Volume 53 · Issue 10 · 2017

This issue focuses on the clinical and basic research of ocular immunology. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Zhang Meifen.

Uveitis is a common and etiologically complex disease. The diagnosis of uveitis is mainly based on clinical findings, and no ancillary test is needed for diagnosis of the most common uveitis entities in China. Ancillary tests, however, are needed to identify the underlying cause when the clinical presentation points to some specific disease entity, and when infectious uveitis or masquerade syndrome is suspected. A variety of ophthalmic imaging techniques and laboratory tests analyzing blood or intraocular fluid are currently available for etiological identification in uveitis as well as for disease follow-up. When these tests are considered, the less invasive, expensive and time-consuming ones should be chosen. (Chin J Ophthalmol, 2017, 53: 721-723)

Diabetic macular edema (DME), which is the consequence of the failed blood-retinal barrier, has become a leading cause of blindness in diabetic patients. Vascular endothelial growth factors (VEGF) and a series of inflammatory factors participate in the pathophysiology of DME. Laser photocoagulation was accepted as the first-line therapy before anti-VEGF therapy was proved to be more effective by several clinical trials. Anti-VEGF therapy has been regarded as the standard treatment, but there are still lots of cases resistant to anti-VEGF therapy. Corticosteroid treatment has also been proved effective, especially in refractory DME. This demonstrates that inflammation plays a role in DME as well. Here we discuss the situation of anti-VEGF and anti-inflammation therapies for DME. (Chin J Ophthalmol, 2017, 53: 724-728)

Fundus coherence tomography angiography (OCTA) is a new fundus imaging technique. The principle of this technology is to perform repeated coherent light tomography on the same cross-section based on the presence of flowing blood cells in fundus blood vessels; Through a special calculation method, the signal of moving blood cells, that is, blood flow, is obtained; Based on this, three-dimensional reconstruction of vascular structure was carried out, and the image of fundus blood vessels was presented layer by layer in the form of coronal plane (en face). Different from traditional angiography and OCT, OCTA adopts a brand-new imaging mode. Therefore, the operation process of the equipment, the acquisition and evaluation of images, and the writing of image reports need corresponding standards and specifications. In view of this, after careful discussion, the Fundus Disease Group of Ophthalmology Branch of Chinese Medical Association and the Fundus Disease Professional Committee of Ophthalmologists Branch of Chinese Medical Doctors Association formulated the operation procedure specification and image reading specification of fundus OCTA for clinical reference.

To measure vascular density in retinal and choroidal capillary layers by optical coherence tomography angiography (OCTA) and to explore their potential clinical values in Vogt-Koyanagi-Harada disease (VKH).

This is a cross-sectional case-control study. Twenty-one acute VKH cases presented to Peking Union Medical College Hospital between April 2015 and July 2015 and 49 healthy controls were enrolled in this study. OCTA was performed with a split-spectrum amplitude-decorrelation angiography-optical coherence tomography (SSADA-OCT) system borrowed from Optovue Inc. Vascular densities of the capillary layers were analyzed by the built-in software. Bilateral independent sample t-test was used to compare retinal and choroidal vascular density of eyes in acute phase VKH with healthy controls. Spearman correlation test was used to analyze the correlation between the vascular density of retina and choroid in acute phase VKH and LogMAR best corrected visual acuity (BCVA).

Mean vascular density of superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) in eyes of the acute VKH group were statistically lower than those of healthy control group (51.56%±2.88%, 56.51%±2.31%, 58.14%±2.10% vs. 53.55%±2.51%, 58.14%±2.10%, 58.14%±2.10%, t=-3.890, 3.910,-6.554, all 3 P values were<0.01). In VKH patients, eyes with retinal detachment (RD) had statistically lower mean vascular density in the CC layer than those without (NRD) (63.46%±2.19%vs. 65.85%±1.79%, t=3.890, P<0.01), while no statistically significant differences were found in vascular densities of SCP and DCP layers between RD and NRD eyes. Spearman's correlation test revealed a negative correlation between vascular density of the CC layer and logMAR BCVA(r=-0.437, P<0.01), while no statistically significant associations were found between logMAR BCVA and vascular densities of SCP and DCP.

OCTA can be used for quantitative detection of vascular density of retina and choroidal capillary in acute VKH. There is circulatory disturbance in SCP, DCP and CC of acute VKH. Vascular density of CC is associated with visual acuity and retinal detachment. (Chin J Ophthalmol, 2017, 53: 735-739)

To explore clinical and laboratory factors that influencing treating procedure of cytomegalovirus retinitis (CMVR) after allogeneic bone marrow hematopoietic stem cell transplantation (HSCT).

This is a retrospective case series study. A total of 9 CMVR patients (15 eyes) between January 2016 and March 2017 were included in this study. All patients received intravenous or oral ganciclovir, together with intravitreous injection of ganciclovir alone or combined with foscanet sodium. One day before the first injection, aqueous humor samples from the affected eyes were collected, and CMV-DNA and interleukin-8 (IL-8) level were examined. Blood samples were acquired and CMV-DNA was examined too. Best corrected visual acuity, intraocular pressure (Goldmann), slit-lamp and fundus examination, ultra-wide fundus photography were performed before the first injection and every visit since then. Fifty eyes were divided into stop treating group (Group A) and continue-to-treat group (Group B) according to whether local treatment could be seized after loading phase. Image-Pro plus 6.0 was exploited to determine the area of CMVR in the retina, together with number of quadrants involved and whether macular was involved.Then the clinical and laboratory data were compared between two groups. ROC curve was used to calculate the cutoff values for quantitative factors that showed significant differences between two groups.

The interval time between HSCT and diagnosis of CMVR, visual acuity and CMV-DNA in the blood at baseline, area of CMVR and number of quadrants involved and whether macular was involved didn't show any difference between two groups. But the intraocular pressure (Z=-2.488, P=0.017), CMV-DNA (Z=-2.239, P=0.013) and IL-8 level (Z=-2.475, P=0.012) in aqueous humor at baseline, proportion of eyes with active inflammation in anterior (P=0.003) and proportion of eyes with ocular hypertension (P=0.021) in group B were significantly higher than those in group A. The cutoff values of intraocular pressure, CMV-DNA and IL-8 level in aqueous humor at baseline were 14.5 mmHg (P=0.013), 2.99×10⁵ copy/ml (P=0.025) and 447.8 pg/ml (P=0.013), respectively.

Higher intraocular pressure, CMV-DNA and IL-8 in aqueous humor at baseline, especially combined with active inflammation in anterior segment and ocular hypertension suggest longer treating period and more times of intravitreous injections. (Chin J Ophthalmol, 2017, 53: 740-745)

To explore the Cytokine of aqueous humor in AIDS patients with different eye diseases.

A case-control study including 38 patients who was diagnosed as acquired immunodeficiency syndrome(AIDS) at Infectious Center and Department of Ophthalmology in Beijing You'an Hospital, Capital Medical University. And 16 cases of 38 patients were cytomegalovirus retinitis (CMVR), 14 cases were HIV-related retinal disease, and 8 cases presented as normal. A series of tests were performed including vision acuity check, intraocular pressure, fundus photography, blood cell count of CD4+ T lymphocyte and the content of cytokines in aqueous humor by Luminex 200^TM liquid chip analyzer. Intraocular pressure was analyzed by one-way ANOVA, visual acuity, CD4⁺ T lymphocyte count and cytokines were analyzed by Kruskal-Wallis test, the differences between the two groups were compared by Mann-Whitney U test corrected with Bonferroni.

Of the 38 AIDS patients [mean age (33.7±10.0) year], 37 were males and 1 was female. The mean visual acuity of 38 patients is logMAR 1.00(0.000, 1.000). The difference of visual acuity among three groups was statistically significant (χ²=9.963, P=0.007). The visual acuity in CMVR group was significantly higher than that in HIV-related retinal disease group and AIDS-normal eye group. There was no statistically significant difference of intraocular pressure among three groups (F=0.830, P<0.05). The mean CD4+ T lymphocyte count was 58(4, 550)/μl and the difference was statistically significant among three groups(χ²=6.106, P=0.047). The CD4+ T lymphocyte count in AIDS-normal eye group was significantly higher than that in CMVR group and HIV-related retinal disease group. There was no statistically significant difference in CD4+ T lymphocyte count between HIV-related retinal disease group and CMVR group. The following cytokines in CMVR group were significantly higher than the other two groups with statistically significant differences: MIP-1b, IL-6, TNF-α, VEGF, IL-8, MCP-1, IP-10.

In patients who was diagnosed as AIDS, cytomegalovirus retinitis would damage vision acuity seriously. The elevated cytokines' level in aqueous humor such as MIP-1b, IL-6, TNF-α, VEGF, IL-8, MCP-1, IP-10, compared with HIV-related retinal disease and AIDS-normal eye cases, may be related to the activity of Th1 cell and monocyte-macrophages system including chemokines, inflammatory factors, and vascular endothelial factors.(Chin J Ophthalmol, 2017, 53: 746-752)

To investigate the clinical characteristics of Sturge-Weber syndrome (SWS) in the patients with Port-wine stain (PWS).

A total of 279 PWS patients, 164 males, 115 females with a median age of first visit 17.00 (4.75, 56.00) months. Most of the PWS patients were referred to the Ophthalmology Department for screening eye problems when the cutaneous angiomas involved the ophthalmic division of the trigeminal nerve distribution. The intraocular pressure (IOP), cup to disk ratio (C/D), corneal condition and other essential measurements were examined to screen glaucoma or choroidal hemangioma. The differences of age, gender and vascular ectasia in the ipsilateral eyes were compared among PWS and SWS patients with chi-square test. The differences about the first visit time, IOP, C/D and corneal diameters were evaluated with independent-sample T test or nonparametric test followed by Mann-Whitney U test.

A total number of 66 out of 279 PWS patients (23.7%) were confirmed as SWS with glaucoma. The IOP of the ipsilateral eye with vascular ectasia in PWS and SWS was 13.00 mmHg (1 mmHg=0.133 kPa) (IQR: 9.75, 17.00) and 23.00 mmHg (20.00, 32.00), respectively (Z=-8.212, P<0.001); the IOP differences between the ipsilateral and contralateral eye in PWS and SWS was 1mmHg (0, 2) and 7 mmHg (3, 11) respectively; the C/D in the ipsilateral eye and the contralateral eye was 0.30 (0.30, 0.35) and 0.7 (0.6, 0.8) respectively in SWS cases with secondary glaucoma.

There is a high proportion of SWS with glaucoma in ophthalmic division affected PWS patients. Fundus examinations were necessary for this type of patients. (Chin J Ophthalmol, 2017, 53:753-757)

To evaluate the clinical features of retrocorneal fungal infection and the therapeutic effects.

This was a retrospective, noncomparative study of nine patients with retrocorneal fungal infection and an intact corneal epithelium treated at Qingdao Eye Hospital. The history, clinical features, diagnostic methods, pathogens and therapeutic effects were analyzed.

Five patients had a history of trauma by plant, two had a non-plant injury, and two had unidentified reasons. The duration between the initial onset and the first visit to our hospital was 7.9 months (range, 3 months to 2 years). There was endothelial plaque and sometimes with white infiltration in the deep stroma, but the corneal epithelium remained integrated, and the anterior stroma was uninfected. The patients were misdiagnosed as uveitis, herpes simplex keratitis or bacterial keratitis in the other hospitals. Visual acuity was 20/200 in four eyes, 20/60 in one eye, 20/40 in two eyes, and 20/30 in two eyes. Fungal hyphae were detected by confocal microscopy in six eyes. All the eyes had poor response to the antifungal medication before penetrating keratoplasty was performed. The smear examinations of the corneal endothelial plaque showed fungal hyphae in six eyes. Alternaria Nees, Apospory, Phialophora verrucosa, and Fusarium were identified.

Plant injury is the most common risk factor of retrocorneal fungal infection. Slow onset and no initially obvious symptoms may lead to delayed diagnosis and misdiagnosis. The diagnosis can be confirmed by confocal microscopy before surgery. The effect of antifungal medication is usually poor. (Chin J Ophthalmol, 2017, 53:758-765)

Treatment of dacryocystitis, nasal dacryocystostomy by cutaneous approach^[1,2]It is a classic treatment method, through nasal endoscopic approach^[3,4]Provide a broader vision and a more minimally invasive therapeutic approach. At the same time, simple lacrimal drainage implantation surgery through mucosal approach^[5]Because of its safety and speed, it also occupies an important position in the treatment of dacryocystitis.

The patient was a 39-year-old male. On May 14, 2014, he went to the Department of Ophthalmology, Beijing Friendship Hospital affiliated to Capital Medical University due to the decrease of visual acuity in both eyes for more than 2 years and aggravation for 2 months. Recurrent episodes of previous blurred vision in both eyes were 2 years, genital ulcers were 15 years, oral ulcers were 2 years, and erythema nodosum was 1 year. Those who deny having a similar medical history in their family. General physical examination: No obvious abnormalities were found, routine blood and urine examinations and biochemical examinations showed no abnormalities, sacroiliac joint X-ray and chest X-ray showed no abnormalities, and blood flow of both carotid arteries, renal arteries and subclavian arteries showed no abnormalities. Eye examination: the best corrected visual acuity was 0.15 for the right eye and 0.2 for the left eye; The cornea of both eyes was transparent, the depth of the anterior chamber was normal, the iris texture was clear, the pupil was sensitive to light, the lens was transparent, and the vitreous body was not obviously opaque; Circular hiatus in the macular area of both eyes (Figure 1）。 OCT examination: macular hole in both eyes, macular hole in left eye with retinal detachment (Figure 2）。 FFA examination: Intense fluorescence of optic discs in both eyes in the late stage, with chorioretinal leakage, and fluorescence in macular area (Figure 3）。 Ocular B-ultrasound examination: vitreous opacity in both eyes, incomplete posterior vitreous detachment. Clinical diagnosis: Behcet's syndrome in both eyes with macular holes in both eyes. Patients were routinely given oral glucocorticoids and immunosuppressants to treat Behcet's syndrome. It is recommended that elective vitrectomy should be performed after 3 months of stable ocular inflammatory response.

患者男性，28岁。因头痛、呕吐20 d，复视3 d，于2016年5月12日就诊于北京大学第一医院眼科。外院查头颅MRI未见明显异常（图1）。既往白塞综合征病史10余年，2年前于外院诊断左眼"全葡萄膜炎" ，曾口服糖皮质激素、免疫抑制剂等治疗。全身检查：未见明显异常，无意识障碍。眼部检查：双眼矫正视力均1.0，眼压正常，右眼前节未见异常，左眼晶状体前可见少许陈旧性色素颗粒，双眼瞳孔大小3.5 mm，直接及间接对光反射正常，相对性传入瞳孔障碍（-）。双眼眼底视盘充血，全周边缘模糊，水肿隆起2 PD，视盘周围视网膜水肿约0.5 PD，视盘周围毛细血管纡曲扩张，视网膜中央静脉近视盘区略迂曲扩张，右眼较重。右眼5:00及1:00方向可疑神经纤维层出血，距视盘约0.2 PD，黄斑未见异常（图2A）。左眼视网膜后极部近视盘区隐见视网膜放射状皱褶，黄斑未见异常（图2B）。角膜映光法（33 cm）：右眼角膜映光点位于瞳孔中央，左眼角膜映光点位于瞳孔中心偏颞侧约1 mm。右眼注视，左眼内斜+7°，左眼注视，右眼内斜+15°。眼球运动：右眼各方向眼球运动到位；左眼外转轻度受限伴跳动感，水平左侧注视时颞侧角膜缘距外眦约1 mm，余各方向眼球运动到位。无眼球震颤。复视像：双眼水平同侧复视，向左侧注视时复视像距离均较正前方及右侧注视大，周边物像属左眼。视神经OCT检查：双眼神经纤维层显著增厚，视杯几乎消失（图3）。视野检查：未见明显异常。诊断：（1）外直肌不全麻痹（左眼）；（2）视盘水肿（双眼）；（3）白塞综合征。建议神经内科及风湿免疫科就诊，后收入风湿免疫科住院。患者入院后神经内科会诊，行腰椎穿刺测脑脊液压力高于330 mmH₂O（高于上限测不出，1 mmH₂O=0.0 098 kPa），红细胞沉降率18 mm/h，C反应蛋白23.00 mg/L，细胞学检查未见明显异常。查头颅磁共振静脉血管成像（MRV）未见明显异常（图4）。高颅压诊断明确，予以甘露醇250 ml，每8 h 1次对症脱水治疗，甲强龙80 mg、硫唑嘌呤100 mg每日1次+沙利度胺50 mg每晚1次口服治疗。1周后患者诉复视症状减轻，复查视神经OCT示双眼视盘水肿较前稍减轻（图5）。10 d后颅内压降至正常，患者诉复视症状基本缓解，双眼矫正视力1.2，视神经OCT示双眼视盘水肿高度较前稍有降低，双眼视盘水肿较前稍缓解，残留鼻侧半周水肿，右眼视盘旁视网膜5:00及1:00方向见线样视网膜出血（图6）。风湿免疫科及神经内科共同诊断：神经白塞综合征、颅内高压。

患者女性，41岁，因左眼视力下降10 d于2015年11月10日前来西安市第四医院眼科就诊。患者10 d前行左侧颞部注射"修饰透明质酸钠凝胶"时即刻出现左眼视物不清，上方视野缺损，不伴有眼红、眼痛、眼胀等症状。在西安交通大学附属第二医院以左眼缺血性视神经病变给予糖皮质激素冲击治疗后改为口服，并给予营养神经等治疗，左眼视力无好转。随来西安市第四医院眼科就诊，患者既往体健，无糖尿病、高血压病史；无心脏、肾脏疾病史；无消化道疾病及肺病史；无外伤史；无眼部手术史。入院后检查：视力：右眼1.0，左眼20 cm指数，眼压：右眼10.9 mmHg（1 mmHg=0.133 kPa），左眼9.9 mmHg。右眼结膜无充血，角膜透明，角膜后沉积物（-），前房较浅，房水闪光（-），虹膜纹理清，瞳孔圆，直径约3 mm，对光反应存在，晶状体透明，玻璃体絮状混浊，眼底视盘色淡红，界清，视网膜未见明显异常，黄斑中心凹反光清。左眼结膜无充血，角膜透明，角膜后沉积物（-），前房中深，房水闪光（-），虹膜纹理清，瞳孔圆，直径约3 mm，直接对光反应迟钝，间接对光反射存在，晶状体透明，玻璃体絮状混浊，眼底视盘水肿，上半水肿明显，下半色淡，盘沿可见少量出血，静脉迂曲，上方视盘表面毛细血管扩张，视网膜未见明显异常，黄斑中心凹反光清。头颅及眼眶MRI检查（图1）：双侧眼眶MRI未见明显异常，双侧颞部、颌面部及鼻背皮下异常信号，考虑透明质酸注射术后改变。视野检查：左眼上半视野缺损（图2中A）。视觉电生理检查：图形视觉诱发电位检查结果右眼无异常，左眼振幅低平，峰时延长，提示左眼视传导不良（图2中B）。视盘OCT检查：左眼视盘毛细血管扩张，盘沿不清（图2中C），盘周神经上皮层厚度上方211 μm，下方238 μm，鼻侧136 μm，颞侧111 μm。视杯呈Ⅱ级视杯（图2中D）。初步诊断：左眼缺血性视神经病变，透明质酸钠注射术后。给予改善眼部血液循环和营养神经缺血性损害，甲泼尼龙琥珀酸钠500 mg全身冲击治疗，左眼半球后注射地塞米松，左侧颞浅动脉旁皮下注射复方樟柳碱。10 d后复查视盘OCT：左眼视盘上方轻度水肿，鼻侧和颞侧盘沿较清，盘周神经上皮层厚度上方195 μm，下方214 μm，鼻侧111 μm，颞侧85 μm。视觉电生理检查发现左眼图形视觉诱发电位振幅较前好转，峰时缩短（图3中A)。期间患者左眼视力有一过性的视力好转，出院时眼部检查：左眼视力0.2，结膜无充血，角膜透明，角膜后沉积物（-），前房中深，房水闪光（-），虹膜纹理清，瞳孔圆，直径约3 mm，直接对光反应存在，间接对光反射存在，晶状体透明，玻璃体絮状混浊，眼底视盘边界清，视网膜未见明显异常，黄斑中心凹反光清。视野检查上方视野缺损范围缩小（图3中B）。复查视盘OCT结果显示：左眼视盘边界清，盘周神经上皮层厚度上方119 μm，下方89 μm，鼻侧91 μm，颞侧59 μm（图3中C）。视杯呈Ⅳ级视杯（图3中D）。

The patient was a 60-year-old female. He had pain in his left eye and visual acuity decreased for 3 days, and was seen in the Department of Ophthalmology of the First Hospital of Jilin University. Eye examination: visual acuity was 0.8 for the right eye and 0.2 for the left eye; IOP was 13 mmHg (1 mmHg =0.133 kPa) in the right eye and 43 mmHg in the left eye. The lens of the right eye was mildly opaque, and the rest was roughly normal; Left eye ciliary hyperemia, retrocorneal lambite deposits, aqueous humor flashes (+ +), and several gray-white Busacca nodules around the iris (Quintessence Picture 1), the anterior capsule of the lens was pigmented under the nose, the lens cortex was turbid, the anterior vitreous body was filamentous turbid, and no obvious abnormalities were observed in the fundus. Anterior segment OCT examination is presented inQuintessence Picture 2。 Clinical diagnosis: Granulomatous anterior uveitis of left eye; Secondary glaucoma of the left eye.

Sympathetic ophthalmia (SO) is a rare, bilateral, non-necrotizing, granulomatous uveitis that usually occurs after open ocular injury or intraocular surgery. The pathophysiology is not clearly understood, but generally SO is an immediate hypersensitivity mediated by T lymphocytes which are related to ocular tissue antigens. The main histopathological features are granulation tissues composed of lymphocytes, macrophages and multinucleated giant cells. The clinical manifestations are different from person to person, which might be mild or severe. Although it could be presented with anterior uveitis, intermediate uveitis and posterior uveitis, panuveitis is the most common sign. The ophthalmic examinations, such as fundus fluorescein angiography, optical coherence tomography and B-scan, could be used to observe the patients' conditions and monitor the therapeutic effect. The main treatment of SO is medical therapy with corticosteroids, immunomodulators and biomodulators. Topical drug administration, including intravitreal injection of triamcinolone acetonide and implantation of a fluocinolone acetonide implant, can be considered. There is controversy about whether enucleation or evisceration is more appropriate and when the procedure should be done. The prognosis of SO could be poor. SO is liable to deteriorate and may lead to blindness. This article reviews the etiology, mechanisms, histopathology, clinical characteristics, diagnosis and treatment of SO.(Chin J Ophthalmol, 2017, 53:778-782)

Transthyretin (TTR)-related familial amyloid polyneuropathy (FAP), which is caused by mutant TTR, is a rare but fatal autosomal dominant disease. TTR is synthesized by the liver (95%) , the choroid plexus of the brain and the retinal pigment epithelium. FAP leads to peripheral neuropathy, and the main ocular manifestations are vitreous opacity (yellowish cotton-like), secondary glaucoma and keratoconjunctivitis sicca. Liver transplantation has proven to be the most effective treatment for TTR-FAP. Nowadays, tafamidis is the only drug approved for TTR-FAP (early stage). However, neither liver transplantation nor tafamidis is capable to halt the progression of ocular involvement. Panretinal photocoagulation could damage the retinal pigment epithelium, and thus prevent the progression. Recent investigations on TTR-FAP and its ocular involvement are reviewed in this article. (Chin J Ophthalmol, 2017, 53: 783-785)

Exosomes are small vesicles with a molecular diameter of 30 to 100 nm, which are secreted into the cell after the fusion of the multivesicular bodies with the plasma membrane. Exosomes contain various molecular constituents of their cell origin, including proteins, microRNAs and lipids. Different cell-derived exosomes have different biological functions. Exosomes play a very important role in the development and progression of age-related macular degeneration (AMD). The exosomes derived from the eye are involved in the processes of cell growth, metastasis, angiogenesis and immunosuppression by transferring contents to adjacent or distant cells. Some of the specific molecules may be used for early diagnosis and treatment of AMD. This article reviews the relationship between exosomes and AMD pathogenesis and treatment, which may provide a new insight into the pathogenesis and treatment strategy of AMD. (Chin J Ophthalmol, 2017, 53:786-790)

Glaucoma, as the first leading cause of irreversible blindness in the world, is a chronic progressive optic neuropathy. The pathogenesis of glaucoma is still not fully understood till now. A lot of studies about vascular diameter, tortuosity, location, disc perfusion, vascular regulation and systemic vascular factors had been conducted to investigate the relationship between the vascular states and glaucoma since vascular hypothesis proposed. However, direct and convincing evidence for primary mechanisms of glaucoma is still lacking. The development of OCT, especially the Angio-OCT makes the real time visualization and measurement of ocular perfusion in vivo possible, gives some new evidences of vascular dysfunction of optic nerve head associated with glaucoma, which enhancing thinking of the pathogenesis of glaucoma. This review summarizes the literatures on vascular factors associated with glaucoma to provide the references for clinical researches. (Chin J Ophthalmol, 2017, 53:791-796)

hematopoietic stem cell transplantation (HSCT) is an effective method for treating hematological malignant tumors, aplastic anemia and other blood diseases, metabolic diseases such as mucopolysaccharidosis and lysosomal storage diseases, and severe combined immunodeficiency^[1]。 After more than 20 years of development, treatment options have continued to advance, and more and more patients are receiving and benefiting from HSCT. More than 20,000 patients in the United States undergo HSCT treatment each year. The 5-year disease-free survival rate can reach 70% in chronic myeloid leukemia and 40% in diffuse large cell non-Hodgkin lymphoma^[2]。 With the improvement of patient survival rate and prolongation of survival time, many post-HSCT complications are gradually discovered.