Volume 50 · Issue 02 · 2014

Along with the science and technology development,cataract surgery technology and the equipment as well as the IOL design and the technique of manufacture all had the considerable progress,cataract surgery had transformed into the refractive surgery gradually.The imaging quality of IOL eyes had influenced by the scatter light,the optical characters of the intraocular refractive mediums and the interactions among the different higher order aberrations.Therefore when choosing the IOLs,paying attention to many details and depending on the different sickness condition to carry on the personalized choice,can enhance sickness the degree of satisfaction.

Objective To investigate the distribution of the spherical aberration in people with senile cataract,in the interest of the customized selection of the intraocular lens in cataract surgeries and the future design of the intraocular lens.Methods Retrospective study.Analysis of 922 eyes from 504 patients over 60-years-old was made.Patients were subdivided into 3 age groups (153 patients of 60-＜ 70 years-old in group 1,251 patients of 70-＜ 80 years-old in group 2,100 patients of 80-≤90 years-old in group 3).Pentacam anterior segment analyzer (OCULUS,Germany) was used to measure the average corneal and posterior surface K-readings.The Zernike coefficients of corneal spherical aberration was calculated.The difference of corneal parameters among each age group was compared.Results The average age of all patients was (73.5 ± 6.8) years-old.The average corneal K-reading was (44.50 ± 1.39) D and the average K-reading of corneal posterior surface was (-6.44 ± 0.25) D.There was no difference among 3 age groups (F =0.738 and 0.373 retrospectively,P ＞ 0.05).The corneal and posterior surface average K-readings had no correlation with the age.The average spherical aberration of anterior corneal surface was (0.361 ± 0.122) μm in group 1,(0.401 ±0.139)μm in group 2 and (0.440 ±0.145) μm in group 3 respectively.The spherical aberration of posterior corneal surface was (-0.122 ± 0.035) μm,(-0.105 ± 0.040) μm and (-0.090-0.043)μm respectively.The total corneal spherical aberration was (0.360 ± 0.142)μm,(0.421 ±0.158)μm and (0.476 ±0.170)μm respectively.Significant differences were observed among 3 age groups (F =10.561,20.937 and 17.257 retrospectively,P ＜0.01).The spherical aberrations of the corneal anterior,posterior surface and total cornea had positive correlation with the age (r =0.203,0.288 and 0.258 respectively,P ＜0.01).The corneal spherical aberrations had no differences between fight and left eyes,and had significant positive correlation between both sides.Conclusions The people with senile cataract over 60-year-old had higher corneal spherical aberrations than other age.The corneal spherical aberrations increased with the age and had significant correlation inter-ocularly.

Objective To explore the time and method of secondary intraocular lens (IOL) implantation in open-globe injury after vitrectomy and to analyze the efficacies and relative factors of the treatment.Methods This is a retrospective case series study.Clinical data of 78 eyes of 78 patients with open-globe injury who underwent secondary IOL implantation after vitrectomy in Tianjin Medical University General Hospital from 2007 to 2012 were analyzed.There were 27 eyes of 27 patients with penetrating iujury,36 eyes of 36 patients with intraocular foreign body (IFB),4 eyes of 4 patients with ocular rupture,and 11 eyes of 11 patients with eudophthalmitis.The IFB included magnetic foreign body in 23 eyes of 23 patients,glass foreign body in 6 eyes of 6 patients,and eyelash foreign body in 7 eyes of 7 patients.Thirty-one eyes of 31 patients were temponaded with silicone oil,and 47 eyes of 47 patients were temponaded with C3F8 during vitrectomv.The methods of IOL implantation included posterior chamber IOL implantation in 32 eyes of 32 patients and sulcus-fixed IOL implantation in 46 eyes of 46 patients.The examinations before IOL implantation mainly included visual acuity,slit lamp biomicroscope,direct and indirect ophthalmoscope,visual electrophysiology,corneal endothelium,B scan,ultrasound biomicroscope and intraocular pressure.Four eves of 4 patients underwent suturing of peripheral iris,and 5 eyes of 5 patients underwent suturing of iris laceration.The visual acuity ranged from light perception to 0.1 before vitrectomy.The mean follow-up time was 15 43 months with a range from 6 to 36 months.Results The mean interval between IOL implantation and vitrectomy was 2.5 ± 0.2 months with a range from 1.5 to 6 months.The best corrected visual acuity was from 0.1 to 1.0 after vitrectomy.The uncorrected visual acuity ranged from 0.1 to 0.8,and the best corrected visual acuity was from 0.1 to 1.0 after IOL implantation.The postoperative complications mainly included mild anterior chamber exudates in 4 eyes of 4 patients,temporary intraocular pressure elevation in 7 eyes of 7 patients,and recurrent retinal detachment in 2 eyes of 2 patients.Conclusions The appropriate interval of secondary IOL implantation in open-globe injury after vitrectomy is important.Posterior chamber IOL implantation is performed in eyes with integrity of posterior capsule,and IOL sutured in the sulcus in eyes without posterior capsule support.It is safe and effective for secondary IOL implantation in open-globe injury after vitrectomy.

Objective To systematic review the effectiveness of refractive multifocal intraocular lens (MIOL) versus diffractive MIOL in the treatment of cataract.Method Randomized controlled trials comparing refractive MIOL with diffractive MIOL were identified by searching PubMed (1966 to May,2013),EMbase (1980 to May,2013),Medline (1966 to May,2013),and The Cochrane Library (Issue 1,2013).We also hand-searched related journals.All the searches were restricted in English or Chinese.Methodological quality of randomized controlled trials (RCT) was evaluated by simple evaluate method that recommended by the Cochrane Collaboration.Data extracted by two reviewers with designed extraction form.RevMan software (release 5.2) was used for data management and analysis.Results A total of 11 trials (1460 eyes) were included for systematic review.Subgroup analyses were used according to different model comparison of MIOL.The results showed a significant difference in the mean of the uncorrected distance visual acuity (UCDVA) and the uncorrected intermediate visual acuity (UCIVA) in the refractive MIOLgroup with WMD-0.04,95％ CI-0.06 to-0.03 (P ＜0.01) and WMD-0.05,95％ CI-0.09 to-0.02 (P =0.001).It showed a significantly difference in the mean of the uncorrected near visual acuity (UCNVA),complete spectacle independent rate,halo rate and glare rate in the diffractive MIOL group with WMD 0.11,95％ CI 0.08 to0.15 (P＜0.01),WMD2.98,95％CI2.17 to4.09 (P＜0.01),WMD 1.52,95％ CI 1.14 to 2.04 (P =0.004) and WMD 1.27,95％ CI 1.07 to 1.50 (P =0.005).There was no significant difference between the two groups in the mean of the best corrected distance visual acuity (BCDVA),the best distance corrected intermediate visual acuity (BDCIVA),the best distance corrected near visual acuity (BDCNVA) and the best corrected near visual acuity (BCNVA) with WMD-0.01,95％CI-0.03 to0.01 (P=0.45),WMD-0.06,95％CI-0.15 to 0.03 (P=0.18),WMD 0.08,95％CI-0.01 to 0.17 (P =0.09) and WMD-0.02,95％CI-0.26 to 0.23 (P=0.88).Conclusions Patients implanted with refractive MIOL show better uncorrected distance and intermediate visual acuity; patients implanted with diffractive MIOL show better uncorrected near visual acuity with less likely to appear light halo,glare and other visual adverse reactions.As for spectacles correction cases,patients implanted with diffractive or refractive MIOL have considerable performances in the far,middle,near visual acuity.

Objective To evaluate the clinical efficacy and influencial factors of vitrectomy for open-globe injuries in different timing.Methods Prospective cohort study.The clinical effect and complication of the vitrectomy performed by the same surgeon for open-globe injury in different timing (2-4 d or 10-14 d) from April 2011 to January 2013 were compared.Emergent intraocular surgeries such as intraocular foreign body and traumatic endophthalmitis were excluded.Result A total of 33 patients (33 eyes) were included in the study with 15 cases in the early group (2-4 d) and 18 cases in routine group (l0-14 d).The rate of retinal re-attachment showed that 11 of 13 eyes that had retinal detachment were re-attached in the early group.One of 13 eyes had retinal re-attachment after the second surgery and 1 eye failed to re-attach.Five of 15 eyes with retinal detachment had retina re-attached in the routine group.Four of 15 eyes had retina re-attached after second surgery and 6 eyes failed to re-attach.There was a statistical significance between the two groups (U =46.500,Z =-2.638,P =0.008).The eye-globe saving rate had no statistical significance (x2 =3.48,P =0.095).Fourteen eyes had been saved and 1 eye failed to have vitrectomy in the early group.Twelve eyes had been saved and 6 eyes failed to have vitrectomy in the routine group.The incidence of traumatic proliferative vetreo-retinopathy(TPVR) had statistical significance between the two groups (x2 =12.34,P =0.001).One eye occurred TPVR in the early group and 12 eyes occurred TPVR in the routine group.The visual acuity recovery showed that patients in the early group had better vision recovery than patients in the routine group (U =61.500,Z =-2.858,P=0.004).Complications like intraoperative bleeding and postoperative infection had no significant difference between the two groups.Conclusion Cases performing vetrectomy earlier had relatively good prognosis.

Objective In this study,we evaluate the association profiles of the lysyl oxidase-like 1 (LOXLI) gene polymorphisms with exfoliation syndrome in XFS Uygur population.Methods Case-control study.Sixty-four unrelated Uygur patients with XFS (including 7 patients with Exfoliation Syndrome Glaucoma) and 127 Uygur control subjects were included.All of control subjects were selected from the same area,passed through the same ophthalmic checks and confirmed without any expressions of XFS.Most of them suffered from cataract and other ophthalmic disease.Genotypes of the three single nucleotide polymorphisms (SNPs) of LOXL1 (rs1048661,rs2165241 and rs3825942) were analyzed by direct sequencing following PCR amplification,and a case-control association study was performed and judged by odd ratio (OR) with (95％ confidential interval).Results G allele of rs1048661 [OR:1.92 (1.14-3.22)],G of rs3825942 [OR:4.86 (2.02-11.68)],and T of rs2165241 [OR:3.98 (2.54-6.25)] were risk alleles for the disorder.The genotypes TT for rs2165241 [OR:2.20 (1.04-4.65)] were risk genotypes for the disease.Conclusion LOXL1 is a susceptibility gene of XFS in the Uygur populations.The risk alleles of rs1048661,rs3825942 and rs2165241 in Uygur subjects were identified to be significantly associated with XFS individually.

Objective To evaluate the characteristics of postoperative refractive status in agerelated cataract patients with shallow anterior chamber and the correlation between pre-operative anterior chamber depth and postoperativerefractive status.Methods Prospective case-control study.Sixty-eight cases(90 eyes) with age-related cataract were recruited from October 2010 to January 2012 in People's Hospital Peking University including 28 cases(34 eyes) in control group and 40 cases(56 eyes) in shallow anterior chamber group according to anterior chamber depth(ACD) measured by Pentacam system.Axial length and keratometer were measured by IOL Master and intraocular lens power was calculated using SRK/ T formula.Postoperative refraction,ACD and comprehensive eye examination were performed at 1 month and 3 months after cataract surgery.Using SPSSI3.0 software to establish a database,the two groups were compared with independent samples t-test and correlation analysis were performed with binary logical regression.Results The postoperative refractive deviation at1 month were (-0.39 ± 0.62)D in control group and (+ 0.73 ± 0.26) D in shallow anterior chamber group respectively which present statistical significance between the two groups (P =0.00,t =3.67) ; the postoperative refractive deviation in 3 month was(-0.37 ± 0.62) D in control group and (+ 0.79 ± 0.28) D in shallow anterior chamber group seperatively which present statistical significance between the two groups (P =0.00,t =3.33).In shallow anterior chamber group,with the shallowerof ACD,the greater of refractive deviation (P =0.00,r1month =-0.57,r3monthhs =-0.61).Conclusion Hyperopic shift existed in age-related cataract patients with shallow anterior chamber and the shallower of ACD was,the greater of hyperopic shift happened.

Objective To compare the efficacy and complications of Artisan iris claw intraocular lens implantation with those of posterior chamber intraocular lens implantation with ciliary sulcus suture fixation for correction of aphakia in vitrectomized eyes without capsular support.Methods This was a prospective interventional case series.From Jan 2009 to Feb 2012,53 aphakicvitrectomizedeyes without sufficient capsular support were divided into two groups according to the condition of residual capsule.Group one:28 eyes received Artisan iris claw intraocular lens implantation.Group two:25 eyes received posterior chamber intraocular lens implantation with ciliary sulcus suture fixation.The best corrected visual acuity and intraocular pressure,corneal endothelial cell loss rate,duration of surgery and complications were compared between two groups.Two-independent t-test,Mann-Whitney test and x2 test were used to analyze measurement data of normal distribution,non-normal distribution and count data respectively.Results The mean duration of surgery in group one [(11.23 ± 1.54) min] was much shorter (t =-26.60,P ＜ 0.05)than that in group two [(31.68-3.15)min].The endothelial cell loss rate of group one were (4.39 ±1.85)％,(4.76-±2.06)％ and (6.30 ±2.71)％ at 3 months,6 months and 1 year after surgery,and the data of group two were (3.92 ± 1.85)％,(4.33 ± 1.80)％ and(5.73 ±2.12)％.No statistically significant difference was noted between two groups at any time point(t =0.77,0.66,0.69;P ＞ 0.05).The best corrected visual acuity of group one (0.40,0.12-0.80) was better than that of group two (0.30,0.08-0.60) at 1 day after surgery (t =-2.16,P ＜ 0.05).However,there was no statistically significant difference at 1 month and 3 months after surgery (P ＞ 0.05).The intraocular pressure of group two [(11.63±2.29)mmHg,1 mmHg=0.133 kPa] was much lower (t=2.34,P＜0.05) than that of group one[(13.61 ± 3.37) mmHg] at 1 day after surgery.There was no statistical significant difference at 1 month and 3 months after surgery between two groups (P ＞ 0.05).The postoperative complications of group one were anterior uveitis,iris depigmentation,pupillary distortion and spontaneous lens dislocation.Those of group two were choroidal detachment,intraocular haemorrhage,intraocular lens decentration and retinal detachment.Conclusions Iris claw intraocular lens implantation is a simple,fast,less complications and minimally invasive method for the correction of aphakic eyes after vitrectomy.There were on difference in stability and safety between these two implantation methods.Due to the difference of indication choice,either of them can be a viable complement for the other.

Objective To compare visual function and patient satisfaction in patients with bilateral diffractive multifocal intraocular lenses (IOL) and patients with monofocal IOL monovision.Methods Prospective nonrandomized controlled study.This study comprised consecutive bilateral cataract patients 45 cases(90eyes) between January 2011 and March 2012.All cases were divided into two groups:multifocal IOL group(23 patients) having implantation of AcrySof ReSTOR +3D(SN6AD1) multifocal IOL,monovision group(22 patients) having implantation of AcrySof IQ (SN60WF) IOL.Parameters analyzed 3 months postoperatively included binocular uncorrected distance,intermediate,and near visual acuities; stereo vision;photopic and mesopic contrast sensitivity function without glare.Parameters analyzed 6 months postoperatively included spectacle independence; subjective visual symptoms; and patient satisfaction.The independent-samples t test were used to compare the measure data which met normal distribution.The chisquare test was applied to compare categorical variables.Results There were no significant differences between groups in bilateral uncorrected distance vision(0.13 ±0.06,0.17 ±0.19;Z =1.755,P =0.086),intermediate(0.34-0.05,0.33 ±0.06;Z =-0.821,P =0.416),and near vision (0.35 ±0.06,0.41 ± 0.09 ;Z =2.117,P =0.051).There were significant differences between groups in stereo vision (Median:150",525" ;Z =-2.092,P =0.036).Percentage of patients wearing spectacle were less than 10％ in all groups [91.3％ (21/23),90.9％ (20/22)].On the questionnaire,patients in multifocal IOL group complained with double vision,trouble in night vision and halo(21.7％).Conclusions Pseudophakic monovision and MIOL achieved distance vision,intermediate vision and near vision.But monovision was no risk for disturbing visual symptoms associated with multifocal IOL.

Femtosecond assisted phacoemulsification is being used in clinic widely.There have been many reports about its safety and effectiveness.In our country,femtophaco is launching and being developed gradually.The early clinical results and experiences showed that femtosecond lasers assisted cataract surgery had less complications and good repeatability with a much shorter learning curve.More importantly,it provided a standardized and precise platform and would become a milestone in the technology renovation of cataract surgery.

A 20-year-old female was admitted to the hospital on March 29, 2012 due to "paroxysmal headache for 50 days, visual acuity decreased in the left eye for 9 days and visual acuity decreased in the right eye for 7 days". The patient had a history of unclean eating 2 months before admission, and developed paroxysmal occipital pain 50 days before admission. MRI examination of the head in the local hospital showed multiple abnormal intracranial signals, partially enhanced; Lumbar puncture showed normal intracranial pressure, and routine examination of cerebrospinal fluid showed 20×106 white blood cells/L; Cerebrospinal fluid biochemistry: albumin 1601 mg/L, IgG 197 mg/L, diagnosed as "multiple sclerosis", given methylprednisolone sodium succinate for injection pulse 1 000 mg/d for 3 days, 500 mg/d for 2 days; Dexamethasone 15 mg/d for 2 days, 10 mg/d for 7 days; Methylprednisolone tablets 24 mg/d for 7 days and 20 mg/d for 2 days, the patient's headache was completely relieved, and reexamination of skull MRI showed that the lesions were also reduced compared with before; Reexamination of cerebrospinal fluid routine: white blood cells 2×106/L; Cerebrospinal fluid biochemistry: albumin 556 mg/L, IgG 61.8 mg/L. 9 days before admission (hormone decreased to 20 mg/d, total 2 days), the patient suddenly found that the left eye was occluded, the upper field was occluded at first, and the full field was occluded after 1 day; About 7 days ago, the patient had blurred vision in the right eye, which was gradually aggravated, so he went to the local hospital. The examination found that the visual acuity of the right eye was 1.2, and the left eye was manual in front of the eye. The intraocular pressure was 31.8 mmHg (1 mmHg =0.133 kPa) in the right eye and 28 mmHg in the left eye; Anterior segment of both eyes (-). Fundus: the right optical papilla boundary is clear and colored, the retinal vessels are flat, the fovea is unclear, the left optical papilla boundary is clear and colored, the retinal color is pale and edema, the retinal vessels are thin, and the macula is cherry red. The diagnosis is "obstruction of branch retinal arteries in both eyes (vasculitis type)". After injection of methylprednisolone sodium succinate 500 mg/d for 7 days, retrobulbar injection of dexamethasone, local injection of compound anisodine and urokinase thrombolytic therapy, the visual acuity does not improve significantly, so it is transferred to the Department of Neurology, Beijing Tongren Hospital affiliated to Capital Medical University. Past history: self-complaint of repeated oral ulcer in recent 4 years; Aunt has a history of rheumatoid arthritis.

The child was a 3-year-old male. The parents found that the right lower eyelid of the child was swollen, which gradually increased with age. On September 15, 2011, he went to the Department of Ophthalmology, Beijing Tongren Hospital affiliated to Capital Medical University. No obvious abnormalities were found in the whole body examination. Eye examination: there was no light sensation in the right eye and light sensation in the left eye. The right lower eyelid was raised, the surface was cyan-blue, the surface structure of the eyeball was unclear, and the soft mass in the orbit could be palpated by palpation. The left eye cornea was small in diameter, the anterior chamber was shallow, the pupil was small, the lens was transparent, and the fundus was not peeked into. The parents of the child were in good health, the mother denied taking deformity-causing drugs during pregnancy, and the child delivered naturally at full term. The results of color Doppler ultrasound examination showed that the axis of both eyes was short. The structure of the right eyeball was unclear, and irregular hypoechoic lesions could be detected in the orbit, and membranous echo diaphragm could be seen in it. No obvious blood flow signal was found in it. No obvious abnormal echo or obvious blood flow signal was found in the left eyeball (Figure 1). MRI examination of both orbits was performed, The results showed bilateral microphthalmos with obvious abnormal shape and an irregular cystic space-occupying lesion in the right orbit. The cyst content showed low signal in T1 WI and high signal in T2WI, and the internal signal was uniform (Figure 2, 3).

The patient was a 72-year-old farmer. The main reason was "2 weeks after the firewood collapse in the right eye, the vision in the left eye decreased for 10 days". The patient suffered from the firewood collapse in the right eye 2 weeks before the treatment, feeling teariness, no bleeding, and no diagnosis and treatment. The vision in the left eye gradually decreased 10 days ago. Ophthalmic examination: naked eye vision: right eye front manual, left eye 0.02 (correction does not improve), intraocular pressure in both eyes 15 mmHg (1 mmHg =0.133 kPa, Goldmann tonometer). The conjunctiva of the right eye is mixed and congested, the nasal sclera is localized and bulged, purple-red (Figure 1), tenderness (-), large corneal pannus, retrocorneal keratic precipitates (KP) are unclear, anterior chamber exists, aqueous humor flash is unclear, iris tremor, pupil irregular dilatation, light reflection disappears, lens cortex is opaque (mature stage), displaced to the upper temporal, and fundus is unclear. The conjunctiva of the left eye is mixed and congested, the cornea is clear, dusty KP (+), the peripheral anterior chamber is shallow, aqueous humor flash is unclear B-ultrasound showed that the right eye had opacification of the vitreous body and widening and weakening of the echo of the globular wall; The macular area of the left eye was confined to bulge, the echo of the spherical wall of the posterior pole was widened and weakened, and a strong echo light band was seen in the vitreous cavity, and the liquid dark area could be reached below it (Figure 2). Ultrasound biomicroscopy showed that the left eye had full peripheral ciliary body detachment (Figure 3). fundusfluorescein angiography (FFA) showed that the right eye was unclear; OCT coherence optical tomography showed macular edema in the left eye (Figure 5). Follow-up medical history: The patient had injured his right eye in a car accident 36 years ago, and underwent debridement and suture in a local hospital. The details were unknown. The visual acuity of his right eye was 0.02 after operation, and the treatment was not continued.

The patient was a 29-year-old female. She came to Shenzhen Eye Hospital on July 10, 2012 because of "no tears in her right eye and blurred vision in both eyes for 2 years". The patient was admitted to the hospital 2 years ago due to sudden eye pain, headache and unsteady walking. It was confirmed by echocardiography and MRI of the head that multiple cerebral infarction was caused by the detachment of neoplastic embolus on the mitral valve of the heart, and mitral valve replacement was performed. After more than 2 years of rehabilitation training, she gradually recovered, but the following ocular symptoms were left behind: only the left eye shed tears when crying, but the right eye had no tears; The central visual acuity of both eyes was 1.0, but the visual sensation was always blurred. Previous CT examination of the head showed low-density shadow of the left occipital lobe (cerebral infarction lesion) and no compression of the ventricles (Figure 1). Previous MRI examination of the head showed: right posterior lesion of the inferior pons; T1WI was low signal and not enhanced, and T2WI was high signal, which was a cerebral infarction lesion, involving the right upper secretory salivary nucleus (Figure 2). Visual field examination was performed at this visit, and hemianopia in the same direction on the right side below the 10° range of the center of both eyes was found (Figure 3). The diagnosis was multiple cerebral infarction caused by cardiogenic embolus detachment: occipital lobe, medulla oblongata and pontin infarction. The patient's condition was stable, no special treatment was given, and there was no change in visual field and ocular symptoms at the follow-up.

The patient, a 30-year-old male, went to the ophthalmology department of Henan Armed Police Corps Hospital on June 24, 2009 because of blurred vision in both eyes for about 14 years. The patient started to have blurred vision in both eyes at the age of 16. The local hospital examined and diagnosed "refractive error in both eyes", and wore glasses for treatment. Now, he came to the ophthalmology department of our hospital for surgical treatment of myopia. The patient was in good health before, but denied the history of eye surgery trauma and systemic diseases. Ophthalmological examination: UCVA: right eye: 0.2, left eye: 0.2; Optometry: right eye: -2.50 DS-1.00 DC ×172-1.2, left eye: -3.00 DS-1.00 DC ×165-1.2; IOP: right eye: 14 mmHg (1 mmHg =0.133 kPa), left eye: 12 mmHg; Anterior segment and fundus examination of both eyes showed no abnormality. Auxiliary examination: blood routine and coagulation time were normal. Femtosecond laser was performed to make corneal flap combined with LASIK on June 26, 2009. During the operation, the patient was nervous and had poor cooperation. After the operation, the patient immediately felt a large number of dark shadows fluttering in front of his eyes, which did not relieve after resting. Ophthalmological examination: visual acuity: right eye: 1.2, left eye: 1.2. There was no abnormality in corneal flap. Fundus examination under small pupil: flocculate hemorrhage was seen in the vitreous cavity of the right eye, the boundary of the optic head was clear, there was no edema, the thickness and movement of retinal blood vessels were normal, the reflection of foveal macula was visible, and a preretinal hemorrhage with a size of about 3.5×2.5 optic head diameter (DD) was seen on the nasal side of the optic head, with clear boundary, dark red color, raised, and protruding 2 diopters (D) from the vitreous cavity. He was diagnosed as "vitreous hemorrhage in the eye and preretinal hemorrhage in the right eye", and was admitted to hospital for treatment. After hospitalization, he was given brake rest, high pillow lying position, and hemostasis treatment, and the results of all laboratory tests were normal. On the second day after operation, the pupil was dilated, and the fundus was examined with indirect ophthalmoscopy. Blood accumulation was seen below the vitreous cavity, which was dark red in color and clotted in the shape of blood strips (Figure 1A), and the preretinal hemorrhage on the nasal side of the optic papilla was navicular in shape, and the liquid level was visible above (Figure 1B). No abnormalities were found in the peripheral retina.

A 49-year-old female was admitted to the Department of Ophthalmology of Changhai Hospital affiliated to the Second Military Medical University on April 10, 2012 due to sudden painless visual loss in her right eye for 10h. The patient had repeated dizziness, headache, tinnitus without obvious trigger 3 years ago, and amaurosis in her right eye, which could be relieved in vain. The history of hypertension and diabetes, and the history of family hereditary diseases were denied. Physical examination: consciousness, automatic posture, no yellowing stain, no ecchymosis, no swelling of lymph nodes, no abnormalities in heart and lung, flexible movement of joints of limbs, tendon reflex, and no pathological signs were drawn out. Eye examination: visual acuity in right eye: no light sensing, visual acuity in left eye 0.8 (no improvement after correction), flexible movement of both eyeballs, no congestion and edema in eyelids, transparent conjunctiva, transparent cornea, clear anterior chamber, and transparent lens. The pupil of right eye was moderately dilated, direct light reflection disappeared, the pupil of left eye was not abnormal, and the fundus papilla of both eyes was edema and bulge (Figure 1), the diopter of right eye was about +4.00 D, and the diopter of left eye was about +3.00 D The right ophthalmic artery was obviously thinner, the infratemporal branch artery was white-lined, and the macula was cherry red. The intraocular pressure was normal. Related examinations after admission: blood routine: red blood cell count 6.37×1012/L [normal value: (3.5~5.0) ×1012/L], hemoglobin 156 g/L (normal value: 110~150 g/L), platelet count 596×109/L [normal value: (100~300) ×109/L], white blood cell count 11.85×109/L [normal value: (4~10) ×109/L].

The patient was a 38-year-old male who came to Tianjin Eye Hospital for treatment due to the decrease of visual acuity in his left eye for 1 year. The eye examination showed that the visual acuity in his left eye was 0.2 and the intraocular pressure was 14 mmHg (1 mmHg =0.133 kPa); The conjunctiva was not congested and the sclera was not yellowed; The corneal epithelium was intact, the stroma was not edema, the endothelium was transparent, and no retrocorneal deposition was observed; The pupil is round, the pupil diameter is 3 mm, the response to light is normal, the anterior chamber depth is normal, the aqueous humor is clear, the iris is not atrophied or adhered, the lens position is normal, the nuclear opacity (essence picture 1), and the fundus is not clearly seen. B-ultrasound examination shows the lens opacity, the vitreous body and retina are normal (essence picture 2). The admission diagnosis is: congenital nuclear cataract in the left eye. Shooting skills: BX900 slit lamp microscope (Canon EOS30D camera) camera system is used to shoot the anterior segment images. The slit light and the slit light are used to shoot obliquely, so that the morphological changes of the plane and cross-section of the lens opacity are displayed on one picture at the same time. Shooting conditions: shutter speed is 1/125 s, sensitivity is IS0 1000, aperture is in the third gear (this machine's aperture is set to 1~5 gear), magnification is 6.3 times, and exposure is in the 60% gear. During shooting, the focus is placed behind the anterior capsule of the lens, and the examiner and the examinee should hold their breath before pressing the shutter.

The patient, a 22-year-old male, came to the Department of Ophthalmology of Peking Union Medical College Hospital for 2 years due to conscious decrease of visual acuity in both eyes. No obvious abnormalities were found in the whole body examination. Eye examination: the naked eye visual acuity was 0.5 in the right eye and 0.6 in the left eye, and the intraocular pressure was normal; There were no abnormalities in the outer eye and anterior segment of both eyes; The thick and tortuous retinal vessels from the optic head were seen in both eyes. The color of the retinal arteries and veins was similar and indistinguishable, and several retinal arteries and veins were anastomosed. Fluorescein fundus angiography: the early retinal abnormal arteries were rapidly filled, and the artery and vein communicated, and then returned to the optic head; No fluorescein leakage was observed in the late stage; The macula is roughly normal (essence pictures 1 and 2). Clinical diagnosis: retinal viniform hemangioma in both eyes.

Clinically, the characteristic opacity of trinitrotoluene (TNT) toxic cataract has been described in detail, and the diagnostic criteria have been specified. The images can provide valuable basis for diagnosis staging, dynamic observation, treatment and prevention effects. In the cataract screening work, TNT-induced occupational toxic cataract patients were collected, and the manifestations of different stages of lens opacity were displayed by fundus red light reflection after illumination (essence pictures 1-4).

Postoperative endophthalmitis (PE) is the most dangerous complications of the cataract surgery.The incidence of PE is low,but the consequence is always devastating.The cataract surgeon paid much more attention on the prophylaxis of PE.Research results have been achieved in the different periods of perioperation.We reviewed the research literatures of infective routes,causative organisms,preoperative use of topical antibiotics and antiseptics,intraoperative and/or postoperative delivery of antibiotics.

According to the statistics of the World Health Organization, cataract accounted for 51% of blinding eye diseases in 2010, and the number of cataract patients reached as high as 20 million. In order to solve this worldwide health problem, cataract surgery has undergone several changes. At present, phacoemulsification and aspiration combined with folding intraocular lens (IOL) implantation has become the most effective surgical procedure for the treatment of cataract. The core principle of phacoemulsification technology is to pulverize the lens nucleus and suck it out together with the cortex through high-frequency oscillation of the emulsifying needle. Because of its small incision, small astigmatism and fast recovery, it is deeply loved by patients and ophthalmologists. After decades of development, phacoemulsification and cataract aspiration surgery is close to perfection, and the cataract surgical mode has successfully transitioned from vision restoration surgery to refractive surgery. The progress of science and technology has promoted the rapid development of new medical technology. In recent ten years, femtosecond laser has the advantages of high accuracy in the cutting and separation of eye tissue, and has been successfully applied in the field of refractive surgery. Such as excimer laser in situ keratomileusis and a new femtosecond laser stromal keratectomy. In recent years, femtosecond cataract surgical instruments have been introduced.

In order to use the terminology and its abbreviations in this field more conveniently and concisely, this journal specifically publishes some foreign language abbreviations which are well-known and recognized. Authors can directly use the following abbreviations in the abstract and text without giving their full names when writing articles. For unpublished terms, please write the full Chinese name when it first appears, and write the full foreign name and its abbreviation in parentheses, such as tumor necrosis factor (TNF).

In order to comply with the development trend of network and digitalization of journals and provide high-quality services for authors and readers, the Journal of Chinese Medical Association has developed a remote manuscript management system. The system is designed according to the business requirements of manuscript processing process, editing and processing specification, manuscript review system and management specification of Chinese Medical Association series magazines. It adopts advanced database and network technology, and has strong data processing and analysis ability. The remote manuscript management system will assist authors, editors, reviewers, editorial boards,

If the topic involved in the thesis is a national or ministerial or provincial fund or key project, the name of the fund project should be indicated with "Fund Project:" as the logo at the foot of the front page of the article, and the project number should be indicated in parentheses. The name of the fund project shall be filled in according to the official name stipulated by the relevant departments of the state, and a number of funds shall be listed in turn, separated by ";".

With the development and improvement of clinical diagnosis technology, the role of all kinds of ophthalmology clinical pictures in disease diagnosis has been paid more and more attention. In order to encourage clinical accumulation of relevant data, promote experience exchange, improve clinical diagnosis and treatment technology, provide a new platform for academic exchange for readers, and at the same time enrich the content and form of this journal to better serve the majority of ophthalmologists, this journal continued to open the "Picture Essence" column in 2014. The submitted pictures can be arranged according to the type of case or diagnostic technique, with relevant instructions,

It is co-sponsored by Ophthalmology Branch of Shanghai Medical Association, Ophthalmology Branch of National Ten Provincial Medical Associations, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, College of Optometry of Wenzhou Medical University and China International Science and Technology Conference Center of China Association for Science and Technology; The 14th International Conference on Ophthalmology and Optometry jointly organized by Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, China International Science and Technology Conference Center and Shanghai Ruiou Exhibition Service Co., Ltd. will be held at Shanghai Transnational Procurement Exhibition Center (No.35 Zhongjiang Road, Putuo District, Shanghai) from March 27th to 30th, 2014.

The 2014 National International Summit Forum on Strabismus and Pediatric Ophthalmology, sponsored by the Strabismus and Pediatric Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association and hosted by the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, will be held in Nanning, Guangxi Zhuang Autonomous Region from June 13 to 15, 2014. This forum will invite well-known experts at home and abroad to give academic lectures on basic and clinical research on strabismus, amblyopia, childhood optometry, congenital cataract, congenital glaucoma, infantile vitreoretinal diseases, childhood eye trauma, childhood hereditary eye diseases and other childhood eye diseases.

The "16th National Conference on Cataract and Intraocular Lens" will be held on June 19-22, 2014 at Hyatt Regency Beijing-Tianjin New Town, Tianjin (Address: No.8 Zhujiang Avenue, Zhouliangzhuang, Baodi District, Tianjin; Switchboard: 022-59211234). This conference was sponsored by Ophthalmology Branch of Chinese Medical Association, and jointly organized by Cataract Group of Ophthalmology Branch of Chinese Medical Association, Zhejiang Medical Association, Tianjin Medical Association, Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University and Tianjin Eye Hospital.

With the approval of Ophthalmology Branch of Chinese Medical Association, the 14th National Academic Conference on Corneal and Ocular Surface Diseases and the 6th National Academic Conference on Corneal Refraction will be held in Shanghai from April 24 to 27, 2014. The Keratology Group of Ophthalmology Branch of Chinese Medical Association and the organizer of the conference-Eye, Ear, Nose and Throat Hospital affiliated to Fudan University sincerely invite domestic and foreign ophthalmologists, colleagues and ophthalmology business people to attend.

The donation signing ceremony of "Ophthalmology Branch of Chinese Medical Association · Santian Pharmaceutical Ophthalmologist Scholarship" co-sponsored by Santian Pharmaceutical (China) Co., Ltd. was held in Beijing on December 8, 2013. Liu Yanfei, Vice President and Secretary General of Chinese Medical Association, Professor Wang Ningli, Chairman of Ophthalmology Branch of Chinese Medical Association, Professor Zhao Kanxing, former Chairman, and other ophthalmology experts, as well as Mr. Akira Kurokawa, President of Shenmi Pharmaceutical, relevant leaders of Santian Pharmaceutical (China) Co., Ltd. and authoritative media witnessed the signing ceremony of this donation.