Volume 59 · Issue 01 · 2023

The fruit is full of branches to bid farewell to the old year, and the new year is welcomed with high spirits. Spring and autumn 2022 has quietly passed, and 2023 with vitality and vitality is coming to us. Looking back at the past few years, China's ophthalmology clinical medical technology has made continuous progress, bravely climbed to the peak, and has approached or even surpassed the world's advanced level. However, there is still a vast territory to be explored in the fields of original research, new technology and new equipment research and development. Scientific and technological innovation is the source and driving force of the development of contemporary ophthalmology. Editor-in-chief Yao Ke pointed out in the foreword of this issue "Strengthening Scientific and Technological Innovation to Promote the Rapid Development of Ophthalmology in China" that we should further promote the development of ophthalmology in China from four aspects: "strengthening innovation confidence, doing a good job in basic research", "focusing on clinical ophthalmology, overcoming key and difficult points", "attaching importance to interdisciplinary disciplines, strengthening the integration of medicine and engineering" and "promoting scientific and technological innovation and promoting the transformation of achievements".

Orbital vascular malformation, one of the common orbital diseases, is confronted with problems like complex clinical manifestations, difficulties in treatment, and poor efficacy. In recent years, the therapeutic methods have been continuously explored and expanded, including sclerotherapy, laser coagulation, intra-arterial embolization, surgical resection, and targeted therapy. And the technology has been constantly innovated and improved to overcome difficulties in treatment and enable more favorable outcomes of orbital vascular malformation. By summarizing the existing innovations, this article proposes to study the pathogenesis, widely explore novel therapeutic targets, and integrate advanced auxiliary technologies, so as to develop more accurate and minimally invasive therapies for orbital vascular malformation.

Orbital inflammatory pseudotumor (OIP) is a kind of orbital idiopathic benign space-occupying lesion with no clear etiology and mainly characterized by inflammatory response. The clinical diagnosis of OIP should be based on exclusion of other diseases or surgical biopsy. Medication and surgical excision are both diagnostic and therapeutic methods. The choice of which is a problem that baffles clinicians. This article discusses a new strategy basing on the imaging features and classifications of OIP. It is expected to be further discussed and promoted in clinical practice to improve the diagnosis and treatment of OIP.

Viral corneal endotheliitis, a blinding corneal disease, is often misdiagnosed due to the diverse clinical manifestations, complex conditions, unclear diagnostic criteria, and limited methods of ocular virus detection. In addition, there is still a lack of unified and standardized treatment for viral corneal endotheliitis. The consensus, basing upon the latest research progress and expert recommendations regarding the clinical care of patients with viral corneal endotheliitis, targets to offer best practice advice for the clinical management of viral corneal endotheliitis and has been fully discussed by the experts of the Ocular Infection Group of Chinese Ophthalmologist Association.

To investigate the histopathological classification of orbital space-occupying lesions.

This is a retrospective case series study. The clinical and pathological data of 1 913 tissue specimens from 1 913 patients with space-occupying lesions of the orbit which were examined in the Second Affiliated Hospital, Zhejiang University School of Medicine from January 2000 to December 2021 were collected. The mass lesions were classified based on histogenesis, pathological nature and age.

There were 913 males (47.7%) and 1 000 females (52.3%). The lesions were benign in 1 489 patients (77.8%) and malignant in 424 patients (22.2%). Based on histogenesis, there were 521 vasculogenic lesions (27.2%), which rancked first, 407 cystoid lesions (21.3%), 277 lymphoproliferative lesions (14.5%), 182 lacrimal gland lesions (9.5%) and 121 inflammatory lesions (6.3%). By pathological nature, there were 1 489 benign lesions, including cavernous hemangioma (275, 14.4%), dermoid cyst (225, 11.8%), other hemangiomas (199, 10.4%), epidermoid cyst (136, 7.1%) and benign mixed tumor of the lacrimal gland (134, 7.0%), and 257 malignant lesions, including lymphoma (210, 11.0%) and sebaceous gland carcinoma (47, 2.5%). The age of all patients ranged from 0 to 90 years, while 247 lesions (12.9%) occurred in patients aged 0 to18 years, 1 270 lesions (66.4%) in patients aged 19 to 59 years, and 396 lesions (20.7%) in patients aged 60 to 90 years.

In 22 years, almost 2/3 benign orbital lesions in the Second Affiliated Hospital, Zhejiang University School of Medicine occurred in young and middle-aged patients, and males were fewer than females. The most common benign orbital tumors was cavernous hemangioma, followed by dermoid cyst and epidermoid cyst. And the most common malignant orbital tumor was lymphoma, which occurred more frequently in older patients.

To observe the clinical effect of free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound and after periorbital tumor resection and orbital enucleation.

It was a retrospective case series study. Twelve patients with orbital tumors admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from February 2017 to April 2021 were included. There were 4 males and 8 females, aged 48 to 87 years. Nine patients had cutaneous squamous cell carcinoma, and 3 had basal cell carcinoma. All patients underwent extended resection of the tumor, resection of orbital contents and wound repair.All patients had the lesion completely removed, chimeric anterolateral thigh flap of the anterolateral femoral flap and perforator flap were transplanted to repair the wound. The donor area of the flaps was closed with tension sutures. The size of intraoperative resection lesion,intraoperative resection flap and muscle flap and the depth of the wound cavity were summarized. The postoperative flap survival, wound healing, surgical area appearance, flap color, thickness and texture, scarring and sensation in the surgical area, and tumor recurrence were observed.

The surgical procedures were successfully completed in all the 12 patients. The intraoperative resection lesion ranged from 7.0 cm × 5.0 cm to 15.0 cm × 8.0 cm. The depth of the wound cavity was 4.0 to 5.0 cm. The intraoperative resection flap range was 7.0 cm × 5.0 cm to 19.0 cm × 8.0 cm. The muscle flap size ranged from 4.0 cm × 3.0 cm to 5.0 cm × 4.0 cm. All flaps completely survived after surgery, and the wounds healed. The sutures at the recipient area were removed at 5 to 7 days after surgery, while the sutures at the donor area were removed at 12 to 14 days. All of the patients were followed up for 3 to 30 months. The scar at the periorbital area was concealed, and the color, thickness and texture of the flaps were similar to those of the surrounding normal skin. The scarring in the flap supply area was not hypertrophic, with localized decreased skin sensation around it. None of the patients had any tumor recurrence during the follow-up period.

The anterolateral femoral muscle flap and perforator flap transplantation could efficiently repair the huge wound after orbital content removal, achieving satisfactory therapeutic effects.

To evaluate the efficacy and safety of nerve loop blocking in the treatment of blepharospasm caused by Meige syndrome.

It was a retrospective case series study. Patients with Meige syndrome characterized by blepharospasm or blepharospasm-oromandibular dystonia who underwent nerve loop blocking in the Ophthalmology Department of Henan No. 3 Provincial People′s Hospital from April 2018 to January 2020 were included. Before and after surgery, blepharospasm was graded, and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to score the symptoms of ocular and oral dystonia. The improvement rate of ocular spasm was calculated after surgery according to the scores. The postoperative complications were observed. The Wilcoxon rank test was used to compare the BFMDRS movement subscale scores before and after surgery. The independent sample Mann-Whitney U test was used to compare the improvement rates of eye spasm between male and female patients and between patients with and without combined oromandibular dystonia.

Among the 199 patients included, 64 (32.2%) were males, and 135 (67.8%) were females, aged 58 (51, 64) years (22-79 years). The postoperative follow-up period was 24 (21, 28) months. Preoperatively, blepharospasm was graded as grade 3 in 12 patients (6.0%) and grade 4 in 187 patients (94.0%), while the postoperative blepharospasm grades were grade 0 in 100 patients (50.3%), grade 1 in 64 patients (32.2%), grade 2 in 31 patients (15.6%), and grade 3 in 4 patients (2.0%). There was statistically significant difference in the BFMDRS scores of ocular dystonia before and after surgery [8.0 (8.0, 8.0) vs. 0.0 (0.0, 1.0); Z=-12.41, P<0.001]. The improvement rate of blepharospasm in all patients was 100% (87.5%, 100%), ranging from 43.8% to 100%, with no statistically significant difference between patients of different genders and between patients with and without combined oral dystonia (both P>0.05). Statistically significant difference existed in the scores of oral dystonia before and after surgery [2.0 (0.5, 4.5) vs. 1.0 (0.5, 2.0); Z=-4.38, P<0.001], with 25 of 65 patients (38.5%) having their oral symptoms improved. Postoperative complications included eyelid valgus (7.5%, 15/199), frontal numbness (100%, 199/199) and tearing (89.9%, 179/199).

Nerve loop blocking is a relatively safe and effective method in the treatment of blepharospasm symptoms of Meige syndrome.

To evaluate the clinical efficacy of bleomycin lavage combined with N-butyl-2-cyanoacrylate glue embolization and resection in the treatment of orbital vascular malformations.

It was a retrospective case series study. Patients with orbital vascular malformations diagnosed at the Ophthalmology Division of Chinese PLA General Hospital from January 2018 to October 2021 were included and divided into exophthalmos group and non-exophthalmos group based on whether the patients had postural exophthalmos. Intralesional bleomycin injection and N-butyl-2-cyanoacrylate glue embolization were performed. The preoperative and postoperative visual acuity, the dosages of bleomycin and isobutyl cyanoacrylate glue, pathological results, imaging findings and remission rate were recorded and analyzed. The Chi-square test, Wilcoxon signed rank analysis and Mann-Whitney U test were used for statistical analysis.

A total of 58 patients (58 eyes)were included, and there were 22 males (37.9%)　and 36 females (62.1%). Nineteen (32.8%) patients had postural exophthalmos, and 39 (67.2%) patients did not suffer postural exophthalmos. The patient's age of the two groups was 39.0 (28.0, 54.5) years vs. 14.0 (5.7, 26.5) years, with a statistically significant difference (Z=-3.96, P<0.001). There was no significant difference in gender, eye laterality, follow-up time and the disease course between the two groups (all P>0.05). During the operation, the dosage of bleomycin was 15 000 (13 500, 15 000) U in the exophthalmos group, and 15 000 (9 000, 16 500) U in the non-exophthalmos group (Z=-0.70, P=0.944). The dosages of N-butyl-2-cyanoacrylate glue were 2.8 (1.0, 3.0) ml and 1.7 (1.0, 2.2) ml, respectively, in the two groups, with no significant difference (Z=-1.11, P=0.268). There was no visual impairment in both groups, while the visual acuity in 5 patients without postural exophthalmos was improved postoperatively. The imaging examination results showed no difference in the malformed vascular area before and after the treatment in the exophthalmos group [384.0 (329.0, 458.0) mm²vs. 330.5 (271.6, 356.7) mm²; Z=-1.26, P=0.208], but a significantly decreased area after the treatment in the non-exophthalmos group [960.8 (822.1, 1058.3) mm² vs. 311.6 (164.6, 361.6) mm²; Z=-2.67, P=0.008]. All patients had no obvious local or systemic adverse reactions during the follow-up. The pathology reports showed vascular malformations in all 15 specimens obtained from the exophthalmos group, as well as vascular malformations in 41.0% (16/39) of specimens and venous lymphatic malformations in 59.0% (23/39) of specimens from the non-exophthalmos group. Thirty-nine patients had complete remission (67.2%), 19 patients had partial remission (32.8%), and the effective treatment rate was 100%.

Bleomycin lavage combined with N-butyl-2-cyanoacrylate glue embolization can achieve good therapeutic effects on orbital vascular malformations.

To investigate the correlation of peripapillary hyper-reflective ovoid mass-like structures (PHOMS) in children and adolescents with myopia and its correlation factors.

It was a cross-sectional study. From September 2021 to January 2022, myopic children and adolescents aged 6-16 years treated in Wuhan Central Hospital and Renmin Hospital of Wuhan University with a myopic spherical equivalent (SE) ≥0.5 D were consecutively included. All patients underwent best corrected visual acuity, refraction, intraocular pressure, slit lamp microscope, axial length, fundus photography and enhanced depth imaging optical coherence tomography (EDI-OCT) examination. EDI-OCT optic disc parameter measurements included diameter, degree of tilt and shift and PHOMS height. The patients were divided into PHOMS group and non-PHOMS group according to the presence or absence of PHOMS. According to the height of PHOMS, the patients were further divided into 3 subgroups: large (>400 μm), medium (200-400 μm) and small (<200 μm). The optic disc characteristics of the PHOMS group and the non-PHOMS group and each subgroup were observed, and the correlation factors of PHOMS were analyzed. Mann-Whitney U test, Kruskal-Wallis test, chi-square test, Logistic regression analysis and Kendall′s tau-b correlation coefficient were used.

A total of 108 patients (108 eyes) were included, including 46 males (46 eyes) and 62 females (62 eyes). There were 70 eyes (64.8%) in the PHOMS group and 38 eyes (35.2%) in the non-PHOMS group. Small PHOMS can only be detected by EDI-OCT, while medium to large PHOMS showed blurred optic disc boundaries on fundoscopy images. Univariate Logistic regression analysis showed that PHOMS was associated with age (OR=1.36, 95%CI: 1.13-1.65, P=0.001) and myopic SE (OR=4.57, 95%CI: 2.51-8.32, P<0.001), axial length (OR=2.28, 95%CI: 1.37-3.82, P=0.002), optic disc tilt (OR=3.44, 95%CI: 2.09-5.66, P<0.001), optic disc shift (OR=0.95, 95%CI: 0.93-0.98, P<0.001) and optic disc diameter (OR=0.75, 95%CI: 0.58-0.95, P=0.019). Multivariate Logistic regression analysis showed that the higher the myopic SE (OR=3.01, 95%CI: 1.27-7.17, P=0.013) and the greater the tilt of the optic disc (OR=4.06,95%CI:1.99-8.29,P<0.001), the higher the risk of PHOMS. Kendall′s tau-b correlation coefficient analysis showed that the height of PHOMS was negatively correlated with optic disc shift (r=-0.31, P<0.001).

PHOMS can be found in a subset of myopic children. The fundus manifestations of PHOMS of different heights are slightly different. The large myopic SE and great optic disc tilt are risk factors of PHOMS, and their magnitudes correlate with the border tissue angle.

Silicone oil insertion is a common modality in vitreoretinal surgeries after ocular perforating injury. It needs surgical removal after several months. Extraocular silicone oil migration to orbit and eyelid is uncommon complication. We reports a case of silicone oil migration to orbit and eyelid. A 41-year-old male presented with left upper eyelid swelling following silicone oil injection 3 years before admission. Orbital computed tomography scan showed multiple high-density well-defined masses in vitreous, left upper eyelid and orbit. We diagnosed the patient with orbital and eyelid mass, meanwhile, speculated mechanical ptosis. Excision of orbital and eyelid masses were performed. Cystic spaces with delicate fibrous wall and small vessels, and clear fluid in cyst were discovered on histologic examination. The patient was followed up after 1 week. The left upper eyelid slightly depressed and the mechanical ptosis was significantly improved.

A male patient presented to department of ophthalmology for progressive left eye blurred vision with visual deformation for 1 month. Imaging findings were typical intraocular lymphoma infiltration, and head MRI and positron emission tomography-CT showed no mass in other parts of the body. After review of the medical history, the patient first presented with extrocular signs such as lacrimal gland enlargement, eyeball protrusion and extraocular myoedema, without any abnormal changes in the fundus. Combined with the history, the patient was diagnosed as a binocular primary accessory mantle cell lymphoma with intraocular infiltration. After 9 months of systemic treatment with rituximab combined with zbrutinib, the patient′s binocular visual acuity was significantly improved and the intraocular and intraocular manifestations disappeared.

The structure of orbit is complex and its function is critical. Quantitative determination of orbital volume is valuable to diagnosis and treatment of orbital diseases, but a standardized and reproducible orbital volume measurement method is still not available. Recently, with the development of three-dimensional reconstruction, many researchers gradually convert their insight into three-dimensional orbital measurement. This paper reviews the common methods of three-dimensional orbital measurement used by investigators, including some innovative ideas, and their clinical applications in order to make a comprehensive overview of the current orbital measurement technology, explore the possible improvement direction, and better serve the clinical.

Uveitis is a common sight-threatening ocular disease that has multiple heterogeneous clinical entities, complicated pathogenesis, and a high complication rate. The visual impairment caused by uveitis, the side effects of long-term systemic therapy, and the economic burden due to the high cost of treatment have a significant impact on the patient′s physical, psychological, and social functions, resulting in a decrease in the quality of life of uveitis sufferers. Accurate assessment of patients′ quality of life is helpful to guild treatment, enhance compliance and improve patients′ overall quality of life. This article reviews the current progress on the quality of life assessment scales and psychological assessment tools to evaluate overall quality of life in patients with uveitis, thereby to provide reference and theoretical basis for selecting and developing the quality of life assessment tools for uveitis patients.

Pachychoroid disease spectrum encompasses central serous chorioretinopathy,polypoidal choroidal vasculopathy,pachychoroid pigment epitheliopathy,pachychoroid neovasculopathy,focal choroidal excavation,peripapillary pachychoroid syndrome and peripheral exudative hemorrhagic chorioretinopathy,etc. The typical choroidal changes of the spectrum are abnormally dilated pachyvessels,choroidal thickening with overlying retinal pigmentary epithelium changes. However,the clinical manifestations and prognosis of entities described within pachychoroid spectrum are different. Significant advances in multimodal imaging have enabled a deeper understanding of the pachychoroid disease spectrum. This paper reviews the pathophysiological alterations,multimodal imaging features and possible pathogenesis of pachychoroid disease spectrum.

Thyroid-associated ophthalmopathy (TAO) is an autoimmune ophthalmopathy with the first incidence of orbital disease. In order to improve the standardized diagnosis and treatment level of TAO in China, the Ophthalmology and Orbitology Group of Ophthalmology Branch of Chinese Medical Association and the Thyroid Group of Endocrinology Branch of Chinese Medical Association formulated and issued the Guidelines for the Diagnosis and Treatment of Thyroid-related Eye Diseases in China (2022) (hereinafter referred to as the Guidelines). In order to promote clinicians to better understand and master the contents of the Guidelines, this article makes supplementary explanations and in-depth interpretation of the key points in the Guidelines.