Volume 57 · Issue 11 · 2021

With the vigorous development of the market economy and the continuous improvement of people′s living standards, the pursuit of beauty has grown correspondingly. Among the plastic surgeries, ocular plastic surgery is the most popular one, accounting for the largest number of plastic surgeries in the world, especially in China. However, due to issues concerning policies, regulations, market supervision and professional talents, medical cosmetology incidents occur frequently, including disfigurement after cosmetology, which causes great harm to beauty seekers and seriously affects their work and life. This article sorts out the main existing problems in the ocular plastic surgery market, and calls for more attention and standardization at the levels of society, policies, and regulations. (Chin J Ophthalmol, 2021, 57: 801-804)

In recent years, orbital disease has received considerable attention and developed rapidly. It is both an opportunity and a challenge to carry out the construction of orbital disease subspecialty scientifically and efficiently. This article focuses on the necessity of establishing a subspecialty department, the particularity and complexity of orbital disease, and how to effectively perform clinical work. The large quantity of potential patients and the urgent requirement of comprehensive academic progress give rise to the necessity of developing the orbital disease subspecialty. The difficulty of diagnosis and the high risk of operation in orbital disease place emphases on specialist allocation and personnel training. The equipment support and specialist training should go hand in hand, requiring professionals to have strong pressure resistance ability and solid theoretical knowledge, so as to ensure stable, efficient and sustainable development of the orbital disease subspecialty. (Chin J Ophthalmol, 2021, 57: 805-808)

Thyroid-related ophthalmopathy is the most common orbital disease in adulthood. It is an autoimmune disease with diverse and complex clinical manifestations and is easily confused with various ophthalmic diseases. In order to improve the diagnosis of thyroid-related ophthalmology, this article lists a variety of ophthalmic diseases that need to be differentiated according to the characteristics of clinical manifestations, and introduces the main differentiation methods and principles of diagnosis and treatment, providing reference for ophthalmologists and endocrinologists.(Chin J Ophthalmol, 2021, 57: 809-813)

Congenital nasolacrimal duct obstruction is a common ophthalmic disease in children with a high incidence. The main clinical manifestation is persistent epiphora soon after birth, sometimes accompanied by an abscess. At present, the treatment methods used include conservative treatment and surgical treatment, but there exist some problems, such as improper surgical indications and non-standard surgical operation. In view of this, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association has reached a consensus after full discussion, in order to standardize the clinical diagnosis and treatment of congenital nasolacrimal duct obstruction in China. (Chin J Ophthalmol, 2021, 57: 814-818)

Intraocular foreign body injury, as a special type of eye trauma, threatens visual function seriously via mechanical damage and a series of pathological changes to the eyeball due to the presence of a foreign body in the eye. Recently, the diagnosis of intraocular foreign body injury has been distinctly improved attributing to the advancement of medical imaging technology. Moreover, the ophthalmic microsurgery technology has been promoted and popularized, especially the technology of vitrectomy, which enhances the success rate of intraocular foreign body removal remarkably. In order to further standardize the principles and strategies for treatment of intraocular foreign body, China Ocular Trauma Society has reached a consensus based on serious discussions, which can be applied to ophthalmologists′ daily clinical work as a reference. (Chin J Ophthalmol, 2021, 57: 819-824)

To discuss the ultrasonic manifestations of blind microphthalmia, and to explore the correlation between axis length and complicity of intraocular structure of blind microphthalmia.

Retrospective case series study. The data of ultrasonic imaging and axis length of 162 patients (162 eyes) with blind microphthalmia diagnosed in Tongren Eye Center, Beijing Tongren Hospital from July 2013 to July 2018 were collected. According to the degree of internal structure disorder, all affected eyes were divided into groups of the normal, the abnormal and the indistinguishable. The binocular axial length in these patients were compared. The relationship between the axial length and the age of the patients, and the structural changes of the blind microphthalmia with a basic structure were analyzed. Statistical methods were mainly performed by paired t-test, one-way linear regression analysis and one-way analysis of variance.

The disease was unilateral in all the 162 patients. The age ranged from 1 month to 58 years old. And 139 cases (85.80%) were under 12 years old. There were 90 males and 72 females. The mean axial length of the affected eyes (162 eyes) was (13.17±3.77) mm, while the mean axial length of the control eyes (162 eyes) was (21.85±2.01) mm. There was significantly statistical difference in the ocular size between them (t=-27.369; P<0.01). There was no significant correlation between the axial length of the affected eye and age in patients with unilateral blind microphthalmia (r=0.027; P>0.05), while there was a significant correlation between the axial length of the control eye and age (r=0.590; P<0.01). The axial length of the groups of the normal (14 eyes), the abnormal (91 eyes) and the indistinguishable (57 eyes) was (17.80±2.19) mm, (14.81±2.92) mm and (10.05±2.46) mm, respectively, and the difference was statistically significant (F=72.800; P<0.01), and there was also significant difference between the two groups (allP<0.01). Ocular ultrasonic imaging showed that 105 eyes (64.81%) had a basic ocular structure, 83 eyes (51.23%) had retinal detachment, 15 eyes (9.26%) had bulbar ossification, and 10 eyes (6.17%) had optic disc abnormality.

Blind microphthalmia mostly has a basic ocular structure and is often associated with retinal detachment. The axial length of the affected eye is correlated with the degree of intraocular structural disorder. (Chin J Ophthalmol, 2021, 57: 825-829)

To explore the application value of ⁹⁹Tc^m-diethylenetriaminepentaacetic acid (DTPA) orbital single photon emission computed tomography/computed tomography (SPECT/CT) in staging evaluation of thyroid associated ophthalmopathy (TAO).

A case-control study. A total of 40 patients with binocular TAO were recruited from May 2019 to December 2019 in the Second Hospital of Dalian Medical University. According to the clinical activity score (CAS) standard, 40 TAO patients were divided into the active group (15 cases) and the inactive group (25 cases), and 10 healthy volunteers were recruited as the control group. All subjects underwent ⁹⁹Tc^m-DTPA orbital SPECT/CT examination, and each subject′s CAS, reading results and maximum standardized uptake value (SUVmax) were recorded. The Kruskal-Walis H test was used for the CAS comparison among the three groups. The analysis of variance was used for the SUVmax comparison among the three groups. The comparison between CAS and SUVmax before and after treatment was performed by paired samples Wilcoxon signed rank test and paired-sample t test, and Spearman correlation analysis was performed between SUVmax and CAS. The Kappa test was used to check the consistency between the reading result and CAS′s judgment of TAO activity. The receiver operating characteristic curve was used to analyze the diagnostic value of the reading results and SUVmax for TAO.

The age difference among the three groups was not statistically significant, and the gender difference was not statistically significant (all P>0.05). The difference in CAS among the three groups was statistically significant (H=39.894; P<0.01). Patients with active TAO showed abnormal concentration and enhancement of nuclides in the orbital tissue, and the uptake of radionuclides was significantly increased, while patients with inactive TAO had a slight increase, and healthy volunteers had no significant or only mild uptake. The SUVmax of the active group (2.24±0.47) was highest, and that of the inactive group (1.57±0.43) was higher than the healthy control group (0.67±0.22). After pairwise comparison, there were statistical differences between groups (allP<0.05). According to Spearman correlation analysis, the SUVmax of all TAO patients was linearly, positively correlated with their CAS (r=0.753; P<0.05). In assessing the clinical activity of TAO, the reading results were consistent with CAS (Kappa value=0.737;P<0.05). Taking the reading results as the standard, the area under the receiver operating characteristic curve (AUC) of SUVmax was 0.992, and the threshold of SUVmax to distinguish between active and inactive periods was 1.850, with a sensitivity of 86.70% and a specificity of 76.00%. Taking CAS results as the standard, the AUC of SUVmax was 0.853, and the threshold of SUVmax to distinguish between active and inactive periods was 1.850, with a sensitivity of 100.00% and a specificity of 87.50%. Five patients had inconsistent SUVmax and CAS. The CAS was ≥3, but the orbits did not show any inflammatory lesions in two of them; the CAS was<3, but the orbits showed inflammatory lesions in three of them. Thirteen active TAO patients with⁹⁹Tc^m-DTPA orbital SPECT/CT showing significant accumulation of nuclides were given hormone shock therapy 12 times. After treatment, the CAS 2.00 (2.00) was lower than the pre-treatment 3.00 (1.50) score, and the difference was statistically significant (Z=-3.100, P<0.01). The SUVmax after treatment (1.60±0.20) was lower than the pre-treatment value (2.17±0.34), and the difference was statistically significant (t=10.197, P<0.01).

⁹⁹Tc^m-DTPA orbital SPECT/CT can relatively accurately determine the state of orbital inflammation in patients with TAO, and can be used as a useful supplement to evaluate the clinical activity of TAO, helping to guide clinical treatment. (Chin J Ophthalmol, 2021, 57: 830-836)

To explore the feasibility of navigation-guided nasal endoscopy for removal of the cavernous hemangioma of the orbital apex through the sphenoid approach.

Retrospective case series study. From May 2012 to December 2019, 12 patients (12 eyes) with imaging findings of cavernous hemangioma in the orbital apex were collected at the Eye Hospital Affiliated to Nanchang University, including 3 males and 9 females aged 32 to 59 years. All patients underwent navigation-guided sinusoscopy through the sphenoid approach to remove the cavernous hemangioma of the orbital apex (video attached). Changes of visual function and complications after operation were analyzed.

In 3 patients without visual impairment, the postoperative visual function was still normal. Among the remaining 9 patients with preoperative visual impairment, visual function was fully recovered in 3 patients after operation, was improved in 2 patients, and had no change in 4 patients. There were no complications in 3 of the 12 patients, and 9 patients had transient, mildly limited intraocular rotation with diplopia after operation, which all returned to normal within 1 month.

Navigation-guided sinus endoscopy through the sphenoid approach is effective and feasible in the removal of the cavernous hemangioma of the orbital apex. (Chin J Ophthalmol, 2021, 57: 837-843)

To evaluate the demographics, etiology composition, clinical characteristics and surgical outcomes of acquired ptosis patients.

Retrospective case-series study. The clinical records of 176 consecutive patients (312 eyes) with acquired ptosis were reviewed from January 2009 to December 2018 in the Ophthalmology Department of Tianjin Medical University General Hospital. The demographics, etiology composition, clinical characteristics, surgical strategies and outcomes were analyzed.

There were 59 male (33.5%) and 117 female (66.5%) patients suffering acquired ptosis, with an average age of (64±7) years. The disease was bilateral in 136 cases and unilateral in 40 cases. There were four etiological components of acquired ptosis: 145 cases (82.4%) of aponeurotic ptosis, 17 cases (9.6%) of neurogenic ptosis, 10 cases (5.7%) of myogenic ptosis and 4 cases (2.3%) of traumatic ptosis. The clinical characteristics of acquired ptosis varied significantly depending on etiology. Ptosis surgeries were performed on 152 cases (279 eyes), and the success rate was 92.1% (140/152). Surgical procedures included levator aponeurosis surgeries on 148 cases (275 eyes), frontal muscle suspensions on 2 cases (2 eyes) and conjunctival-Müller′s ectomies on 2 cases (2 eyes).

Acquired ptosis is more likely to occur in senile and female populations with bilateral eyelids involved mostly. Aponeurotic ptosis is the predominant type of acquired ptosis. The treatment is performed according to the clear etiological diagnosis based on clinical features, and operations are efficient for most patients with acquired ptosis. (Chin J Ophthalmol, 2021, 57: 844-849)

To investigate whether the wide field imaging system (WFIS), 25G optical fiber and intraoperative optical coherence tomography (iOCT) can perform real-time screening and diagnosing in patients with highly suspected fundus diseasesintraoperatively.

A cross-sectional study was carried out. One hundred and eighty-three densely cataractous eyes of 183 patients with suspected fundus diseases were included in the Affiliated Hospital of Nantong University from July 2019 to June 2020. Lens phacoemulsification combined with intraocular lens implantation was performed in these eyes. Following the opaque lens was removed, the patients were divided into 4 groups according to fundus examination methods: WFIS SW-8000 group (49 eyes), 25G optical fiber group (40 eyes), iOCT group (36 eyes), and combination group of three examination methods (58 eyes). Optical coherence tomography and/or fundus fluorescence angiography were used to detect the fundus after surgery. The intraoperative and postoperative examination results were compared to verify the accuracy of intraoperative diagnosis in each group. Chi-square test was used for statistical analysis.

There were 79 males and 104 females in all patients, and the mean age was (69±10) years. Intraoperative examinations showed 82 eyes with fundus disease (positive rate was 44.81%), while postoperative examinations revealed 93 eyes with fundus disease (positive rate was 50.82%). In the WFIS SW-8000 group, fundus disease was found in 19 eyes intraoperatively and 26 eyes postoperatively (sensitive rate was 73.08%). In the 25G optical fiber group, fundus disease was found in 18 eyes intraoperatively and 20 eyes postoperatively (sensitive rate was 90.00%). In the iOCT group, fundus disease was observed in 20 eyes administratively and 22 eyes postoperatively (sensitive rate was 90.91%). In the combination group, fundus disease was observed in 25 eyes intraoperatively, which was consistent with the results of postoperative examinations (sensitive rate was 100.00%). There were statistically significant differences in the diagnostic sensitivity of fundus diseases among different methods (χ²=9.26; P<0.05). The diagnostic sensitivity of fundus diseases of the WFIS SW-8000 group was lower than that of the the combination group, the difference was statistically significant (χ²=7.80,P<0.01), and there was no significant difference between the other two groups (allP>0.05). Forty-nine eyes with fundus neovascular disease or severe macular edema requiring drug intervention were identified intraoperatively, and intravitreal anti-inflammatory and/or anti-vascular endothelial growth factor drugs were injected in 41 eyes.

The WFIS, 25G optical fiber and iOCT can be used to examine the fundus and detect fundus disease intraoperatively, facilitating timely diagnosis and treatment of retinopathy in patients with dense cataract. The combined application of the three methods has the highest sensitivity. (Chin J Ophthalmol, 2021, 57: 850-856)

Two male patients presented with painless vision loss to blindness in one eye, and the radiography examinations revealed an intraocular mass suspicious for choroidal melanoma. They underwent enucleation. The histopathological and immunohistochemical findings were compatible with the diagnosis of intraocular perivascular epithelioid cell tumor. Because of its rarity, intraocular perivascular epithelioid cell tumor is easy to be confused with other intraocular tumors on histopathological and immunohistochemical examinations. (Chin J Ophthalmol, 2021, 57: 857-860)

Surgeon IntroductionLi Dongmei, professor, chief physician, doctoral supervisor. Director of the Department of Ophthalmology and Plastic Surgery, Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University. President of the Asia Pacific Society of Ophthalmoplastic Surgery and member of the American Society of Ophthalmoplastic Surgery. Deputy Head of Ophthalmology and Orbitology Group of Ophthalmology Branch of Chinese Medical Association, Standing Committee Member of Ophthalmology Society of Chinese Women Physicians Association, Editorial Committee of Chinese Journal of Ophthalmology. Since 1993, he has specialized in clinical and scientific research of ophthalmoplastic surgery and cosmetic surgery. He has accumulated tens of thousands of surgical experience in clinical work and won many international and domestic awards.

The patient was a 20-year-old female. Because his right eye shed tears since childhood, he went to the Department of Ophthalmology of Bozhou Hospital of Traditional Chinese Medicine. Family history of hereditary disease denied. Eye examination: 1 fistula was found in the medial canthus of the right eye by slit lamp examination (Quintessence Picture 1In a). The patient took a sitting position to flush the lacrimal duct, and the flushing probe entered the lacrimal duct from the lower tear point. After injecting normal saline, a large amount of liquid and air bubbles flowed out from the fistula at the medial canthus (Quintessence Picture 1Middle B;Quintessence Video 1), no secretion overflow was seen, and no liquid flowed into the mouth and nose consciously; After fluorescein staining of the conjunctival sac, the lacrimal duct was flushed under slit lamp cobalt blue light, and traces of fluid flowing from the fistula at the medial canthus were clearly visible (Quintessence Picture 1Medium C; Quintessence Video 2). Clinical diagnosis: congenital lacrimal fistula in the right eye.

Primary orbital melanoma (POM) is a sort of extremely rare orbital malignancy. It often associates with melanin lesion such as congenital ocular melanocytosis and blue nevus. The most common clinical manifestation of POM is progressive painless proptosis. There are some difficulties in diagnosing this disease. MRI shows characteristic expression of this disease as an important way to diagnose POM, while pathology is the gold standard. Surgery is the mainstay of treatment in patients with POM. In addition, adjuvant radiotherapy and chemotherapy should be considered. This article systematically reviews the research progress of pathogenesis, clinical manifestation, auxiliary examination, differential diagnosis and treatment of POM, in order to provide some thoughts for the future study of the rare malignancy. (Chin J Ophthalmol, 2021, 57: 861-864)

Acquired immune deficiency syndrome caused by human immunodeficiency virus (HIV) infection is a fatal disease involving multiple systems. Syphilis is a systemic chronic infection disease caused by treponema pallidum infection. In recent years, the incidence of the two infectious diseases in China has been on the rise. Both of them have the same high-risk population and similar transmission routes, and co-infection is increasing day by day. They can influence each other. Syphilis significantly increases the risk of HIV infection, and HIV is able to change the natural course of syphilis. HIV and syphilis co-infection leads to diverse ocular manifestations which are not typical or specific. This condition results in not only a high rate of missed diagnosis and misdiagnosis, but also a high rate of treatment failure and recurrence. There is a high correlation between ocular syphilis and neurosyphilis in HIV-positive patients. Many patients with HIV/syphilis co-infection visit eye clinics for the initial symptom. In order to provide reference for clinical diagnosis, treatment and research, this article reviews the recent advances on the studies of the co-infection of HIV and syphilis, including epidemiological characteristics, ocular manifestations and treatments. (Chin J Ophthalmol, 2021, 57: 865-870)

Coronaviruses are RNA viruses. We should be alerted from the outbreak of the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003, the discovery of the human coronavirus NL63 (HCoV-NL63) in 2004 and the pneumonia outbreak caused by the novel coronavirus in 2019 (2019-nCoV). Coronaviruses can adhere to mucous membranes of the eye, nose, mouth, respiratory tract and digestive tract through various media, which leads to inflammatory reaction, pulmonary fibrosis, kidney failure and death in severe cases. As an exposed organ, the eye can also be infected. With the progress of molecular technology and the in-depth research of coronaviruses, there have been seven known coronaviruses that can infect humans, among which HCoV-NL63, SARS-CoV and 2019-nCoV can cause eye diseases. This article summarizes and analyzes the latest research results at home and abroad concerning the structural characteristics, transmission routes, ocular pathogenic characteristics and treatment of HCoV-NL63, SARS-CoV and 2019-nCoV, in order to provide reference for clinical diagnosis and treatment.(Chin J Ophthalmol, 2021, 57: 871-875)

Blood tears refer to the symptoms of bloody tears from the eyes caused by various reasons. Its etiology is complex and diverse, involving multiple disciplines and specialties, but different etiologies and different clinical diagnosis and treatment methods. In order to make clinicians know and master the clinical diagnosis and treatment methods of blood and tears and related diseases more, and improve the clinical diagnosis and treatment level, on the basis of soliciting the opinions of all members and young members of the lacrimal apparatus disease group of Ophthalmologist Branch of Chinese Medical Doctors Association and the lacrimal apparatus disease group of Ophthalmology Committee of Chinese Society of Integrated Traditional Chinese and Western Medicine, this paper comprehensively expounds the etiology, clinical characteristics and diagnosis and treatment process and methods of blood and tears.(Chinese Journal of Ophthalmology, 2021, 57:876-880)