Volume 54 · Issue 03 · 2018

This issue focuses on the research progress of glaucoma diagnosis and treatment. Professor Wang Ningli is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

The standardization of clinical diagnosis and treatment of glaucoma is crucial to ensuring the quality of medical treatment and yielding high quality results in clinical research. Based on the results of a questionnaire survey, this paper analyzes the reasons for the gap between the current situations of glaucoma diagnosis and treatment in China and the international and domestic guidelines and consensus, emphasizes the importance of standardization in clinical diagnosis and treatment, and discusses the feasible strategies for improving the standardization of diagnosis and treatment.The goal is to improve glaucoma diagnosis and treatment service capability, bridge the gap between reality and domestic and international guidelines and consensus, and further standardize the management of glaucoma as a chronic disease, through efforts in strengthening training and promoting standardization. (Chin J Ophthalmol, 2018, 54: 161-163)

In clinical diagnosis and treatment work, the coverage of descriptive terms is very wide, including patient complaints, medical history, signs, special examinations, laboratory tests, clinical disposition, etc. At present, the number of terms in the international classification of diseases (ICD) 10, ICD-9 and other databases is very small, and the use of many descriptive terms in ophthalmology clinic lacks standardized guidance. Today, with the rapid development of medical informatization, if the basic clinical descriptive terms cannot be unified, it will not only affect the clinical diagnosis and treatment work, but also make the statistical analysis of clinical data deviate, which seriously affects the accuracy and scientificity of clinical research results and clinical decision-making. Therefore, standardizing clinical descriptive terms can effectively improve the speed and efficiency of clinical information collection and data mining, and help maintain the integrity and authenticity of clinical information in multiple work links of collection, storage, transmission and utilization, so as to make clinical scientific research work based on data more scientific.

Despite being the most influential in the worldTHE LANCETpublished Level I evidence, EAGLE (effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma) The results provided by the study still cause great controversy in China.

Recently published inTHE LANCETEAGLE (effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma) The results of the study, that is, clear lens extraction for patients with angular closure with increased intraocular pressure and PACG [intraocular pressure ≥21 mmHg (1 mmHg =0.133 kPa), except for those with mean defect value inferior to-15 by Humphery field 24-2 method and cup-to-disc ratio of optic disc ≥0.9], showed that compared with conventional series of glaucoma treatments, namely laser peripheral iridotomy, trabeculectomy, and anti-glaucoma drug treatment, this surgical method can significantly increase the anterior chamber depth, better visual recovery, lower intraocular pressure and less anti-glaucoma drug use, and the probability of patients undergoing intraocular surgery again is greatly reduced, which has better hygienic and economic benefits in the long term. In terms of safety, the incidence of posterior lens capsule rupture, a major complication of clear lens extraction, is comparable to that of ordinary cataract extraction. Accordingly, the EAGLE study believes that clear lens extraction can be promoted as a first-line treatment for PACG, which will benefit patients^[1]。 However, the authors believe that although the EAGLE study provides important evidence and has important implications for clear lens extraction in the treatment of angular closure with intraocular hypertension and PACG, the study also has limitations and has not yet formed a consensus opinion on the global scale. In view of the uneven socio-economic conditions and medical level in China, blindly promoting this treatment method may cause unexpected adverse consequences.

To evaluate the association between corneal biomechanical parameters and visual field (VF) progression in normal tension glaucoma (NTG) using the Corvis-ST device, and to evaluate the ability of corneal biomechanical parameters to predict the VF progression.

Corneal biomechanical parameters of newly diagnosed NTG patients were obtained using Corvis-ST in the baseline follow-up visit. The VF progression was defined as a 4-point increase in the Advanced Glaucoma Intervention Study (AGIS) score compared to the baseline in three consecutive follow-up visits (per 3-6 months). Corneal biomechanical parameters were compared between progressive and nonprogressive VF loss eyes using the independent-sample t test and Mann-Whitney U test. Spearman correlation analysis was used to explore the relationship between the corneal biomechanical parameters and the VF progression. Receiver operating characteristic curves were studied for the parameters and the sensitivity and specificity for distinguishing between progressive and nonprogressive glaucomatous eyes. The areas under the receiver operating characteristic curves (AUC) were also evaluated.

Sixty patients with NTG were enrolled in this study. Among them, 12 were lost to follow-up. A total of 48 patients completed all follow-up visits on schedule. Eleven of them were excluded due to one or more uncontrolled intraocular pressure (IOP) during the follow-up (less than 30% IOP reduction from the baseline). Thirty-seven eyes of 37 diagnosed NTG patients were enrolled. Ten eyes reached a progression endpoint. There was no significant difference in age, central corneal thickness, axial length, baseline IOP or baseline VF between the two groups. There was significant difference in Time A1 [(7.10±0.17) ms vs. (7.37±0.28) ms, t=-3.357, P=0.002], Length A1 [1.74(1.61, 1.77) mm vs. 1.78(1.77, 1.79) mm, Z=-3.036, P=0.002], Velocity A1 [0.16(0.14, 0.16) m/s vs. 0.15(0.14, 0.15) m/s, Z=-2.627, P=0.009] and DefAmpl HC [(1.22±0.13) mm vs. (1.12±0.11) mm, t=2.601, P=0.013] between progressive and nonprogressive glaucomatous eyes. Correlation analysis showed that Time A1, Length A1, Velocity A1 and DefAmpl HC were correlated with VF progression (r=-0.521, -0.463, 0.401, 0.349, P<0.05) . Time A1 demonstrated the highest AUC (0.817, P=0.001), followed by Length A1 (0.780, P=0.003), Velocity A1 (0.734, P=0.012) and DefAmpl HC (0.713, P=0.022). The cut-off set of Time A1 was 7.2 ms, the sensitivity was 80.0%, and the specificity was 82.8%.

There were differences in corneal biomechanical parameters between eyes with progressive and nonprogressive VF loss in patients with NTG. There were lower Time A1 and Length A1 values and higher Velocity A1 and DefAmpl HC values in progressive glaucomatous eyes. This indicates a quicker response to reach first degree applanation and a larger degree of corneal deformability in progressive eyes. It is predicted that the easier deforming of the cornea, the smaller tolerance of the sclera and lamina cribros on IOP, making the optic disc more vulnerably. This may be one of the causes of glaucomatous optic nerve damage. Time A1 was the best parameter to predict the progression of VF among the corneal biomechanical parameters obtained by Corvis-ST. (Chin J Ophthalmol, 2018, 54: 171-176)

To analyze potentials of frequency-doubling technology perimetry (FDP) for diagnosing open-angle glaucoma (OAG) in perimetrically normal eyes of OAG patients diagnosed with standard automated perimetry (SAP) and relating factors from abnormalities on FDP to visual field loss on SAP.

A prospective cohort study. Sixty-eight eyes of 68 OAG patients visiting the ophthalmic clinic of Peking University Third Hospital during November 2003 and October 2007 [32 primary open-angle glaucoma patients and 36 normal tension glaucoma patients, 32 males and 36 females, with an average age of (59±13) years] with unilateral field loss detected by SAP (Octopus101 tG2 program) were examined with the FDP N-30 threshold program (Humphrey Instruments) at baseline. Two groups, FDP positive group and FDP negative group, were divided based on the FDP results, and visual field examinations were followed by a series of SAP examinations for the perimetrically normal eyes over 8 years. During the follow-up, the difference of the converting rate of SAP tests between the two groups was analyzed. Differences between "convertors" and "non-convertors" of SAP tests in the FDP positive group, such as the cup-to-disk ratio and glaucomatous optic neuropathy rate, were also compared with the independent-samplet test or Wilcoxon two-sample test for continuous variable data and the χ ² test or Fisher exact test for classified variable data and rates.

Forty-eight perimetrically normal eyes of 48 participants had complete data and a qualifying follow-up. Baseline FDP results were positive in 33 eyes and negative in 15 eyes. Of the eyes with positive FDP results, 22 eyes developed abnormal SAP results after 4.0 to 90.0 months (median 14.5 months) , whereas none of the eyes with negative FDP results developed abnormal SAP results. For perimetrically normal eyes in the FDP positive group, "converters" showed a greater cup-to-disk ratio (0.73±0.09 vs. 0.63±0.14, Wilcoxon two-sample test, P=0.011) and more eyes with glaucomatous optic neuropathy (19/22 vs. 4/11, Fisher exact test, P=0.006).

In perimetrically normal eyes of OAG patients, FDP could detect visual field loss of these eyes and predict to some extent future visual field loss on SAP. Severity of glaucomatous optic neuropathy at baseline is related to converting from abnormalities on FDP to visual field loss on SAP. (Chin J Ophthalmol, 2018, 54: 177-183)

To investigate the patterns of surgical treatment for patients with glaucoma in the Eye Hospital of Wenzhou Medical University from 2005 to 2014.

Retrospective case series about 6 781 glaucoma patients (7 751 eyes) who received surgical treatment from January 1, 2005 to December 31, 2014 in the Eye Hospital of Wenzhou Medical University. Among them, 2 869 were males and 3 912 were females, aged (62±14) years. The data of patients' demographic information, diagnosis and surgical procedures [trabeculectomy, aqueous shunts of ExPRESS and Ahmed for extraocular reservoir, cataract extraction with intraocular lens (IOL) implantation, and combined operations for glaucoma and cataract] were collected and the patterns of surgical treatment were evaluated. SPSS 21.0 statistical software was used, mainly for statistical description of the data.

The ratio of trabeculectomies increased between 2005 and 2009, from 48.2% (95/197) to 57.7% (488/846), but decreased to 21.1% (220/1 041) in 2014. The ratio of aqueous shunts of ExPRESS and Ahmed increased to 6.1% (63/1 041) and 7.6% (79/1 041) from 2005 to 2014, respectively. The ratio of cataract extraction with IOL implantation increased to 28.4% (294/1 036) in 2012, but decreased to 21.6% (225/1 041) in 2014. The ratio of combined operations for glaucoma and cataract decreased to 6.6% (47/717) from 2005 to 2010, and increased to 36.6% (381/1 041) in 2014. Over the decade, the ratio of cataract extraction with goniosynechialysis increased from 2.4% (15/623) to 17.7% (184/1 041). The rate of iridotectomy decreased to 0.2% (2/1041) in 2014.

Trabeculectomy, cataract surgery and combined surgery for glaucoma with cataract were still the mainstream of glaucoma surgery in the Eye Hospital of Wenzhou Medical University from 2005 to 2014. And the ratio of cataract extraction with IOL implantation, aqueous shunts of ExPRESS and Ahmed, and combined operation for glaucoma and cataract rapidly increased, with cataract extraction with goniosynechialysis increasing most rapidly and becoming the mainstream procedure of treatment for glaucoma and cataract. Inversely, the rate of trabeculectomies and iridotectomies decreased dramatically over this period.(Chin J Ophthalmol, 2018, 54: 184-188)

To retrospectively investigate the medication structures and characteristics among the outpatients diagnosed with glaucoma at West China Hospital of Sichuan University in 2015.

Based on retrospective study method, the data of glaucoma patients (6 236 people, and 13 693 person-times) who received medication at the outpatient department of West China Hospital in 2015 were collected from hospital information system, such data include date, doctor's advice date, doctor's advice ID, diagnosis, western medicine fee, Chinese medicine fee, etc. Excel 2011 software was used to analyze the drug use of glaucoma outpatients.

(1) The total of outpatients with glaucoma medication were 13 693 person-times, of which 4 247 persons-times patients who did not take intraocular pressure (IOP)-lowering drugs accounted for 31.02%. (2) There were 7 types of IOP-lowering drugs used, including 14 kinds of different drugs. The top three most frequently used drugs were prostaglandin analogs (PGA, 36.98%, 5 847 cases), β-adrenergic receptor blockers (26.61%, 4 207 cases), and carbonic anhydrase inhibitor (CAI, 20.95%,3 312cases). (3) Among all the patients who have taken IOP-lowering drugs, the patients that received single-drug treatment accounted for 62.41% (5 895/9 446), and the most frequently used single IOP-lowering drug is PGA(44.94%,2 649/5 895). Patients that received two-drugs combined treatment accounted for 28.03% (2 648/9 446), and the most frequently used combined treatment is "β-adrenergic receptor blockers+ PGA" (27.57%,730/2 648). Patients that received three-drugs combined treatment accounted for 7.88% (744/9 446), and the most frequently used combined treatment is "β-adrenergic receptor blockers+ PGA+ CAI" (46.24%,344/744). Patients that received four-drugs combined treatment accounted for 1.57% (149/9 446), and the most frequently used combined treatment is "β-adrenergic receptor blockers+α-adrenergic receptor agonist +PGA + CAI" (87.25%,130/149). And patients that received five-druges combined treatment accounted for 0.11% (10/9 446).

The most frequently used single IOP-lowering drug for outpatients with glaucoma at West China Hospital of Sichuan University in 2015 is PGA. The most frequently used combined medications are "β-adrenergic receptor blockers+ PGA" for two-drugs combined treatment and "β-adrenergic receptor blockers+ PGA + CAI" for three-drugs combined treatment. (Chin J Ophthalmol, 2018, 54: 189-193)

To compare the significance of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of uveal melanoma.

It was a retrospective case series study. Sixty-three cases (63 eyes) of uveal melanoma patients (confirmed by histopathology) who underwent CEUS and DCE-MRI examination at Beijing Tongren Hospital during January 2010 and May 2014 were collected, including 30 males and 33 females, with average age of 47 years (ranged from 27 to 69 years). The data and images of CEUS and DCE-MRI were analyzed and the findings were reviewed and compared to pathology results so as to evaluate the diagnosis coincidence rate of using CEUS, DCE-MRI and both (combined CEUS and DCE-MRI). Fisher's exact test method was used to explore the efficiency of diagnosing uveal melanoma with CEUS, DCE-MRI and the two combined.

Among the 63 cases of uveal melanoma, the coincidence rates of CEUS, DCE-MRI and combined diagnosis for uveal melanoma were 93.7% (59/63), 90.5% (57/63) and 100% (63/63) respectively. There was no significant difference between CEUS and DCE-MRI (P=0.663). Fifty-five cases showed fast wash in and fast wash out, and 8 cases showed fast wash in and slow wash out in time-intensity curve of CEUS. Fifty-four cases showed rapid increase and rapid decrease, and 7 cases showed rapid increase and slow decrease, and 2 cases showed sustain enhancement in signal intensity-time curve of DCE-MRI.

CEUS is an effective method in diagnosis of uveal melanoma. CEUS and DCE-MRI are of similar value in the diagnosis of uveal melanoma, physicians may be able to acquire more diagnostic information when using the two methods in combination.(Chin J Ophthalmol, 2018, 54: 194-198)

To observe computed tomography (CT) imaging parameters of congenitally blind microphthalmia in Chinese patients and to provide clinical reference data for the Chinese population.

It was a retrospective study for a consecutive case series of congenitally blind microphthalmia from July 2011 to July 2013. All of the patients were diagnosed in the Ocular Plastic Department, Tongren Eye Center, Beijing Tongren Hospital. We employed multi-section helical CT imaging with a computer-aided design system to observe and measure the imaging features in 82 Chinese patients (85 eyes). The paired T-test was applied for comparing the axial lengths, transverse diameters, and vertical diameters between the both sides in patients with congenital microphthalmia. The Pearson correlation was used for analyzing the relationship between the axial length and the age of the patients.

In the 82 patients, the age ranged from 1 month to 40 years old. Forty-one patients were male and 41 were female. The disease was unilateral in 96.34% of the patients. The orbital cysts were observed in 12.94% of them, and 76.47% of them presented basic structures on the CT scan. The abnormalities of the lens (62.35% of the eyes) and vitreous (82.35% of the eyes) were observed. The mean maximum axial length of the affected eyes (85 eyes) was (14.52±0.56) mm and the mean axial length of the unaffected eyes (79 eyes) was (22.79±0.36) mm. There was significantly statistical difference in the ocular size between the affected and unaffected eyes (t= 1.156, P<0.001) .

Congenitally blind microphthalmia is usually complicated with the abnormalities of the lens and vitreous. The ocular size decreases significantly. The results of the present study provide a clinical reference for evaluating congenitally blind microphthalmia.(Chin J Ophthalmol, 2018, 54: 199-204)

To investigate the static and dynamic features of the normal lacrimal sac (LS)-nasolacrimal duct (NLD), and find out if tear flows while the subject is in supine position with eyes closed.

Cross-sectional study. Healthy volunteers and patients whose head were examined by MRI in Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine with normal LS-NLD were recruited. The normal lacrimal ducts of the candidates were scanned, while candidates remained in supine position, by static or dynamic imaging procedures with a 1.5T MRI system, which adopted the thinnest slice thickness, consecutive sections (no spacing) and two scanning planes (axial and coronal planes of LS-NLD). The static and dynamic imaging procedures were done in June and July 2014 and October 2015, respectively. The static imaging was performed with conventional T₂WI, contrast-enhanced 3D FIESTA-C, contrast-enhanced T₁WI and heavy T₂WI pulse sequences under normal physiological condition, and 104 eyes with normal LS-NLD from 39 patients and 13 healthy volunteers (21 male and 31 female) aged 10 to 75 years were scanned with the static procedure. The dynamic imaging was done with heavy T₂WI pulse sequence. The coronal dynamic imaging was done only after 0.9% NaCl was instilled in the conjunctival sacs, and 20 eyes with normal LS-NLD of 10 volunteers (6 male and 4 female) aged 23 to 53 years were scanned with the coronal dynamic procedure. The axial dynamic imaging was done under normal physiological condition and after 0.9% NaCl was instilled in the conjunctival sacs respectively, and 20 eyes with normal LS-NLD of 10 volunteers (8 male and 2 female) aged 20 to 40 years were scanned with the axial dynamic procedure. The incidences on the axial dynamic imaging under the two conditions were compared with χ ² test.

A total of 104 eyes with normal LS-NLD (52 candidates) were scanned with the static imaging sequences. In all LS-NLDs, an indentation located at the posterior-lateral side wall of the junction of LS-NLD was discovered, and its depth was variable. In 28.8% (30/104) of LS, 64.4% (67/104) of the junctions and 22.1% (23/104) of NLD, lumens were closed. As for the coronal dynamic imaging (20 eyes with normal LS-NLD in 10 subjects), segmental tear transit was observed in 15/20 of NLD. As for the axial dynamic imaging (20 eyes with normal LS-NLD in 10 subjects), after 0.9% NaCl was instilled, dynamic changing of their lumen size was revealed in 17/20 of LS-NL and the occurrence rate of the lumen size changing (29.3%, 94/321, the number of the axial slices with lumen changes/total number of the axial slices imaged) was higher than that (16.4%,52/317) under normal physiological condition. The difference between the two rates was statistically significant (χ²=14.993, P<0.001). LS contained more tear than NLD.

While the candidates are in supine position with eyes closed (absolutely no blinking), an indentation is at the posterior-lateral side wall of the junction of LS-NLD, and there are autonomous, segmental lumen open-close actions in normal LS-NLD and tear transit in their lumens. (Chin J Ophthalmol, 2018, 54: 205-211)

To investigate the possibility of the visual system homeobox 1 (VSX1) gene as a candidate susceptibility gene for Chinese patients with sporadic keratoconus, and to identify sequence variants of the VSX1 gene in such patients.

Cross-sectional study. Genomic DNA was extracted from the leukocytes in the peripheral venous blood of 50 patients with sporadic keratoconus and 50 control subjects without this ocular disorder. Five exons and the intron-exon splicing of the VSX1 gene were amplified by polymerase chain reaction (PCR). The PCR products were directly sequenced and compared to the GeneBank database to find mutations. Bioinformatics analysis was done to predict the influence of these mutations on proteins.

One novel missense heterozygous mutation (p.R131P) was found in exon 1 of the VSX1 gene in one keratoconus patient. Another heterozygous mutation (p.G160V) in exon 2 was found in two keratoconus patients. These mutations were not detected in the control subjects. Bioinformatics analysis predicted that the p.R131P mutation may not cause a pathogenic change, but the p.G160V mutation might be functionally deleterious. In intron 3 of the VSX1 gene, the nucleotide substitution of g.8326G>A was detected to be heterozygous in 3 cases of sporadic keratoconus and 4 cases of control and homozygous in 2 cases of sporadic keratoconus and 1 case of control. The variation of g.8326G>A belonged to a single polymorphism change of the VSX1 gene.

The p.R131P detected in this study is a novel mutation of the VSX1 gene. Sequence variants of the VSX1 gene were identified for the first time in Chinese patients with sporadic keratoconus, but their precise role in disease causation requires further investigations. (Chin J Ophthalmol, 2018, 54: 212-217)

The patient was a 14-year-old male. On January 20, 2015, he went to Beijing Aier Yingzhi Eye Hospital due to decreased visual acuity in both eyes accompanied by intermittent swelling and pain for more than 1 year and an increase in intraocular pressure for 2 days. The patient had a full-term natural delivery, no history of oxygen inhalation, and denied systemic medical history and trauma history. The parents and brothers in the family are all normal in intelligence and physical development. They deny similar medical history in the family and deny that their parents are intimate married. Full body examination showed no limb abnormalities and spider fingers. He is 174 cm tall, weighs 55 kg, and is emaciated. Eye examination: right eye uncorrected vision acuity (UCVA) 0.1, near vision<Jr7, best corrected vision acuity (BCVA) 0.25, intraocular pressure 31 mmHg (1 mmHg =0.133 kPa); Left eye UCVA 20 cm anterior manual, near vision<Jr7, no improvement in corrected visual acuity, intraocular pressure 35 mmHg; Transparent corneas in both eyes, retrocorneal deposits (-), slightly shallow central and peripheral anterior chambers, about 1/4 corneal thickness on the temporal side, aqueous humor flash (-), iris tremor, obvious swelling, round pupil, about 4 mm, attenuated direct light reflex, severe left side. The lens is transparent, and the equatorial part of the lens and the suspensory ligament are seen after dilated pupil, and the suspensory ligament is relaxed (Figure 1), the vitreous body is transparent, the optic disc edge is clear and pale in color, C/D is about 0.9, the upper and lower disc edges are narrow, and the retina is in place. Auxiliary examination: B-ultrasound showed no obvious abnormality in the posterior segment of both eyes; A-ultrasound showed that the axial length of the eye was 23.74 mm in the right eye, 23.27 mm in the left eye, and the lens thickness of both eyes was 4.58 mm; Corneal endothelial count right eye 2 150/mm²2 637/mm in left eye²； Computerized optometry right eye-7.75 D-3.00 D ×55° =0.25, left eye-7.75 D-2.00 D ×110° with no improvement in corrected visual acuity. UBM showed that the anterior chamber of both eyes was slightly shallow, narrow chamber angle, and ciliary process morphology was abnormal. The central depth of the anterior chamber of the right eye was 1.97 mm, and the central depth of the anterior chamber of the left eye was 1.79 mm. 2 quadrant angles were closed in the right eye and 3 quadrant angles were closed in the left eye (Figure 2）。 Visual field examination revealed a tubular field in the right eye. Preliminary diagnosis: secondary glaucoma in both eyes, high myopia in both eyes, globular lenses in both eyes, subluxation of lenses in both eyes, congenital dysplasia of the suspensory ligament of the lens in both eyes? Marfan syndrome to be excluded.

The patient was a 68-year-old male. On September 28, 2015, he went to the Department of Ophthalmology of Beijing Friendship Hospital affiliated to Capital Medical University due to sudden blurred vision in his left eye for 2 months and aggravated for 1 day. Previous history: Hypertension for 30 years, with high pressure up to 200 mmHg (1 mmHg =0.133 kPa) and low pressure up to 100 mmHg, treated with oral indapamide tablets and nifedipine controlled-release tablets, with stable blood pressure control. Type 2 diabetes for 20 years, oral metformin, glimepiride treatment, now blood sugar control well. Cerebral infarction for 1 year (July 25, 2014), oral aspirin, atorvastatin treatment. One year ago (September 2014), the patient underwent stenting of the left internal carotid artery due to severe stenosis of the left internal carotid artery (90% stenosis). Seven years ago (2008), the patient underwent phacoemulsification aspiration and intraocular lens placement in the left eye due to senile cataract in the left eye. Four years ago (2011), the patient underwent phacoemulsification and aspiration of cataract in the right eye + intraocular lens placement due to senile cataract in the right eye. Three days ago, the patient underwent laser posterior capsulotomy with neodymium-doped yttrium aluminum garnet lens in the left eye due to posterior cataract in the left eye. Smoking and drinking for 30 years, and has quit smoking and drinking for 1 year. Two months ago (August 1, 2015), the patient suddenly experienced blurred vision in the left eye, visual acuity (international standard vision chart) 1.0 in the right eye, 0.25 in the left eye, intraocular pressure (non-contact tonometer) 9 mmHg in the right eye, 11 mmHg in the left eye, no abnormality in the anterior segment of both eyes, thinning of the arteries in both eyes in the fundus, and scattered bleeding spots and hard exudation in the retina in the left eye (Figure 1）； FFA showed a few retinal microaneurysms and small patches of hemorrhagic occlusion in both eyes, prolonged brachioretinal circulation time in the left eye, and fluorescent staining of the late retinal vascular wall (Figure 2，Figure 3）； Diagnosis of diabetic retinopathy stage II in both eyes combined with fundus examination. To improve circulation, protect nerves and other drugs. 1 d ago, the patient felt that the symptoms were aggravated. Reexamination: visual acuity 1.0 in the right eye and 0.08 in the left eye, intraocular pressure 14 mmHg in the right eye and 24 mmHg in the left eye, and massive plexiform neovascularization in the iris of the left eye (+ + +) (Figure 4), no other abnormalities were found in the anterior segment of the eye, and the fundus was unchanged compared with 2 months ago. No retinal non-perfusion area and neovascular growth were found in FFA reexamination.

The patient was a 54-year-old female. The visual acuity of the left eye was reduced with the dark shadow fluttering in front of the eye for 2 months, and he was seen in the Department of Ophthalmology of the First Hospital of Jilin University. Eye examination: left eye naked visual acuity 0.12, corrected visual acuity 0.15; The anterior segment was roughly normal; A round cystic mass of about 7 PD in diameter can be seen at the posterior pole of the vitreous body, and the retinal structure can be seen through. There is brown pigment deposition on the surface, and yellow-white pigment deposition can be seen in the central area. The white strip below the mass is connected to the cyst, and the cyst floats in the vitreous body by rotating the eyeball (Quintessence Picture 1）。 B-ultrasound examination: A circular cystic strong echo was seen in front of the eyeball wall, which was connected to a strong echo light band (Quintessence Picture 2）。 Clinical diagnosis: vitreous cyst in the left eye.

Migraine is a common primary headache disorder. The estimated annual prevalence rate of migraine in China is 9.3%. Migraine is typically involved with a series of ocular symptoms including glaucoma, visual performance tests relevant to glaucoma exhibited correlation between glaucoma and migraine. Even though migraine patients exhibit no glaucoma-related signs during intermissions of migraine attacks, the results of visual function tests (visual field, electrophysiology, ocular imaging) relevant to glaucoma still indicate abnormalities. It is fairly typical that most of the patients may neglect their ocular problems when migraine breaks out. Epidemiological data suggests an increasing prevalence of migraine patients with glaucoma, particularly normal tension glaucoma. This paper reviews and discusses the effect of migraine on the clinical assessment and diagnosis of glaucoma. (Chin J Ophthalmol, 2018, 54: 224-228)

Sturge-Weber Syndrome is a sporadic rare disease. Its characteristic feature of Port-wine Stain in patient's face has been an important indicator for screening secondary glaucoma, which further provides patients with possibility of early diagnosis and treatment of Sturge-Weber Syndrome induced glaucoma. This paper focuses on the pathogenesis, risk factors and treatment of Sturge-Weber Syndrome secondary glaucoma.(Chin J Ophthalmol, 2018, 54: 229-233)

As a programmed cell death manner which is distinguished from apoptosis and autophagy, necroptosis is a newly discovered pathway of regulated necrosis that requires the protein receptor interacting protein kinases 1 and 3 and mixed lineage kinase domain-like protein. Necroptosis is mediated by death receptors, toll-like receptors and probably other mediators. Emerging evidences have delineated that necroptosis plays an important role in the occurrence and development of various blinding eye diseases. In this review, the related mechanism of necroptosis, the relationship between necroptosis and multiple blinding eye diseases, such as age-related macular degeneration, retinitis pigmentosa and glaucoma, and the potential therapeutic targets of necroptosis are discussed. (Chin J Ophthalmol, 2018, 54: 234-240)