Volume 54 · Issue 05 · 2018

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

The aim of modern micro-incision phacoemulsification combined with foldable intraocular lens implantation and femtosecond laser-assisted cataract surgery is evolving from a simple pursuit of recuperation to a refractive procedure, which involves the correction of ametropia according to preoperative and postoperative refractive conditions, especially corneal astigmatism, in order to achieve the goal of optimized postoperative uncorrected full range of vision. Nowadays, due attention to the effect of preoperative corneal astigmatism, surgery-induced astigmatism and residual astigmatism after operation is lacked, which affect postoperative visual acuity significantly. There are many effective ways to reduce corneal astigmatism after cataract surgery including selecting appropriate size and location of clear corneal incision, employing astigmatism keratotomy and the implantation of Toric intraocular lenses, which need to be appropriately applied and popularized. At the same time, surgical indications, predictability and safety should also be taken into account.(Chin J Ophthalmol, 2018, 54: 321-323)

Nowadays cataract extraction combined intraocular lens (IOL) implantation has become the conventional treatment for cataract. Numbers of IOL exchange after cataract extraction combined IOL implantation have been increasing in recent years. As a non-routine surgery, IOL exchange is normally combined with other surgeries and accompanied by some complications to various extents. Is IOL exchange necessary for all abnomal IOLs? Can IOL exchange be avoided? How to avoid IOL exchange? The purpose of this article is to stress the importance of indication of IOL exchange and how to avoid IOL exchange. (Chin J Ophthalmol, 2018, 54: 324-327)

Cataract is the first eye disease causing blindness in the world, and phacoemulsification cataract aspiration is the mainstream surgical method recognized in the world today. In recent years, the introduction of femtosecond laser has further developed cataract extraction surgery. The femtosecond laser cataract extraction surgical system can make the transparent corneal incision, limbal release incision, circular anterior lens capsule incision and pre-splitting nucleus more accurate, thus optimizing the position of IOL and the refractive state of the surgical eye, and greatly improving the accuracy, effectiveness and safety of cataract extraction surgery. Meta-analysis results showed that femtosecond laser-assisted cataract surgery (FLACS) used less ultrasound time and lower ultrasound energy compared with traditional phacoemulsification cataract aspiration, reduced corneal endothelial cell loss, reduced corneal edema, and showed superiority in capsulorhexis quality^[1]Better visual effects were obtained at 1 week and 6 months after surgery, but there was no significant difference in the visual effects between the two procedures at 1 to 3 months after surgery and the incidence of intraoperative complications such as anterior lens capsule tear, postoperative macular edema and intraocular pressure increase^[2,3]。 Femtosecond laser surgery system was first introduced in China in 2013, and more than 100 ophthalmology institutions across the country use this technology. In the era of refractive cataract extraction surgery, FLACS has been recognized and popularized by more and more clinicians. In order to further standardize and guide FLACS, the Cataract and Intraocular Lens Group of Ophthalmology Branch of Chinese Medical Association reached the following consensus opinions after careful, comprehensive and sufficient discussion on the basis of reference to domestic and foreign literatures, combined with China's national conditions and actual medical status, for ophthalmologists to use in clinical work.

Acute endophthalmitis after cataract extraction surgery is a complication that seriously threatens vision. It refers to endophthalmitis that occurs within 6 weeks after cataract extraction surgery. It is usually caused by strongly virulent bacteria. The average incidence rate in China is about 0.06% (the incidence rate of literature statistics is 0.01% ~0.4%^[1]）。 Once acute endophthalmitis occurs, the treatment effect is often very poor, which often causes patients' vision to decrease seriously, so it is the surgical complication that cataract doctors are most worried about. Extensive literature evidence shows that although endophthalmitis cannot be completely eliminated, the incidence of endophthalmitis can be reduced to a lower level if appropriate preventive measures are given during the perioperative period.

Cataract extraction surgery is the most common and important vision restoration surgery in ophthalmology. Nowadays, surgery has entered the era of refractive correction, but postoperative endophthalmitis is still one of the few serious complications that can lead to permanent visual impairment, which can be catastrophic once it occurs. In recent years, the European Society of Cataract and Refractive Surgery (ESCRS) has taken the lead in recommending intrachamber injection of antibiotics before Cataract extraction Surgery to prevent endophthalmitis. This method has attracted more and more clinical attention because of its definite effect, but whether it can be used as a routine application of Cataract extraction Surgery is still controversial. Combined with the current situation at home and abroad and its application risk, this paper deeply discusses the clinical application significance of this method.

To evaluate the clinical efficiency of an iris hook combined with a modified double-eyelet capsular tension ring (MCTR) in the treatment of serious lens subluxation.

Retrospective case series. A total of 16 patients (20 eyes) with serious lens subluxation were enrolled in Zhongshan Ophthalmic Center from March 2016 to December 2016. All the patients had an iris hook inserted to support the capsule during the phacoemulsification. Then an MCTR was implanted and sutured onto the sclera. Both intraoperative and postoperative complications, such as posterior capsular opacification and macular edema, were recorded. The postoperative examinations included visual acuity, intraocular pressure, slit-lamp examination, and Pentacam for evaluation of the positions of the capsule and the intraocular lens(IOL). The best corrected visual acuities before and after operation were compared with the matched t test.

There were 11 males(12 eyes) and 5 females (8 eyes) among the 16 patients (20 eyes) aged (36±16) years, including 5 cases of Marfan's syndrome (7 eyes), spontaneous ectopia lentis in 7 patients (9 eyes), and traumatic lens dislocation in 4 patients (4 eyes). All the MCTRs were successfully implanted into the capsule. The best corrected visual acuity ranged from 0.3 to 1.0, with 0.5 or higher accounting for 90% (18 eyes). It was 0.20±0.14 and 0.21±0.13, respectively, at 3 and 6 months, which was significantly better than the preoperative best corrected visual acuity (logarithm of the minimal angle of resolution) (0.74±0.51;t=5.302, P<0.001; t=5.131;P<0.001). One eye had macular edema 3 months after surgery, and then was treated by conservative management. Two eyes(2 case) developed mild posterior capsular opacification 6 months after operation. No intraocular hypertension was persistently observed. All IOLs and capsular bags were in the expected position without an obvious tilt or displacement.

The surgical strategy of iris hooks combined with MCTRs in the treatment of serious lens subluxation could maintain long-term stability of the capsule. (Chin J Ophthalmol, 2018, 54: 343-348)

To evaluate the effectiveness and safety of Proming^®Toric intraocular lens (IOL) in adults with cataract combined with corneal regular astigmatism.

Multicentre, randomized, open and positive parallel controlled clinical study. A total of 121 patients (121 eyes) who had cataract combined with corneal regular astigmatism and met the inclusion criteria were enrolled in 9 hospitals from May 2014 to May 2016. There were 45 males and 76 females and the median age was 71 (42-88) years old. A total of 121 patients (121 eyes) were randomly assigned to the study group and the control group through the Central Randomization System. Sixty patients (60 eyes) of the study group were implanted with Proming^®Toric IOL (Model: AT1BH-AT6BH) from Eyebright Medical Technology (Beijing) Co., Ltd., and 61 patients (61 eyes) of the control group were implanted with AcrySof ^®IQ Toric IOL (Model: SN6AT2-SN6AT7) from Alcon Laboratories, Inc. The visual acuity, IOL axial position, slit lamp examination, residual astigmatism and contrast sensitivity were recorded at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperatively. Statistical analysis was performed using χ ² test, independent sample t test, Mann-Whitney U test, Friedman repeated measured ANOVA on ranks and non-parametric 2-factor variance analysis.

A total of 118 patients completed 6 months of follow-up, including 59 from the study group and 59 from the control group. The difference between the two groups in terms of the percentage of best corrected distance visual acuity (BCDVA) reaching 20/40 was 1.69% [100% (59/59) vs. 98.31% (58/59) ], and the lower limit of the 95% CI (-1.60%) was greater than -10.00%. A total of 90 patients were followed up for 1 year, including 43 patients from study group and 47 patients from control group. At 1 year after operation, the percentages of the BCDVA up to 20/40 were 97.67%(42/43) in the study group and 97.87% (46/47) in the control group, and there was no significant difference between the two groups (χ²=0.00, P=0.95);the percentages of the uncorrected distance visual acuity (UCDVA) up to 20/40 were 81.40%(35/43) in the study group and 82.98%(39/47) in the control group, and there was no significant difference between the two groups (χ²=0.04, P=0.84). At 1 year follow-up, the difference of contrast sensitivity at 18.0 c/d under the bright light, dark light, bright glare and dark glare between the two groups was not statistically significant (U=468.50, P=0.17;U=528.00, P=0.28;U=465.50, P=0.19;U=629.00, P=0.39);the difference of residual astigmatism between the two groups was not statistically significant (U=798.50, P=0.08);the difference of IOL rotation degree between the two groups was not statistically significant (U=869.00, P=0.25). There were no severe inflammatory responses nor other complications associated with IOL in both groups at each follow-up point.

The visual quality, astigmatism correction effect, rotation stability and safety of Proming^®Toric IOL for the treatment of cataract combined with corneal regular astigmatism is equivalent to AcrySof^® IQ Toric IOL. (Chin J Ophthalmol, 2018, 54: 349-356)

To observe the ultrastructure of lens epithelium cells in cataract associated with uveitis.

A cross-sectional study. Seven patients(7 eyes) received phacoemulsification in Peking University First Hospital from August 2016 to March 2017 due to complicated cataract associated with uveitis[2 males and 5 females,with an average age of (49±20) years] and 3 patients of age-related cataract (3 eyes, females, aged 54, 71, 74 years) were enrolled. Anterior capsule samples were collected during surgery. Transmission electron microscopy was performed. The cell morphology, the proportion of cell nuclear and organelle changes and the proportion of apoptosis in cataract associated with uveitis were described statistically by ±s or median (range).

Spindle-shaped epithelial cells were observed in cataract associated with uveitis (100%), while 28.00%,16.67%,16.67% of spindle-shaped epithelial cells were observed in age-related cataract. The organelle changes included mitochondria swelling and damage to the tight cell junction in cataract associated with uveitis. The tight junction between two cells was damaged in different degrees, only 8.33% (0-16.67%)of the cell nuclei appeared normal, and increased chromatin density(47.07%±22.28%), nuclear pyknosis(38.02%±19.61%) and nuclear fragmentation (9.96%±8.10%) were observed in cataract secondary to uveitis. The apoptosis rate was (48.16%±26.66%) in cataract associated with uveitis and correlated to the duration of intraocular inflammation. While the apoptosis rate were 0, 8.33%, 0 in age-related cataract patients. No autophagosome was observed in cataract associated with uveitis.

Ultrastructure changes existed in lens epithelium cells in cataract associated with uveitis. The increased rate of apoptosis and inhibition of autophagy could be the possible mechanism of cataract formation in uveitic eyes. (Chin J Ophthalmol, 2018, 54: 357-362)

To investigate the effect of L-carnitine on the apoptosis of human lens epithelial cells through endoplasmic reticulum (ER) stress pathway.

HLE-B3 cell lines were used to set up an oxidative stress model with H₂O₂ treatment for 12 h, and lead to ER stress. Cells were divided into four groups: H₂O₂ group, L-carnitine (100 μmol/L) with H ₂O₂ group, phosphate buffered saline (PBS) group and L-carnitine (100 μmol/L) group. Cell counting kit-8 was used to detect the cell viability under the treatment of different concentrations (200, 400, 600 and 800 μmol/L) of H ₂O₂. The apoptosis ratio of HLE-B3 treated by 400 μmol/L H ₂O₂ was tested by flow cytometry. When HLE-B3 was treated by 400 μmol/L H ₂O₂, the expression levels of cysteinyl aspartate specific proteinase 3 (caspase-3) gene and glucose-regulated protein 78 (GRP78) gene were measured by RT-PCR, and the expression levels of caspase-3 protein and GRP78 protein were assayed by Western blotting. Data from groups was analyzed by the one-way analysis of variance, and the LSD-t test was used for the comparison of groups.

Cell counting kit-8 assay showed that when H₂O₂ concentration was 200, 400, 600 and 800 μmol/L, there was significant difference in the H ₂O₂ group(77.6%±0.8%,58.1%±3.1%,39.2%±1.5%,28.1%±2.2%), L-carnitine with H₂O₂ group(83.3%±4.2%,74.5%±3.1%,46.4%±1.7%,32.4%±1.2%), PBS group(97.6%±2.1%,98.3%±0.2%,96.3%±2.2%,98.5%±1.1%) and L-carnitine group(98.5%±1.3%, 96.1%±2.1%, 98.1%±0.2%, 97.3%±1.4%) (all P<0.05). There was no significant difference between groups (PBS group compared to L-carnitine group, all P>0.05). When the concentration of H₂O₂ was 400 μmol/L, the survival rate of the L-carnitine with H ₂O₂ group was higher than the H₂O₂ group. The difference was statistically significant (t=18.14, P=0.020). With increasing of the H₂O₂ concentration, cell necrosis was increased. The cell survival rate had no significant difference between the L-carnitine with H₂O₂ group and H₂O₂ group (both P>0.05). Flow cytometry results of the H₂O₂ group, L-carnitine with H₂O₂ group, PBS group and L-carnitine group were 31.4%±4.5%, 16.5%±2.8%, 2.1%±0.2% and 1.9%±1.8%, respectively (F=126.784, P=0.024) . The rate of apoptosis in the L-carnitine with H₂O₂ group was lower than that in the H₂O₂ group (t=24.67, P=0.013). There was no significant difference between the PBS group and L-carnitine group (P>0.05). The results of RT-PCR showed that the expression of caspase-3 mRNA in the L-carnitine with H₂O₂ group was lower than the H₂O₂ group (0.424±0.041 vs. 0.752±0.203), and the expression of GRP78 mRNA in the L-carnitine with H₂O₂ group was lower than the H₂O₂ group (0.521±0.223 vs. 0.821±0.103). The difference was statistically significant (caspase-3: t=27.92, P=0.018;GRP78: t=16.31, P=0.019). Western blotting showed that the protein expression of caspase-3 in the L-carnitine with H₂O₂ group was lower than the H₂O₂ group (0.712±0.212 vs. 1.126±0.251), and the GRP78 protein expression in the L-carnitine with H₂O₂ group was lower than the H₂O₂ group (0.512±0.012 vs. 0.735±0.051). The difference was statistically significant (caspase-3: t=15.43, P=0.010;GRP78: t=20.62, P=0.018).

L-carnitine can reduce the apoptosis rate of HLE-B3 during oxidative stress through ER stress pathway. (Chin J Ophthalmol, 2018, 54: 363-368)

To analyze the relationship between optical coherence tomography(OCT) performance and visual acuity of patients with acute retinal necrosis (ARN).

Retrospective analysis was performed on the patients diagnosed with ARN at the ophthalmology department of Peking union hospital during October 2011 and May 2016. Fourteen patients (15 eyes), 9 males and 5 females, whose anterior and posterior inflammation disappeared and the retinal necrosis lesion in the fundus of the eye subsided were included. The mean age was (41.6±12.2) years. All patients underwent careful examinations including best corrected visual acuity (BCVA), slit-lamp microscope, indirect ophthalmoscope, color fundus picture, fundus fluorescein angiography (FFA) and OCT (results of their last consultations).

BCVA: 8 eyes were increased, 2 eyes were unchanged and 5 eyes were decreased at the last visit; light perception (LP) 1 eye, finger count (FC) 1 eye, 3 eyes of 0.01 to 0.1, 6 eyes of 0.15 to 0.25. The inflammatory reaction in the anterior segment of 14 eyes disappeared, while the inflammatory reaction of the remaining 1 eye was relieved. The fundus lesions of all 15 eyes disappeared. According to OCT results: five eyes (5/15) exhibited normal macula area, among the 5 eyes, 4 eyes are of 0.15 to 0.25 visual acuity, and 1 eye is of 0.5 visual acuity;macular epiretinal membrane is present in three eyes (3/15), of which the visual acuity is 0.02, 0.25 and 0.3 respectively macula edema is present in three eyes (3/15), among the 3 eyes, 1 eye (visual acuity of 0.01)showed thickening of neurosensory retina, cystoid change of fovea and several fluid dark areas, the other 2 eyes (visual acuity of 0.02 and 0.5 respectively) showed small diffuse fluid dark area in the neurosensory retina;atrophy of neurosensory retina and absence of IS/OS was found in four eyes (4/15), among the 4 eyes, the visual acuity of 3 is below 0.01, and the other 1 eye is of 0.08 visual acuity.

The OCT performance of stationary phase of ARN tends to be positively correlated with the visual acuity of patients. The prognosis of visual acuity of the patients whose OCT results showed atrophy of neurosensory retina and absence of IS/OS is poor. (Chin J Ophthalmol, 2018, 54: 369-374)

To observe the influence of exogenous insulin-like growth factor-Ⅰ(IGF-Ⅰ) on the expression of myocyte differentiation factor 5 (Myf5) and transforming growth factor β1(TGF-β1) in medial rectus muscle of cat model with strabismus.

Experiment research. Twenty-seven kittens which were in sensitive period of visual development (4-6 weeks old), were randomly divided into experimental, control and blank control groups by random numbers table method. Each experimental group was further divided into 3 sub-groups (4 weeks, 8 weeks and 12 weeks) based on drug intervention time, hence 3 kittens in each sub-group. The control group and the blank control group were also divided into 3 sub-groups respectively. Exotropia treatment models were set up through surgical methods and injection of IGF-Ⅰ(0.05 ml,0.1 g/L). The internal rectus muscles of 4 weeks sub-group, 8 weeks sub-group and 12 weeks sub-group were taken respectively after the treatment model had been set up. The internal rectus muscles of the control group and the blank control group were also taken according to corresponding time. The expressions of Myf5 and TGF-β1 were tested with immunohistochemistry staining method, and optical density analysis method were employed to measure the average optical density value. The expression of Myf5 and TGF-β1 was analyzed by Kruskal-Wallis and Bonferroni test. The correlation between the expression of Myf5 and TGF-β1 and the time of drug intervention was analyzed by simple linear regression.

(1) In the experimental group, the expression of the Myf5 of the 4 weeks sub-group, 8 weeks sub-group and 12 weeks sub-group were 33.34±17.16, 39.24±15.25 and 47.70±19.39, which were higher than the control group (21.30±7.44, 19.43±4.75, 4.82±2.66) and the blank control group (18.95±6.59, 18.00±7.29, 5.86±2.61) at the same time point, and the differences were statistically significant in 8 weeks sub-group and 12 weeks sub-group (χ²=21.864, 31.814, both P<0.01). The expression of Myf5 in the experimental group increased with the extension of IGF-Ⅰ intervention time (R²=0.99, P<0.05). But there were negative correlation between expression of Myf5 and drug intervention times in the control group and the blank control group (R²=0.81, 0.80, both P<0.05). (2) In the experimental group, the expression of the TGF-β1 of the 4 weeks sub-group, 8 weeks sub-group and 12 sub-weeks group were 0.80±0.12, 0.53±0.09, 0.42±0.08, which were higher than the control group (1.91±0.23, 2.30±1.03, 1.82±0.72) and the blank control group (2.01±0.31, 2.62±1.11, 1.83±0.67) at the same time point, and the differences were statistically significant (χ²=30.801, 40.278, 35.177, all P<0.01). The expression of TGF-β1 in the experimental group decreased with the extension of IGF-Ⅰintervention time (R²=0.83, P<0.05). The average optical density value regression equation of TGF-β1 in the sterile water control group and the blank control group was 0.04 and 0.06, respectively, and the fitting degree was very poor. Therefore, there was no correlation trend with time.

Exogenic IGF-Ⅰ could enhance the expression of Myf5 in medial rectus muscle of cat model with strabismus. Exogenic IGF-Ⅰ could inhibit the expression of TGF-β1 in medial rectus muscle of cat model with strabismus. Repeated injection of exogenous IGF-Ⅰ may continuously enhance the expression of Myf5 and inhibit the expression of TGF-β1.(Chin J Ophthalmol, 2018, 54: 375-382)

The patient was a 39-year-old male. Due to the progressive decline of visual acuity in both eyes for several years and the aggravation of left eye for 2 months, he went to the Department of Ophthalmology of the First Affiliated Hospital of Suzhou University in July 2016. The patient reported that his eyesight was good when he was young. In recent years, his eyesight has progressively decreased, and he has no history of red eyes, eye pain, photophobia and tearing. After wearing myopic glasses, his eyesight can be slightly improved, but the degree of wearing glasses is deepening year by year. Two months ago, the patient consciously felt that the blurred vision in his left eye was aggravated, which could not be improved by wearing glasses. The patient had been found to have proteinuria for more than 10 years, and the pathological examination of renal puncture revealed "mesangial proliferative nephritis", which progressed to uremia for 6 years. He was treated with hemodialysis three times a week regularly and used heparin anticoagulation for a long time. The patient complained of progressive hearing decline in both ears in recent years and was diagnosed as sensorineural deafness. The patient is married and has 2 children. The spouse and children are in good health. After asking about the family history, the patient's parents were close relatives, and they gave birth to 6 daughters and 1 son. The parents were in good health, and 3 of the children had a history of "kidney disease", of which 2 female patients had died. General physical examination: clear consciousness, normal body temperature, heart rate 83 beats/min, breathing 16 beats/min, blood pressure 139/87 mmHg (1 mmHg =0.133 kPa), hearing loss in both ears, no special in the rest of the physical examination. Eye Examination: Right eye naked visual acuity 0.12, computerized optometry-8.50 DS-6.00 DC × 110° corrected to 0.5; The visual acuity of the left eye was 0.20, and the correction did not improve. IOP was 11 mmHg in the right eye and 10 mmHg in the left eye. Slit lamp examination after dilated pupil with compound tropicamide eye drops showed that the right eye lens was transparent, and the anterior pole central localized lens capsule and cortex bulged toward the anterior chamber (Figure 1In a), the posterior pole capsule and cortex bulge toward the vitreous (Figure 1B), the slit lamp examination post-imaging showed an oil droplet sign in the right eye lens (Figure 1C in). The central localized anterior capsule and cortex of the lens of the left eye protrude towards the anterior chamber, with prominent folds of the lens capsule and mild opacity of the cortex, surrounded by a circle of white opacity at the base (Figure 1In D, E). Corneal analysis by Scheimpflug imaging (Sirius 3D anterior segment analyzer, CSO, Italy) showed myopic astigmatism in both eyes, 12° axially on the 1.76 D flat axis in the right eye and 5° axially on the 1.19 D flat axis in the left eye. Observation of Scheimpflug tomography showed a localized conical bulge in the central area of the anterior pole of the right eye lens, bulging towards the anterior chamber, and the capsule was intact (Figure 2In a); High-density shadows in the central capsule and subcapsule of the anterior pole of the lens of the left eye, which bulge towards the anterior chamber (Figure 2In B). The fundus photography of both eyes is not clear. OCT showed thinning of the temporal retina in both eyes (Figure 3）。 Combined with the patient's general condition and ocular specific changes, the diagnosis is: (1) Alport syndrome; (2) Anterior and posterior bipolar conic lens of the right eye; (3) Left anterior conical lens complicated with anterior polar cataract; (4) uremia; (5) Sensorineural deafness.

患者男性，21岁。因双眼球进行性突出伴酸痛不适2个月，于2016年1月14日就诊福建医科大学附属协和医院眼科。2个月前患者无明显诱因出现双眼球突出伴眼部酸痛不适，无视物模糊、复视，无怕热、多汗、心悸，无发热、畏冷、头晕、乏力等不适，家族中无类似病史，未予重视，症状无改善。1个月前就诊当地医院，诊断"甲状腺相关性眼病"并予对症处理（具体不详），眼球进行性突出。1周前转诊外院，查血常规：白细胞28.01×10⁹/L，血红蛋白137 g/L，血小板111×10⁹/L，甲状腺功能正常，骨髓检查示急性粒细胞白血病，眼眶MRI+增强示双侧眼球突出，眼肌、视神经不规则增粗、边缘模糊，眶内脂肪信号不均，见弥漫性软组织信号影，增强呈明显不均匀强化，双眼眶上静脉明显增粗（图1中A~C），考虑"白血病眼眶浸润"，转诊我院。全身体检:胸骨压痛明显，全身浅表淋巴结未触及，甲状腺功能正常。骨髓穿刺活检病理示骨髓腔内弥漫均一的原始细胞浸润，细胞质少，核不规则，核仁不明显，提示急性白血病（图2）；网状纤维（+）；骨髓常规细胞学检查示：骨髓有核细胞增生明显活跃，原幼单核细胞占37.5%，原幼淋巴细胞占23.5%，粒系、红系增生减低，骨髓流式细胞仪检查结果：74.9%细胞（占全部有核细胞）表达CD4、CD10、CD19、CD22、CyCD79a、HLA-DR、CD34、CD13、CD15、CD33，诊断为急性混合细胞白血病（mixed acute leukemia，MAL）。眼部情况：双眼球突出（眼球突出度：右眼20 mm，左眼19 mm，眶距104 mm）（图3），眼球各方向转动受限，眶压增高，眶部轻压痛，眶缘可扪及肿物，质中，固定，境界不清，无搏动感。右眼睑闭合不全（图4），球结膜充血水肿（图5）；左眼睑闭合尚可，球结膜轻度充血水肿。双眼视力、眼压、眼前节、眼底、视野检查未见异常。明确诊断后予IA+VCP方案[伊达比星8 mg/m²1次/日，静脉滴注，化学治疗第1~3天（D1~3）；阿糖胞苷100 mg 2次/日，静脉滴注D1~5；长春地辛4 mg 1次/日，静脉滴注D1、8、17；环磷酰胺750 mg/m²1次/日，静脉滴注D1、17；泼尼松20 mg 3次/日、口服D1~14，20 mg 2次/日、口服D15~28]诱导化学治疗，化学治疗第2天，患者眼部胀痛明显好转，双侧眼球突出明显改善。化学治疗第16天时患者再诉双侧眼球肿胀不适，骨髓涂片示：有核细胞增生活跃，原幼单核细胞占50.5%，原幼淋巴细胞占22.5%，染色体回报4，XY，t（9；22）（q34；q11.2），BCR/ABL融合基因阳性，再予阿糖胞苷（100 mg 2次/日，静脉滴注D1~2）化学治疗1次，加用甲磺酸伊马替尼（400 mg 1次/日口服）靶向治疗，患者眼部胀痛再次缓解。此后继予伊马替尼靶向治疗及IA方案（伊达比星10 mg/m²1次/日，静脉滴注D1~3；阿糖胞苷100 mg 2次/日，静脉滴注D1~7）化学治疗1个疗程，患者眼部胀痛缓解，眼球突出无恶化，眼球突出度:右眼17 mm，左眼16 mm（眶距104 mm），眼眶MRI+增强示眼球、眼眶内未见占位病变，眼肌无增粗、信号未见明显异常（图6）。患者2016年10月22日行异基因造血干细胞移植，移植过程顺利。2017年10月23日复查见血常规幼稚细胞占54%，考虑复发，拟择期再次行异基因造血干细胞移植。

患者女性，57岁。因右侧额颞部刺痛3周伴右眼上睑下垂3 d，于2016年6月8日至复旦大学附属眼耳鼻喉科医院眼科就诊。患者3周前劳累后出现右侧额颞部触电样刺痛，阵发性加剧，夜间难以入睡；5 d后右侧颞部、额部、右眼上睑及眉中出现鲜红色斑疹，上有米粒大小簇状水疱，疱液清亮，皮损呈带状分布，不超过面部正中线，遂至当地医院就诊。当地医院检查：体温37.2 ℃，红细胞沉降率加快（42 mm/1 h）、超敏C反应蛋白升高（16.5 mg/L），血常规示中性粒细胞正常、淋巴细胞轻度升高（4.3×10⁹/L），轻度贫血（血红蛋白105 g/L）；腰椎穿刺示脑脊液压力、常规、生化正常，细菌培养阴性；余全身检查无特殊；诊断为眼部带状疱疹（herpes zoster ophthalmicus，HZO），予静脉抗病毒及神经营养治疗（更昔洛韦250 mg+甲钴胺2 mg每天1次静脉滴注）。1周后水疱干涸结痴，但疼痛无好转。2周后患者右眼突发上睑下垂，伴复视及眼球运动障碍，遂至我院就诊。患者既往无高血压、糖尿病、自身免疫性病及肿瘤病史，无肝炎、结核、梅毒、艾滋病、水痘感染史，有青霉素过敏史。全身体检：右侧颞部、额部、上睑小片状呈带状分布的斑丘疹，鼻背部右侧也可见少量斑丘疹；神经系统检查：双侧角膜反射存在，双侧面纹对称，右额部针刺觉减退，双侧面颊部感觉对称，伸舌居中，四肢肌力Ⅴ级，病理征（-），颈软，全身淋巴结（-）。眼部检查：视力右眼0.4，矫正0.8；左眼0.6，矫正1.0；眼压右眼8.0 mmHg（1 mmHg=0.133 kPa），左眼10.9 mmHg。右上睑完全下垂、稍红肿，右眼球外展位固定伴复视，右眼向上、下、内运动不能（图1）。裂隙灯显微镜检查示右眼结膜无充血，瞳孔圆，直径6 mm，直接、间接对光反射消失，角膜可见细点状浸润，荧光素染色（+），房水闪光（-），眼底未见异常；左眼眼睑、眼位、眼球运动正常，结膜、角膜、眼底未见异常。患者色觉及视野检查正常；眼部CT平扫示右眼睑、球壁和泪腺轻度肿厚，眼球前突，右眼外、下直肌稍增粗；双侧海绵窦无扩大，未见血栓或占位（图2）；颅内未见明显异常。根据患者病史及临床表现，考虑其诊断为：（1）右眼HZO；（2）右眼动眼神经麻痹。嘱患者继续全身抗病毒治疗，予阿昔洛韦750 mg 3次/d，静脉滴注7 d；右眼局部使用阿昔洛韦凝胶及激素类滴眼液；口服维生素B₁、甲钴胺片营养神经。随访3个月时患者面部皮损消退，右侧动眼神经麻痹症状明显好转（图3）。眼部检查：右眼眼睑运动可，眼位稍下移，眼球向上方运动受限；瞳孔圆，直径4 mm，直接、间接对光反射迟钝；角膜透明，荧光素染色（-）。

Congenital cataract is a common eye disease that seriously affects the visual development of infants and young children. The etiology is complex, and the location, degree and shape of opacity are different (Quintessence Picture 1）。

Both microRNA (miRNA) and long noncoding RNA (lncRNA) fall within the category of noncoding RNA. MiRNA is a 20-24 nt long, highly conserved, single-stranded noncoding RNA. MiRNA can specifically bind to the 3' untranslated region of target mRNA, induce the transcript degradation or translation inhibition, and eventually impact the biological functions of the cell, such as proliferation, differentiation, and apoptosis. Whereas lncRNA is an over 200 bp long, single-stranded, noncoding RNA, which can regulate the important biological processes, such as cell division, growth, differentiation and apoptosis. Research has demonstrated that the abnormal expression of miRNA or lncRNA may result in disruption of normal lens development, apoptosis of lens epithelial cells, disarrangement of lens fibrocytes and treduced lens transparency, thereby causing cataract. This review summarizes the effects and the mechanisms of 7 miRNAs (miR-184, miR-204, let-7, miR-29, miR-16, miR-125b, miR-34a) and 2 lncRNAs (lncRNA-MIAT, LOXL1-AS1) during lens development and cataract formation, in the hope that it could provide insights for the novel interventional and therapeutic targets to cataract.(Chin J Ophthalmol, 2018, 54: 390-395)

Nucleotide-binding oligomerization domain-like receptor pyrin domain containing-3 (NLRP3) inflammasome is a type of multi-protein complex within the cell, the activation of which promotes the release of bioactive interleukin(IL)-1β and IL-18 and contributes to inflammatory progress. In recent years, the research on the role of NLRP3 inflammasome in the pathogenesis and development of ocular surface and fundus diseases has made considerable progress. This review summarizes current understanding in the structure, ocular expression, and mechanisms of activation of NLRP3 inflammasome, as well as the contribution of this protein complex to eye diseases, thereby revealing the theoretical possibility that NLRP3 inflammasome might serve as a novel therapeutic target for the related ocular diseases.(Chin J Ophthalmol, 2018, 54: 396-400)