Volume 54 · Issue 09 · 2018

This issue focuses on the research progress in the diagnosis and treatment of ocular tumors. Professor Li Bin is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

Intraocular biopsy is an important method of preoperative ophthalmic diagnosis. It can provide an objective basis for precise treatment of diseases, and has important guiding significance in the diagnosis of eye diseases, the selection of treatment strategies and the anticipation of prognosis. Eye biopsy technology has not yet been widely carried out to date in our country, and ophthalmologists should attach great importance to the role of intraocular biopsy in the diagnosis and treatment of eye diseases. Ophthalmologists should particularly improve the success rate of intraocular biopsy by strengthening the standardization of material sampling; facilitate the guiding effect of eye biopsy on the diagnosis, treatment and prognosis of eye diseases through efficient cooperation between clinician and pathologist; to improve the sensitivity and specificity of intraocular biopsy through organized combination of traditional cellular pathology with molecular pathology. (Chin J Ophthalmol, 2018, 54: 641-644)

Ophthalmology is a discipline that is highly dependent on the development of technology. Artificial intelligence is a new technological revolution, which will in all-round and fundamentally influence the progression of modern ophthalmology. Ophthalmologists should actively pay close attention to the development of artificial intelligence technology with great enthusiasm, and gradually realize the maximum utilization of artificial intelligence technology so as to facilitate the new development in ophthalmology. We should proactively seek for the opportunities of cooperating with the research organization and expert engineers in the area of artificial intelligence to promote the application of artificial intelligence in ophthalmology as soon as possible. Ophthalmology is likely to be radically changed by artificial intelligence technology. (Chin J Ophthalmol, 2018, 54: 645-648)

In recent years, the treatment concept of retinoblastoma has changed from focusing on saving children's life to preserving the eyeballs and useful visual function. As a promising way to retain the eyeball, the application of vitrectomy in patients with retinoblastoma has long been debated. In view of the special anatomical structure of eyes and the biological characteristics of retinoblastoma cells, retinoblastoma is always prone to recurrence and metastasis after vitrectomy. Therefore, vitrectomy could hardly be a routine treatment and it should be used in retinoblastoma patients cautiously.(Chin J Ophthalmol, 2018, 54: 649-651)

To study the histopathology manifestation and imaging characteristics of in vivo confocal microscopy (IVCM) for diagnosis of ocular surface squamous neoplasia (OSSN) and analyze the reliability of IVCM in differential diagnosis from OSSN cases.

A prospective study. Twenty-three patients (23 eyes) with OSSN were collected from September 2015 to November 2017 in Beijing Tongren Eye center. They were underwent the examinations sequentially as follows: visual examination; slit-lamp microscope examination and ocular surface photography; color fundus image; anterior segment optical coherence tomography examination; IVCM examination and histopathology examination after surgery. With histopathology diagnosis, all subjects were divided into two groups: conjunctival intraepithelial neoplasm (CIN) and squamous cell carcinoma (SCC). Compared with histopathological findings, the IVCM results (cell morphology, cytoplasm and nucleus) of OSSN were analyzed. The difference analysis between the count data of two groups was carried out by the chi square test or Fisher's exact test. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate SCC from OSSN.

There were 12 males and 11 females among the 23 patients aged (62±15) years. With the histopathological diagnosis, there were 15 cases (15 eyes) in the CIN group and 8 cases (8 eyes) in the SCC group. Eye redness, pain, foreign body sensation and tears were the symptoms of OSSN. There was no significant difference in clinical symptoms between the CIN and SCC groups. The size of tumors and the incidence of trophoblastic vessels in the SCC group were greater than those in the CIN group [8.5(6.5-15.5) mm vs. 5.8(4.0-8.5)mm, Z=4.702,P=0.029; 7/8 vs. 5/15, χ ²=6.135, P=0.013). In histopathology, multilayered epithelia with cellular polymorphism, varied cytoplasm staining, and slightly thicker nuclei were observed in the CIN group. The corneal epithelial cells of SCC patients were markedly heterogeneous, and the intercellular bridge structure can be detected. Proliferative cells appeared with spindle shaped cells, nuclear mitotic figures and syncytial cells in the SCC group. The IVCM examination in the CIN group and SCC group showed that the cytoplasm was high and the ratio of nuclear plasma increased. There was no significant difference between the two groups in the size of epithelial cells, cytoplasm reflectivity, and nuclear cytoplasm ratio (P=0.053, 0.108, 0.067). The proportions of nuclear mitotic figures, spindle or chimeric cells, nests of whirlpool cells and the abnormal cells of the superficial stroma layer (8/8, 8/8, 8/8 and 8/8) in the SCC group was higher than those (2/15, 1/15, 4/15 and 0/15) in the CIN group, and the difference was statistically significant (P=0.001, 0.001, 0.003; P<0.001). Among these IVCM parameters, the abnormal cells of the superficial stroma layer had the highest diagnostic ability with the AUC value of 1.000, and the following AUC values were 0.933 for mitotic or double nuclei, 0.901 for spindle or chimeric cells, and 0.867 for the nests of whirlpool cells.

The IVCM characteristics of OSSN are the dysplastic cells, hyper-reflective cytoplasm and increased nuclear plasma ratio in the corneal epithelium. Dysplastic cells appearing in the superficial stroma layer, nuclear mitotic figures and nests of vortex cells are the main IVCM parameters to support the malignant change of OSSN lesions. (Chin J Ophthalmol, 2018, 54: 652-660)

To summarize the clinical pathologic characteristics of conjunctival osseous choristoma.

Retrospective case series study. Six cases of conjunctival osseous choristoma between January 2009 and June 2016 from Tianjin Eye Hosptial were reviewed retrospectively. The clinical features, CT characteristics and histological characteristics were analyzed.

The 6 cases includes 3 male patients and 3 females. The age of the patients ranged from 4 to 20 years. Three cases involved with the right eye and the other 3 involved with the left eye. Major clinical feature of the patient is the flat uplift tumor in the superior temporal quadrant of the conjunctiva. CT features of conjunctival osseous choristoma revealed a oval calcium spot of eyeball surface. All the patients received surgery. Pathological examination showed that the tumor is composed of bone tissue which was surrounded by fibrous tissue, and Haversian canals are present in compact bone tissue. Five patients were followed for 23 months to 8 years. None of the patients relapsed after operation.

The major feature of conjuncital osseous choristoma is a tumor in the superior temporal quadrant of conjunctiva. Imaging examination reveals a oval calcium spot of eyeball surface. Pathological examination reveals that the osseous tumor is composed of compact bone tissue which was surrounded by fibrous tissue.Haversian canals are present in compact bone tissue.Diagnosis is dependent on histopathological examination. It is not prone to relapse after complete resection surgery. (Chin J Ophthalmol, 2018, 54: 661-664)

To investigate the clinical features, imaging features, diagnoses and therapeutic regimens of orbital ectopic meningiomas.

A retrospective study. All the clinical data of 10 patients (10 eyes) with orbital ectopic meningiomas were analyzed retrospectively from August 1999 to October 2016. They included imaging data such as color Doppler ultrasound, CT and MRI, and information of diagnosis, pathology, therapeutic regimen and prognosis.

The age of orbital ectopic meningiomas was 7 to 68 years old. There were 4 males and 6 females. The clinical manifestations were mainly with swollen eyelid (8 cases), exophthalmos (7 cases), visual impairment (2 cases) and accidentally found a mass in the orbit with physical examination(2 cases). The tumor was located in (5 cases) or outside (5 cases) the muscular funnel of the orbit. The imaging features of CT included the irregular shape, unclear border, and extraocular muscular adhesions (10 cases). T₁ weighted image of MRI showed low and medium signals and T₂ weighted image showed medium and high signals(8 cases). There was no definite diagnosis before surgery. Ten patients were treated with surgery, and it was confirmed intraoperatively that the tumors were not adjacent to the optic nerve and orbital periosteum. The pathological diagnoses were mostly epithelial meningiomas (9 cases). There were no significant changes in visual acuity, but temporary eye movement disorders occurred postoperatively (10 cases). The patients were followed for 6 months to 6 years. Two cases underwent recurrent at 3 months and 2 years after operation, and received treatment of γ-knife radiation therapy. The tumor reduced after γ-knife radiotherapy, and had no change in 2 years and 6 years, respectively.

As a kind of rare orbital tumors, it is difficult to diagnose orbital ectopic meningiomas accurately. The clinical features and imaging findings can help to detect the disease, but lacking the characteristics of optic nerve sheath meningiomas and periosteal meningiomas. Surgical resection could achieve a good prognosis without visual impairment. If the tumor recurs after pathological diagnosis, γ-knife conformal radiation therapy may still be effective for tumor recurrence. (Chin J Ophthalmol, 2018, 54: 665-670)

To observe pathological features of levator aponeurosis in patients with involutional ptosis.

A prospective study. Twenty-nine consecutive patients with involutional blepharoptosis who underwent levator aponeurosis advancement surgery for blepharoptosis correction were enrolled at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from 2007 to 2013. Twenty-nine specimens of the levator aponeurosis were obtained during surgery. Hematoxylin-eosin staining, Van Gieson staining, Masson staining, immunohistochemistry and transmission electron microscope observations were performed to observe the features of levator aponeurosis. Twelve normal specimens of fresh levator aponeurosis were obtained from Beijign Tongren Eyebank as control group. Mann-Whitney'sU-test and multiple linear regression were used for statistical analysis.

Among the enrolled cases, there were 19 males and 10 females;14 cases were diagnosed with moderate ptosis and 15 cases with severe ptosis;9 cases involved with both eyes, 9 cases with right eyes, and 11 cases with left eyes. The mean age was 59 years. Among the 12 normal cases, there were 5 males and 7 females. The mean age was 56 years. Histopathological observation showed fascicle disruption(+++, ++, + 24, 2, 3 vs. 0, Z=-5.666, P<0.001), scarcity of cross-striations(+++, ++, + 23, 2, 4 vs. 0, Z=-5.582,P<0.001), collagen fibers hyperplasia(+++, ++, + 15, 10, 4 vs. 0, Z=-5.223,P<0.001), fatty infiltration(+++, ++, + 24, 5, 0 vs. 0, Z=-5.671,P<0.001), and a decrease of myoglobin expression(+++,++,+,- 9, 1, 1, 15 vs. 8, 1, 0, 0, Z=-3.004, P=0.005) in levator aponeurosis. Transmission electron microscope recorded presence of collagen fiber hyperplasia and cellular degeneration including mitochondria swelling and hyperplasia, vacuoles, lipid droplets, nucleus pycnosis, chromosome condensation, disintegrated organelles, myeloid body and autophagy. Multivariate linear regression showed a correlation between fat infiltration and age(β=0.425,P=0.043) while suspicious related clinical features as independent variables and observed histopathological features as dependent variables.

The levator aponeurosis appears to be involved with muscle fiber degeneration, collagen fiber hyperplasia and cellular degeneration in patients with involutional blepharoptosis. (Chin J Ophthalmol, 2018, 54: 671-677)

To explore the difference and agreement in the measurement of anterior chamber depth (ACD) and anterior chamber angle data in age-related cataract patients between swept source anterior segment optical coherence tomography (SS-AS-OCT) and ultrasound biomicroscopy (UBM).

A prospective study. Forty-five eyes from 45 age-related cataract patients were selected at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from November to December 2016. There were 23 males and 22 females aged (51±19) years. SS-AS-OCT and UBM were used to measure the ACD, angle opening distance (AOD 500) and trabecular-iris angle (TIA 500). The paired samples t-test and Pearson linear correlation were used for statistical analysis, and the Bland-Altman analysis was used to evaluate the measurement consistency of the two tools.

The ACD measured by SS-AS-OCT and UBM was (2.750±0.544) mm and (2.775±0.531) mm, respectively, the difference was statistically significant (t=2.109, P=0.040), and the measurement results were positively correlated (r=0.989, P<0.001). In the nasal, temporal, upper and lower positions, the AOD 500 and TIA 500 values measured by SS-AS-OCT and UBM had a significant difference [AOD 500: (0.451±0.201) mm vs.(0.421±0.194) mm, (0.499±0.229) mm vs. (0.465±0.207) mm, (0.390±0.215) mm vs. (0.355±0.208) mm, (0.441±0.226) mm vs. (0.423±0.215) mm, t=4.262, 4.350, 5.355, 4.415; TIA 500: 39.587°±14.698°vs. 36.944°±13.790°, 42.149°±14.138°vs. 40.289°±13.041°, 36.482°±15.887°vs. 35.600°±15.215°, 38.504°±14.805°vs. 36.818°±14.931°, t=5.131, 4.658, 4.174, 5.731; all P<0.001] and a significant linear correlation (AOD 500: r=0.971, 0.975, 0.979, 0.973; TIA 500: r=0.972, 0.957, 0.956, 0.970; all P<0.001). The Bland-Altman method showed that the two modalities had comparable results for the ACD, AOD 500 and TIA 500 (2.22%-6.67% of the measured value outside the 95% consistency boundaries).

SS-OCT and UBM show a good agreement in the measurement of ACD and anterior chamber angle data in age-related cataract patients, though there is difference between them in measurement results. (Chin J Ophthalmol, 2018, 54: 678-682)

To evaluate the association of the ultrasonographic optic nerve sheath diameter (ONSD) and intracranial pressure (ICP), and the feasibility of ultrasonographic ONSD in predicting high ICP.

A prospective study. The outpatients who planned to measure ICP by lumbar puncture in Department of Neurology, Xuanwu Hospital, Capital Medical University were selected from January 2011 to May 2012. All the retrobulbar ONSD measurement with B-scan ultrasound was performed just before lumbar puncture. When high ICP was defined as ICP more than 200 mmH₂O(1 mmH₂O=0.009 8 kPa), the participants were divided into the high ICP group and the normal ICP group. The Pearson correlation coefficient analysis was used to analyze the correlation between ICP and postbulbar ONSD measurements. The difference in ONSD was compared between the high ICP and normal ICP groups with the t test. The receiver operating characteristic (ROC) curve was used to calculate the cutoff value of mean ONSD and evaluate the sensitivity and specificity of the method.

A total of 130 participants were involved in this study. There were 71 males and 59 females, aged (38±14) years.The mean ICP was (209.84±79.99) mmH₂O. The mean ONSD was (5.68±0.78) mm in the right eyes, (5.78±0.78) mm in the left eyes, and (5.73±0.71) mm in both eyes. The ICP had a significant correlation with ONSD in the right eyes (r=0.54, P<0.001), ONSD in the left eyes (r=0.56, P<0.001) and ONSD in both eyes (r=0.60, P<0.001), but no correlation with age (r=-0.14, P=0.114) and gender (r=0.20, P=0.817). The ONSD in the high ICP group (n=65) was (6.11±0.66) mm, (6.22±0.56) mm and (6.17±0.50) mm in the right eyes, left eyes, and both eyes, respectively. Compared with the ONSD in the normal ICP group (n=65), which was (5.26±0.64) mm in the right eyes, (5.34±0.72) mm in the left eyes and (5.30±0.62) mm in both eyes, there was a significantly enlarged ONSD in the high ICP group (t=-7.507, -7.778, -8.779, all P<0.001). The ROC analysis showed the ONSD of 5.6 mm was the best cutoff value with a sensitivity of 86% and a specificity of 71% for identifying high ICP.

There is a significantly positive correlation between ICP and postbulbar ONSD measured by ultrasound. This non-invasive method may be an alternative approach to predicting the ICP value of patients whose ICP measurement via lumbar puncture is at high risk. However, it can not replace the direct ICP measurement with the invasive method. (Chin J Ophthalmol, 2018, 54: 683-687)

To compare the differences in the central macular choroidal thickness (CMCT) between thyroid-associated ophthalmopathy (TAO) patients in active and inactive stages, and the healthy subjects used spectral-domain optical coherence tomography (SD-OCT) and assess the potential of using CMCT as an indicator for follow-up of TAO patients.

Cross-sectional study. Eleven active stage TAO patients (22 eyes, active TAO group) and 21 inactive stage TAO patients (42 eyes, inactive TAO group) who received treatment at the Department of Ophthalmology, First People's Hospital of Nantong during January 2015 and December 2017 were enrolled. Twenty-three healthy subjects (46 eyes) with comparable ages to the two TAO groups were enrolled in the healthy control group. TAO activity was assessed using the TAO clinical activity score (CAS) system. All subjects underwent best corrected visual acuity, slit lamp examination, Goldmann tonometer for intraocular pressure measurement, direct ophthalmoscopy, A-superelocular measurement, ocular protrusion measurement, and SD-OCT detection of CMCT. The variance analysis was used to compare the differences of intraocular pressure, eyeball protrusion and CMCT between the three groups. The correlation between CMCT and various clinical indicators was analyzed by univariate linear regression analysis and multivariate linear regression analysis.

The intraocular pressure and eyeball protrusion indicators of the active TAO group, the inactive TAO group, and the control group were (20.16±3.49) mmHg (1 mmHg=0.133 kPa) and (18.68±1.64) mm, (15.42±2.49) mmHg and (15.64±1.01) mm, (15.72±2.38) mmHg and (12.02±0.83) mm, respectively. The intraocular pressure and ocular protrusion of the active TAO group were higher than those of the inactive TAO group and the healthy control group, the differences between the groups are of statistical significance (all P<0.001). The CMCT value of the active TAO group, the inactive TAO group and the healthy control group were (391.27±33.89) μm, (317.31±29.62) μm, and (304.26±42.26) μm, respectively. The CMCT of the active TAO group was significantly higher than the inactive group and the healthy control group, the differences between the groups are of statistical significance (all P<0.001). Based on univariate analysis, thicker CMCT was significantly associated with intraocular pressure (t=4.600, P<0.001); after correction of intraocular pressure, thicker CMCT was significantly associated with CAS (β=0.848, 95%CI 15.608-21.499, P<0.001). Multivariate analysis showed a correlation between thicker CMCT and CAS scores (P<0.001), thyroid function (P<0.001), and intraocular pressure(P=0.039).

The CMCT in the eyes of active TAO patients is higher than that of the inactive TAO patients and healthy people. The CMCT examination is of referential value, and may be used as a tool for assessing the activity of lesions in patients with TAO and clinical follow-up. (Chin J Ophthalmol, 2018, 54: 688-693)

The patient was a 56-year-old male. On January 18, 2017, he was admitted to the Affiliated Optometry Hospital of Wenzhou Medical University due to the conjunctival mass of the external superior fornix of his left eye for more than one year. He visited the local hospital many times and was treated with local eye drops, but there was no relief. Past physical health, denying a family history of similar eye diseases. No obvious abnormalities were found on the general examination at admission. Eye examination: Naked eye visual acuity: 0.6 in right eye, 0.15 in left eye. Corrected visual acuity: right eye-0.75 D ×90° =1.0, left eye +3.00 D-2.00 D ×70° =0.3. Intraocular pressure: right eye 11.1 mmHg (1 mmHg =0.133 kPa); Left eye 9.1 mmHg. No obvious abnormalities were found in the anterior segment and fundus examination of the right eye; The eyelid of the left eye is mildly red and swollen, normal in position, incomplete closure, red tongue-like bulge in the upper temporal conjunctiva, prolapse outside the palpebral fissure, unclear posterior boundary, conjunctival congestion on the surface, vasodilatation (Figure 1), no tenderness and spontaneous pain, flaky defect of corneal epithelium, opacity of the stromal layer below the central heminose, normal anterior chamber depth, clear iris texture, round pupil, about 3 mm in diameter, direct and indirect light reflection sensitivity, and invisible structure in the remaining eye. Local orbital CT examination before admission showed soft tissue density mass, homogeneous and irregular shape in the conjunctival area of left upper eyelid. Color ultrasound examination of the eye showed that a hypoechoic bulge could be detected outside the superior temporal bulb of the left eye, and the internal echo was uniform, with clear boundary and compressible. No abnormal blood flow signal was found in color Doppler flow (Figure 2）。 The initial diagnosis of admission was a conjunctival mass in the left eye, which may be a conjunctival cyst. Since he had been treated with various ocular drugs locally and did not improve, he underwent a mass removal operation under local anesthesia on January 19, 2017. Surgical findings: The conjunctiva was cut along the surface of the tumor in an arc shape, and the tumor was red, soft and enveloped when it was separated under the conjunctiva. The surrounding adhesive tissues were separated and cut along the envelope, and then completely removed. The shape was irregular and the size was about 10 mm ×10 mm ×5 mm, and it was sent for pathological examination. After operation, the eyes were treated with 0.5% levofloxacin eye drops, 0.1% fluorometrolone eye drops and 0.3% sodium hyaluronate eye drops; One week later, reexamination and suture removal showed that the left eyelid was completely closed, the temporal conjunctival incision healed well, the conjunctiva was mildly congested, and the cornea was transparent and intact. The pathological report was conjunctival stromal tumor (Figure 3), immunohistochemical staining results: S-100 (-); CD34 (+); CD68 (partial +); vimentin (+); myosin (-); Smooth muscle actin (smooth muscle actin, SMA) (−); B-cell lymphoma-2 (Bcl-2) (+); Ki-67 (-); Schiff staining method of alicinlan periodic acid (alcian blue periodic acid schiff staining, AB-PAS) (+).

The patient was a 57-year-old female. The right eye was found to protrude for 2 months, and he went to Nanchang University Eye Hospital on August 12, 2016. Two months ago, the right eye was found to protrude without obvious trigger, without discomfort, and no diagnosis and treatment were performed. Previous physical health, no family history. Systemic conditions are acceptable, laboratory tests only suggest hyperlipidemia. There were no obvious abnormalities in CT of the head. Chest X-ray showed thickening of the hilar shadow (Figure 1）。 Ophthalmic examination: visual acuity: 0.25 (correction 0.5) in right eye, 0.5 (correction 1.0) in left eye; Right exophthalmos, restricted upward and inward turning of the eye (Figure 2), increased orbital pressure, tenderness at the upper, outer and inner edges of the orbit, swelling of the eyelids, and no obvious abnormalities in the fundus. Orbital CT showed abnormal bone fibrous proliferation in the upper wall, outer wall and medial wall of the right orbit, considering abnormal bone fibrous proliferation and right ethmoid sinusitis (Figure 3）。 Combined with symptoms, signs and CT findings, diagnostic considerations: fibrous dysplasia, right ethmoid sinusitis. During the hospitalization, the patient's visual acuity decreased progressively, considered due to compression of the optic nerve, and he underwent right orbital decompression on 16-Aug-2016 with the patient's consent. During the operation, it was found that the supraorbital wall, external wall and medial wall were thickened, the surface of bone tissue was rough and honeycomb, and the periosteum was destroyed. The thickened bone walls on three sides were excised and sent for pathological examination to confirm the diagnosis. Hemostasis and anti-inflammatory treatment were given after operation. Pathological examination showed abnormal glands between trabecular bones. Combined with immunohistochemical staining, the results were: cytokeratin7 (CK7) +, thyroid transcription factor-1 (TTF-1) +, novel aspartie proteinase A (Napsin A) +, and metastatic lung adenocarcinoma (Figure 4）。 Half a month later, he was transferred to the local oncology department for continued treatment. Bone scans revealed multiple bone metastases throughout the body. Chest CT showed right lung occupying space. MRI of the head showed extensive bone destruction and soft tissue mass at the anterior and middle skull base. Diagnosis of bone metastasis from right lung adenocarcinoma (T2N2M1, stage IV), given chemotherapy: docetaxel 100 mg + carboplatin 400 mg. The patient was lost to follow-up on 10 Sep 2016.

The patient was a 26-year-old male. Because his right eye was stabbed with bamboo chopsticks for 3 h, he went to the Department of Ophthalmology, Wuqing District People's Hospital, Tianjin on September 19, 2016. After complaining of injury, the patient pulled out the chopsticks, and there was no injury in the whole body except the eye. The patient was in prior health and had no family genetic history. Eye examination: Skin laceration of the right eyelid, the upper eyelid wound is about 1.5 cm long, the lower eyelid oblique wound is about 2.5 cm long, the upper and lower eyelid wounds are discontinuous, and the rest of the examination patients do not cooperate. In the emergency department, Siemens 64-slice dual-energy spiral CT was used to perform orbital CT transverse and coronal examinations. The transverse position was scanned with the auditory inferior orbital line as the baseline, and the coronal position was scanned with the vertical line to the auditory inferior orbital line as the baseline. The slice thickness was 5 mm and the slice distance was 5 mm (Figure 1), Return of results: Consider right orbital soft tissue injury with intraorbital pneumatosis and bilateral ethmoid sinus nasal mucosa thickening. The emergency ophthalmologist performed debridement and suture of the right eyelid under local anesthesia. During the operation, the upper and lower lacrimal ducts were explored with a lacrimal duct irrigation needle, and the lacrimal punctum and lacrimal duct were not damaged. After the operation, levofloxacin eye drops and lomefloxacin eye gel were applied to the eye, and the right eye was partially pressurized and bandaged. At the request of the patient, the ophthalmology department was hospitalized on the same day after the operation. A laceration of the right eyelid was diagnosed.

The patient was a 43-year-old female. On April 11, 2016, he went to the outpatient clinic of Chongqing Aier Eye Hospital because his left eye was injured by a glass door and his visual acuity in both eyes decreased for 3 days. The patient underwent binocular phakic intraocular lens implantation (ICL) in our hospital in July 2012. During the operation, the astigmatic posterior chamber ciliary sulcus fixed intraocular lens (lens model referred to as V4) of STARR Company was implanted. The operation was smooth, and the postoperative uncorrected distance visual acuity (UCDVA) was 1.0. The postoperative uncorrected distance visual acuity (UCDVA) was reviewed on time 3 years after the operation, and the visual acuity was good without decline. Three days ago, the patient accidentally hit the "glass door" with his left eye, and immediately developed binocular vision loss, eye pain, tearing, dizziness, headache, no nausea, vomiting, etc. After bed rest and ice application for about 30 minutes, his vision gradually improved. After 1 h of collision, he felt that his vision was ok, which did not affect normal living activities, and the patient did not care. After going out to play 1 d ago, I consciously felt foreign body sensation, redness and vision decrease in my left eye, so I came to our hospital on the third day after the injury. The outpatient clinic was admitted to the hospital with blunt contusion of my left eye, hyphema of my left eye and intraocular lenses in both eyes. There was no special medical history in the past, and no obvious abnormalities were found in the whole body examination. The patient's mother was a highly myopic patient. Patient admission eye examination: right eye UCDVA 0.8, corrected visual acuity +0.50 D-0.50 D x 10° =1.0; Left eye UCDVA 0.5, corrected visual acuity-1.00 D =1.0, non-contact tonometer (NCT): 15 mmHg (1 mmHg =0.133 kPa) in right eye and 16 mmHg in left eye. There were no obvious scars on the patient's face, no edema, bleeding and scab. Slit lamp microscopy showed: conjunctiva congestion in the right eye, transparent cornea, retrocorneal deposit (-), anterior chamber flash (-), V4 lens in front of the anterior chamber iris, periiris incision at 10 points, round pupil, about 3 mm in diameter, sensitive to light reflection, and no obvious abnormalities were found. Conjunctival congestion and edema of the left eyeball (+), corneal edema (+), posterior elastic layer folds (-), posterior corneal deposits (-), 1 mm ×4 mm blood clot below the anterior chamber, anterior chamber flashes (-), peripheral incision holes at 2 and 10 o'clock of the iris are visible, the pupil is round, about 3 mm in diameter, sensitive to light reflection, and a V4 lens is visible in the posterior chamber with an arch height of about 0.5 mm, but no obvious abnormalities are observed (Figure 1）。 The results of UBM showed: (1) There was strong intraocular lens echo in the anterior chamber of the right eye, and the upper and lower angle of the chamber were slightly narrowed. The iris root swelled forward near the corneoscleral limbus, the nasal and temporal angle was open, and the echo of the iris root was interrupted at about 10 o'clock (periiris incision). No obvious abnormality was found in the ciliary body, and the lens echo was visible; (2) There are scattered punctate weak echoes in the anterior chamber of the left eye, the arch height of the ICL lens is 0.86 mm, the angles of each quadrant are open, the echoes at the root of the iris are interrupted at about 2 o'clock and 10 o'clock (periiris incision), and there is no obvious abnormality in the ciliary body, and the lens echoes are visible. Fundus OCT showed high refractive error in both eyes and fundus changes. Corneal endothelial cell count: right eye (2 152.0 ± 123.1) /mm²Left eye (1 976.5±80.9) /mm²。

The patient was a 48-year-old female. He went to the ophthalmology clinic of Xuanwu Hospital of Capital Medical University on June 24, 2016 due to headache accompanied by painless progressive visual acuity loss in both eyes for 40 days and aggravated visual acuity loss in both eyes for 20 days. 40 days ago, the patient went to the neurosurgery department of our hospital due to headache accompanied by nausea and vomiting, and performed magnetic resonance cerebral venous sinus angiography. It was found that the patient had congenital cerebral vascular stenosis, resulting in an increase in intracranial pressure, and the intracranial pressure was 300 mmHg (1 mmHg =0.133 kPa). 20 days ago, the visual acuity of both eyes decreased, without red eyes and swelling, without visual deformation and dark vision. Past physical health, denying systemic disease and family genetic history. Eye examination after admission: visual acuity: no light sensation in both eyes; IOP: 12 mmHg in right eye and 14 mmHg in left eye; The conjunctiva of both eyes is slightly congested, the cornea is transparent, the anterior chamber is deep, the pupil is medium large, the diameter is 4 mm, the direct and indirect light reflection disappears, and the lens of both eyes is opaque. Fundus: optic disc edema in both eyes, up to 5 D, unclear boundary, tortuous dilatation of optic disc veins, dense flame-like bleeding around the optic disc in both eyes, retinal edema around the optic disc, and macular stellate exudation (Figure 1）。 B-ultrasound of the eye showed widening of the optic nerve in both eyes, and fluid was visible in the sheath (Figure 2）。 The admission diagnosis was binocular papilledema and congenital cerebral vascular stenosis. After admission, all preoperative preparations were completed. On June 27, 2016, the right eye optic nerve sheath decompression was performed under local anesthesia. During the operation, the retrobulbar optic nerve was fully exposed, and it was found that the optic nerve was thickened, and fluid was visible in the optic nerve sheath. The thickened optic nerve sheath was cut open, and cerebrospinal fluid was seen flowing out of the optic nerve sheath. The operation was successful. After operation, levofloxacin eye drops were given for anti-inflammatory treatment and neurotrophic drugs were given. Ocular review 1 week after surgery: visual acuity: right eye light sensation, left eye no light sensation, intraocular pressure: right eye 11 mmHg, left eye 14 mmHg, right eye conjunctiva congestion, suture in place, transparent cornea in both eyes, deep anterior chamber, round pupil, direct and indirect light reflection slow, lens opacity, fundus: retina in both eyes is rosy, right optic disc edema is significantly reduced compared with before, the boundary is ill, the arteries are thin, retinal edema around the optic disc can be seen, a small amount of flame-like radial bleeding and exudation, macula can be seen exudation, left eye optic disc edema is obvious, the boundary is unclear, the optic disc veins are tortuous, and the periphery can be seen flame-like bleeding.

The patient was a 10-year-old female. Because of poor vision in both eyes since childhood, he went to Changchun Aier Eye Hospital. Physical examination: The skin and hair color of the whole body of the child were normal. Eye examination: Right eye naked visual acuity 0.5, corrected visual acuity 0.6 (+1.00 DS-1.25 DC x 175°); The left eye visual acuity was 0.1 in the naked eye and 0.15 in the corrected eye (-4.00 DS-3.00 DC x 10°); IOP was 14 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye; The iris in both eyes is of normal color, clear texture, transparent lens, transparent vitreous body, extensive pigmentation loss in the fundus of both eyes, large choroidal vessels visible, optic disc tilted with clear boundaries, normal color, flattened fovea, and thick vortex veins visible below the temporal (Quintessence Picture 1）。 Clinical diagnosis: refractive error in both eyes; The cause of fundus pigmentation loss in both eyes remains to be investigated.

Radiation treatment, including episcleral plaque radiotherapy, stereotactic radiosurgery, proton beam therapy and so on, is the primary eye-conserving choice for uveal melanoma. But the complications resulted from radiotherapy's nonselective kill to tumor cells can be visual-threatening and eventually result in the enucleation of eyeball. This review summarizes current radiation strategies for uveal melanoma and how these complications occur, develop and present, in the hope that it could provide insights for the radiation interventions and diagnosis of radiative complications.(Chin J Ophthalmol, 2018, 54: 707-711)

Autoimmune uveitis is a major cause of visual disability. Treatment of chronic and recurrent uveitis can be extremely difficult, as various complications of it could impede the long-term usage of corticosteroids and immunosuppressants. Mesenchymal stem cells are of both immunosuppressive and neurotrophic effect, and can enhance the antimicrobial ability of the body, thereby hold great promise in clinical application for treating uveitis. (Chin J Ophthalmol, 2018, 54: 712-715)

The mechanisms of primary angle closure are complex and varied. It is well known that the anatomic features of iris and lens may have influence on the presence of angle closure. However, the effect of structural features of ciliary body on primary angle closure remain unclear yet. The anterior situation of ciliary processes was extensively proved to be one of the predisposing factors of angle closure. While it's still controversial how the thickness of ciliary body may affect angle closure. Recent researches found that primary angle closure was associated with thinner ciliary body thickness. This review is aimed at introducing current researches of the effects of ciliary processes position and ciliary body thickness on primary angle closure.(Chin J Ophthalmol, 2018, 54: 716-720)