Volume 53 · Issue 03 · 2017

This issue focuses on the research progress of ocular surface diseases. The responsible editorial committee responsible for the planning, composition and review of the key contents of this issue is Professor Shi Weiyun.

Corneal epitheliopathy is a commonly seen disease in the clinical work. However, due to its complicated causes, there remain misdiagnosis and mistreatment, which would aggravate epithelial keratopathy and induce corneal scars, eventually leading to irreversible visual impairment. In this article, the primary and secondary causes of corneal epithelial lesions are described in detail. The classification, diagnosis and treatment principles of the disease are also presented to arouse more concern about corneal epitheliopathy. (Chin J Ophthalmol, 2017, 53: 161-163)

Corneal transplant is the main treatment for blindness caused by corneal diseases. The common methods of corneal transplant include penetrating keratoplasty and lamellar keratoplasty. With the advances of microsurgical instruments and technology in recent years, deep anterior lamellar keratoplasty (DALK) has gradually increased. Compared with conventional penetrating keratoplasty, the optical effects of DALK are not much different, but DALK has fewer complications. So DALK is expected to become the mainstream of corneal transplantation. Clinical surgeons try to promote DALK in China. However, there are certain learning curves and some controversies. Therefore, we discuss the controversial issues about DALK in this article.(Chin J Ophthalmol, 2017, 53: 164-166)

At present, trabeculectomy is still one of the most predominant anti-glaucoma surgical methods. However, this operation has many complications such as bleb ptosis, thin wall bleb, bleb inflammation, endophthalmitis, etc., and causes permanent ocular surface changes. Therefore, finding non-bleb-dependent anti-glaucoma surgery has been a hot spot of clinical attention. Mucosal tubuloplasty can achieve the goal of reducing intraocular pressure by dredging the physiological channels of aqueous humor. Because the operation completely eliminates the complications associated with filtering vesicles and has a good effect of lowering intraocular pressure, this operation has become one of the important surgical methods for open-angle glaucoma^[1]。 However, the operation is complicated, requires the fabrication of scleral cistern and Dickel membrane window, and the incidence of intraoperative complications is high. Clinical studies using UBM examination found that patients can still maintain good intraocular pressure after mucous tubuloplasty with the disappearance of the scleral cistern and the closure of the Dickel membrane window, indicating that the most difficult step in this operation, that is, the making of the scleral cistern and Dickel membrane window may not be necessary for the operation. Therefore, aqueous humor outflow pathway reconstruction, i.e., mucous tubuloplasty without the need to make scleral cistern and Dickel membrane window during the operation, not only has a similar surgical success rate as mucous tubuloplasty, but also avoids related surgical complications and has better safety^[2,3,4]。

Primary congenital glaucoma is the main type of glaucoma in children. It is a kind of glaucoma caused by abnormal development of eyeball angle tissue during embryonic and developmental stages. The first choice of treatment for primary congenital glaucoma is surgery. At present, the most commonly used surgical method is external trabeculotomy. However, this procedure has shortcomings such as unclear incision site and small incision range (120°).

To introduce the surgical methods and investigate the treatment effects of conjunctival lesion resection combined with transplantation of allogeneic limbal epithelia cultured in vitro for treatment of varied large conjunctival lesions.

A retrospective analysis of case data of the patients receiving transplantation of allogeneic limbal epithelia cultured in vitro for large conjunctival lesions at Qingdao Eye Hospital from January 2013 to December 2015 was conducted. Fresh donor corneal limbal epithelial tissues were obtained for cellular digestion and isolation. The cells were cultured on de-epithelized amniotic membrane to form a stratified cell sheet with 3 to 5 layers of cells for reservation. Conjunctival lesions were removed, and corneal limbal epithelial cell sheets corresponding to the size of the conjunctival defects were covered on the scleral flaps, before the conjunctivae were para sutured with corneal limbal epithelial cell sheets. The stitches were removed 7 days after surgery. The treatment effects were evaluated.

There were 11 cases (12 eyes) in this study, including 6 cases (6 eyes) of recurrent pterygium combined with symblepharon, 3 cases (3 eyes) of conjunctival compound nevus, 1 case (1 eye) of conjunctival primary acquired melanosis, and 1 case (2 eyes) of dermoid lipoma. The patients were 6 to 69 years old, with an average age of (46±23) years old. There were 5 male patients and 6 female patients. The follow-up time was 6 to 39 months, with an average time of (24.8±12.4) months. The conjunctival lesions in all patients were more than 2 quadrants. No patients had intraoperative and postoperative complications. No obvious irritation symptoms were observed after surgery. There were a few small pieces of epithelial defects on the limbal epithelial cell sheets at the end of the operation due to operative injury. With postoperative cellular proliferation and repair, the epithelium gradually healed and tended to become firm, and the boundaries with original conjunctival epithelium gradually disappeared. The healing time of the epithelium after surgery was 3 to 7 days, with an average time of (4.5±1.2) days. No immunological rejection occurred after surgery. No recurrence of original diseases was observed among all the patients at the last follow-up.

Transplantation of allogeneic cultured limbal epithelial cells, which was carried out for the treatment of large conjunctival lesions, witnessed rapid epithelization at the areas of lesion resection. It could reduce the risk of recurrence of original diseases and effectively avoid the occurrence of postoperative symblepharon. The postoperative inflammatory reaction was also minor. (Chin J Ophthalmol, 2017, 53:172-176)

To describe corneal alterations visible on in vivo confocal microscopy in patients with debilitating ocular sequelae caused by Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

Twenty-two eyes of 11 consecutive patients suffering from chronic SJS or TEN were studied using slit lamp and in vivo confocal microscopy in the Ophthalmology Outpatient Department of Peking Union Medical College Hospital from March 2014 to April 2015.

Dry eye with meibomian gland dysfunction (19 eyes of 10 patients, 86.4%) was the most frequent clinical sequelae. Two patients (3 eyes, 13.6%) had severe vison loss with corneal neovascularization and conjunctivization. One patient had asymmetric binocular disease. Corneal epithelial cells were observed at an active state in 10 patients (19 eyes, 86.4%) and corneal stromal cells at an active state in all patients (22 eyes, 100%). Twenty eyes (10 patients, 91%) were noted with abnormal nerve layout and 10 eyes (5 patients, 45.5%) with dendritic cell infiltration around pathological nerve damages. Numerous inflammory cells were observed in 6 eyes (3 patients, 27.3%).

The corneas of patients with chronic ocular sequelae associated with SJS or TEN present a number of abnormalities. In vivo confocal microscopy is a potetial useful tool for therapeutic indications and for follow-up of the debilitating chronic ocular problems linked to SJS and TEN. (Chin J Ophthalmol, 2017, 53:177-181)

To investigate the effect of optical zone diameter on corneal biomechanical properties after small incision lenticule extraction (SMILE).

In this prospective case-control study, 62 eyes of 42 patients with myopia and myopic astigmatism that had undergone SMILE procedure were divided into 2 groups according to the optical zone (OZ) diameter: group A, 31 eyes of 19 patients, OZ= 6.5 mm; group B, 31eyes of 23 patients, OZ=6.0 mm. These patients were examined for corneal hysteresis (CH) and corneal resistance factor (CRF) with the Ocular Response Analyzer (ORA) preoperatively and at 1 week, 1 month and 3 months postoperatively; at the same time, the central corneal thickness-corrected indices of DifCH and DifCRF were calculated. Pearson correlation was applied to analyze the correlation between CH and CRF and central corneal thickness. Independent-samples t test was utilized to compare CH and CRF between the two groups. Repeated ANOVA was used to compare the difference of corneal biomechanical properties at different follow-up timepoints.

The preoperative mean CRF and CH values were (10.13±1.19) mmHg and (9.65±1.12) mmHg in group A and (10.34±0.89) mmHg and (10.04± 1.05) mmHg in group B, respectively, and no significant differences were found in CRF and CH between the two groups (CRF: t=-0.807, P=0.423. CH: t=-1.405, P=0.165). The mean CRF values in group A at postoperative 1 week and 3 months were (6.62 ± 1.09) mmHg and (6.83 ± 1.07) mmHg, respectively, which were significantly lower than the relevant mean CRF values in group B (t=-2.703, P=0.009. t=-3.733, P= 0.001). Meanwhile, the mean CH values at 1 week, 1 month and 3 months postoperatively in group A were (7.31±1.06) mmHg, (7.37±0.96) mmHg and (7.82±0.97) mmHg, respectively, which were significantly lower than those in group B (t=-2.415, P=0.019. t=-2.113, P=0.039. t=-2.67, P=0.01). Moreover, the DifCRF and DifCH values in group A were significantly lower than those in group B at 3 months postoperatively (t=-3.409, P=0.001. t=-2.064, P=0.044). The CRF and CH values in both groups showed a significant reduction at 1 week, 1 month and 3 months postoperatively (P<0.05).

The size of optical zone has some effects on corneal biomechanical properties after SMILE. The smaller optical zone diameter has a relatively smaller effect. (Chin J Ophthalmol, 2017, 53:182-187)

To study the clinical manifestations, diagnosis and treatment of corneal epithelial dysfunction after cataract extraction.

Fifteen cases diagnosed as corneal epithelial dysfunction after cataract extraction between November 2014 and September 2016 were retrospectively analyzed, mainly including clinical manifestations, characteristics of morphological changes imaged by in vivo laser confocal microscopy, management and therapeutic effects.

There were 6 (40%) males and 9 (60%) females with an average age of 66±7 years (59 to 86 years). Three patients had meibomian gland dysfunction. The clinical manifestations of corneal epithelial dysfunction after cataract extraction were corneal epithelial permeability increase, limitations of epithelial edema, corneal epithelial dot staining, corneal epithelial defects and ulceration. In vivo laser confocal microscopy showed enhanced reflection of the nucleus of the corneal basal cells, abnormal cell structure and decreased cell density. The morphology of corneal sub-basal nerve plexus was disordered and diminutive. After the therapy of protecting corneal epithelium and promoting healing, all 15 cases were cured completely.

The early characteristics of cataract extraction-related corneal epithelial dysfunction are edema of the corneal epithelium and dot staining. Delayed diagnosis and treatment may result in filamentous keratitis and corneal ulcers. Timely use of corneal epithelium protection medicine may contribute to a favorable prognosis. (Chin J Ophthalmol, 2017, 53:188-192)

To investigate the prevalence and treatment effects of Demodex species in eyelash follicles in patients with meibomian gland dysfunction (MGD).

The MGD patients (MGD group) and normal subjects (control group) were collected from the Ophthalmology Clinic in PUMCH from July 2015 to December 2015. The symptom score of MGD patients was recorded. Eyelash sampling, Demodex counting, tear film break-up time (BUT), cornea fluorescein staining (Fl) and Schirmer test Ia (S Ⅰ aT) were measured for both groups. All the measurements were repeated after 4 weeks of meibomian function treatment for the MGD group. Symptom score, BUT, Fl and S ⅠaT were normally distributed and displayed as mean± standard deviation. Demodex counting was not normally distributed and displayed as median (interquartile range P25, P75).

Forty-four MGD patients (88 eyes) and 48 controls (96 eyes) were recruited. For the MGD and control groups, the number of Demodex was 3.5 (2, 7) and 0 (0, 7), respectively (Z =-4.912,P= 0.000). The percentage of Demodex infestation was 86.4% and 39.6%, respectively (χ²=35.957, P=0.000). The BUT was (3.57±2.09) s and (10.17±3.25) s, respectively (t=-5.154, P=0.000). The Fl was 2.73±1.23 and 0.85± 0.33, respectively (t=4.583, P=0.000). The SⅠaT was (8.75±5.61) s and (14.51±5.29) s, respectively (t=-2.278, P=0.028). The symptom score of the MGD group before and after treatment was 4.77 ± 3.01 and 2.79 ± 2.01, respectively (t=6.224, P=0.000). The BUT, Fl and number of Demodex of the MGD group after the treatment were (5.43±2.37)s, (1.91±0.66) and 2 (0, 3), respectively, and all had significant difference with the data before the treatment (BUT, t=-4.705, P=0.000. Fl, t =3.902, P =0.000. number of Demodex, Z=-4.623, P =0.000). The S Ⅰ aT of the MGD group after the treatment was 8.86 ± 6.76, with no significant difference with the data before the treatment (t=-0.277, P=0.833).

The Demodex infestation has some effects on the pathogenesis of MGD. The treatment of MGD may help to decrease the number of Demodex and thus relieve the ocular discomfort.(Chin J Ophthalmol, 2017, 53:193-197)

To explore the characteristics, prognoses and corneal complications of children wearing orthokeratology lenses (Ortho-K) at night.

Retrospective case analysis. A total of 113 cases (219 eyes) wore Ortho-K for myopia at night, including 7 cases with unilateral glass wear. The average age was (11.5±2.0) years old. The myopia ranged from -1.00 D to -9.00 D in all eyes and from -2.00 D to -4.00 D in 157 of them. Examinations were performed before lens wearing, at 1 hour, the next morning, 2 days, 3 days, 1 week and 2 weeks after lens wearing, and thereafter once a month. The follow-up was 6 months. Slit lamp examination was used to observe whether there was edema, mechanical damage, pigment deposition, turbidity or infiltration. The morphology, location, number, range and depth of fluorescein staining were tracked for more than 6 months.

There were punctate corneal epithelial exfoliation in 18 cases (29 eyes, 13.24%), corneal stromal infiltration and opacity in 5 cases (6 eyes, 2.74%), and corneal iron deposition in 9 cases (17 eyes, 7.76%), with no obvious symptoms. After stopping wearing lenses and related treatment, the punctate epithelial exfoliation was completely cured, and the other complications gradually disappeared within 6 months. These complications occurred within 3 months after lens wearing in six eyes and after at least 6 months of lens wearing in 46 eyes.

Children who have complications after wearing Ortho-K at night should immediately stop wearing the lenses. Timely treatment and follow-up help to avoid deterioration and serious complications. Orthokeratology should be performed in medical institutions, with the follow-up by qualified ophthalmic doctors. (Chin J Ophthalmol, 2017, 53:198-202)

To evaluate the efficacy of microcatheter-assisted trabeculotomy for untreatable childhood glaucoma with traditional surgeries repeatedly.

Clinical charts of fifteen cases (16 eyes) with childhood glaucoma patients from Beijing Tongren Hospital were retrospectively analyzed. All eyes had previously received 2 or more traditional anti-glaucoma surgeries. We performed microcatheter-assisted trabeculotomy for these patients. The intraocular pressure (IOP), numbers of anti-glaucoma medications and post-operative complications were analyzed. The differences between pre-operative and last post-operative IOP and numbers of anti-glaucoma medications were compared using paried t test and wilcoxon signed rank test.

Thirteen male and 2 female children aged between 2—10 (median: 4) years old were recruited. 11 cases (12 eyes) were diagnosed as primary congenital glaucoma, 3 eyes of 3 cases were late-onset childhood glaucoma, and 1 eye was secondary glaucoma. The mean pre-operative IOP was (35.69 ± 6.27) mmHg (1 mmHg=0.133 kPa) on a mean of 3(1—4) medications for childhood glaucoma patients. The mean post-operative IOP decreased to (17.88 ± 7.74) mmHg (t=6.97, P< 0.01) and the median post operative medications decreased to 0(0—3)(Z=-3.15, P <0.01) at last visit. Twelve cases and 14 cases achieved complete and qualified success, respectively. No severe complications were observed for all patients.

Microcatheter-assisted trabeculotomy got lower introcular pressure results for 15 childhood glaucoma patients with untreadtable traditional surgeries repeatedly with minimal complications. (Chin J Ophthalmol , 2017, 53:203-206)

To explore the inhibitory effect of insulin-like growth factor binding protein-related protein 1 (IGFBP-rP1), a novel anti-angiogenic factor, on retinal angiogenesis and its underlying molecular mechanisms.

Experimental study. C57BL/6J mice were classified into three groups: control group (n=24), oxygen-induced retinopathy (OIR) non-intervention group (n=24) and OIR intervention group (n=72). The OIR mouse model was established using improved Smith's methods (n= 96). Twelve-day-old mice in the OIR intervention group were randomly assigned into three groups receiving intravitreal injection of recombinant mouse IGFBP-rP1 (50 μg/L, 100 μg/L and 200 μg/L, respectively). Five days later, the proliferative neovascular responses were estimated by quantifying the new vessel area relative to the total retinal area in flattening retinas stained by high molecular FITC-Dextran and counting the number of neovascular cell nuclei breaking through the internal limiting membrane (ILM) in cross-sections. Retinal phosphor-ERK1/2 (p-ERK1/2), ERK1/2 and vascular endothelial growth factor (VEGF) protein expression was assessed by Western blot.

In the fluorescence angiograms, irregular neovascularization and fluorescence leakage were observed in the OIR model. In the OIR non-intervention group, the expression of p-ERK1/2 and VEGF was significantly up-regulated in comparison with the control group (t=100.068, P=0.000. t=6.526, P=0.003). The area ratios of new retinal vessels and the number of neovascular cell nuclei in mice receiving intravitreal injection of recombinant mouse IGFBP-rP1 both decreased significantly (F=1920, P=0.000. F=852.387, P=0.000), following the down-regulation of retinal p-ERK1/2 protein expression (F=859.587, P=0.000) and VEGF protein expression (F=24.301, P= 0.000) in a dose-dependent manner (P<0.05). There was no significant difference in ERK1/2 protein expression (P>0.05).

IGFBP-rP1 inhibits retinal angiogenesis by blocking ERK signaling pathway and down-regulating VEGF expression. This highlights the potential importance of IGFBP-rP1 serving as a target of gene therapy for retinal neovascularization. (Chin J Ophthalmol, 2017, 53: 207-211)

Fundus yellow spot disease is a familial hereditary fundus lesion, which mostly involves both eyes. Its pathological changes first occur in RPE, and local atrophy of photoreceptor cells and choroidal capillaries appears as the disease progresses. The lesions are usually located at the posterior pole, and with damage to the structures of the macular area, visual acuity also decreases significantly. There have been clinical reports on binocular yellowspots complicated with choroidal neovascular membrane in the macular area in one eye^[1]However, fundus yellowspots combined with other macular diseases are relatively rare. A patient with binocular yellowspots complicated with macular defect was admitted to the outpatient department of Tianjin Eye Hospital, which is reported as follows.

A 38-year-old male was admitted to Tianjin Medical University Eye Hospital on August 22, 2013 due to obscuration of the nasal shadow of his left eye for 2 d. The patient had previously been highly myopic in both eyes with a diopter number of-13.00 D and congenital nystagmus in both eyes. The patient's parents were not close relatives, and there were no other patients suffering from albinism in the family. The patient's parents, younger siblings and only son did not have similar manifestations. At the time of admission, the examination found that the hair color was pale, and there was no abnormality. Eyebrows and eyelashes have a touch of white. Ocular examination: right eye visual acuity 0.1, correction 0.12, intraocular pressure 14.6 mmHg (1 mmHg =0.133 kPa), pendulum nystagmus, anterior segment (-), clear optic disc boundary visible in the fundus, leopard print retina, posterior pole RPE without pigment, and thick choroidal blood vessels visible. The visual acuity of the left eye was manual before the eye, correction was not improved, intraocular pressure was 9.4 mmHg, ocular pendulum tremor, anterior segment (-), wavy retinal bulge at 4~6 o'clock in the fundus, involving the macular area, a horseshoe-shaped hole at 1 o'clock, about 3/4 PD in size, the posterior pole RPE was depigmented, and thick choroidal blood vessels were seen (Figure 1）。 Auxiliary examination: B-ultrasound showed left eye retinal detachment, OCT showed left eye temporal macular neuroepithelial detachment. Diagnosis: Rhegmatogenous retinal detachment in left eye, fundus alterations in albinism in both eyes, congenital nystagmus in both eyes, high myopia in both eyes, and high myopic retinopathy in both eyes. Treatment plan: Left eye vitrectomy + gas-liquid exchange + retinal photocoagulation + silicone oil filling was performed under local anesthesia on 23 August 2013. Postoperative eye examination: Left eye visual acuity 0.1, +5.00 D corrected to 1.2, intraocular pressure 12.9 mmHg, vitreous cavity filled with silicone oil, posterior pole RPE without pigment in the fundus, thick choroidal blood vessels, hiatus closed, omentum in place (Figure 2）。 Silicone oil removal of left eye under local anesthesia was performed on 10 Mar 2014. Postoperative ocular conditions: Left eye visual acuity 0.02, intraocular pressure 13.7 mmHg, retina in position. After that, the patient's visual acuity gradually decreased, and the examination found that the lens was opaque and the retina was in place. Left eye cataract phacoemulsification with intraocular lens implantation under local anesthesia on 20 Mar 2015.

The patient was a 46-year-old female with visual acuity decline in her left eye for 1 month. She came to the Ophthalmology Center of Wuhan University People's Hospital on August 26, 2015. Patient's past history: 5 years of premature cardiac beats, no special treatment. History of eye disease and trauma were denied. Ophthalmologic examination: 1.0 for right eye and 0.06 for left eye. IOP is normal. The slit lamp examination of the anterior segment of both eyes showed no abnormalities. The fundus image shows that the optic disc of both eyes is clear and correct in color, the retina is flat, the blood vessels are distorted and dilated, and small patches of bleeding can be seen below the nasal side of the optic disc of the right eye, and the reflection of the fovea is vague; There were several small patches of bleeding scattered on the temporal side of the optic disc of the left eye, and the foveal reflection was dim (Figure 1,Figure 2）。 Wide-angle FFA showed hemorrhagic occlusion fluorescence below the nasal side of the right eye optic disc; There were several scattered bleeding on the temporal side of the optic disc of the left eye to block the fluorescence. The second and third grade arterioles of the retina in both eyes were distorted, especially in the posterior pole and around the optic disc, and the ends showed spiral-like changes without dilatation, coarctation and fluorescein leakage. No abnormalities were observed in the retinal aorta and veins (Figure 3）。 Fundus examination was performed immediately on two family members of the patient's son and daughter, and it was found that the color fundus photograph of her daughter (24 years old) showed symmetrical macular arterioles in both eyes (Figure 4,Figure 5), autofluorescence and flow imaging OCT showed binocular symmetrical second and third grade macular arterioles tortuous (Figure 6,Figure 7）。 Diagnosis: Familial retinal arteriole deformity in both eyes. No special treatment was given, and regular follow-up was instructed.

Common causes of inferior rectus dysplasia leading to superior strabismus include inferior rectus absence, inferior rectus hypoplasia and inferior rectus attachment point ectopia. Among them, the most common one reported in the literature is the absence of inferior rectus muscle^[1]In this case, the attachment point of the inferior rectus muscle is ectopic.

Example 1The patient was a 37-year-old male. Due to conjunctival mass in his right eye since childhood, he was consulted on November 26, 2007. The patient was in prior health and had no family genetic history. Eye examination: visual acuity 1.0 in the right eye and 1.2 in the left eye. Intraocular pressure: 10.0 mmHg (1 mmHg =0.133 kPa) in the right eye and 10.1 mmHg in the left eye. No abnormalities were found in all examinations in the left eye. There was no congestion and edema in the eyelid of the right eye, no valgus and trichiasis. The lacrimal duct was irrigated unobstructed and no discharge was observed. The conjunctiva was mildly congested, the temporal bulbar conjunctiva was mildly flat and bulged, the surface was white and rough, with black hair visible, and the interior was yellowish-white, the distance between the outer edge and the limbus was 4 mm, and the inner edge was adhered to the conjunctiva at the lateral canthus, extending to the back of the bulb, and the inner edge insertion point was not visible (Figure 1), there was no yellowing stain and congestion of the sclera. The cornea is transparent, the anterior chamber axis is 1/2 CT deep, the iris texture is clear, the pupil is equal size and round, the diameter is 3 mm, the light reflection is present, and the lens density is normal. Fundus examination: optic disc boundary is clear, color is normal, C/D is 0.3, retina is flat, macula is dark. Orbital pressure was normal, and eyeball movement in all directions was normal. There was no double vision in both eyes. CT examination of orbital transverse axis (Figure 2): A uniform low-density shadow can be seen at the lateral bulb of the right orbit, with a CT value of-111.2 HU. It is adhered to the surface of the eye ring in a half-moon shape, with a chord length × chord height of 18 mm ×4 mm. The base occupies about 1/3 of the eye ring. The anterior edge is located behind the tangent point between the lens and the eye ring (equivalent to the corneoscleral limbus), and the posterior edge ends at the lateral rectus scleral attachment point. The highest point of the lesion bulge is located at the lateral front of the orbital margin, slightly pressing the lacrimal gland of the eyelid, and there is no obvious abnormal change in the bone quality of the orbital wall. A type of circular high-density shadow was visible in the lesion, close to the eye ring, with a size of about 6 mm ×5 mm, and a CT value of +803.2 HU. The blood and urine routine were normal, the electrocardiogram was normal, the chest radiograph was normal, and there were no other systemic diseases. Clinical diagnosis: dermoid lipoma of the conjunctiva of the right eye. Mass resection under local anesthesia was performed on 28 November 2007. Histopathological examination of tumor: Under the microscope, the tumor was adipose tissue, the epithelium was conjunctival and skin-like structure, and the underside was fiber, interspersed with a large number of adipocytes, and differentiated and mature bone tissue could be seen. Pathological diagnosis: Complex dermoid lipoma (complex fuzzoma) of the conjunctiva of the right eye. The patient recovered well after surgery. One week after surgery, the visual acuity was the same as before surgery, and there were no complications such as ptosis, reduction of tears, eye movement disorders and corneal diseases.

The patient was a 57-year-old male. Because he found that his right eye had turned black for 5 years, he went to the Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University. One month ago, a new biopsy of the right conjunctiva was performed in an external hospital, and the histopathological examination diagnosed as malignant melanoma of the right conjunctiva. The whole body examination showed no abnormalities. Eye examination: visual acuity was 0.8 for the right eye and 1.0 for the left eye; IOP was 14 mmHg (1 mmHg =0.133 kPa) in the right eye and 13.5 mmHg in the left eye; the anterior segment of the right eye was presented inQuintessence Picture 1No obvious abnormalities were observed in the left eye. Clinical diagnosis: Malignant transformation of primary acquired melanosis of the corneoconjunctiva of the right eye. Subtotal extraction of orbital contents in the right eye was performed under general anesthesia. Postoperative pathological diagnosis: Primary acquired melanosis of the right corneal conjunctiva, with malignant transformation into melanoma in some areas.

Topical anti-inflammatory therapy has become the significant way of treating dry eye so far. However, as the long-term use of routine anti-inflammatory medications are restricted from their side effects, it is inevitable to explore safer and more effective alternatives. Essential fatty acids have proven to be anti-inflammatory systemically, which makes it possible to treat dry eye. Clinical trials have demonstrated that supplementation with either ω-3 or ω-6 essential fatty acids or both has multifactorial efficacies including improvement of subjective symptoms, alleviation of inflammation of ocular surface and eyelid margin, prolongation of tear break-up time and increase of tear flow secretion. Besides anti-inflammation effects, several basic researches have revealed that other mechanisms of essential fatty acids treating dry eye might lie in the corneal epithelial healing and tear secretion promotion. This review puts emphasis on the effectiveness, feasibility and mechanism of treating dry eye with essential fatty acids. (Chin J Ophthalmol, 2017, 53: 225-229)

Stem cells are becoming a hot topic of basic medicine and clinical research because of their wide self-renewal and differentiation potential in recent years. A number of small molecules that can be used to control stem cell self-renewal, lineage differentiation, reprogramming and regeneration could regulate stem cell fate quickly and reversibly. If small molecules could induce human embryonic stem cells to differentiate into corneal epithelial-like cells in vivo, corneal cell transplantation therapy will have unlimited source of corneal epithelium. More patients will obtain effective and timely treatment. (Chin J Ophthalmol, 2017, 53: 230-235)

LGR4, also known as GPR48, is a member of the leucine-rich, G protein-coupled receptor family. It is widely expressed in tissues of the reproductive system, urinary system, sensory organs, digestive system, and central nervous system. LGR4 plays an important role in the development of various organs and cancer development and progression by modulating multiple signaling pathways. Recent studies have revealed that LGR4 is related with many kinds of human diseases such as gastrointestinal carcinomas. Eye development is a dynamic process regulated by a number of growth factors and cytokines. LGR4 is extensively expressed in the eyes in a finely tuned spatiotemporal pattern. Mice lacking LGR4 have been found to display anterior segment dysgenesis, including microphthalmia, iris hypoplasia, iridocorneal angle malformation and corneal dysgenesis, cataract and other defects. Here we review the role of LGR4 in the eye development and related molecular mechanisms. (Chin J Ophthalmol, 2017, 53: 236-240)