Volume 53 · Issue 06 · 2017

Thyroid-associated ophthalmopathy (TAO) is a common autoimmune syndrome affecting the thyroid and orbit. It can result in the fibrosis of extraoular muscles and hyperplasia of adipose tissue. The mechanism of TAO is not clear and there was few effective treatment. Recently, orbital decompression was performed on more and more patients. The surgery can improve the appearance of the patient and relieve the symptoms caused by the high orbital pressure. Therefore, it is necessary to re-evaluate the clinical value of the orbital decompression and surgical indications. The principles and techniques of orbital decompression with relative factors were discussed in this review. (Chin J Ophthalmol, 2017, 53: 401-403)

Thyroid associated ophthalmopathy is a complex autoimmune disease characterized by inflammation of the orbital tissue, hyaluronan deposition and tissue remodeling due to a skewed production of preadipocytic fibroblasts and increased adipogenesis in the late stage. Its progression is strongly related to the functional status of thyroid. So far, there is no consensus on staging, grading and treatment worldwide owning to the complexity of its clinical manifestations and therapies. However, it is of great importance to accurately judge its status and make individualized therapeutic regimen. Therefore, we propose how to standardize the TAO diagnosis and treatment. (Chin J Ophthalmol, 2017, 53: 404-407)

TAO is a common autoimmune orbital disease. 20% to 30% patients in active phase of moderate to severe TAO have no reponse to treatment or relapse after treatment, which become a difficult problem in clinical treatment. In this paper, the necessity of the treatment, etiology, treatment difficulties and treatment measures of TAO are discussed, in order to make great efforts to solve the clinical problems and to treat such patients. (Chin J Ophthalmol, 2017, 53: 408-412)

Sebaceous gland carcinoma is one of the main malignant tumors on the human body surface. The eyelid and its adjacent tissues are the best sites for sebaceous gland carcinoma. Eyelid sebaceous gland cancer originates from the sebaceous glands of the eyelid (including the meibomian glands, Zeis glands, and tiny glands surrounding hair follicles), the vast majority of which originate in the meibomian glands. Meibomian gland carcinoma is highly malignant, easy to invade adjacent tissue structures, and even metastasize and endanger patients' lives. Meibomian gland cancer is easily misdiagnosed and delays the opportunity of treatment. Surgery is the main method for treating meibomian gland carcinoma. Choosing appropriate surgical methods can help to improve the cure rate, reduce the risk of recurrence and metastasis, and improve the prognosis and quality of life of patients.

To evaluate the effectiveness of maximal orbital decompression in treatment for severe dysthyroid optic neuropathy (DON) of thyroid associated ophthalmopathy (TAO) and predictive factors of this therapy.

The group consisted of 21 patients (30 eyes) with DON. The diagnosis was based on the following criteria: Deterioration of best corrected visual acuity (VA≤0.1), enlargement of extraocular muscles and sign of apical crowding in CT imaging, loss of colour vision. Exclusion criteria: VA of DON>0.1 or other diseases with visual function damage. Maximal 3-wall orbital decompression was undergone. Clinical outcomes were recorded and assessed including pre- and postoperative VA, age, clinical activity score (CAS), thyroid hormonal status and duration of DON. The pre- and postoperative VA were compared by Wlicoxon signed rank analysis. The relationships between the change of VA and age(<50 years vs ≥50 years), thyroid hormonal status(hyperthyroidism vs hypothyroidism), CAS(<3 vs ≥3), duration (<3 months vs ≥3 months), pre-VA(<0.01 vs ≥0.01) were made statistically by Mann-WhitneyU-test, rank correlation analysis,and Logistic regression analysis.

Thirty eyes of 21 patients (11 male, 10 female) were included in this study. Hyperthyroidism was recorded in 13 cases, the other 8 cases with hypothyroidism. The average age at the time of diagnosis was 52.9 years (range, 33.0—71.0 years). The median of the duration of DON was 4.5 months (range, 1.0—12.0 months). Twenty-eight eyes (28/30, 93%) showed improvement of visual acuity after surgery (Z=-4.62, P=0.000). There was positive correlation between pre- and postoperative VA(r=0.38, P<0.05 ). Patients with VA of 0.01 or better had better postoperative VA than those with poorer VA (0.10 vs 0.50, Z=-2.09, P=0.037). There was negative correlation between the duration and degree of improvement of postoperative VA (r=-0.44, P<0.05). Other factors such as age, thyroid hormonal status, CAS were not statistical factors for postoperative VA (Z=-1.83—-0.97, P>0.05 ) and improvement of postoperative VA (Z=-1.80—-0.82, P>0.05).

Maximal orbital decompression is safe and effective for management of visual damage in severe DON in this small sample study. Preoperative VA and duration of DON were important predictive factors for surgical outcome. Earlier diagnosis and treatment are possibly useful for improvement of prognosis of DON but large sample data are needed.(Chin J Ophthalmol, 2017, 53:416-423)

To analyze the change of globe position after different orbital decompression in thyroid-associated ophthalmopathy (TAO).

It was a retrosective case series study. Twenty-nine TAO patients (33 eyes) underwent orbital decompression were collected between October 2014 and December 2016 at Eye & ENT Hospital of Fudan University. There were 17 males and 12 females, and the average age was 46 years (ranging from 21 to 66 years). Fifteen patients (17 eyes) underwent balanced decompression, 11 patients (11 eyes) underwent deep lateral decompression, and 4 patients (5 eyes) underwent medial decompression. CT scan was performed pre and postoperatively for each patient and a reference coordinate system was established on the three-dimensional reconstructed image. The eyeball vector from the eyeball center to the corneal apex was defined and the coordinates (X_E, Y_E, Z_E)(X^C, Y_C, Z_C) were calculated. The angle M between and the midsagittal plane and the angle F between and the Frankfort plane were also calculated. Paired t test and one way ANOVA were used for statistical analysis.

The average value of X_C before and after deep lateral decompression was 19.53 mm and 17.25 mm (t=10.87, P<0.05) and average value of X_E was 7.73 mm and 5.69 mm (t=12.22, P<0.05). The average value of X_C before and after medial decompression was 20.24 mm and 18.17 mm (t=7.93, P<0.05) and average value of X_E was 7.14 mm and 5.52 mm (t=9.24, P<0.05). The average value of X_C before and after balanced decompression was 22.16 mm and 18.83 mm (t=12.71 , P<0.05) and average value of X_E was 10.20 mm and 6.67 mm (t=11.91, P<0.05). The average value of horizontal deviation angle M before and after medial decompression was 6.48° and 13.34° (t=- 8.41, P<0.05). The average value of angle M before and after balanced decompression was 1.42° and 6.76° (t=- 2.86, P<0.05). The average value of angle M before and after deep lateral decompression was 5.18° and 1.39° (t=2.57, P<0.05).

The proptosis reduction was significant after deep lateral decompression, balanced decompression and medial decompression. Additionally, the horizontal deviation tended to increase after medial and balanced decompression, whereas the horizaontal deviation tended to decrease after deep lateral decompression. (Chin J Ophthalmol, 2017, 53: 424-429)

To explore the feasibility of the semi-quantitative rectus extraocular muscle (EOM) parameters of dynamic contrast-enhanced magetic resonance imaging (DCE-MRI) in assessing the clinical course of thyroid associated ophthalmopathy (TAO).

It was a retrospective case series study. A total of 136 cases of TAO were recruited from March 2011 to October 2012 in the Tianjin the first center hospital including 63 males and 72 females, aged 24.0—65.0 years, with an average age of (40.5±10.9) years. Forty healthy volunteers were recruited as control group (CG). According to clinical activity score (CAS), all TAO patients were divided into 2 groups, activity group (AG) and inactivity group (IAG). MRI and DCE-MRI orbit scan were performed in each subject. Drew time-intensity curves (TIC) by Siemens 3.0 MR (syngo) post-processing workstation. The semi-quantitative parameters of DCE-MRI were calculated. The semi-quantitative paramters based on TIC include early enhancement coefficient (EEC), maximum enhancement coefficient (Emax) and wash-out coefficient (WC_5min). Kruskal-Wallis H rank test was used for comparing signal intensity among 3 groups, and Nemenyi test for pairwise comparison between groups. The DCE-MRI parameters (EEC, Emax, WC_{5 min}) among groups were compared by one-way ANOVA, and Bonferroni t test is for pairwise comparison between groups. The diagnostic value of mean EEC, mean Emax, WC_5min for assessment of the clinical course in TAO was analyzed by ROC curve.

There were significant difference in signal intensity (SI) of rectus EOM on T₂WI among CG, AG and IAG, which is significantly different in 88 cases of AG including 45 cases of high intensity 51.1%, 23 cases of moderate intensity 26.1%, and 20 cases of low intensity 22.7%,compared with CG and IAG. EEC (P<0.05), Emax and WC5min values of rectus EOM of TAO group were significantly lower than those of CG(P<0.05), which values of rectus EOM of TAO active group of EEC are 0.63±0.06、0.61±0.05、0.56±0.09、0.57±0.09, and values of rectus EOM of TAO inactive group of EEC are 0.49±0.05、0.50±0.08、0.57±0.10、0.55±0.09. The values of rectus EOM of TAO active group of Emax are 1.35±0.09、1.28±0.09、1.21±0.17、1.25±0.10, and the values of rectus EOM of TAO inactive group of Emax are 1.04±0.06、1.05±0.10、1.20±0.19、1.16±0.11. The values of rectus EOM of TAO active group of WC_{5 min} are 0.13±0.03、0.13±0.03、0.13±0.06、0.13±0.03 and the values of rectus EOM of TAO inactive group of WC5min are 0.08±0.02、0.79±0.03、0.11±0.06、0.09± 0.03. EEC (χ²=9.20, P<0.05), Emax and WC_5min values of rectus EOM of TAO group were significantly lower than those of CG (P<0.05). EEC, Emax and WC_5min values of medial rectus and inferior rectus EOM of IAG were significantly lower than those of AG(P<0.05). WC_5min values of superior rectus EOM of IAG were significantly lower than those of AG (P<0.05). There were no differences in EEC and Emax values of lateral rectus and superior rectus EOM between IAG and AG (P>0.05). There were no differences in WC_5min values of lateral rectus EOM between IAG and AG (P>0.05). The area under the curve (AUC) were 0.771, 0.879, 0.898 for mean EEC, mean Emax, and mean WC_5min, respectively.

The semi-quantitative paramters of DCE-MRI can show the clinical activity of TAO patients and can be considered as the quantitative index of TAO activity staging. (Chin J Ophthalmol, 2017, 53: 430-435)

To conclude the characteristics of fundus appearance and spectral domain optical coherence tomography(SD-OCT) findings of patients with acute Vogt-Koyanagi-Harada (VKH) disease.

The clinical data of 17 patients (34 eyes) diagnosed of acute VKH in Peking Union Medical College Hospital from Jan. 2012 to Dec. 2014 were studied retrospectively.Examinations included visual acuity, slit lamp, fundus, color fundus pictures, FFA and SD-OCT.

Eight men and 9 women were enrolled with mean age of (40.5±11.6) years old ranging from 26.0 to 62.0 years old. Vision acuity of their first consultations were as follows: 14 eyes (41.2%) were below 0.01—0.09, 17 eyes(50%) were among 0.1—0.3, 3 eyes (8.8%) were among 0.4—0.7. All patients were divided into 3 groups according to their fundus appearance: 14 eyes (41.2%) were optic disc swelling-type, 10 eyes (29.4%) were retinal detachment type and 10 eyes(29.4%)were mixed type. Subretinal fluid and serous retinal detachment appears in SD-OCT of all 34 eyes, with highly reflective signals in detached area. Other common characters were also noticeable, suh as RPE folds(19 eyes, 55.9%), subretinal septa (16 eyes, 47.1%) and internal limiting membrane(ILM) fluctuation (8 eyes, 23.5%). In addition, SD-OCT features were in accordance with multilobular dye pooling at late period of FFA.

SD-OCT of acute VKH presents some typical features: subretinal fluid and serous retinal detachment, RPE folds, ILM fluctuation, and subretinal septa.(Chin J Ophthalmol, 2017, 53: 436-439)

To optimize the method of acquiring the ONSAS parameter and to access the repeatability of the new method comparing with the traditional one.

This is a cross-sectional study. Standard operation procedure of an optimized method of acquiring the ONSAS sectional area was made against the defect of the traditional method. Ten healthy volunteers (20 eyes) in different ages were recruited from March 2016 to October. Two times of MRI scan were proceeded with the interval of one week. The optimized and traditional methods were both applied for each scanning. The images were analyzed by two ophthalmologists. The rate of high quality images between two groups was compared with matching chi-square test. The orbital subarachnoid space areas between groups at different locations were compared using analysis of variance of repeated measurement data. The ICC between different scans and different ophthalmologists was calculated.

The mean age of the volunteers was 43.8±13.1 years old. Male/Female was 1∶1. The rates of high quality images from the optimized method (100%, 83%, 78%) was higher than those of the traditional method(80%, 78%, 70%). The orbital subarachnoid space area at 3 mm, 9 mm and 15 mm behind the eye ball acquired from the new method(7.2±1.8, 6.1±1.8, 5.9±1.4 mm²) were bigger than those of the traditional method (9.0±2.9, 7.6±2.4, 7.1±1.6 mm²). Statistical significances were found at 9 mm(F=4.30, P=0.048) and 15 mm(F=5.67, P=0.026) behind the eye ball. The ICC between two different scans (0.879, 0.857, 0.857 vs 0.741, 0.762, 0.639) and two different ophthalmologists (0.864, 0.890, 0.894 vs 0.785, 0.609, 0.753) were higher in the new method group than in the traditional method group.

The optimized method of acquiring the parameters of optic nerve subarachnoid space is easier to get the sectional cross area. The measuring reproducibility is better than the traditional one. (Chin J Ophthalmol, 2017, 53: 440-444)

To compare the curative effect of two different artificial tears on dry eye after phacoemulsification.

Prospective randomized controlled clinical trial. From March to June in 2012, 102 patients (102 eyes) with age-related cataract were treated with phacoemulsification at Beijing Tongren Hospital, Capital University of Medical Sciences, and these eyes were randomly divided into blank group (group A ) 32 cases, treatment group 1 (group B) 35 cases and treatment group 2 (group C) 35 cases. Group A was treated with conventional antibiotics. Group B was sodium hyaluronate eye drop, group C was lipid-containing carbomer gel respectively. All patients finished a dry eye questionnaire called Ocular Surface Disease Index (OSDI), and Schimmer's test (SIt), break up time (BUT) and fluorescein staining (FL) tests were performed before surgery and at 7, 30 and 90 days after surgery respectively. Optometry were performed at 90 days after surgery. The χ² test was used to analyze the sex of the patients, and the age of the patients was analyzed by one-way ANOVA. Partial data in eye tests and in OSDI does not meet the normal distribution. Therefore, they were analyzed by Kruskal-Wallis H test. If significant difference existed, these data were then analyzed by independent sample Wilcoxon rank sum test.

Twelve patients were lost to visit within 3 months. A total of 90 patients were followed up for 90 days. The mean age of all patients was (69.5±9.5) years (46.0—89.0 years), 38 males and 64 females. There were 30 patients in Group A, group B and group C respectively. The prevalence of dry eye was 56. 7% (60/102). There was no significant difference among the three groups (P>0.05). OSDI questionnaire showed that OSDI score was significantly different among the three groups at 7, 30 and 90 days after operation (H=9.89, 55.53, 45.43, P<0.05). At 30 and 90 days after operation, the median OSDI scores were 12.50 and 10.42 in group C, respectively, which were better than those of group A scores 27.09 and 20. 8 (Z=- 6.30, -5.94, P<0.05), and were better than those of group B scores 17.71 and 13. 54 (Z=-3.40, -3.52, P<0.05). At 90 days after operation, the median BUT of B and C treatment groups was 9. 00, which was better than that of group A (4.00). The difference was statistically significant (H=21.51, P<0.05), There was no significant difference between group B and group C (Z=-0.34, P>0.05).

The treatment of artificial tears with lipid composition in the early stage after phacoemulsification is beneficial to the improvement of postoperative symptoms and signs of dry eye. (Chin J Ophthalmol, 2017, 53: 445-450)

To observe the influence on spectacle independence, satisfaction and visual function after cataract surgery monovision with different ADD.

Prospective clinical study. All patients were collected from the department of ophthalmology, Shanghai JiaoTong University Affiliated Sixth People's Hospital who were diagnosed as bilateral cataract from Oct. 2013 to Mar. 2015. This study comprised 64 cases (128 eyes). All consecutive patients scheduled to undergo bilateral cataract phacoemulsification and implantation of a monofocal AcrySof IQ IOL. The average age of patients was (65.4± 6.0) years old, ranged from 51 to 70 years. 28 males and 36 females. According to the different demands of spectacle independence and living habits of patients, all cases were divided into two groups: MV1 group (32 patients), whose near addition being 1.25—1.75 D and MV2 group (32 patients), whose near addition being 2.25—2.75 D. Parameters 6 months postoperatively included binocular uncorrected distance, intermediate, and near visual acuities, stereo vision and refractive states were analyzed. Parameters of spectacle independence, subjective visual symptoms and patient satisfaction according to visual function questionnaire were analyzed at the same time. T test was used to compare uncorrected visual acuity. WhitneyU test was operated in stereo vision comparison. Chi-square test was applied in sex-distribution comparison and visual function questionnaire between two groups.

The uncorrected distance vision in MV1 group was (0.09±0.09), while it was (0.11±0.08) in MV2 group. The uncorrected intermediate vision in MV1 group was (0.27±0.25), and it was (0.30±0.22) in MV2 group. There were no significant difference between two groups in bilateral uncorrected distance vision (t=1.62, P=0.264, LogMAR), intermediate (t=- 0.23, P=0.876, LogMAR). However, there was significant difference between two groups in uncorrected near vision (t=2.38, P=0.021, LogMAR). It was (0.06±0.06) in MV1 group and (0.02±0.07) in MV2 group. Moreover, near stereo vision was better in MV1 group than MV2 group (Z=- 1.29, P=0.031). On the questionnaire, all patients in two groups had no significant difference in their daily lives discomfort (χ²=0.10, P=0.756). In MV2 group, there were 2 patients complained obstacles while walking stairs dimly. In MV1 group, there were 3 patients had to wear low degrees of presbyopic glasses when they were on near work. Percentage of patients spectacle independence was less than 90% in MV1 groups. In MV2 group, one case needed low degrees of myopic glasses when he was on intermediate computer work and playing table games.

Different near addition has similar advantages to different patients on spectacle independence, satisfaction and visual function after cataract surgery. (Chin J Ophthalmol,2017,53: 451-454)

To analyze RB1 gene mutation in retinoblastoma (RB) patients using gene capture technology.

Experimental research. The clinical data of 17 RB patients were collected at Department of Ophthalmology, Peking University People's Hospital from June 2010 to Jun 2014. Peripheral blood samples of seventeen RB patients and their parents were collected and genomic DNA were extracted. DNA library from RB patients was mixed with designed gene capture probe ofRB1 exons and its flanking sequences. The data were analyzed using bioinformatics software. To avoid the false positive, the abnormal sites were verified using the Sanger sequencing method.

Totally, there were 17 RB patients, including 12 males and 5 females, from 0.5 to 23 years old, average ages were (3.2±5.2) years old. Both eyes were involved in 6 patients. The other 11 cases were only one eye was attacked. Four RB patients were found to have germline mutations, among whom 2 had bilateral tumors and 2 had unilateral tumors. 2 novel missense mutations were identified, including 15^th exon c.1408A>T (p. Ile470Phe) and c.1960G>C (p. Val654Leu) at 19^th exon. No RB1 mutation was identified in any of their parents. We also identified 2 mutations reported previously. One is c.1030C>T termination mutation at 10^th exon in a bilateral RB patients and his father, who was diagnosed with unilateral RB. The other is c.371-372delTA frame shift mutation at 3^rd exon. No mutation was found in their parents.

Two novel germline RB1 mutations were found using gene capture technology, which enriched RB1 mutations library.(Chin J Ophthalmol, 2017, 53: 455-459)

To identify the primary disease spectrum and trends of surgical procedure of keratoplasty patients.

Retrospective case series study. To review all patients who underwent keratoplasty at Department of ophthalmology in Tongji Hospital from January 1, 2012 to December 31, 2015. The data collected included age, sex, birthplace, and primary corneal disease and associated surgical procedures. Then the data were compared with similar papers domestic and foreign.

A total of 315 keratoplasties were performed during this 4-year period. The average age of patients at time of surgery was (42.0± 1.8) years, range from 33 days to 89 years, 229 cases (72.7%) were from 18 to 65 years; male: female ratio was 2.06:1. Totally 289 cases (91.8%)came from Hubei province, 26 cases (8.2%) were from other provinces. The leading indications for corneal transplantation were keratitis in 125 cases (39.7%), followed by corneal scar in 71 cases (22.5%), keratoconus in 41 cases (13.0%), pseudophakic bullous keratopathy in 26 cases (8.3%), corneal dermoid in 18 cases (5.7%), corneal dystrophy and degeneration in 16 cases (5.1%), and others (including chemical injuries, thermal burns, post-traumatic corneal scar and corneal opacity) in 18 cases (5.7%). Of the 125 keratitis cases, 51 cases (40.8%) were associated with fungus, 43 cases (34.4%)were associated with virus, and 24 cases (19.2%)were associated with bacterial. In accordance with the classification of corneal transplant surgery, penetrating keratoplasty was performed in 212 cases (67.3% ), lamellar keratoplasty was completed in 87 cases (27.6% ), corneal endothelial transplantation was made in 16 patients (5.1%).

Infectious keratitis was the leading indication for corneal transplantation followed by corneal scar, keratoconus and pseudophakic bullous keratopathy in Tongji hospital patients who underwent keratoplasty. And fungus was the first cause of infectious keratitis. Penetrating keratoplasty was still the main part of corneal transplantation. (Chin J Ophthalmol, 2017, 53: 460-463)

The patient was a 43-year-old male. He was admitted to the Department of Ophthalmology of Yijishan Hospital affiliated to Wannan Medical College on January 31, 2015 due to pain in his right eye with visual acuity loss for more than one month. Past history: In November 2012, a new organism the size of a soybean grain was discovered in the vulva, located at the foreskin of the penis, with hardening of the posterior glans, bleeding from the external urethral opening with mild tenderness. Circumcision and penile space-occupying biopsy were performed in an external hospital. Pathology considered condyloma-like changes, and CO was given.₂Cryo-removal of warts and antiviral treatment; The hyperplasia reappeared in situ, and superficial mass resection was performed. The pathology showed penile cancer. On July 24, 2013, radical resection of penile cancer was performed. The pathological examination results showed that well-differentiated squamous cell carcinoma of the penis invaded the muscle layer. After re-examination, bilateral inguinal mass was found, and bilateral inguinal lymph node dissection was performed. Later, due to metastasis of subcutaneous soft tissue at the root of the left thigh, bilateral inguinal and iliac paravascular lymph nodes, vascular exploration of the left lower limb + pedicled myocutaneous flap resection and transplantation + resection of skeletal muscle and soft tissue tumor around the left hip joint + inguinal lymph node dissection was performed on September 29, 2014. On January 13, 2015, the patient visited the ophthalmology department for the first time due to visual loss in the right eye. MRI plain scan showed choroidal metastatic cancer in the right eye. Further examination was recommended but the patient refused and was later admitted due to loss of vision in the right eye with severe pain in the eyeball.

Example 1The patient was a 57-year-old female. On July 16, 2007, I went to Tianjin Eye Hospital for treatment due to the discovery of subcutaneous hard knots in the upper and lower eyelids of my left eye with red and swollen eyelids for half a year and aggravated for half a month. One year ago, the patient was operated in an external hospital for subcutaneous induration of the lower eyelid of the left eye with eyelid redness and swelling, and the postoperative pathological diagnosis was benign granulosa cell tumor of the left eyelid. Half a year after the operation, the upper and lower eyelids of the patient appeared red and swollen again, and gradually worsened without obvious pain. In order to seek further treatment, he went to our hospital. Eye examination: Right eye visual acuity 0.8. The visual acuity of the left eye is 0.3, the skin of the upper and lower eyelids is red, swollen and hypertrophic, the skin temperature is not high, and irregular shape induration can be palpable under the supraorbital notch of the upper eyelid, the size is about 10 mm ×11 mm ×4 mm, the boundary is not clear, and the mobility is poor; Irregular shaped induration can be palpable 2 mm below the temporal margin of the lower eyelid, with a size of about 12 mm ×15 mm ×5 mm, with poor border and poor mobility. The anterior segment and fundus examination of both eyes showed no obvious abnormalities, the eye position was correct, and there was no obvious restriction of movement in all directions. Left orbital pressure (+), right orbital pressure normal. Exophthalmia measurement: 11 mm in the right eye and 11 mm in the left eye, with an orbital distance of 102 mm. B-ultrasound examination showed irregular shaped hypoechoic lesions in the left orbit. Color ultrasound Doppler examination showed subcutaneous space-occupying lesions of upper and lower eyelids of left eye, with unclear boundaries and irregular shapes; Space-occupying lesions can also be seen on the medial side of the posterior part of the eyeball, with moderate internal echo, and strip-like blood flow signals can be seen inside the lesion, and the blood flow speed is relatively fast. CT scan of the transverse axis of the orbit showed irregular high-density space-occupying lesions in the upper and lower eyelids and muscle cones of the left eye, which were homogeneous, cast with the eyeball, and the boundary between the medial and lateral rectus muscles was unclear. The optic nerve was wrapped by the lesions, and there was no obvious abnormality in the adjacent bone. The CT value of the intraorbital lesion area was 53.09 HU. The clinical diagnosis was a space-occupying lesion in the left orbit. The whole body examination of the patient showed no abnormalities, and no lymph node enlargement was found. In April 2005, the patient underwent resection of the mass in the upper quadrant of the left breast in another hospital, and the postoperative pathological diagnosis was benign granulosa cell tumor of the left breast; Half a year later, the recurrence was performed again, and the pathological diagnosis was still benign granulosa cell tumor of the left breast.

The patient was a 36-year-old female. Transient visual acuity in both eyes decreased for 1 d, and he was seen in Daqing Eye Hospital of Heilongjiang Province. Previous history of diabetes mellitus 5 years. Ophthalmic examination: the best corrected visual acuity was 0.6 for the right eye and 0.6 for the left eye; IOP was 14 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye; No obvious abnormalities were observed in the anterior segment of both eyes; Fundus examination seeQuintessence Picture 1。 Laboratory tests: peripheral blood was chyloid, fasting blood glucose concentration was 13.8 mmol/L, urine glucose (-). Clinical diagnosis: binocular retinal lipidemia.

Thyroid-associated opthalmopathy(TAO) is a common autoimmune syndrome affecting the thyroid and orbit, which can result in the fibrosis of extraoular muscles and hyperplasia of adipose tissue. Advanced TAO patients could even lose vision caused by cornea ulcer and congestion of optic nerve from expansion of the extraocular muscles and orbit fat. Currently, there are no therapies shown to prevent it, because its cellular and molecular mechanisms are not clear. Some studies have recently implicated bone marrow-derived fibroblast-like, called fibrocytes are involved in the pathogenesis of TAO. We reviewed and summarized the research advances of TAO and also the relationship between the fibrocytes and pathogenesis of TAO in the paper. (Chin J Ophthalmol, 2017, 53: 470-473)

Thyroid associated ophthalmopathy (TAO) is a common complication of Graves' disease (GD). The clinical manifestations are mainly swelling and retracted eyelid, protopsis and limited eye movements, and optic neuropathy can be seen in severe cases. The mechanism of TAO is not yet clear. A large number of studies have found that the disorders of autoimmunity play an important role in TAO, while genetic factors, oxidative stress, and environmental factors such as smoking participate in it. Therefore, we consult a large number of studies and expound the pathogenesis from the aspects of genetic susceptibility, immune mechanism, oxidative stress, and the effects of smoking to provide referrences for clinical associated studies.(Chin J Ophthalmol, 2017, 53: 474-480)

This issue focuses on the clinical and basic research of thyroid-related ophthalmopathy. The responsible editorial members in charge of the planning, composition and review of this issue are Professor Sun Fengyuan of Tianjin Medical University Eye Hospital and Professor Luo Qingli of Chengdu Huaxia Eye Hospital.