Volume 48 · Issue 06 · 2012

Ocular hypertensions (OHTs) in juvenile are characterized by occurrence in teenage with intraocular pressure (IOP) frequently fluctuated and increased over 30 mm Hg( 1 mm Hg =0.133 kPa)without any ocular symptoms and disturbance of visual acuity.IOPs are normalized in the majorities of juvenile over adolescence stage with long-term follow up.The medical terminology of ' adolescence IOP fluctuation' or 'adolescence ocular hypertension' is therefore used. The diagnosis and management of juvenile OHT remain difficult clinical challenges.OHTs in juvenile sometimes are incorrectly diagnosed due to inappropriate IOP measurement and thicker central cornea as younger children are non-compliant and resisting the examination.In this paper,we reviewed OHT in juvenile in the light of significant studies in the past and based on our experience of clinical practice in order to provide a better understanding and management of OHTs in juvenile.

Large scale,multicenter,and randomized controlled glaucoma clinical trials are very important clinical research. The results of scientific evidences are useful to make clinical guideline of glaucoma prevention and management or working mode.Glaucoma is the second leading cause of blindness in the world,which is associated with irreversible damage to optic disc.At present,glaucoma prevalence in China was approximately 1.95％ to 3.60％.In order to effectively prevent and treat glaucoma,it' s necessary to promote and design glaucoma clinical trials that fit in our national medical care system.Much experience of carrying out clinical glaucoma trials has been obtained and achieved in the past.However,there is still a big gap between China and developed countries in such aspects as funding deficiency,disunity of operational standardization,quality irregularity and so on.This article presents a synthesis of modern principle data concerning glaucoma clinical trials in domestics and abroad aiming at emphasizing the importance of this issue.

Neovascular glaucoma (NVG) has long been recognized as a very difficult case to manage for its very poor prognosis of visual function,NVG is also remarked as an ' end stage' of ocular diseases.Conventional treatments with extremely uncontrolled cases are retinal cryotherapy or enucleation.Currently,management of this medical condition is directed toward a new era with great advancement in diagnosis and treatment. Glaucoma drainage implant surgery brings a time window of normal range of intraocular pressure (IOP) for physicians to process underlying disease of NVG. Regression of iris neovascularization by employing panretinal photocoagulation (PRP) or intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) antibodies create a chance to undertaken antiglaucomatous surgery.Adjunctive anti-VEGF treatment promotes the surgical success rate for NVG.Current approaches in NVG are able to provide patients with an individualized management using a sound treatment strategy according to etiology,stage of disease,visual potential and other factors.

Objective To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV)implantation in the early stage of glaucoma sccondary to contusion injuries.Methods A retrospective case series study.The study was made in 29 consecutive patients with glaucoma secondary to blunt trauma who were uncontrolled by multiple medications and then performed AGV implantations in less than 2 mouths after the trauma.The duration from injury to IOP elevation was Ⅰ to 30 (6.10 ± 1.13 ) days.The time from injury to AGV implantation was 16 to 60 (40.03 ± 2.97 ) days,The patients were followed-up for a period of 6 to 42 ( 20.75 ± 1.66) months.The main outcome measures included intraocular pressure ( IOP),visual acuity (VA),number of glaucomatous medications,intra-and postoperative complications,IOPs were analyzed by repeated measures analysis of variance,numbers of medication assessed by Kruskal-Wallis rank sum test followed by Bonferroni test,and VA comparison was performed using paired Student t-test.Results The absolute success rate was 86.21％ and the conditional success rate was 13.79％ after ACV implantation.Compared with pre-operation,the IOP was significantly ( F =124.09,P ＜ 0.05 ) lowered at the last following-up of post-operation(42.59 ± 1.82 ) vs ( 15.12 ± 0.56 )mm Hg ( 1 mm Hg =0.133 kPa),the numbers of glaucomatous medications were significantly ( H =131.73,P ＜ 0.05 ) reduced post-operatively (3.93 ± 0.15 ) vs ( 0.21 ± 0.12 ) species,and the VA was significantly ( t =-3.466,P ＜ 0.05 ) improved post-operatively( logMAR 0.40 vs logMAR 0.70).Two cases with shallow anterior chamber and three cases with hyphaemia were observed in the early stage after the surgery.No persistent hypotony,tube exposure or other serious complications were noted. Conclusion AGV implantation is safe and effective in the management of intractable secondary glaucoma at early stage of contusion injuries.

Objective To evaluate the changes of visual field and retinal nerve fiber layer (RNFL)thickness during 24 months follow up in primary open-angle glaucoma (POAG) patients.Methods In this retrospective case series study,visual field and RNFL were detected by using GDx-VCC system and Octopus perimeter in 60 patients with POAG in early stage (60 eyes),32 in moderate stage (32 eyes) and 30 in advanced stage (30 eyes).The parameters of the RNFL thickness and mean defect (MD) of the visual fields were recorded and analyzed by rcpcated measures analysis of variance among the same group and by one-factor analysis of variance for different stages of POAG groups at each time of follow-up.Results The baseline MD of visual field in POAG was( 1.93 ± 1.66) dB in early group,(5.83 ± 1.95 ) dB in moderate group and ( 14.62 ± 3.53 ) dB in advanced group,respectively.At 24 months,MD in POAG was significant (F =9.47,P ＜0.05) increased to(7.24 ±2.17)dB in moderate group,but not in other two groups ( F=2.03,1.40;P ＞0.05).Compared with baseline of total average RNFL thickness in POAG at temporalsuperior-nasal-inferior-temporal [TSNIT:(53.72 ± 8.07 ) μm,(49.73 ± 7.16) μm,and (41.42 ± 8.30) μm in each group,respectively],RNFL thickness in each group was significant ( F =21.39,18.65,16.63 ;P ＜ 0.05 ) decreased ( 50.43 ± 7.08 ) μm,(45.47 ± 6.50) μm,and ( 37.62 ± 7.28 ) μm ( respectively ) at 24 months.The inferior RNFL was significantly ( F =30.25,P ＜ 0.05 ) reduced from ( 61.85 ± 9.77) μm to(54.35 ±7.47 )μm in early stage group,while the superior RNFL was changed more dramatically from ( 55.67 ± 9.50 ) μm to (49.75 ± 9.54) μm in moderate stage group ( F =31.72,P ＜ 0.05 ).Both baselines of MD and RNFL thickness were significantly different in each group ( F =428.99,21.32 ; P ＜ 0.05 ).Conclusions Our results demonstrate that GDx-VCC system is useful to evaluate the progression of POAG in early and moderate stage by detecting the change of the RNFL thickness with long term follow up.

Objective To investigate morphological monitoring indexes of anterior segment in AACG.Methods Case-controlled study was conducted in the following groups:55 eyes of 55 patients with unilateral AACG in first attack,60 eyes of 60 cases with shallow anterior chamber,and 60 eyes of 60 cases with normal individuals.Images of anterior chamber angle in each group were collected by OCT. Using software of Photoshop,the opening degree of anterior chamber angle was quantified.Anterior chamber depth (ACD),lens thickness (LT),lens position (LP),and chamber crowding rate (CCR) were measured by A-ultrasound.Anterior segment biometric parameters among the three groups were compared using one-way ANOVA test.Results LT,LP,and CCR were significantly (LT:F =27.73,LP:F =47.33,CCR:F =79.22 ;P ＜ 0.05 ) different between A ACG,narrow angle and normal group in age group ranged from 50 to 59 [LT:(5.72±0.22)mm,(5.57 ±0.28)mm,(4.55 ±0.36)mm,LP:(4.33±0.24)mm,(4.63 ±0.20)mm,(5.71 ±0.34)mm,andCCR:3.28 ± 0.16,2.64 ± 0.19,1.70 ± 0.10,respectively]and significantly different ( LT:F =22.51,LP:F =56.67,CCR:F =74.84 ; P ＜ 0.05 ) in age group ranged from 60 to 69 [LT:(5.81 ±0.37) mm,(5.72 ±0.41) mm,(4.98±0.59) mm,LP:(4.26 ±0.18) mm,(4.51 ± 0.14) mm,(5.62 ±0.19) mm and CCR:3.39 ± 0.35,2.74 ± 0.37,1.86 ± 0.36,respectively].However,in age group ranged above 70 group,LP and CCR ( LP:F =23.09,CCR:F =60.08;P＜0.05) were significantly changed [LP:(4.25 ±0.30) mm,(4.46 ±0.22) mm,(5.49 ±0.23) mm,CCR:3.48 ±0.21,2.85 ±0.30,2.03 ±0.17,respectively],but not LT [(5.85 ±0.27) mm,(5.74 ±0.21) mm,(5.43 ±0.36) mm](F =8.29,P ＞0.05).Conclusions The study results indicate that LT,LP and CCR,are useful indicators to observe the anterior chamber status in AACG by using Stratus OCT-3.

Objective To investigate the expression of Nogo-A and its receptor NgR mRNA and protein in the retina of rats with chronic elevated intraocular pressure (IOP).Methods Experimental study.Rat chronic ocular hypertension (OHT) was induced by obstructing episcleral veins and temporal limber veins.The retiual tissues were collected at day 3,7,14 and 28 after the IOP elevated in rats.Each group includes 16 rats and one group served as normal control.Expression of Nogo-A and NgR mRNA was detected by reverse transcription polymerase chain reaction ( RT-PCR),while the protein levels of Nogo-A and NgR were expressed by the western blot in rat retinal tissues in different groups.Expression of Nogo-A,NgR mRNA and protein were analysed by one way analysis of variance ( ANOV ) and multiple comparison ANOV.Results IOP in rat OHT group was significantly increased after day 3 lasting for 28 day.Compared with control group,the level of Nogo-A mRNA and protein in rat chronic OHT groups were significantly (mRNA:F=7.464,protein:F=5.677;P＜0.01) increased at day7,14,and28 (mRNA:0.661 ±0.065vs 0.831 ± 0.055,0.813 ± 0.063,0.844 ± 0.077,protein:1.284 ± 0.043 vs 1.359 ± 0.033,1.381 ±0.063,1.361 ±0.044),respectively.There is a tendency of increase of Nogo-A mRNA expression at day 3 but did not reach statistical significance.However,the level of NgR in the retina in rats with the chronic OHT was not significantly ( mRNA:F =0.598,protein:F =0.460; P ＞ 0.01 ) changed compared with normal group.Conclusion The increased expression of Nogo-A in retina of rat OHT indicates that Nogo-A may play a primary role in obstructing regeneration of optic nerve,which is mediated by other receptors and elements ralher than NgR.

Objective To detect the expressions of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptors (VEGFR) in cultured rat conjunctival fibroblasts. Methods Experimental study.Gonjunctiva was obtained from each eye of five Sprague Dawley(SD) rats under local anesthesia.Tissues were minced and grown in culture flask containing Dulbecco's Modified Eagle's medium (DMEM).The fibroblasts were identified by observing cell morphology,and the expression of staining of cytokeratin and vimentin by inverted microscopy and indirect immunofluorescence technique.mRNA primers were designed for VEGF164,VEGFR-1 ( Flt-1 ),and VEGFR-2 ( Flk-1 ).mRNA was extracted by Trizol method.cDNA was synthesized under the action of RNA reverse transcriptase.Ladder-like pattern of DNA fragmentation appeared upon 2％ agarose gel electrophoresis. The amplification curves and dissociation curves of VEGF164,VEGFR-1 (Flt-1),and VEGFR-2 (Flk-1) were detected by realtime polymerase chain reaction (PCR).The expression of VEGFR-1 on fibroblast was observed by immunofluorescence technique.Results The fluorescent staining was negative in cytokeratin of fibroblasts,but was positive in vimentin of fibroblasts.The mRNA expressions of VEGF164,VEGFR-1 ( Flt-1 ) and VEGFR-2( Flk-1 ) were detected in fibroblast and verified by gene sequencing.The peaks of the dissociation curves were all steep and specific.The fluorescent staining of VEGFR-1 was positive. Conclusions Our results demonstrate that the expression of VEGF,VEGF receptors,and VEGFR-1 cytokine in rat conjunctival fibroblasts suggests that anti-VEGF compounds may exert a direct influence to the growth of rat conjunctival fibroblast.

Objective To compare the refractive results between open-field auto ref/keratometer and conventional autorefractor,and to investigate the effect of cycloplegic to this difference. Methods Three hundred and four primary and secondary school students were consecutively enrolled in Beijing Tongren Hospital.Non-cycloplegic and cycloplegic objective refractions were performed for each subject by conventional autorefractor (Accuref-K9001,S(h)in Nippon,Japan) and binocular,open-field auto ref/keratometer (Grand Seiko Co.,Ltd.,Hiroshima,Japan ).The coincidence rate of sphere,spherical equivalent (SE) and axis (defined as difference of diopter ≤0.50 D,difference of axis degree ≤20°) were calculated ; Bland-Altman and distribution analysis were performed according to mean and difference of SE.Results The coincidence rate of sphere,SE and axis were 77.3％,78.6％ and 66.0％ before cycloplegic and increased to 94.4％,95.1％ and 69.5％ after cycloplegic,respectively.The difference (95％ CI) of SE before cycloplegic between these two refractometers was 0.12 (-1.04 to 1.29 ) D and was positively correlated with the mean of SE (after cycloplegic) (rpearson =0.21,P ＜ 0.001 ).The difference (95％ CI) of SE after cycloplegic was-0.08 (-0.60 to 0.45) D.The difference (95％ CI) of SE of K9001 autorefractor before and after cycloplegic was larger than that of WAM autorefractor [ 0.51 (-0.83-1.84) D and 0.31 (-0.66 to 1.28) D,P＜0.001]. Before cycloplegic,SE measured by WAM autorefractor showed myopic more than 0.25 D than K9001 ( group 1 ) was found in 51 ( 16.8％ ) subjects; difference within 0.25 D was found in 160 ( 52.6％ ) subjects; hyperopic more than 0.25 D ( group 3) was found in 93 ( 30.6％ ) subjects.After cycloplegic,69 ( 22.7％ ) subjects were found in group 1,and subjects increased to 213 ( 70.1％ ) and decreased to 22 (7.2％) in group 2 and group 3,respectively.Conclusion The binocular, open-field auto ref/keratometer provides more hyperopic readings than conventional autorefractor.It will be useful in both clinical screening and scientific research because it produces less instrument myopia than that of conventional autorefractor.

Objective To investigate the prevalence of blindness and moderate and severe visual impairment among adults aged 50 years or above in Ji'an county of Jiangxi province,China.Methods It was a population-based cross-scction study.Geographically defined cluster sampling was used in 5402 randomly selected individuals aged ≥50 years in 28 clusters in Ji'an from September to November 2006.The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out.All participants were enumerated through village registers followed door-to-door visits.Eligible individuals were invited to receive visual acuity measurement and eye examination.Statistical analyses were performed using Stata/SE Statistical Software,release 9.0.Chi-square test was used to investigate the association of age,gender and education with presenting and best corrected visual acuity.Results Five thousands four hundreds and two individuals were enumerated and 5010 persons were examined,the response rate was 92.74％.Based on the criteria of World Health Organization visual impairment classification in 1973,78 persons were diagnosed as blindness,265 persons were diagnosed as moderate and severe visual impairment defined as best corrected visual acuity,the prevalence of blindness and moderate and severe visual impairment were 1.56％ and 5.29％ respectively.Ninety-four persons were diagnosed as blindness,726 persons were diagnosed as moderate and severe visual impairment defined as presenting visual acuity,the prevalence of blindness and moderate and severe visual impairment defined as presenting visual acuity was 1.88％ and 14.50％ respectively.The prevalence of blindness and moderate and severe visual impairment was higher in aged ( trend x2 =970.15,P =0.000),female ( x2 =89.81,P =0.000),and illiterate persons (trend x2 =241.85,P =0.000).Cataract was still the first leading cause of blindness and visual impairment,the retinal diseases was the second.Un-corrected refractive error also was the main cause of visual impairment.Conclusions The prevalence of blindness and moderate and severe visual impairment was higher than other district in China.The first leading cause of blindness and visual impairment is still cataract.

Objective To estimate the prevalence of cataract,the outcomes of cataract surgery,cataract surgical coverage rate,cataract blindness social burden rate in Ji'an county of Jiangxi province,China.Methods Cluster sampling was used in randomly selected 5010 individuals aged ≥ 50 years in Ji'an county of Jiangxi province.All individuals were received visual acuity and eye examination,including the evaluation of lens status and cataract surgical status by slit lamp biomicroscopy, Data bank was established by Epi-info Software.Statistical analyses were performed using Stata/SE Statistical Software,release 9.0 (Stata Corp,College Station,TX).Confidence intervals and P values (considered significance at the P ＜0.05 level) for prevalence of cataract,cataract surgical coverage rate,cataract blindness social burden rate and outcomes of surgery were calculated with adjustment for clustering effects and stratification associated with the sampling design.Results In 5010 individuals,1158 cases of cataract were found,the prevalence of cataract was 23.11％ among adults aged 50 or above.The prevalence of cataract was higher in the aged,female( P ＜ 0.0 1 ).In 99 eyes with cataract surgery,50.51％ and 5.05％ of eyes were performed by the modern extra-capsular surgery and phocoemusification respectively. The rate of intraocular lens implantation was 55.56％.Post-operative presenting and best corrected visual acuity equal to or more than 0.7 was 10.1％ and 45.5％ of operated eyes respectively.The main causes of the post-operated eyes with worse visual acuity were post-capsular opacity and refractive error.The cataract surgical coverage rate was 32.29％,and the cataract blindness social burden rate was 3.83％.The cataract surgical rate was lower and cataract blindness social burden rate was higher in the aged persons ( P ＜ 0.01 ).Conclusions Cataract is the most common eye disease that may lead into blindness and severe visual impairment among older adults aged equal or more than 50 years.The cataract surgical coverage rate is not high but the cataract blindness social burden rate is heavy in Ji'an county.The rate of intraocular lens implantation need increase and the visual outcomes of the surgery should be fuaher improved in the future.

Objective To evaluate preliminary clinical outcome of Boston type Ⅰ keratoprosthesis in ocular chemical bum patients.Methods Six keratoprosthesis were implanted into 6 patients of bilateral blindness.Visual acuity in these patients before the operation was light perception and all of them were unsuitable for standard penetrating corneal transplantation.The causes for corneal opacity were alkali bum in 2,sulfate acid bum in 3 and ethanol injury in 1 patient.Shirmer's test revealed severe dry eye in 3 patients,only one eye had normal lacrimal secretion.All patients were male,with follow-up period ranged from 17 to 26 months ( mean 24 months).Results The postoperative visual acuity ranged from 0.05 to 0.5,5 of them was better than 0.1.The retention rate within the follow-up period was 100％.Intraocular pressure was in normal limit,no retinal detachment was detected by type B ultrasonic examination. Postoperatively,retrokeratoprothestic membrane occurred in 2 cases and was treated with YAG laser membranectomy,one eye complicated with elevated intraocular pressure and treated with shunt implantation.Conclusion The Boston type 1 keratoprosthesis is a viable option for patients with obsolete chemical burns.

Objective To analysze the changes of ocular bacterial isolates and their susceptibility to ciprofloxacin,ofloxacin,levofloxacin,gatifloxacin and tobramycin in Henan Province in the past six years.Methods Retrospective study of ocular bacterial isolates and their in vitro antimicrobial susceptibility test results of Henan Eye Institute in the past six years. Results A total of 2044 bacterial isolates were classified into 39 kinds in the past six years,which were mainly from the conjunctival sac.Staphylococcus epidermidis was the most common,followed by Pseudomonas aeruginosa,Staphylococcus aureus and Bacillus cereus.All kinds of the ocular bacteria had the highest susceptibility to gatifloxacin ( 92.3％ ) among the tested drugs.Rods were more sensitive to quinolone drugs than cocci and gram-positive rods were more sensitive to tobramycin than the other types of germs.The drug's susceptibility of the four kinds of quinolone except ciprofloxacin decreased year by year with a decreasing ladder fashion every two years in the susceptibility change of levofloxacin in the past six years,while the susceptibility of tobramycin increased slowly from 2004 to 2008 and then decreased.Staphylococcus epidermidis susceptibility to every drug had the similar trend with the general changes in the past six years,that is,their susceptibility to ofloxacin decreased significantly since 2008,their susceptibility to gatifloxacin and tobramycin reduced significantly in 2009.Altbough Pseudomonas aeruginosa susceptibility to all the drugs had no significant change,for all gramnegative rods,their susceptibility to the four kinds of quinolone drugs were higher than their susceptibility to tobramycin while their susceptibility to levofloxacin and gatifloxacin reduced significantly as time passed by,especially from the year 2008 to 2009.Conclusions The most common ocular bacterial isolates were Staphylococcus epidermidis,followed by Pseudomonas aeruginosa.Ocular bacterial isolates' susceptibility to gatifloxacin in vitro was significantly higher than to other drugs in every year but decreased significantly in 2009 while their susceptibility to ofloxacin and levofloxacin decreased significantly since 2008. Their susceptibility to tobramycin increased slowly from 2004 to 2008 and then decreased.

A 35-year-old female was seen for 4 days due to recurrent foreign body sensation in her left eye. One month ago, she had a history of dog contact. After 2 days of contact, she felt redness and foreign body sensation in her left eye, and occasionally obscured by white objects in front of her eyes. She went to the ophthalmology department of a nearby hospital. After 4 transparent line-like worms were removed from the conjunctival sac, the foreign body sensation disappeared. Four days ago, the left lower eyelid foreign body sensation appeared again, and he went to our hospital. Physical examination: visual acuity: right eye 1.0, left eye 1.2, right eye (-), left eyeball conjunctiva congestion, lower eyelid conjunctiva congestion, large and small spot bleeding (Figure 1), two hyaline nematodes peristalsis, which were clearly visible under cobalt blue light after fluorescein staining (Figure 2). After spot anesthetic, the worm body moved slowly, gradually moved to the conjunctiva near the medial canthus and disappeared. No worm body penetrated into the lacrimal duct, and the conjunctival penetrating wound was not obvious. No penetrating wound was found in the cornea, and no abnormality was found in the inner eye. No abnormality was found in the whole body examination, nematode antibody (-). After the patient rested for one day, the worm body reappeared in the conjunctival sac, the lower eyelid was opened, and the living translucent parasite was taken out with ophthalmic forceps, and put it in normal saline for examination.

The patient was a 73-year-old female who came to the Department of Ophthalmology of Peking Union Medical College Hospital on May 24, 2001 because of the dark shadow floating in front of her left eye for half a year.The eye examination showed that the visual acuity was 1.0 in the right eye and 0.6 in the left eye. Examination of dilated pupils showed that a large number of yellow-white crystalline particles were seen in the vitreous cavity of the left eye, and the optic papilla and retina were vaguely seen through the crystalline particles (Quintessential Picture 1); The vitreous body of the right eye was transparent, and the fundus of the eye was normal.

The patient was a 44-year-old male with blurred vision in his left eye for 1 day after severe vomiting after drinking. He came to Changchun Aier Eye Hospital on February 2, 2012. Ocular examination showed that the visual acuity was 1.0 in the right eye and 0.12 in the left eye, and the intraocular pressure was 15 mm Hg in the right eye (1 mm Hg =0.133 kPa) and 15 mm Hg in the left eye. Anterior segment of both eyes normal; For the condition of the heel base of the left eye, see essence pictures 1 and 2. Clinical diagnosis: Valsalva retinopathy of the left eye.

The accumulating evidences from experimental and clinical studies suggested that the ocular surface could be injured by topical anti-glaucoma medications.The ocular surface injury not only caused dry eyes,red eye,eye itching,photophobia and other discomforts,but also increased the risk of failure of glaucoma surgery in patients.The commonly used preservative Benzalkonium Chloride ( BAK )plays an important role in ocular surface damage and its side effects are dose-and time-dependent,particularly,in the combined medications.Topical application of preservative BAK could result in the damage of epithelial cells and endothelial cells,and also affect the central corneal thickness.Prevention of ocular injury should be seriously taken into consideration in the anti-glaucoma medical treatment.Development of complex preparations,preservative-free and/or novel preservative preparations for glaucoma therapy may provide a promising approach in the prevention of ocular surface injury.

Coexisting glaucoma and cataract is a common eye disorder in elderly population.Recent advances in the management of patients with coexisting cataract and glaucoma offer a promising alternative in patients with uncontrolled glaucoma and a cataract and provide an individualized treatment depending upon patient's characteristics and intraocular pressure (IOP).Based on many significant studies that have been conducted in the combining cataract extraction with a glaucoma surgery in recent years,present article reviews the different surgical options on the control of their postoperative IOP level in the different stages of glaucoma and the surgical strategies for patients with combined cataract and glaucoma.

Blocking of retrograde transport after the optic nerve injury results in deprivation of neurotrophic support to retinal ganglion cells (RGCs),and leads to apoptotic cell death in glaucoma.As an important member of neurotrophins,the brain-derived neurotrophic factor (BDNF) plays a substantial role in the repair of retinal ganglion cells injury,but its signaling pathway in the pathogenesis of glaucoma remains unclear.This review focuses on the structure,distribution and receptors of BDNF and its effects on RGC survival, axon regeneration and relevant signaling pathway, to provide theoretical foundation for neuroprotective treatment of glaucoma.

Vogt-Koyanagi-Harada disease is a multi-systems inflammatory disease that affects the eye,skin,inner ear and meninges.The characteristics of this disease are with meningismus,auditory dysfunction and integumentory changes.Bilateral granulomatous panuveitis with serous retinal detachments are the typical ocular findings.Vogt-koyanagi-Harada disease is characterized by the acute onset,poor response to the treatment and high blindness rate.The diagnosis is mainly made on the history and ocular findings with various systemic manifestations.Fundus angiography is often used to assist in the diagnosis.High dosages of systemic corticosteroids are the first line therapeutical choice.The immunosuppressive agents and biologic agents combined with systemic corticosteroids shows good results in some recurrent cases.The good visual prognosis is guarded with earlier accurate diagnosis and aggressive treatment.

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. The main readers of this journal are ophthalmologists across the country, and it is publicly distributed at home and abroad. China Standard Issue Number: ISSN0412-4081, CN11-2142/R; Postal Code: 2-60; National map code: M93.

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.

1. Statistical symbols: According to the relevant provisions of GB3358-1982 ((Statistical Terms and Symbols), all statistical symbols are printed in italics.

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.

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.

With the development and improvement of clinical diagnosis technology, the role of all kinds of ophthalmology clinical pictures in disease diagnosis has been paid more and more attention. In order to encourage clinical accumulation of relevant data, promote experience exchange, improve clinical diagnosis and treatment technology, provide a new platform for academic exchange for readers, and at the same time enrich the content and form of this journal to better serve the majority of ophthalmologists, this journal continued to open the "Picture Essence" column in 2012.

The description format of reference documents in this journal basically implements GB/T7714- -2005 "Rules for Description of Reference Documents after Text". Sequential encoding is used to make a record, which is marked by Arabic numerals in the order in which it appears in the text, and the serial numbers are placed in square brackets and arranged at the end of the text. Try to avoid citing abstracts as references. Internal publications, unpublished materials, personal correspondence, etc. should not be cited as literature. Quoted documents (including the text and the original meaning expressed) are asked to be checked by the author with the original.

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 China's ophthalmology. 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 launched the "Chinese Ophthalmology Journal Network", the website is http: / /www.cjo-eye.com.

The book "Choroidal Neovascular Diseases", edited by Professor Wang Yusheng, Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University and Institute of Ophthalmology, written by frontline scientific and technical personnel engaged in clinical and basic research of ophthalmology and visual science in Fourth Military Medical University, reviewed by Professor Yan, West China Ophthalmology Center, Sichuan University, and prefaced by Professor Luo Chengren, has been officially published by People's Medical Publishing House. The contents of this book include basic research and clinical diagnosis and treatment of choroidal neovascular diseases, taking into account both advancement and practicality.

Ocular Surface Live Confocal Microscope (edited by Professor Xu Jianting), 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 a clinically practical auxiliary diagnostic device, ocular surface in vivo confocal microscope can perform non-invasive,

The book "Wavefront Aberration and Clinical Visual Correction", edited by Professor Wang Yan and Professor Zhao Kanxing, and 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.

The Atlas of Fundus Diseases, edited by Professor Zhang Huirong of Peking University Third Hospital, and compiled by many fundus disease experts from Peking University Ophthalmology Center of Peking University Third Hospital, Beijing Tongren Ophthalmology Center of Beijing Tongren Hospital affiliated to Capital Medical University, and Peking Union Medical College Hospital of Chinese Academy of Medical Sciences, has been officially published by People's Medical Publishing House.

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.

If the topic involved in the paper 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.

The Atlas of Corneal Diseases edited by Professor Xie Lixin was officially published by People's Medical Publishing House in March 2011. The book systematically reflects the clinical characteristics of corneal diseases in the form of images, characteristically reflects the effects of modern corneal imaging examination and modern scientific treatment, and enables readers to "read pictures".

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 years' 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. Jing Chen Jiaqi,

Edited by Professor Zhang Chengfen, Department of Ophthalmology, Peking Union Medical College Hospital, Fundus Diseases (Second Edition) was published by People's Medical Publishing House in September 2010.

Chinese Medical Association is scheduled to hold the 17th National Ophthalmology Academic Conference in Nanjing, Jiangsu Province from August 21 to 25, 2012. This is another large-scale ophthalmology event held in China after the 16th National Ophthalmology Academic Conference of Chinese Medical Association and the 4th Global Chinese Ophthalmology Academic Conference in 2011. It is expected that 5,000 delegates will participate in the event, and more than 1,000 famous international and domestic ophthalmologists will give special reports on new technologies, new knowledge and new experiences in ophthalmology development.