Volume 48 · Issue 10 · 2012

Age-related macular degeneration (AMD) is the leading cause of irreversible severe vision loss among people over the age of 50 and a major cause of blindness among people aged over 65 in developed countries.With the improvement of China's economic levels and entering the aging society with an acceleration speed,the growing number of AMD patients has become an increasing concern of the whole society.The etiology and pathogenesis of AMD are still not clear and this is a hot spot for ophthalmic research around the world.Currently thoughts that environment factors and genes,oxidative damage,inflammation,immune reaction,imbalance between angiogenesis factors and anti-angiogenesis factors,etc.are all involved in the occurrence and development of AMD.However,how to explore the pathogenesis of AMD in Chinese population from the complex reported literature deserved attention.The authors suppose that we should start from analysis of controversy and find a breakthrough in the dispute,to explore the pathogenesis of AMD in Chinese population.

Neovascular age-related macular degeneration (AMD) is the major cause of visual impairment in elder people.The progress in biomedicine and the launch of new agents provide hope to the patients with AMD.Factors assoeiated with the response of AMD to treatment have been investigated,including the baseline visual acuity,age,the characteristics of the AMD lesions and the genotype of the patients,etc.Preferred Practice Pattern(R) guidelines are developed in different countries based on these evidences,which providet guidance for the pattern of practice,not for the care of a particular individual.To develop an evidence-based individual treatment strategy for the wet AMD patients,accurate and comprehensive evaluation are critical in initial visit and during the follow-up.Individual treatment strategy will not only benefit the patient with better visual outcome and higher quality of life,but also promote the best health economic efficiency for AMD treatment in our aging society.

Many retinal vascular diseases have all been shown to share the upregulation of VEGF expression of vascular endothelial growth factor (VEGF) in the pathologies,recent clinical trials regarding the intravitreal injection of anti-VEGF agents have shown a shrink of CNV and decreased leakage.Certain efficacy was shown in the treatment of angiogenic pathologies including neovascular AMD,choroidal neovascularization caused by several different causes,macular edema by diabetic retinopathy and vein occlusion,Retinopathy of prematurity,and neovascular glaucoma.A controversies in the indication of treatment using anti-VEGF are:inhibit the new vessels of proliferative diabetic retinopathy? decreased bleeding using intravitreal bevacizumab before vitrectomy of diabetic retinopathy? reduced leaking in Coats Diseases? The controversy based on a new finding of fibrosis formation after using intravitreal anti-VEGF.however,recurrent/persistent leaking from CNV or macular edema is common,there is a potential risk of endophthalmitis for frequently intravitreal injections.

Objective To determine the quantitative changes of choroidal thickness in central serous chorioretinopathy.Methods Cross-sectional study.Twenty-three patients with unilateral central serous chorioretinopathy (CSC) in acute and chronic stages were diagnosed after fluorescein angiography,indocyanine angiography and enhanced depth imaging optical coherence tomography (EDI OCT).EDI OCT scan across the fovea was performed in each eye and the result was compared with that from an age-,sex-matched and spherical equivalent-matched control subject.Subfoveal thickness of choroid was calculated by a onboard software in HRA2.Results Choroidal thickness in the CSC eyes and the fellow eyes was (464.43 ±97.15) μm and (399.91 ± 124.01) μm,respectively.No significant difference between the two groups (t =4.653,P ＜ 0.05).Choroidal thickness was (313.09 ± 70.67)μm in the control group.There was statistically significant difference in thickness between the CSC goup and the control group (t =5.077,-2.085 ;P ＜ 0.05).Choroidal thickness in the fellow eyes with choroidal vascular hyperpermeability was (506.44 ± 75.66) μm,which was differed significantly(t =4.749,P ＜ 0.05) from the non-hypermeability eyes (331.43 ±97.94)μm.Conclusions Subfoveal choroid thickness in the symptomatic eye and the fellow eyes in CSC gruoup is thicker than that of the control group.The subfoveal choroidal thickness of eyes with hypermeability is thicker than that in the non-hypermeability eyes.EDI-OCT is a noninvasive procedure which can be used to evaluate the choroidal hypermeability in CSC.

Objective To evaluate the characteristics of choroidal thickness changes and abnormalities in choroidal circulation in cases of central serous chorioretinopathy (CSC).Methods This was a case control study,we measured the bilateral choroidal thickness in 21 patients with unilateral CSC and 24 eyes of 24 age-and sex-matched normal subjects using enhanced depth imaging optical coherence tonography (EDI-OCT).The choroid was measured from the posterior edge of the retinal pigment epithelium (RPE) to the choroid-scleral junction at 500 μm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea.Paired-samples t-test was conducted to compare mean choroidal thicknesses between symptomatic eyes and fellow eyes of patients.The datum between patients and normal subjects were analyzed by independent-samples t-test.Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed and the digital images were analyzed in CSC patients.Results The 21 CSC patients had a mean age of 45.6 years,and 12 patients (57.1％) were male.The choroid in symptomatic eyes was thickest beneath the fovea (519.0 ± 102.5) μm.It was significantly thicker than that in the fellow eyes (439.3 ± 94.1) μm (t =4.171,P ＜ 0.05).Choroidal thickness in both groups was significantly greater than that in the eyes of age-and sex-matched normal subjects (332.0 ± 67.3) μm (t =7.125,4.441 ;P ＜0.05).Choroidal thickness at each of the other 12 points showed a similar tendency (t =2.544 to 3.819,4.799 to 7.816,2.487 to 5.236;P ＜0.05).ICGA showed a choroidal filling delay (100％),vessels dilation (90.5％),and focal choroidal hyperfluorescence (100％) surrounding leakage from the RPE in symptomatic eyes.Pigment epithelium detachment with abnormal choroidal circulation was observed in 6 fellow eyes.In 4 symptomatic eyes and 11 fellow eyes,ICGA revealed choroidal hyperfluorescence but FFA showed normal appearance.Conclusions CSC seems to be a bilateral eye disease with choroidal focal ischemia followed by vessels congestion and hyperpermeability.EDI OCT is a useful tool for monitoring choroidal thickness changes caused by choroidal vascular hyperpermeability.

Objective To detect macular foveal by CirrusTM HD-OCT using the post acquisition fovea detection and to study its influence on the results of measurement of central retina thickness (CRT).Methods In this retrospectively studies,the 512 × 128 cube scans from 50 eyes of normal subjects and 50 eyes of macular edema patients were analyzed.Three methods for the foveal detection were used,the scan center (SC),the automated detected foveal (AF) and the manually identified foveal (MF).The foveal detected by MF was set as the reference.Radial distances from SC and AF to MF were calculated.Subfields retinal thickness acquired from different groups using different foveal detection methods were compared by paired Student's t test for normal data or Wilcoxon-Mann-Whitney for non-normal data.Results For normal subjects,it is reliable determing the foveal by special tomography features.The means of the radial distance from the MF was (35.0 ± 23.O) μm in scan center group and was (6.0 ± 9.0) μm in automated center (t=-3.732,P ＜0.05).The average CRT difference between the SC and MF groups was (7.4 ±10.4) μm.The median difference between the AF and MF groups was 0 μm (0 to 3),which is significantly less than that between the SC and MF groups (Z =-2.956,P ＜ 0.05).In subjects with macular edema,the means of the radial offset was (59.0 ± 26.0) μm in SC group and was (34.0 ± 23.0)μm in AF group (t =-4.555,P ＜ 0.05).The average CRT difference between the SC and MF groups was (28.0 ± 36.0) μm,which was not significantly greater than the difference between the AF and MF groups (23.0 ± 31.0) μm in macular edema eyes.Conclusions Post acquisition detection of foveal reduces the radial offset to the real fovea,and may improve the reproducibility and reliability of the central retinal thickness qtantification using spectral domain OCT in normal subjects.

Objective To evaluate retinal nerve fiber layer (RNFL) thickness in patients and unaffected carriers of Leber hereditary optic neuropathy (LHON) by optical coherence tomography (OCT).Methods This case-control study enrolled 42 LHON maternal family members with mitochondrial DNA G11778A mutation and 100 normal volunteers.RNFL thickness was measured by Stratus OCT in each participant.Mean RNFL thickness of each quadrant,as well as 360° average were calculated and compared in normal controls,LHON carries and LHON patients.Results Among LHON maternal family members,15 cases were unaffected carriers who were subgrouped as normal-fundus-appearing carriers (10 cases) and preclinical carriers (5 cases).Twenty seven LHON patients included 9,5,and 13 cases in the early,advancing and advanced stages,respectively.Normal fundus-appearing carriers showed normal RNFL thickness of each quadrant and 360° average.Preclinical carriers and early-staged patients showed no significant difference in RNFL thickness of each quadrant and 360° average(P =0.138 to 0.645),yet both showed thicker RNFL in temporal,superior and inferior quadrant,as well as 360° average,if compared with normal controls (P =0.000 to 0.018).Compared with normal controls,preclinical carriers and early-staged patients,advancing LHON patients showed thinner RNFL in temporal and inferior quadrant,as well as 360° average (P =0.000 to 0.005).Advanced LHON patients showed thinner RNFL in each quadrant and 360° average,compared with normal controls,LHON carriers,and advancing cases (P =0.000 to 0.037).Conclusions RNFL thickness in LHON patients and unaffected carriers was characterized by OCT in this study,which would improve the understanding of the natural course of LHON.

Objective To analyse the mode of inheritance and clinical characteristics of retinitis pigmentosa (RP) patients with consanguineous marriage.Methods RP patients were recruited for this study in Ningxia Eye Hospital from September 2009 to July 2011.All patients received complete ophthalmic examination.The mode of inheritence were determined based on family history and marriage history.Clinical features were characterized by complete ophthalmic examinations including visual acuity,macular OCT,visual field and electroretinogram (ERG).Results A total of 143 individuals with RP (33 families) were recruited.Based on analysis of family history and marriage history,20 RP families (23 patients) had consanguineous marriage history accounted for 60.6％ RP families (16.1％ RP patients).There were 4 patients (from 4 families) diagnosed as Usher syndrome.In 20 RP families with consanguineous marriage history,7 families (35.0％) were Hui ethnicity and 13 families (65％) were Han ethnicity.The marriages of 15 families were between first cousins and 3 families were between second cousins,only 2 families were between half cousins matrimony.Of 23 RP patients,12 were males and 11 were females.The average age of onset was 11.4 ± 6.8 years and the average age of recruitment was (32.0 ± 13.5) years.The best-corrected visual acuity was less than 0.6 in 78.2％ patients.According to the features of the fundus,13 patients were classical retinitis pigmentosa and 10 patients were retinitis pigmentosa sine pigmento.Visual field examination showed that all patients had varying degrees of peripheral visual field defect.Retinal neuroepithelial layer of macular and peripheral retina became thinner and retinal photoreceptors were disappeared.The average thickness of macular fovea was (186.1 ±78.7) μm on right eyes and (187.4 ±76.3)μm on left eyes.Conclusions The incidence of RP with consanguineous marriages was high in Ningxia Region.The mode of inheritance of RP patients with consanguinity is autosomal recessive.The common marriage pattern of consanguinity is between first cousins.The age of onset is early and the ocular fundus changes of some patients are atypical,this should be paid attention clinically.

Objective To investigate the characteristics and risk factors of biological ocular structures in the development of diabetic retinopathy in diabetes mellitus (DM) patients.Methods Retrospective case series study.Systemic condition,results of laboratory examination,fundus examination,refractive status and ocular biometry measured by IOL Master,were collected from the DM group(118 type-Ⅱ diabetic patients with diabetes more than 10 years) and the control group (50 cataract subjects without diabetes).The DM group was classified to three subgroups:none diabetic retinopathy,minimal and moderate nonproliferative diabetic retinopathy (NPDR) and vision-threatening diabetic retinopathy.Chisquare and Kruskal-Wallis rank sum tests were used to compare the difference between the DM and control groups.Ocular biometry,including axial length (AL),anterior chamber depth (ACD),corneal diameter,corneal curvature and spherical equivalent refraction (SE) were analyzed with multivariate logistic regression.Results 1.There was no significant difference in systemic factors.2.Ocular factors:There were significant differences of AL and ACD between the DM and control groups.The risk for the development of DR and the severity of DR were increasing with shorter AL and ACD between the three DR subgroups,especially the risk of and the occurrence of macular edema (ME) (OR =16.869,7.248,6.577 ;P ＜0.05,respectively).3.The risk of advanced DR increased significantly in hyperopia (OR =1.301,95％ CI =1.044 to 1.621 ;P ＜ 0.05).Conclusions The ocular risk factors of type-Ⅱ DM patients with diabetes more than 10 years are the AL and ACD,which have significant relationship with the development and the progress of DR.

Objective To determine the incidence and risk factors of retinopathy of prematurity (ROP) among premature infants.Methods The fundus examination data of 2185 cases of premature infants [birth body weight ≤ 2000 g or gestational age (GA) ≤ 34 weeks] in neonatal intensive care unit of Bayi Children's Hospitals in Beijing between January 2009 and December 2010 were collected and retrospectively analyzed.Results、Of 2185 cases of premature infants (1571 had used supplemental oxygen) received RetCam-Ⅱ ophthalmoscopy screening,287 cases developed ROP with the incidence of 13.1％ according to the international classification of ROP (ICROP),including 34 cases (11.9％) suffering from zone Ⅰ,147 cases (51.2％) from zone Ⅱ,and 106 cases (36.9％) from zone Ⅲ.Stage 1,2 and 3 lesions were 117 cases,142 cases and 28 cases,accounting for 40.8％,49.5％ and 9.7％,respectively,while stage 4 and stage 5 lesions were not found.Thirty-six cases developed plus disease,accounting for 12.5％.Between ROP and Non-ROP groups,there were significant differences in birth weight (1269.9 ± 380.0) g vs (1479.7±359.3) gvs (1633.9±352.3)g,gestationalage (30.6±2.0) gvs (32.4±1.8) W and time of supplemental oxygen [Median 10 d (0 to 71 d) vs 2 d (0 to 36 d)].Among zone Ⅰ,Ⅱ and Ⅲ groups,there were significant differences in birth weight (1269.9 ±380.0) g vs (1479.7 ± 359.3) g vs (1633.9±352.3) g,gestational age(29.3 ±2.2)W vs(30.5±1.9)W vs(31.2±1.8)W and time of supplemental oxygen[Median 14 d (0 to 52 d)vs 10 d (0 to 71 d) vs 8 d (0 to 52 d)] (x2 =257.5,371.7,6.695 ;P ＜ 0.05),while among stage 1,2 and 3 groups,there were also significant differences in birth weight (1593.3 ±413.7) g vs (1481.3 ±336.7)g vs (1325.3 ±313.7) g,gestational age (30.9 ±2.0) W vs (30.6 ± 1.9) W vs (29.5 ± 1.7) W and time of supplemental oxygen[Median 8 d (0 to 52 d) vs 11 d (0to65 d) vs 12 d (0to71 d)] (x2=230.8,273.5,6.695;P＜0.05).In 1004 cases admitted in 2009,150 developed ROP with the incidence of 14.9％ ; while in 1181 cases admitted in 2010,137 developed ROP with the incidence of 11.6％.There was significant differences in the incidence of ROP between these two years (x2 =5.305,P ＜ 0.05).Thirty-eight infants (1.7％) received laser therapy and only 3 infants progressed to stage 4 after laser therapy.Three infants with laser failed stopped progress after vasectomy.Finally,all patients were cured without blindness.Conclusions Less birth weight,shorter GA and time of supplemental oxygen are close related to the development of ROP.It is necessary to pay high attention to the screen on premature infants with smaller gestation age,lower birth weight or using oxygen for the reduction or even avoid of blindness.

Objective To investigate the prevalence and main causes of blindness and low vision among adults aged ≥ 60 years in the suburban population of Nantong,Jiangsu,China.Methods It was a population-based cross-section study.Census in selecting individuals aged ≥60 years was conducted in two villages of suburb area in Nantong from June to August in 2008.One thousand three hundreds and ninety-one individuals received visual acuity test and eye examination,including lens examination by slit lamp.Blindness and low vision were graded by World Health Organization (WHO) visual impairment criterion and presenting visual acuity criterion,respectively.The main causes of blindness were analyzed in eyes whose visual acuity was lower than 0.05.Chi-square test and trend chi-square test were used to analyze the data.Results Of 1391 enumerated subjects,1305 adults participated in the survey and the response rate was 93.82％.According to WHO visual impairment criterion,the prevalence of bilateral blindness and bilateral low vision was 0.54％ and 4.06％,respectively; the prevalence of unilateral blindness was 3.37％.According to presenting visual acuity criterion,the prevalence of bilateral blindness was 2.15％,the prevalence of unilateral blindness was 7.13％.According to WHO visual impairment criterion and presenting visual acuity criterion,the prevalence of blindness was raised with increasing age (trend x2 =27.97,P ＜ 0.01).The leading cause of blindness were cataract,ocular fundus diseases and ametropia.Conclusions Cataract blindness continues as a significant problem among suburban elderly.There are large cataract patients that need operation in the eastern coastal region.The first important task in blindness prevention still is the elimination of cataract blindness.

Objective To explore the depth of invasion of limbal tumors using in vivo confocal microscope and to compare the result to that in histopathological findings.Methods Five cases of limbal tumors with clinical diagnosis of squamous cell carcinoma were evaluated with in vivo confocal microscope.Tumor excision and lamella corneal transplantation were performed for each patient.The results of confocal microscopy were compared to that in histopathologic sections.Results One case of invasive squamous carcinoma,three cases of intraepithelial dysphasia and one case of squamous papilloma were identified by histopathological examination.The main pathological features could be recognized by confocal microscope images,including papillomatous hyperplasia,cytonuclear atypias,and activation of dendritic cells.Intersection of neoplasm and normal tissue could be displayed by oblique scanning.Conclusions With appropriated oblique scanning,in vivo confocal microscopy can provide information of cellular structure and the depth of invasion,this is useful in the diagnosis and management of limbal neoplasm.However,the identification of tumor cell phenotypes still needs ex vivo histopathological examination.

Objective To investigate the differences of long-term clinical outcomes between two kinds of corneal endothelial keratoplasty (EK):DSEK and DLEK.Methods Retrospective,comparative,clinical case series study.Twenty-six patients (26 eyes),undergoing DLEK and thirty-six patients (36eyes),undergoing DSEK during the period of October 2005 to March 2008,were involved in this study.Before and at 6 month intervals after surgery,patients' data were collected to analyze the surgery success rate,graft dislocation rate,best corrected visual acuity (BSCVA),graft survival rate and endothelial cell density (ECD).The follow-up time was 3 to 5 years.Results The success rate of DLEK was 88.5％ while DSEK was 86.1％.Average BSCVA of DLEK were similar to those of DSEK at each follow-up time after 12 months postoperatively.Graft survival rates of DLEK and DSEK were respectively 87％ and 75.9％,where as ECD were respectively 1638 cells/mm2 and 1874 cells/mm2 at 36 month postoperatively,the data were similar in both ECD and graft survival rate between DLEK and DSEK at 60 months postoperatively.Conclusions The success rate and long-term visual outcomes of DLEK were similar with those of DSEK.To obtain objective results,it is better to consider both ECD and graft survival rate instead of recording ECD only for its localization in evaluating the efficacy of EK.

A 3-year-old female patient came to the Institute of Orbital Diseases of Armed Police General Hospital on May 24, 2010 due to the discovery of a spherical mass in her left eye for 3 years. The spherical mass in her left eye could be seen at birth, and the eye structure could not be seen clearly. There was no obvious change in the mass within 3 years. Full-term cesarean section, and no other abnormalities except the eye were seen after birth. Family history and genetic history are denied. Eye examination: the binocular vision examination was not cooperative, the right eye had a chasing reaction, and no obvious abnormality was found in the right eye.

The patient was a 71-year-old female who came to the Department of Ophthalmology of Tianjin No.1 Central Hospital on December 15, 2009 because of the obvious enlargement of the mass in the lower eyelid of her right eye. She reported that she found that the mass was palpable under the skin of the lower eyelid of her right eye 3 months ago, and the mass was obviously enlarged recently, without diplopia, nausea, vomiting, headache, dizziness and other symptoms. Ocular examination: the right eyeball was exophthalmic, accompanied by internal and upper displacement, and the mass was palpable under the skin of the lower eyelid, about 2 cm ×1 cm in size, irregular in shape, with clear boundary, no obvious adhesion to the surrounding tissues, good mobility, and could be incorporated into the orbit. No obvious abnormalities were found in the anterior and posterior segments of the eye, insufficient movement of the eyeball in all directions, obvious restriction of external rotation, and orbital pressure (-). The exophthalmic degree was 14 and 18 mm in the left and right eyes, respectively, and the orbital distance was 98 mm. Orbital CT showed a space-occupying lesion in the lower part of the right orbit with clear boundary, irregular shape and homogeneous density, involving the posterior part of the eyeball, showing casting-like changes with the eyeball, and displacing inward and upward by compressing the eyeball (Figure 1). B-ultrasound examination showed that a hypoechoic lesion area was seen below the eyeball in the anterior part of the right orbit, with uneven internal echo and mild deformation by compression.The patient had no other systemic diseases, and the superficial lymph nodes of the whole body were not palpated.Under general anesthesia, the right intraorbital mass was resected, and the mass was gray-red, irregular in shape, clear in boundary, slightly adhered to the surrounding fat, without envelope, incomplete in tissue, soft in texture, about 3.0 cm ×2.5 cm in size.

The patient was a 57-year-old male who went to the Ophthalmology Clinic of Peking University People's Hospital on July 22, 2008 because of "blurred vision in his left eye for more than 3 months". The patient was diagnosed with "choroidal melanoma in his left eye" in another hospital. He had suffered from dilated cardiomyopathy for 1 year and apnea syndrome for 5 years, and denied diabetes, hypertension and other systemic diseases. Ophthalmological examination: visual acuity: far visual acuity of right eye 1.2, near visual acuity Jr5, far visual acuity of left eye 0.25, near visual acuity Jr7 was not seen; IOP: 9 mm Hg (1 mm Hg =0.133 kPa) in the right eye and 7 mm Hg in the left eye; The conjunctiva of both eyes was not congested, the cornea was transparent, the sclera was not seen with tumor or pigment, the anterior chamber was medium depth, the iris pigment was normal without tumor, and the lens was clear.

The child was a 4-month-old male, born by caesarean section at term. Because his parents found leukoplakia in both eyes for half a month, he went to a local hospital for treatment. The measured intraocular pressure was higher than 40 mm Hg (1 mm Hg =0.133 kPa), and he was diagnosed as "congenital glaucoma". The intraocular pressure was lowered with 0.005% latanoprost eye drops combined with 1% brinzolamide eye drops. He was transferred to the Department of Ophthalmology of Xinhua Hospital on April 19, 2011 for anti-glaucoma surgery. Physical examination: The child's body temperature was normal, and the systemic medical history was denied, and there was no history of contact with epidemic sources. No abnormalities were found in chest X-ray film and electrocardiogram. Eye examination: The intraocular pressure of the right eye was 16 mm Hg and that of the left eye was 10 mm Hg measured by rebound tonometer. The conjunctiva of both eyes was congested (+), the cornea was hazy, the anterior chamber cells (+ + +), and the surface of the iris was covered with gray and white cords with irregular hill-like bulge. The peripheral anterior adhesion of the iris, the pupil was less round, about 2 mm in diameter, and it was insensitive to light reflection. There was a small amount of exudative membrane on the surface of the lens, and the fundus was unclear (Figure 1). The preliminary diagnosis segment showed the cause of secondary glaucoma to be investigated.

A 6-year-old child came to the Department of Ophthalmic Oncology of Beijing Tongren Hospital on September 7, 2010 due to swelling of the upper lid of his right eye for nearly 1 year. One year ago, the child developed redness and swelling of the upper lid of his right eye without obvious trigger, no redness, eye pain, tearing and itching, no vision loss and diplopia, no fever and other systemic symptoms, and was not diagnosed and treated. Since the onset of the disease, the redness and swelling of the upper lid of his right eye have gradually worsened, and the eyeball of his right eye has gradually protruded. The parents of the child reported that he had suffered from skin eczema for many years and has been basically cured.

The patient was a 68-year-old male who came to the Department of Ophthalmology of Eye, Ear, Nose and Throat Hospital affiliated to Fudan University because of the decrease of visual acuity in his left eye for 4 months. He had undergone phacoemulsification and cataract aspiration and intraocular lens implantation in his left eye 12 years ago. The postoperative visual acuity was 0.8. There was no abnormality in the whole body examination. Ophthalmological examination: the visual acuity of his left eye was 0.3, the intraocular pressure was 16 mm Hg (1 mm Hg =0.133 kPa), the cornea was transparent, the anterior chamber was medium depth, the aqueous humor flashed (-), the posterior corneal deposition (-), the pupil was round, the intraocular lens was in position, and the posterior surface of the intraocular lens under the slit lamp microscope could be seen with a gray-white turbid light band, which bulged backwards. The anterior segment of the eye after the dilated pupil was examined in the essence pictures 1 and 2, and the fundus examination showed no abnormality. Diagnosis: Left eye capsular bag block syndrome.

Recently,many studies indicated that certain medications can delay the apoptosis of retinal nerve cells at different points during the process of apoptosis and have neuroprotective effect on preventing degenerative ocular fundus diseases.N-methyl-D-aspartate receptor (NMDAR) antagonists,NMDAR-associated calcium channel blockers and acetylcholine receptor agonists have been shown to have neuroprotective effects for retinal damages by inhibiting NMDA-induced excitotoxicity.The inhibitors of nitric oxide synthase (NOS) can prevent the cell apoptosis and reduce the retinal cell loss by suppressing the activity of NOS as well-as the production of the nitric oxide.Antioxidants and some Chinese traditional medicine with antioxidant activities can also have protective effect on retinal damage caused by degenerative ocular fundus diseases through their functions in decreasing the peroxidation reaction and the production of the superoxide radicals in the cells.In addition,activation of neurotrophic factor receptors by their ligands plays a key role in neuroprotective and trophic effects for the retina.All of these studies not only provide the foundation,but also offer new theoretical supports for drug neuroprotective therapies in clinical practice.

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 state departments, and a number of funds shall be listed in turn, separated by ";". All fund projects must be accompanied by copies of certificates.

CYP4V2,a relatively new member of human cytochrome P450 (P450) enzymes,is termed an "orphan" P450 because its substrate specificity and physiological roles are unknown.Mutations in the CYP4V2 gene is associated with an autosomal recessive inherited ocular disease named Bietti's crystalline dystrophy (BCD).The strong gene-disease associations provide unique opportunities for elucidating the substrate specificity of this orphan P450s and unraveling the biochemical pathways that may be impacted in patients with CYP4V2 functional deficits.

Researches on lens proteomics are becoming prevalent in recent years.Characterized by their high resolusion and efficiency,proteomics approaches provide reliable methodological support for lenses proteomic research,which demonstrates a new orientation for revealing the mechanism of cataractogenesis.This review outlines the separation,identification and some novel approaches of proteomic techniques applied in recent lenses proteomic research.

Except for the characteristics of stem cells,mesenchymal stem cells (MSC) have other distinct functions such as prompting wound healing,anti-inflammatory and immunoregulatory ability,which has made them one of the most promising candidates for cell therapy.By taking advantage of their different characteristics and functions,MSC have been exploited in the treatment of many ocular diseases,such as corneal diseases,uveitis and retinal diseases.This paper will review the progress of the applications of MSC in ocular diseases in recent years.

The 2012 Symposium on Ophthalmic Excimer Laser Corneal Refractive Surgery of Chinese Medical Doctors Association and the 9th National Symposium on Ophthalmic Excimer Laser Corneal Refractive Surgery will be held in Nanning, Guangxi Province from October 24th to 29th, 2012. The relevant matters of the meeting are hereby notified as follows.

The Ophthalmology Center of Tianjin Medical University will hold the 2012 International Symposium on High Myopia and the New Technology Study Class in the Anteocular Festival from December 8 to 9, 2012 (Saturday and Sunday). At that time, well-known refractive surgery experts, cataract and glaucoma experts at home and abroad will be invited to give special lectures and surgical comments on high myopia, high myopia, cataract and glaucoma related contents and the latest development trends.

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

The title should strive to be concise and eye-catching, which can accurately reflect the theme of the article. Chinese titles are generally within 20 Chinese characters, preferably without subtitles, generally without punctuation, and try not to use abbreviations. The meaning of Chinese and English titles should be consistent.

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 description format of reference documents in this journal basically implements GBIT7714-2005 "Rules for Description of Reference Documents after Text". Sequential encoding is used to make a record, which is marked with 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.

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. This book includes two parts: basic research and clinical diagnosis and treatment of choroidal neovascular diseases, taking into account both advancement and practicality. It involves the basic theoretical research progress of choroidal neovascularization, prevention and treatment, related laboratory research technology, clinical examination technology and treatment methods, etc., and focuses on more than 30 kinds of choroidal neovascular diseases.

In order to promote international exchanges in the field of ophthalmology and enable domestic doctors to read excellent overseas monographs on ophthalmology, the editorial department of the Overseas Excellent Medical Monographs Introduction Project of China International Medical Exchange Foundation organized and published the book "Pathogenesis and Treatment of Ophthalmic Diseases" in August 2012.

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. After auditing by authoritative domestic experts such as Chen Jiaqi, Chu Renyuan, Xie Lixin, Liu Guoguo and Yao Ke, it was listed as the national "Eleventh Five-Year Plan" key audio-visual publication planning project No.150. The video material (DVD) of "Surgical Treatment of Conjunctival Relaxation" was edited and published by China Medical Electronic Audio-visual Publishing House.

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. Fundus Diseases (Second Edition) is supplemented and updated on the basis of the first edition published in 1998. It focuses on the diagnosis and treatment of fundus diseases, incorporates the rich clinical experience of the Department of Ophthalmology of Peking Union Medical College Hospital, and adds recent research results and related literatures, especially supplements the new progress of fundus diseases at home and abroad in recent years, such as frequency domain coherence optical tomography, photodynamic therapy, intravitreal injection of anti-vascular endothelial growth factor drugs, and the diagnosis and treatment of polypoid choroidal vasculopathy, and strives to meet the clinical needs of domestic ophthalmology. The book has more than 1.3 million words and more than 1,500 illustrations. The text is concise and the pictures are excellent. It is a monograph on fundus diseases suitable for Chinese readers.

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.

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.