allow and accept the republication of relevant papers of the same research in different languages.

The "13th National Conference on Ophthalmic Pathology and Clinical Diagnosis and Treatment Technology" co-sponsored by the Ophthalmic Pathology Group of Ophthalmology Branch of Chinese Medical Association and Chinese Journal of Ophthalmology of Chinese Medical Association will be held in Qingdao, Shandong Province from November 4 to 6, 2011. This conference will specially invite famous domestic ophthalmic pathologists to give special lectures and discuss difficult cases, and conduct academic discussions and experience exchanges on basic ophthalmic pathology and clinical pathology with participants.

The 2011 Tianjin Ophthalmology International Forum hosted by Tianjin Eye Hospital will be held at the Tianjin Eye Hospital Conference Center from August 27 to 28, 2011. This event will invite famous experts and scholars from Japan, Germany, Australia and other countries and China to give distinctive academic speeches, on-site surgical demonstrations and comments on hot issues such as the latest technological progress and clinical application experience of cataract, vitreoretinopathy, corneal disease, etc., and conduct in-depth discussions on common clinical related issues.

The 17th National Symposium on Ocular Trauma, Ophthalmoplasty and Orbitopathy was successfully held in Kunming, Yunnan Province from March 24 to 27, 2011, sponsored by the Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association and the Institute of Ophthalmology of Beijing Armed Police General Hospital. The conference opened special lectures, free speeches, case discussions and other sections. A total of 280 academic papers were received, and more than 260 delegates attended the conference, covering 25 provinces, municipalities and autonomous regions in China. At the same time, dozens of domestic and foreign ophthalmology product companies attended the conference. Chinese Journal of Ophthalmology is the academic support media of this conference. This conference is a grand meeting of ophthalmology groups with considerable scale and influence, and it is another example and concentrated display of the vigorous development of ocular trauma, ophthalmoplasty and orbitopathy in China.

The 2nd Symposium on Ophthalmology and Vision Science of Shanghai Jiaotong University School of Medicine, the 11th National Ophthalmology and Cosmetic Surgery Progress Study Class (National Continuing Education Project, Project No.: 20110702141) and the First National Lacrimal Duct Disease Study Class (National Continuing Education Project, Project No.: 20110702051) will be held in Shanghai from October 12 to 1613, 2011. The conference will be sponsored by the Institute of Ophthalmology and Vision Science of Shanghai Jiaotong University School of Medicine, and undertaken by the Ninth People's Hospital, Ruijin Hospital, Xinhua Hospital, Renji Hospital, Sixth People's Hospital and Third People's Hospital of Shanghai Jiaotong University School of Medicine.

The National First New Progress Study Class on Micro-incision Cataract Phacoemulsification and Refractive Intraocular Lens (National Continuing Education Project, Project No.: 2011-07-02-046), organized by Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, will be held in Shanghai from November 3 to 6, 2011.

The 3rd Peking University Ophthalmologist Forum will be held in Beijing from October 8 to 10, 2011. Venue: Science Lecture Hall on the first floor of Peking University Ophthalmology Center.

Electroretinogram (ERG) is the only non-invasive examination method that can objectively detect retinal function. In order to make the detection results of ERG in different hospitals more accurate and easy to learn from each other, the International Association of Clinical Visual Electrophysiology (ISCEV) has been devoted to formulating the standard and outline of ERG detection. Recently, ISCEV updated the standard of clinical routine ERG and the outline of multifocal ERG, and planned to develop the outline of ERG for laboratory animals.

In order to strengthen the academic exchange of ophthalmology at home and abroad, expand the international vision of domestic ophthalmologists, and promote the integration of domestic ophthalmology with international standards as soon as possible, the Health Express Training Network (www.lxlearn.com) has been specially established. The training network will serve all domestic ophthalmologists in the form of public welfare.

In recent years, scholars at home and abroad have conducted a lot of scientific research, which confirms that dry eye is a multi-factor disease, among which inflammatory reaction plays an important role in the occurrence and development of dry eye, but traditional artificial tears can't fundamentally solve the problem of inflammatory reaction of dry eye. In 2010, important domestic academic institutions successively carried out basic research on the inflammatory reaction related to dry eye and the application of non-steroidal anti-inflammatory drugs in the treatment of dry eye, and looked forward to clinical large sample evidence-based medical evidence.

The Chinese Journal of Ophthalmology was founded on October 1, 1950. It was sponsored by the Chinese Medical Association and edited by the Editorial Committee of the Chinese Journal of Ophthalmology. The editorial committee is composed of nearly 100 well-known ophthalmologists in China. The current editor-in-chief Zhao Kanxing and the editorial director Huang Yibin.