Volume 54 · Issue 02 · 2018

This issue focuses on the research of ocular surface diseases. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Liu Guoguo.

Dry eye has become the most common ophthalmic disease besides ametropia. As a chronic ophthalmic disease, dry eye, which in serious cases might even lead to blindness, not only affects the life quality of the patient, but also poses adverse impact on social productivity and work efficiency, and moreover influences the development of society and economy. The incidence of dry eye has been rising in recent years because of the widespread use of video terminals, which poses greater challenges for us. Therefore, we put forward the concept of chronic disease management for dry eye in the hope of drawing extensive attention and planning ahead of time, so as to meet the needs of dry eye patients in China. (Chin J Ophthalmol, 2018, 54: 81-83)

Making oneself more beautiful has always been part of humans' civilized life. Accordingly, the side effects of various cosmetic product and cosmetic procedure long exist. The ocular-surface problems induced by cosmetology mainly include cornea and conjunctiva damages, and tear film damages. Specifically, cornea and conjunctiva damage included: (1) physical injury caused by nonstandard operational procedure, (2) toxic and side effect of cosmetic product, and (3) infection induced by using cosmetic contact lenses, while tear film damage included: (1) injury of normal eyelid structure, (2) decrease of tear production from lacrimal gland, and (3) function and morphology injury of meibomian gland.(Chin J Ophthalmol, 2018, 54: 84-86)

In 2017, the International Association of Tear Film and Ocular Surface published the latest edition of dry eye expert consensus (Dry Eye Workshop II, DEWS II). This consensus modifies the definition of dry eye, removing the specific signs for the diagnosis of dry eye, and emphasizing the homeostasis of the tear film. Homeostatic imbalance suggests that the body has lost its ability to maintain equilibrium, resulting in high osmolarity and instability of the tear film with corresponding consequences, such as inflammatory response, neuropathy, and decreased function (lubricating, moisturizing ability). The correct diagnosis is based on examination, and the examination of dry eye in DEWS II in 2017 is now interpreted.

In 2017, the International Tear Film & Ocular Surface society (TFOS) published the latest version of the Dry Eye Workshop II (DEWS II), in which the content on gender, sex hormones and Dry Eye was organized by Professor David A Sullivan of Harvard University as the first author. Professor David A Sullivan is a Senior Professor of Ophthalmology at Harvard University, the Founder and Former Chairman of TFOS. For nearly 35 years, he has been dedicated to basic and clinical research on the relationship between gender, sex hormones and ocular surface diseases, and has published 225 related articles and obtained 11 patents.

Meige syndrome is a disease first described by and named after French neurologist Henry Meige in 1910, with blepharospasm-oromandibular dystonia as the main symptom. In recent years, some scholars have suggested that this disease be named "segmental craniocervical dystonia"^[1]。 The average age of onset was 60 years, and the ratio of male to female sex was approximately 1:2. Although the overall incidence rate has not been reported at home and abroad, in recent years, it has been found that the number of patients with it has been increasing obviously, which has attracted great attention from ophthalmology and neurosurgery. In view of this, the Neuroophthalmology Group of Ophthalmology Branch of Chinese Medical Association put forward this consensus after collective discussion, in order to guide clinical diagnosis and treatment work and research.

To investigate the clinical outcomes of Pre-descement membrane endothelial keratoplasty (PDEK) for treatment of patients with corneal endothelial decompensation.

Retrospective study of case series. The cases of 20 patients (20 eyes) who were diagnosed with corneal endothelial decompensation induced by various original diseases and received PDEK during July 2016 and December 2016 at Zhongshan Ophthalmic Center have been analyzed. The participants included 8 males and 12 females with an average age of (59.3±11.8) years. All 20 patients received PDEK operation, the Dua's layer, descement membrane and endothelium of donor tissue were separated from the underlying stroma with the application of big-bubble technique, and donor discs with diameters of 7.75 or 8.00 mm were harvested with scissors. The donor discs were stained with 0.06% trypan blue and loaded on inserters which were then gently inserted into the anterior chamber of the recipient. When the rolled inserted graft was unfolded, air was carefully injected into the anterior chamber underneath the graft so that the graft can attach to the stroma of the recipient. Post-operation follow-ups of over 6 months have been conducted for all patients, the best spectacle corrected visual acuity (BSCVA), the position of donor disc, corneal thickness and corneal endothelial cell density (ECD) were documented. The pre-operation and post-operation (6 months postoperatively) corneal thickness data of the patients were analyzed with paired samplet test.

The success rate of preparing PDMEK donor disc with big-bubble technique is 90% (18/20). Eighteen patients (90%) received PDMEK surgery successfully. Anterior segment optical coherence tomography (AS-OCT) results indicated that sixteen donor discs (16/18) were well attached to the back surface of the recipient stroma, and that two discs (2/18) dislocated at 6 days after surgery. At 6 months post-operatively, the corneas of 14 patients (14/18) turned clear with their BSCVA ranging 0.4 to 1.0, and the ECD was (1 389.3±373.2) cells/mm² for the patients with clear corneas. At 6 months post-operatively, the average corneal thickness of the patients reduced to (605±45) μm from the preoperative level of (655±56) μm, and the differences are of statistical significance ( t=2.137, P=0.032).

Application of big-bubble technique could effectively secure the success rate of PDEK disc preparation and control the loss of donated corneas. PDEK disc can be easily handled and unrolled in the anterior chamber, which could improve the postoperative clinical outcomes. (Chin J Ophthalmol, 2018, 54: 105-110)

To analyze the etiology and drug sensitivity of lacrimal canaliculitis.

Retrospective study of case series. The general information, culture results and drug sensitivity results of 52 patients (including 10 males and 42 females with an average age of 60.3 years) clinically diagnosed with lacrimal canaliculitis during 2011 and 2016 at Beijing Tongren Hospital of Capital Medical University have been analyzed. The enumeration data have been tested with Chi-square method.

The positive rate of bacterial culture was 78.8%, and the fungal culture tests of all cases showed negative results. Sixty strains of bacteria were isolated from 41 patients whose bacterial culture tests showed positive results, Gram-positive bacteria have been confirmed as the main among the isolated bacteria with Streptococcus (18.3%), Propionibacterium (18.3%), and Streptococcus (15.0%) identified as the three common genera. Thirteen cases (25.0%, all the 13 patients were female) involved with mixed infection, 13.3% (8/60) of the isolated strains were multi-drug resistant bacteria. The drug sensitive rate of the bacteria to fluoroquinolones antibiotics(79.3%, 230/290) was higher than that to cephalosporins(62.1%, 36/58) and aminoglycoside antibiotics(56.3%, 98/174), and such differences are of statistical significance (χ²=7.977, 27.738, P<0.05). Except for the fact that gram-positive bacteria are mostly sensitive to vancomycin, the sensitive rate of the bacteria to gatifloxacin was the highest and that to tobramycin was the lowest.

Lacrimal canaliculitis tend to affect women and elderly patients. Staphylococcus, Propionibacterium, and Streptococcus are the three most common genera. Gatifloxacin may be the preferred antibiotic. Antibiotics combination therapy should be applied for multi-drug resistant bacteria. (Chin J Ophthalmol, 2018, 54: 111-114)

To analyse the corneal and conjunctival sensitivities of premature babies and to study the relevant influencing factors.

Cross-sectional study. One hundred premature infants born at Women's Hospital School of Medicine Zhejiang University between May 2015 and September 2015 were enrolled, among which 51 were male (51%) and 49 were female (49%), the mean gestational age was (30.93±1.75)w, the mean corrected gestational age was (33.65±1.53)w, the mean birth weight was (1 592±336)g. The thresholds of cornea and conjunctiva of infants' left or right eyes were measured with Cochet-Bonnet aesthesiometer at 8-10 o'clock every morning when they naturally woke up, the minimum length of nylon wire that induced three successive times of eye-blink responses was recorded. Paired samplet test was used to compare the corneal and conjunctival sensitivities, the ocular surface sensitivities of preterm infants of different gender were compared using independent samples t-test, Pearson correlation and multiple linear regression analysis was conducted to analyze the correlation of corneal and conjuncitval sensitivities with gestational age, birth weight, age and corrected gestational age.

The mean corneal sensitivity was (44.85±5.53) mm and the mean conjunctival sensitivity was (23.50±5.48)mm in premature babies, corneal sensitivity was significantly higher than conjunctival sensitivity (t=25.620, P<0.001). No statistical significance was found between male and female preterm infants in corneal sensitivity [(44.80±5.83) mm vs. (44.90±5.25) mm, t=-0.085, P=0.933] and conjunctival sensitivity[(23.14±5.83) mm vs. (23.88±5.13) mm, t=-0.673, P=0.502]. Pearson correlation analysis showed that corneal sensitivity was significantly associated with conjunctival sensitivity in prematurity(r=0.676, P<0.001). There was significant correlation between corneal sensitivity and age, corrected gestational age (r=0.238, P=0.017; r=0.679, P<0.001), however no significant correlation was found between corneal sensitivity and gestational age, birth weight in preterm infants (r=0.067, P=0.510; r=-0.179, P=0.075). There was significant correlation between conjunctival sensitivity and corrected gestational age (r=0.490, P<0.001), however no significant correlation was found between conjunctival sensitivity and gestational age, birth weight and age in preterm infants (r=0.078, P=0.439; r=-0.096, P=0.344; r=0.151, P=0.133). Multiple linear regression revealed that corneal sensitivity(Y1) was positively correlated with corrected gestational age(X), the regression equation was Y1=2.45X-37.52, the conjunctical sensitivity(Y2) was also positively correlated with corrected gestational age(X), the regression equation was Y2=1.75X-35.41.

The corneal sensitivity is higher than conjunctival sensitivity in premature babies.No statistical significance is found between male and female preterm infants in corneal sensitivity and conjunctival sensitivity. The corneal sensitivity and conjunctival sensitivity are correlated with corrected gestational age in preterm infants. The corneal and conjunctival sensitivities of premature babies tend to increase along with the increase of corrected gestational age. (Chin J Ophthalmol, 2018, 54: 115-119)

To assess the reading speed of normally-sighted young Chinese with the International Reading Speed Texts (IReST) Chinese version, and evaluate the normal range of the texts, the equivalence of the ten different texts and the potential clinical value.

Evaluation of diagnostic techniques. Participants aged 18 to 35 years old with junior high school or above education and best corrected visual acuity no less than 0.6 were recruited. Best corrected visions of both eyes and binocular vision were tested, and ocular and nervous system diseases were excluded with slit-lamp microscope and funduscope. All the ten texts were read aloud at a distance of 40cm one by one according to a random sequence for each participant. Reading speeds were calculated based on the reading time measured with a stopwatch and number of characters read correctly. The procedure was repeated once again a week later. Data were collected with Epidata and further analyzed with R software. Data accorded with normal distribution and homogeneity of variance were compared by t-test, or by rank sum test.

One hundred and three volunteers aged (26.0±2.8) years old participated in the survey. Among them, 66% were female, 96.1% had college education, 53.4% wear glasses in daily life. The best corrected vision of both distance and near were 1.0 (decimal). For the first test, average reading speed for all the participants and texts was (295±51) characters/min,much faster than the normal range provided by the reading cards. No significant difference was found between different texts, and the biggest variance between texts was 11 characters/min(P>0.05). The average reading speed of the second test was (315±53) characters/min, which was faster than the first one (P<0.05) . No statistic relationship was found between reading speed and age, education level or wearing of glasses. However, women read faster than men, and significant difference was found between male and female volunteers in 5 texts during the first test.

Normally-sighted young Chinese readers read faster than the normal range provided by IReST cards. There is significant variance of reading speed between different individuals. Although learning effect due to the repeated tests should be considered, the ten texts are of favorable consistency. IReST can be a useful tool for assessing reading performance, especially for comparing results before and after interventions with different texts. (Chin J Ophthalmol, 2018, 54: 120-124)

To construct lentiviral-mediated EphA2 overexpression vectors, transfect them into human lens epithelial cells (HLE-B3) in vitro, and investigate the effect of EphA2 gene overexpression on the proliferation and apoptosis of HLE-B3 exposed to high-concentration dexamethasone.

Experimental Study. The pCDH-CMV- MCS-EF1-RFP plasmid was set up by the digestion of NOTⅠand XbaⅠ double restriction enzyme and ligation of CE ligase, and then the plasmid was transformed into DH10B cells. Seven clons were picked for enzymatic digestion and the clons with correct results were chosen for sequencing. The 293 T/17 cells were co-transfected with the pCDH-CMV-MCS-EF1-RFP-EphA2 and the packaging mixture by Lipofectamine 2000. At different multiplicities of infection (MOI=20, 50, 100, and 200) after 72-hour infection, we observed the expression of RFP and morphological changes of HLE-B3 by an inverted fluorescence microscope, and calculated the transfection efficiency through the flow cytometry. EphA2 protein expression was detected by Western blot. The following experiments were divided into four groups: normal control group (group A), EphA2 overexpression vector transfection group (group B), HLE-B3 cells exposed to dexamethasone group (group C) and EphA2 overexpression vector transfection HLE-B3 cells exposed to dexamethasone group (group D). Statistical analysis method was single factor or two factors variance analysis. Cell survival rate was detected by the Cell Counting Kit-8 assay. Cell apoptosis index was detected by Tunel.

Restriction enzyme digestion and sequencing indicated that EphA2 cDNA fragment was successfully inserted in the vector. The infection efficiency was up to 38.6%±3.9%, 49.2%±4.2%, 79.5%±5.5% and 80.2%±6.0% when the MOI was 20, 50, 100 and 200, respectively. There was statistically significant difference (F=2 600.8, P=0.001) among the four groups and between any two groups except between the MOI=100 group and MOI=200 group (P=2.507) . The relative quantity of EphA2 protein of the normal control group, empty vector transfection group and EphA2 gene overexpression vector transfection group was (0.561 2±0.031 7) , (0.559 7±0.012 8) and (3.032 0±0.041 9) , respectively. There was statistically significant difference (F=2 646.0, P=0.001) among the three groups and between any two groups except between the normal control group and empty vector transfection group (P=0.868) . The survival rate of groups A, B, C and D was 98.18%±1.85%, 122.01%±3.89%, 52.32%±1.99% and 76.18%±3.74%, respectively. There was statistically significant difference among the four groups (F=497.6, P=0.001) . The survival rate of group B was greater than group A (P=0.001) . The survival rate of group D was greater than group C (P=0.001) . Tunel results showed that the apoptosis index of groups A, B, C and D was 5.4%±1.5%, 5.0%±1.3%, 23.0%±3.9% and 14.4%±2.7%, respectively. There was statistically significant difference among the four groups (F=397.6, P=0.001) . The apoptosis index of group B was lower than group A, but there was no statistically significant difference between them (P=0.415) ; the apoptosis index of group D was lower than group C (P=0.018).

The lentiviral vector carrying human EphA2 gene has been successfully constructed and efficiently expressed in HLE-B3 cells. EphA2 gene overexpression could increase the HLE-B3 cell survival rate and protect HLE-B3 cells from high-concentration dexamethasone-induced reduction of the cell survival rate. EphA2 gene overexpression could protect HLE-B3 cells from high-concentration dexamethasone-induced apoptosis, but it has no remarkable effect on apoptosis of HLE-B3 cells under physiological conditions. (Chin J Ophthalmol, 2018, 54: 125-132)

To evaluate the efficacy of modified deep lamellar keratoplasty (DLKP) combined with antiviral medications for severe herpes necrotizing stromal keratitis.

Retrospective case series study. Modified DLKP was performed in combination with antiviral medications in fifty patients (50 eyes) with severe necrotizing stromal keratitis, which was unresponsive to systemic and topical antiviral treatment for 1 week, at Shandong Eye Hospital. Before surgery, the operated eyes were examined using slit-lamp microscopy. The size of corneal ulceration and inflammatory infiltration and the depth of ulceration were observed in all of the patients. Corneal scraping and microbial culture and confocal laser scanning microscopy were used to exclude fungal, bacterial, Acanthamoeba, or other infections, and check the number of corneal endothelial cells. Anterior segment optical coherence tomography was used to examine the depth of infiltration, especially the thickness of the remaining cornea below the deepest ulceration. Antiviral drugs were used topically and systemically to control the infection and inflammation. Postoperatively, both antiviral drugs and low-dose corticosteroids were used. The ocular inflammation, corneal graft status and viral recurrence were monitored intraoperatively and postoperatively.

All of the fifty patients showed obvious inflammatory infiltration and stromal ulcers, and the corneal stroma in 23 patients (46%) remained less than 1/5 of the corneal thickness. Nine (18%) of the patients presented with descemetocele. The depth of infiltration ranged from 128 μm to 519 μm [mean, (265±84) μm]. The depth of corneal ulcers was deeper than 2/3 of the corneal thickness in 36 eyes (72%). The endothelial cells were visible in 26 eyes. The density of endothelial cells ranged from 1 275 cells/mm ² to 2 994 cells/mm² [mean, (2 053±507) cells/mm²]. No fungal or bacterial infection was detected by corneal scraping. The microbial culture results were negative. All the inflammations in patients with severe herpes necrotizing stromal keratitis were under control by DLKP. No intraoperative corneal perforation occurred, and 6 eyes (12%) healed following amniotic membrane transplantation due to slow corneal epithelial healing. The infection was exacerbated two days following the surgery in two eyes (4%). These infections were controlled with enhanced antiviral medications in addition to the immediate withdrawal of corticosteroids. The corneal grafts returned to transparency at 1-2 weeks in 42 eyes (84%). Ten eyes (20%) exhibited recurrence due to medication withdrawal without the doctors' advice and a lack of regular visit during 2-year follow-up. Two patients (4%) developed stromal graft rejection for the same reasons.

DLKP can achieve the results of ulcer healing for severe herpes necrotizing stromal keratitis. Combined antiviral therapy and close follow-up can reduce the viral recurrence. (Chin J Ophthalmol, 2018, 54: 97-104)

The child was a male, 7 and a half years old. On August 10, 2015, I came to the Department of Ophthalmology of Eye, Otolaryngology Hospital affiliated to Fudan University because of the increase in serum ferritin for 2 years and blurred vision in both eyes for 1 year. On April 25, 2013, the parents found that the child's growth and development were retarded after the age of 5. Physical examination found that the serum ferritin was increased, which was 1,454 ng/ml, and on May 20, it was found to be 2,343.64 ng/ml. Later, he went to Shanghai Children's Medical Center of Shanghai Jiaotong University School of Medicine and reexamined the serum ferritin of 961.9 ng/ml. The child had no complaints of discomfort. General physical examination: height 120 cm, weight 20 kg, generally acceptable, no anemia, a few lymph nodes accessible to the neck, 0.50~0.75 cm in diameter, no tenderness, good mobility, no difference in heart and lung, no enlargement of liver and spleen, no rash. The laboratory test on June 13 found that white blood cells were 5.5×10⁹Neutrophils 51.5%, lymphocytes 39.7%, hemoglobin 133 g/L, platelets 2.1×10¹¹Liver/L, reticulocyte percentage 3.4%, liver and kidney function, lactate dehydrogenase, serum iron, serum total iron binding capacity (-), 25 hydroxyvitamin D₃(-), hepatitis B (-), hepatitis C (-), carcinoembryonic antigen (-). B-ultrasound examination showed bilateral cervical lymph node enlargement, 1.5 mm ×7.0 mm, no abnormalities in liver, gallbladder and pancreas, and abdominal lymph node enlargement of 1.3 mm ×0.6 mm. Bone marrow puncture smear: obvious lymphoid hyperplasia. CT scans of head and chest (-), long bones and pelvis of limbs (-). Summary Physical examination showed that serum ferritin was significantly increased, and laboratory examination showed no iron deficiency anemia and increased iron load, and there were no inflammatory indicators and signs of tumor.

The child was a 4-year-old female. He went to Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University with the main complaint of "2-year poor visual acuity in both eyes". Physical examination: visual acuity 0.2 in right eye, 0.1 in left eye, corrected visual acuity 0.3 in right and 0.25 in left eye. IOP was 16.8 mmHg (1 mmHg =0.133 kPa) in the right eye and 18.1 mmHg in the left eye. After dilating the pupils, the lenses of both eyes are clear, the lens of the right eye is displaced below the nose, and the left eye is displaced to the nasal side (Figure 1）。 No abnormalities were observed in the rest of the anterior segment and fundus. Auxiliary examination: color doppler imaging (CDI) of the eye showed that the axis of the eye was 22.68 mm in the right eye and 23.34 mm in the left eye, and no obvious abnormalities were found in both eyeballs. Systemic examination: Echocardiography revealed mild tricuspid insufficiency. No abnormalities were observed. Family history: The mother of the child has a history of lens subluxation in both eyes and high myopia in both eyes. Diagnosis: congenital lens subluxation in both eyes, refractive errors in both eyes, amblyopia in both eyes, suspected Marfon's syndrome.

The patient was a 36-year-old female. He was seen in Tianjin Eye Hospital because he found that the conjunctiva of his right eye had grown for 2 years. The patient had brown pigment in the conjunctiva of the right eye without obvious trigger 2 years ago and was not treated. There were no abnormalities in the whole body examination, and there was no melanin deposition in the trunk, limbs and face. Eye examination: visual acuity was 0.8 in the right eye and 0.9 in the left eye; The appearance of the right eye is normal, the eyelid is not red or swollen, and the conjunctiva is shownQuintessence Picture 1； Anterior segment and fundus examination of both eyes showed no abnormalities. Clinical diagnosis: conjunctival mass of the right eye. Excision of the conjunctival mass of the right eye was performed. Histopathological examination showed that the tumor was brown in gross appearance and had a volume of 15 mm x 3 mm x 1 mm; Under light microscope, the nevus cells were located under the conjunctival epithelium or at the junction of the epithelium. The cell volume was small, most of them were small round, and the size was relatively consistent. The nevus cells located in the superficial layer of the conjunctival epithelium contained a small amount of melanin, and there was no obvious atypia (Quintessence Picture 2）。 Pathological diagnosis: conjunctival composite nevus of the right eye.

Intense pulsed light (IPL) is a broad spectrum incoherent light which is produced by high-output xenon lamp. Since the invention of the first-generation IPL in 1994, IPL technology has been developing rapidly and extensively utilized in multiple fields relevant to dermatology across the world. In 2004, the fourth-generation IPL system was introduced with the optimal pulse technology (OPT) and has soon been used for cosmetic purposes all over the world. In 2002, Dr. Toyos found that the meibomian gland dysfunction (MGD) and dye eye disease (DED)symptoms of the rosacea patients who received IPL treatment have been improving significantly, therefore he started to explore the application of IPL system to treatment of dry eye disease. Several recent clinical studies have demonstrated the therapeutic potential of IPL for improving the symptoms and signs of MGD and DED. However, the published data of IPL treatment for MGD and DED is limited, the mechanism of IPL treatment for MGD and DED remained unclear and more relevant researches needed to be done in the future. This article discusses the clinical application history and general mechanism of IPL, and introduces the treatment of IPL for MGD and DED. (Chin J Ophthalmol, 2018, 54: 140-143)

Dry eye is one of the most common ocular problems in ophthalmology clinic. With the change of social environment and people's life style, the prevalence of dry eye disease is increasing. Currently, the diagnosis criteria for dry eye is controversial, diagnosis of dry eye mainly rely on the comprehensive assessment of symptoms and the presence of associated ocular surface signs. However, previous studies have shown a poor correlation between dry eye symptoms and objective clinical signs in patients. Recent studies have found that neuropathic pain plays an important role in the occurrence of discordance between symptoms and signs in dry eye disease. The purpose of this paper is to present the conception of pain, the distribution and function of sensory nerves in ocular surface, the prevalence and mechanism of neuropathic pain and analgesic treatment in dry eye disease.(Chin J Ophthalmol, 2018, 54: 144-148)

Dry eye disease (DED) is the most common ocular surface diseasenowadays. DED can be divided into different types based on the pathogenesis. The progression of DED is strongly related to chronic ocular surface inflammation, regardless of the type of DED. The corneal Langerhans cells (LC) are the dedicated antigen presenting cells in the ocular surface immune system. Along with further understanding of LC recently, its double-sided functions have been discovered: on one hand, LC phagocytize antigen and induce immune tolerance, and on the other hand, LC process and present antigen, and initiate immune response. Therefore, the functional status of LC is of profound impact on the progression and prognosis of DED. Previous researches on DED pathogenesis were mainly focused on T lymphocyte while the importance of LC have not been emphasized. This article reviews the researches on corneal LC in DED of recent years. (Chin J Ophthalmol, 2018, 54: 149-153)

Ocular drug delivery by conventional routes of administration cannot reach or maintain therapeutic drug concentrations in the target tissues for a long duration due to the presence of various anatomical and physiological barriers. Treatment of chronic ocular diseases especially posterior segment of ocular diseases requires novel drug delivery systems that is capable overcome these barriers for efficacious delivery. In recent years, the ocular sustained-release drug delivery system, as a new drug delivery approach, has drawn tremendous attention for its advantages of improving local drug concentration, prolonging action time and reducing frequency of injection. Researchers have been devoted to the developing more effective sustained-release drug delivery systems in order to achieve better clinical efficacy. This article discusses various current sustained-release corticosteroids delivery systems. (Chin J Ophthalmol, 2018, 54: 154-160)