Volume 47 · Issue 10 · 2011

With the tremendous development of medical technology and translational medicine,the level of diagnosis and management for glaucoma has been advanced dramatically in the past decades.Presently,the viewpoint for glaucoma management from specialists in western developed countries has significantly changed,which includes emphasizing resource sharing,formation and generalization of clinical guidelines,and the individualization and humanization in consensus management of glaucoma patients.Such unprecedented importance has been also attached to all round qualities of glaucoma practitioners.The underlying reason for all these marked changes are that esteem attitude is as essential as techniques in the management of glaucoma.

Higher intraocular pressure (IOP) is a risk factor for the development and progression of glaucomatous neuropathy.Increasing attention has been brought to IOP fluctuation in patients with primary open angle glaucoma (POAG) in recent years.IOP fluctuations include short-term (24-hour IOP fluctuations) and long-term fluctuations,which may contribute to the progression of glaucoma.It is a big challenge for ophthalmologists in their busy daily clinical practice to deal with IOP fluctuation in patients with POAG.In this paper,the research progress in IOP fluctuation of POAG and its relationship with glaucomatous neuropathy was reviewed.Furthermore,how to monitor by useful measures and manage IOP fluctuation by effective medication were discussed.

Objective To evaluate the changes of anterior segment configuration after surgical peripheral iridectomy (SPI)in patients with primary acute angle closure glaucoma (PAACG) by using anterior segment optical coherence tomography (AS-OCT).Methods This retrospective self control study consisted of thirty-seven eyes of 37 patients with PAACG who were consecutively recruited in Zhongshan Ophthalmic Center.The peripheral anterior synechiae (PAS) of these patients was less than 5 clock time point.Central anterior chamber depth (ACD),angle opening distance (AOD),trabecular iris area (TISA),angle recess area (ARA),anterior chamber width (ACW),anterior chamber volume (ACV),and crystalline lens rise (CLR) were measured using AS-OCT before and one month after SPI.Results After SPI,AOD (0.125 ±0.072) μm,TISA (0.091 ±0.041) mm2,ARA (0.095 ±0.042) mm2,ACA (14.230 ± 2.000) mm2 and ACV (90.074 ± 16.796) mm3 were significantly increased compared with before SPI AOD(0.088±0.078) μm,TISA (0.050 ±0.048)mm2,ARA(0.059 ±0.057) mm2,ACA(12.332 ±2.457)mm2,ACV (73.131 ± 16.976)mm3(t =-8.015 to 1.066,P =0.001 to 0.044),respectively.There were no significantly changes in ACD,ACW and CLR(t =- 1.505 to 0.516,P =0.102 to0.609).Conclusions PAACG can be controlled by SPI resulting in an increase of AOD,TISA,ARA,ACA and ACV,but not ACD or CLR.

Objective To investigate the ocular blood-aqueous barrier (BAB) alteration after laser peripheral iridotomy (LPI) or surgery peripheral iridectomy (SPI) in patients with primary chronic angleclosure glaucoma (PCACG).Methods This was a clinical randomized controlled trial.Sixty eyes of 60 subjects with early stage of PCACG were randomly received either LPI or SPI and followed up postoperatively at day 3,week 1,2,3,and 4.Aqueous flare in anterior chamber was measured by FC-2000 flare-cell photometry,intraocular pressure (IOP) measured by tonometer,central corneal endothelium cell counted by endothelioscopy,peripheral anterior synechiae (PAS) detected by gonioscopy.Data were analyzed by using two-way ANOVA for repeated measures,independent samples t-test,paired t-test,nonparametric test,and Spearman rank correlation test.Results On follow-ups of pre-operative and post-operative 3 days,1 week (w),2w,3w and 4w respectively,the mean aqueous flare values for LPI group were (5.47 ± 1.09),( 11.96 ±3.07),(8.08 ± 2.18),(5.68 ±0.83 ),(5.80 ± 1.00),(5.69 ± 1.12) PC/ms,and for SPIgroup were (5.43 ±1.13),(8.44 ±3.22),(6.42 ±1.77),(5.35 ±0.71),(5.53 ± 1.26),(5.45 ±1.23) PC/ms.During post-operative 1w the flare values in both LPI and SPI groups were significantly higher than that on pre-operation (t =- 12.753,- 8.101,P ＜ 0.05 ; t =- 5.971,- 3.870 ; P ＜ 0.05 ) and LPI group had a significantly higher mean flare value than SPI group (t =4.329,3.231 ;P ＜0.05).The IOP spike in LPI group was significantly(x2 =5.079,4.022,P＜0.05) higher than that in SPI group at week 1 of post-operation.Increased IOP was positively correlated with BAB damage(r =0.899,0.833;P ＜0.05).The numbers of medications required to maintain IOP≤21 mm Hg(1 mm Hg=0.133 kPa) at week 4 of post-operation in LPI was significantly(Z =- 1.984,P ＜0.05)more than that in SPI group.There were no significant differences in central corneal endothelium cell count at week 1 ( t =- 0.696,0.008 ) and in extension of PAS at week 4 ( Z =- 1.270,- 1.490) of post-operation when compared to pre-operation ( P ＞0.05 ).No obvious complications occurred in both groups.Conclusions Our results demonstrated that IOP spike in both of LPI and SPI is due,at least in part,to BAB damage,which appears to be more severe in LPI group and can recover within two weeks.PAS progression and central corneal endothelium cell loss are not aggravated in 1 month after operation.

Objective To quantitatively evaluate the long-term changes in anterior segment morphology by using ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) in eyes with primary angle closure (PAC).Methods This was a clinical case series study.A total of 54 eyes with PAC of 31 consecutive patients were enrolled.Routine ophthalmic and UBM examination were performed at visit one ( before LPI),2 weeks,6,and 12 months after LPI.The parameters of anterior chamber were measured by UBM and calculated.Results of each follow-up time were analyzed using repeated measures analysis of variance.Parameters of UBM measurement at 750 μm anterior to the sclera spur and at 500 μm counterpart were compared using paired student t-test.Results Compared to before LPI,anterior chamber depth (ACD) was deepened by approximate 0.10 mm after LPI,however,it was not statistically significant( F=3.50,P ＞ 0.05 ).Angle opening distance (AOD),trabecular-iris angle ( TIA ),angle recess area ( ARA )and trabecular-ciliary process distance (TCPD) were significantly increased at 2 weeks,6 and 12 months after LPI compared with respective baseline [ AOD750:( 165.0 ± 70.3 ),( 185.8 ± 68.5 ),( 196.1 ±77.7)μm vs ( 66.2 ± 51.6) μm,F = 92.60; TIA750:14.10 ± 6.30, 15.50± 6.20,16.40°±5.g°vS6.40°±4.9°,F = 92.60; ARA:( 0.058±0.024),( 0.065± 0.023 ),( 0.068±0.026) mm2 vs ( 0.025±0.017) mm2,F = 92.60; TCPD:( 647.1±113.0),( 701.8±93.4),( 670.1±95.4)μm vs( 571.0±97.2)μm,F= 34.00;P＜0.05 ]. The parameters of UMB measurement at 750 μm were significantlyincreased more than that at 500 μm anterior to the sclera spur( AOD: t = 5.90,TIA750:t =2.70,P＜0.05 ;ARA: t = 2.00, P = 0.05). Conclusions LPI can significantly widen the peripheral anterior angle in eyeswith PAC lasting for at least I year after LPI.Parameters detected by UBM at 750 μm anterior to the scleraspur appear to be more sensitive in evaluating the altemation of peripheral angle structure.

Objective To evaluate the efficacy of low-energy selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) following up to one year.Methods In this prospective clinical study,seventy-four eyes of seventy-four patients with OHT and POAG were enrolled.Thirty-nine patients received low-energy treatment using half of conventional laser energy and 100 spots over 360° of the trabecular meshwork,while thirty-five patients received conventional laser energy as control.Intraocular pressure (IOP) and complications including conjunctival hyperemia and anterior uveitis were followed up at week 2,and month 1,3,6,and 12.Effective rate (reduction of IOP≥20％ ) of treatment between the two groups and total rate of complications were analyzed by the chi-squared test.Results In OHT group,the effective rates of treatment were81.81(9/11),63.63 (7/11),63.63( 7/11 ),63.63 (7/11 ),and 45.45％ (5/11 ) in the low-energy group and 50.00 (5/10),70.0 (7/10),60.0 (6/10),40.0 (4/10),and 50.0％ (5/10) in the control group,at weeks 2,month 1,3,6,and 12after treatment respectively,while in POAG,the effective rates were 83.33 (15/18),88.88 (16/18),72.22 (13/18),66.66 (12/18),and 44.44％ (8/18) in the low-energy group and 84.21 (16/19),73.68 (14/14),57.89 (11/19),57.89 (11/19) and 47.37％ (9/19) in the control group at weeks 2,month 1,3,6,and 12 after treatment,respectively.There were no statistical difference between the low energy and conventional energy group at all time points in OHT ( x2 =2.386,0.096,1.173,1.110,0.043)and POAG ( x2 =0.005,1.393,0.833,0.302,0.032) group( P ＞ 0.05 ).Complications were significantly ( x2 =4.299,P ＜ 0.05 ) different between the two groups ( eight eyes in the low-energy group on the day of treatment and fifteen eyes in the control group).Transient IOP spike ( ≥3 mm Hg,1 mm Hg =0.133 kPa)occurred in three eyes (in the control group) on the day of treatment and partial peripheral anterior synechiae in one eye ( in the control group) one month after treatment.Conclusions Low-energy SLT is as effective in lowering IOP with less complications compared with conventional laser energy SLT,which can be considered as an option for glaucoma therapy.

Objective To evaluate the efficacy and safety of FP-7 Ahmed glaucoma valves (AGV) implantation in neurovascular glaucoma (NVG) as the first choice of surgery.Methods This retrospective,comparative case series study collected a total of 36 eyes of 36 patients with neurovascular glaucoma who underwent AGV implantation in Zhongshan Ophthalmic Center from January 2009 to June 2010.Change of intraocular pressure (IOP),the best corrected visual acuity,numbers of anti-glaucoma medication,success rate and postoperative complications were followed up at day 1,week 1,month 1,and every 3 months after surgery.Complete success of surgery was rated as reduction of IOP≥30％ without medication and those who failed to meet criteria was rated as partial success.Data were analyzed by paired Student t-test for IOP,rank sum test for paired non-parametric numbers of medication,and repeated measures analysis of variance for comparison of IOP between different time points using SPSS 13.0.Results Compared with pre-operation,IOP was significant ( F =9.26,P ＜ 0.05 ) decreased after surgery with FP-7 AGV implantation ( 39.5 ±9.7) mm Hg(1 mm Hg=0.133 kPa)vs(9.2 ±8.9),(11.8 ±3.8),(13.7±4.8),(16.9±5.3),(16.9±6.8) mm Hg at day 1,week 1,month 1,month 3 and the last following-up of post-operation,respectively.The numbers of anti-glaucoma medication were significantly ( Z =6.764,P ＜ 0.05 ) reduced from4.0 (1-6) of pre-operation to 1.0 (1-3) of post-operation.At the last following up,the complete success rate after FP-7 AGV implantation was 80.6％,and qualified success rate was 91.7％.The postoperative complications including occlusion of the drainage tube,exposure of the drainage tube,shallow anterior chamber and encapsulated cystic blebs around the plate were controlled with additional treatment.Conclusions The clinical outcome indicated that the implantation of FP-7 AGV has a stable IOP lowering effect and fewer complications,which can be considered as one of the first choices for management of NVG.

Objective To evaluate the correlation between morphologic appearance of blebs at 3 month and long-term intraocular pressure (IOP) effect in patients with primary angle-closure glaucoma (PACG) after trabeculectomy.Methods Multi-centered cases series.Data were collected from 176 patients aged ≥40 years with PACG who were participated in a randomized clinical trial that aimed at addressing the efficacy of augmented releasable sutures after trabeculectomy.The bleb morphology was graded using the Modified Indian Bleb Appearance Grading Scale (IBAGS) based on standard photos at 3 month after trabeculectomy.IOPs were measured with Goldmann applanation tonometer.The correlation between bleb components and other selected testing influencing factors and long-term IOP was tested by linear Logistic regression analysis.Results 150 patients (85.7％ ) completed 18 months of follow up.IOP was (15.6 ± 5.4) mm Hg at 18 month of post-operation.135 eyes had an IOP ≤ 21 mm Hg without additional medications,10 eyes≥21 mm Hg,and the remaining 5 eyes required one or two medications to maintain normal IOP.Using IBAGS system,bleb was graded in 142 eyes as follows:H0 in 3 eyes,H1 in 45 eyes,H2 in 90 eyes,and H3 in 4 eyes,while V0 was observed in 66 eyes,V1-3 in 76 eyes.IOP at 18 months in bleb with microcysts was 2.77 mm Hg lower( β =- 2.77,95％ CI =- 0.46 to - 5.08 ) than those without microcysts and in bleb with non-vascular was 2.07 mm Hg lower( β =-2.07,95％ CI =-0.15 to -3.98)than those with vascular at 3 months after surgery.IOP was significantly ( β =- 1.20,95％ CI:-0.00 to -2.40) decrensed by 1.2 mm Hg with 10 years of age increase(P ＜ 0.05).Conclusions Early filtering bleb with microcysts,vascular,and age are identified as important factors to predict long-term IOP effect in patients with PACG after trabeculectomy but not early morphological appearance of filtering bleb.

Objective To study and compare the outcomes of coaxial 1.8 mm microincision phacoemulsiflcation with conventional coaxial 3 mm small-incision cataract surgery.Methods A randomized prospective study was conducted on 89 patients with age-related cataract:coaxial 1.8 mm microincision cataract surgery ( MICS group) was performed in 45 cases (45 eyes),and coaxial 3 mm small incision cataract surgery (SICS group) was performed in 44 cases (44 eyes).Statistical analysis was taken with the data of 40 cases (40 eyes) in the MICS group and 40 cases (40 eyes) in the SICS group.The average ultrasound power (AVE) and effective phacoemulsification time (EPT) were recorded during the operation.Visual acuity,endothelial cell density and cornea thickness were compared at intervals of 1 day,1 week,1 month and 3 months after surgerf.In addition,surgically induced astigmatism (SIA) was analyzed.Statistic analysis was taken by student's t test and chi square test.Results There was no significant difference on AVE and EPT (P ＞ 0.05 ) between these two groups.One day after the surgery,the MICS group showed better uncorrected visual acuity (0.16 ±0.14) as compared to the SICS group (0.23± 0.12).The difference was statistically significant ( P ＜ 0.05 ).There were no significant differences on best corrected visual acuity,endothelial cell density and cornea thickness between these two groups.One week,1 month and 3 months after the surgery,SIA was (0.62 ± 0.28) D,(0.48 ± 0.28) D,(0.47 ±0.25) D,(0.40 ± 0.24) DintheMICSgroup,and(1.27 ± 0.65) D,(1.18 ± 0.59) D,(1.02 ±0.56) D,(0.79 ± 0.48) D in the SICS group,respectively.The differences between the MIC and SICS groups were statistically significant (P ＜0.01 ).SIA decreased significantly and became stable 1 week after surgery in MICS group,while the similar tendency appeared one month after the surgery in the SICS group.Conclusions Coaxial 1.8 mm microincision cataract surgery could significantly reduce SIA and obtain more stable astigmatism status.This suggests that the coaxial MICS phacoemulsification surgery could get earlier visual rehabilitation postoperatively.

Objective To observe the visual quality after implantation of Acrysof toric intraocular lens (IOL) in cataract patients.Methods Eighty eyes (60 patients) had implantation of Acrysof toric IOL in our hospital between Oct.2009 and Sep.2010.The patients were divided into four groups according to the toric models (T3,T4 and T5 ).The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),residual cylinders,contrast sensitivity,high order aberration and IOL axis were evaluated preoperatively and 3 months postoperatively.Sixty-five eyes (45 patients ) had implantation of Acrysof Natural IOL.Results The UCVA improved in the toric groups three months postoperatively.The UCVA of group T5b was lower than that of the other three groups.The UCVA of toric group was (0.19 ±0.14) which was better than that of the control group ( t =4.04,P ＜ 0.05 ).The residual cylinder was ( 1.69 ± 0.68) D in group T5b,which was statistically different from the other three groups.The residual cylinder of the toricgroup was (0.51 ± 0.78) D,which was much lower than the control group ( t =2.54,P ＜ 0.05 ).Thedifference of contrast sensitivity between the four toric groups was not statistically significant.The low-order aberration and coma of group T5b was higher than that of the other three groups.The difference of contrast sensitivity between the toric group and the control group was not statistically significant.The low-order aberration and coma of the toric group were lower than those of the control group.The IOLs in 67 eyes (83.75％) rotated less than 5 degrees and all IOLs rotated less than 10 degrees.Conclusion Implantation of the AcrySof toric IOL proves to be an effective,safe,and stable method of managing corneal astigmatism in cataract patients and provides good visual quality.

Objective To detect the changes in the retinal nerve fiber layer (RNFL) and ganglion cell complex ( GCC ) in the eyes of multiple sclerosis patients during the early stage of optic neuritis.Methods A prospective case series study.Suspected acute optic neuritis of multiple sclerosis (MS) patients who attended the department of ophthalmology in Peking Union Medical College hospital from Feb.2007 to Nov.2010 were collected.Twenty two MS patients were evaluated within the first week of the attack of acute optic neuritis.The average thickness of RNFL and GCC was measured and a three dimensional image of optic disk was reconstructed using optical coherence tomography (OCT).Results Within the first week of onset,the average thickness of RNFL and G CC of first attack eyes increased 75％ and 64％,respectively.The average thickness of RNFL and GCC in relapsed eyes decreased 91.7％ and 62.5％ respectively.The average thickness of RNFL and G CC of the fellow eyes also increased 60％ and 43％ respectively,within the first week of onset.More cases of optic disk edema and thickening of RNFL were found by OCT than by direct ophthalmoscopy.Conclusions Different changes of the thickness of RNFL and G CC and morphology of the optic disk were detected during the early stage of the initial attack or relapsed optic neuritis in MS patients.OCT could detect such diffferences.

Objective To investigate and analyze the epidemiological,clinical and prognostic characteristics of ocular trauma in soldiers caused by military affairs and compared with those in trauma caused by non-military causes.Methods A retrospective study on eye injury cases of military inpatients in 15 military general hospitals from 2001 to 2005 was performed and the data of 716 cases (772 eyes) were statistically analyzed.Results Three hundred and sixty inpatients (398 eyes) caused by military affairs accounted for 50.28％ (360/716) of all military inpatients with eye injuries.The difference between trauma cases caused by military affairs and non-military affairs included:higher male/female ratio,99.45％ (358/ 360),96.38％(343/356) (x2 =6.92,P =0.009) and younger age,averaged (23.14 ±5.23) yrs vs.(26.94 ± 10.45)yrs (t =-6.163,P ＜ 0.001 ).The most frequent causes in trauma caused by military affairs were explosion (12.78％,46/360 ) and construction of national defense (12.78％,46/360 ); whereas sports in leisure accounted for 35.96％ cases in trauma caused by non-military affairs.The other characters of trauma caused by military affairs included:more non-mechanical globe injuries,12.06％ (48/398),2.67％ (10/374) (x2 =23.12,P ＜ 0.001 ),less mechanical injuries,81.91％ (326/398),90.64％ (339/374) ( x2 =11.59,P =0.001 ) ; a higher proportion of open globe injuries ( especially intraocular foreign body); more full-thickness laceration of globe wall needed primary repair,57.26％ (71/124),84.78％ (39/46) ( x2 =11.13,P =0.001 ) ; higher rates of enucleation/evisceration,4.52％ ( 18/398 ),1.07％(4/374),(x2 =7.10,P =0.008),lower vision,15.33％ (61/398),4.81％ (18/374) (x2 =22.07,P ＜ 0.001 ) and more blindness,25.38％ ( 101/398 ),10.42％ (39/374) ( x2 =28.03,P ＜0.001); less eyes with final vision ≥0.5,28.02％ (111/396),35.66％ (133/373)(x2 =4.81,P =0.028) and less eyes with increasing vision,68.68％ ( 272/398 ),76.41％ ( 285/374 ) ( x2 =5.35,P =0.021 ).Conclusions Eye injury caused by military affairs is more severe and poorer in prognosis and is the direct factor that causing the decrease of military power.Emphasis should be placed on the prevention and treatment of eye injuries caused by military affairs.

The patient was a 42-year-old male. He went to Guangzhou Aier Eye Hospital on April 25, 2011 due to a sudden decrease in visual acuity in his left eye for 2 days. The patient went to the local hospital 1 day ago and received intravenous drip of "Xueshuantong" injection, but the symptoms were not relieved. The patient was in good health before, without hypertension, diabetes, and no history of vascular diseases and immune diseases. Eye examination: visual acuity was 1.2 in the right eye and anterior index in the left eye; The intraocular pressure was 13 mm Hg (1 mm Hg =0.133 kPa) in the right eye and 14 mm Hg in the left eye. The examination of the right eye was normal, the anterior segment of the left eye was normal, and the condition of the left heel floor was shown in the essence pictures 1~4. Clinical diagnosis: Arteriole obstruction in the macular area of the left eye combined with internal limiting membrane traction syndrome.

The patient was a 37-year-old male. He came to Sun Yat-sen Eye Center of Sun Yat-sen University on July 19, 2010 due to the decrease of visual acuity in his left eye for 20 days. Both eyes were normal in the past, and there was no similar medical history. There were no abnormalities in the whole body examination. Ophthalmological examination: visual acuity in the left eye was 0 9, no abnormalities were found in the anterior segment examination, and the fundus examination showed the essence pictures 1 and 2. Diagnosis: central serous chorioretinopathy (CSC) in the left eye. CSC is a common fundus lesion in ophthalmology clinic. The typical changes of fundus fluorescence angiography (FFA) in the acute attack of this disease are mainly in two forms, namely diffusion type (also known as ink stain diffusion, inkbot diffusion) and ejection type (also known as smoke stack phenomenon). The former is more common in clinic, and the latter is rare, while the two ejection leakages in the same affected eye are rare.

Primary angle-closure glaucoma (PACG) is an independent and complex disease.According to International Society Geographical & Epidemiological Ophthalmology (ISGEO) PACG is defined as primary angle closure (PAC) with glaucomatous neuropathy,whereas a diagnosis of PAC will be given to patients without a neuropathy.This classification is simple and very useful in survey.In contrast,conventional classification of PACG by Chinese Glaucoma Association is based on anatomical predisposition,such as peripheral iridocorneal apposition/adhesions,and functional sub-stages,which is more clinical usefulness.The difference of PACG classification system between Chinese Glaucoma Association and ISGEO appears to hinder the communication and cooperation between Chinese and intemational colleague.In this article,we attempted to review classifications and analyze the epidemiological characteristics of PACG under these two systems.It is obvious that the continuing effects to establish a rational and standardized classification system of PACG will greatly promote and benefit glaucoma research and clinical practice for both international and domestic ophthalmic community.

Primary open angle glaucoma (POAG) is defined as an optic neuropathy characterized by loss of optic nerve axons and retinal ganglion cells.Increase of intraocular pressure (IOP) is a major risk factor for POAG,which is partially due to an abnormally high aqueous humor outflow resistance in trabecular meshwork ( TM ).Trabecular outflow pathway is a key element in drainage of aqueous humor.Malfunction of TM in POAG is associated with over expression of inflammatory markers,cellular senescence,oxidative stress,and decrease of cellularity.The biological changes of TM cell and extracellular matrix compromise trabecular pathway drainage resulting in an increased IOP.This article reviewed the progression in research on aqueous humor outflow pathway emphasizing the alteration of trabecular pathway.

The patient was a 4-year-old male. He came to our hospital on October 18, 2010 due to ptosis since childhood, expressionless face, looking up to see objects, and eyelid trembling when eating. Past history: 2nd birth, 2nd birth, mother in good health during pregnancy, full-term cesarean section, history of amniotic fluid contamination, no history of asphyxia and oxygen inhalation, and denial of birth injury. Parents were not close relatives, and there was no similar medical history in the family. Ophthalmological examination: visual acuity right 0 4+2, left 0.6; atropine dilated optometry: right-1.00 DS () 1.00 DC ×100° corrected visual acuity 0 6, left-0.50 DS () 1.00DC ×70° corrected visual acuity 0 6; compensated head position: mandibular elevation; Eye position: Both eyes are fixed in the medial and inferior oblique position; Eye movement: Both eyes are limited in outward, upward, inner and downward rotation, and the outward and upward rotation cannot cross the midline. The bilateral Bell's phenomenon disappeared, the palpebral ptosis in both eyes, the right eye was the one, the muscle strength of both levator palpebral muscles was 0, the bilateral epicanthus folds were obvious, and the width of palpebral fissure was 3 mm in the right eye and 5 mm in the left eye when viewed head-up; Eyelid insufficiency; When closed, the palpebral fissure was 1 mm on the right and 2 mm on the left (Figures 1-5).

In order to further improve the concept and clinical management level of anti-glaucoma combination therapy in China, provide a communication platform for ophthalmologists to demonstrate their academic level, and finally benefit more glaucoma patients, the Chinese Journal of Ophthalmology of the Chinese Medical Association held a series of case selection activities in 2011 "Concerned Treatment for Glaucoma Makes the World Brighter, NEED" from May to December 2011.

Clinical Pharmacology of Ophthalmology (2nd Edition), edited by researcher Chen Zuji of Henan Institute of Ophthalmology, has been published by Chemical Industry Press. This book is a comprehensive and systematic reference book on ophthalmic pharmacology and ophthalmic pharmacotherapeutics.

The book "In vivo confocal microscope of ocular surface" (edited by Professor Xu Jianjiang), one of the "Application Series of New Ophthalmology Technologies" edited by Professor Sun Xinghuai of Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, has been officially published by Fudan University Press. In vivo confocal microscope of ocular surface is a new type of high precision and high magnification microscope which has appeared in recent years. As an auxiliary diagnostic device with strong clinical practice, ocular surface confocal microscope can observe the corneal and conjunctival tissues in vivo in non-invasive, real-time dynamic and four-dimensional (three-dimensional + time), and can observe the relationship between various layers of tissues. Therefore, it has been widely paid attention by clinicians and scientific researchers.

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.

The book "Wavefront Aberration and Clinical Vision Correction", co-written by famous experts and scholars in the field of vision at home and abroad, has been officially published by People's Medical Publishing House, and its editors are Professor Wang Yan and Professor Zhao Kanxing.

Conjunctivalochalasis is a common age-related ocular surface disease in the elderly. With the accelerating aging of the population, the number of people with conjunctiva relaxation will increase day by day. Severe conjunctival relaxation requires surgical treatment. In order to standardize the surgical treatment plan and prevent iatrogenic ocular surface damage, Professor Zhang Xingru combined his more than 10-year research results on surgical treatment of this disease (including key technologies such as indications for surgical treatment, standardized surgical operation, prevention and treatment of surgical complications) with literature and materials to make a CD.

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 "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 invite famous domestic ophthalmic pathologists to give special lectures and discuss difficult cases. Through academic discussions and experience exchanges on ophthalmic basic pathology and clinical pathology with participants, the latest progress in ophthalmic pathological diagnosis and the latest achievements in basic research will be demonstrated. It is believed that through communication and communication, the clinical level of pathology of ophthalmologists will be improved and the basic research of ophthalmology will be promoted. The following topics will be set up in this conference: (1) basic knowledge training of ocular pathology; (2) Clinical application and case discussion of ophthalmic pathology; (3) Clinical basic research of ocular pathology; (4) Technical exchange of clinical diagnosis and treatment of ocular pathology.

Conjunctiva relaxation is a common eye disease in the elderly, but it has been neglected by domestic ophthalmologists, which is easy to cause misdiagnosis and misdiagnosis. After more than ten years of exploration, the Department of Ophthalmology of Putuo Hospital affiliated to Shanghai University of Traditional Chinese Medicine has systematically studied the diagnosis and treatment technology of conjunctival relaxation, and has formed a standardized diagnosis and treatment plan. The National Class I (6 points) Continuing Education Class: "Pathogenesis and Surgical Treatment of Conjunctivalochalasis" will be held in November 2011 (Project No.: 2011-07-02-052). During the workshop, we will systematically demonstrate the surgical treatment video and live surgical observation of conjunctival relaxation. We sincerely welcome fellow ophthalmologists from all over the country to participate in the exchange.

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.

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.

1. Statistical symbols: According to the relevant provisions of GB3358-1982 ((Statistical Nouns and Symbols), all statistical symbols are printed in italics. Commonly used: (1) The arithmetic mean of the sample is in English lowercase (median is in M); (2) Standard deviation is in English lowercase s; (3) Standard misuse of English lowercase sx; (4) t test is in English lowercase t;

Humphrey perimetry is widely used in the diagnosis and follow-up of clinical Glaucoma. In recent years, its follow-up software has developed from Glaucoma progression analysis (GPA-Ⅰ) to Guided progress analysis (GPA-Ⅱ). Compared with routine diagnostic examination, the reading purposes, observation indexes, related contents and analysis methods of follow-up examination reports are very different. As a follow-up software, the single-field analysis report given by GPA-Ⅱ is different from the content of routine diagnostic examination. In order to facilitate clinicians' understanding and application of Humphrey perimetry Glaucoma follow-up software, the author takes the latest version of GPA-Ⅱ as an example to briefly introduce its basic contents and interpretation methods.