Volume 104 · Issue 24 · 2024

Ocular hypertension (OHT) refers to a condition in which the intraocular pressure increases without causing glaucomatous optic nerve changes or visual field damage. The incidence rate of OHT in people over 40 years old is as high as 4% to 10%. According to the OHT Treatment Study (OHTS), the incidence of primary open angle glaucoma (POAG) among OHT patients is increasing year by year, so it is necessary to conduct long-term follow-up. This article elaborates on five major risk factors for the progression of OHT to POAG: age, intraocular pressure, vertical cup-disc ratio, pattern standard deviation of visual field, and central corneal thickness. It also summarizes other potential risk factors, such as long-term fluctuations in intraocular pressure, asymmetry of intraocular pressure and visual field between the two eyes, structural phenotypes of the optic disk, and optic disk hemorrhage. Predicting the risk of OHT progression to POAG based on risk factors, patients with different risk levels require different timing for treatment initiation and follow-up intervals. Those with higher risks should start preventive treatment earlier and have shorter follow-up intervals. Both drug therapy and selective laser trabeculoplasty can serve as initial treatment options for OHT. Combining evidence-based medicine research and individualized evaluation of treatment can enhance the clinical diagnosis and treatment level of OHT.

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 pulmonary hypertension, characterized by pulmonary arterial thrombotic occlusion leading to vascular stenosis or obstruction, progressive elevation of pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure and even death. Recent years have seen rapid progress in the diagnostic and therapeutic in CTEPH field. More and more patients with CTEPH have been accurately diagnosed and assessed in time. Nevertheless, there is still a lot of work to do in the popularization of CTEPH diagnostic and therapeutic technique and the building of CTEPH expert center. To better guide clinical practice in our country, Pulmonary Embolism & Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism & Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians, National Cooperation Group on Prevention & Treatment of Pulmonary Embolism & Pulmonary Vascular Disease, National Expert Panel on the Development of a Standardized Framework for Pulmonary Arterial Hypertension, convened multidisciplinary experts for deliberation and Delphi expert consensus to develop the "Guidelines for the Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension (2024 edition) ". These guidelines systematically evaluate domestic and international evidence-based medical research on CTEPH and propose recommendations tailored to clinical practice in our country. The key areas covered include definitions, epidemiology, pathogenesis, diagnosis and assessment, treatment, and management, with the aim of further standardizing the clinical diagnosis and treatment of CTEPH in our country.

To explore the risk factors for progression to chronic kidney disease (CKD) in patients with cardiac valve replacement surgery-associated acute kidney injury (AKI).

A retrospective, nested case-control study was conducted at Fuwai Central China Cardiovascular Hospital. The study subjects were patients who underwent cardiac valve replacement surgery from January 1, 2018 to December 31, 2020, with a baseline estimated glomerular filtration rate (eGFR)>60 ml·min^-1·(1.73 m²)^-1 and postoperative complication of AKI. The patients were followed up for 90 days after discharge from hospital. The endpoint event was defined as progression to CKD 90 days after the occurrence of cardiac valve replacement surgery-associated AKI. The patients were divided into CKD group and non-CKD group based on whether they experienced endpoint event. The baseline clinical data were compared between the two groups. The measurement data with non-normal distribution was represented as M (Q₁,Q₃). Logistic regression model was used to analyze the risk factors of endpoint event. The receiver-operating characteristic (ROC) curve was drawn to evaluate the performance for predicting CKD in cardiac valve replacement surgery-associated AKI patients.

A total of 149 cardiac valve replacement surgery-associated AKI patients (86 males and 63 females) were included in the study, aged (59.0±10.2) years. There were 27 patients (18.1%) who progressed to new-onset CKD 90 days after the occurrence of cardiac valve replacement surgery-associated AKI. Compared with non-CKD group, patients in CKD group had older age [66 (58, 70) vs 59 (53, 64) years], lower baseline eGFR [76.3 (65.8, 98.5) vs 92.7 (78.5, 101.6) ml·min^-1·(1.73 m²)^-1], higher proportion of preoperative hypertension [51.9% (14/27) vs 27.9% (34/122)] and serum creatinine at discharge [136 (101, 165) vs 86 (65, 104) μmol/L], and the differences were statistically significant (all P<0.05). The multivariate logistic regression analysis results revealed that older age (OR=1.063, 95%CI: 1.001-1.129, P=0.047), preoperative hypertension (OR=3.070, 95%CI: 1.105-8.532, P=0.031) and higher serum creatinine at discharge (OR=1.026, 95%CI:1.013-1.038, P<0.001) were risk factors for progression to CKD in patients with cardiac valve replacement surgery-associated AKI. The clinical risk model including age, preoperative hypertension, preoperative baseline eGFR, and serum creatinine at discharge produced a moderate performance for predicting progression to CKD in patients with cardiac valve replacement surgery-associated AKI [the area under the curve (AUC)=0.865, 95%CI: 0.790-0.940, P<0.001].

Older age, preoperative hypertension and higher serum creatinine at discharge are risk factors for progression to CKD in patients with cardiac valve replacement surgery-associated AKI.

To assess the efficacy and safety of flexible ureteral lithotripsy (FURL) for treating upper urinary tract calculi in patients ≥80 years.

This study retrospectively analyzed the clinical data of 297 elderly patients who underwent FURL for unilateral upper urinary tract calculi at Beijing Hospital from January 2019 to September 2023. Patients were divided into elderly group (≥80 years) and low-middle aged group (≥60-<80 years). Propensity score matching (PSM) was used to match preoperative clinical data of patients. After PSM, the basic, perioperative and postoperative data of the two groups were compared.

After PSM, 116 patients were enrolled, including 58 patients in each group. The age [M (Q₁, Q₃)] of elderly group was 83.0 (81.0, 86.0) years, which included 29 males. The age of low-middle aged group was 69.5 (64.8, 74.0) years, which included 33 males. The duration of postoperative hospitalization [M (Q₁, Q₃)] in elderly group was longer than that in low-middle aged group [2 (1, 3) d vs 1 (1, 2) d, P=0.002]. Serious postoperative complications occurred in 3 cases in the elderly group and 1 case in the low-middle aged group, respectively, without surgical intervention. There was no significant statistical difference in stone-free rate (SFR) [79.3% (46/58) vs 84.5% (49/58)], operation time [M (Q₁, Q₃), 70.0 (48.3, 100.0) vs 65.0 (46.5, 101.2) min] and postoperative complication rate [25.9% (15/58) vs 22.4% (13/58)] between two groups (all P>0.05).

In the treatment of upper urinary tract calculi in patients ≥80 years, the SFR, operation time and postoperative complication rate of FURL are comparable to those in low-middle aged elderly patients. FURL has good safety and effectiveness in the treatment of upper urinary tract calculi in patients ≥80 years.

To explore the relationship between bioelectrical impedance analysis (BIA)-derived fluid status and nutritional indicators and the prognosis in patients undergoing maintenance hemodialysis (MHD).

A retrospective cohort study was conducted. The clinical data of MHD patients in Jiangsu Province Hospital between January 2014 and December 2016 were analyzed. BIA data of healthy volunteers in Gulou District, Nanjing City, collected between April and October 2022, were used to determine the cut-off value of body cell mass index (BCMI). Referring to previous research, using 0.15 as the cut-off value for the ratio of overhydration and extracellular water (OH/ECW). The data were transformed into binary variables based on these cut-off values to categorize patients into different groups. Kaplan-Meier analysis was used to plot survival curves, and the Cox proportional hazards model was performed to analyze risk factors for all-cause mortality.

A total of 706 MHD patients (407 males and 299 females) were included, aged (54±15) years. MHD patients were classified into four groups based on whether BCMI was<5.4 kg/m² and OH/ECW was≥0.15, which included non-overhydration and non-malnutrition group, overhydration group, malnutrition group, and overhydration and malnutrition group, with 269, 186, 151, and 100 patients, respectively. During a median follow-up of [M(Q₁, Q₃)] 33 (26, 37) months, 162 patients died. Kaplan-Meier analysis showed that the median survival periods of the four groups were 52 months (95%CI: 41-54 months), 46 months (95%CI: 44-49 months), 37 months (95%CI: 34-40 months), and 34 months (95%CI: 30-38 months), respectively, with a statistically significant difference (P<0.001). The 1-year survival rates were 95.5%, 93.5%, 92.1%, and 88.0% (P<0.001), respectively, and the 2-year mortality rates were 92.6%, 87.1%, 83.4%, and 77.0% (P<0.001), respectively. Multivariate Cox regression analysis showed that compared with non-overhydration and non-malnutrition group, the risk of all-cause mortality increased by 1.18 times in the malnutrition group (HR=2.18, 95%CI: 1.29-3.71, P=0.004), and by 1.59 times in the overhydration and malnutrition group (HR=2.59, 95%CI: 1.48-4.54, P=0.001).

BIA-derived fluid status and nutritional indicators are associated with the prognosis of MHD patients. Compared with patients without fluid overload and malnutrition, patients with malnutrition and fluid overload have an increased risk of all-cause mortality.

To explore the value of the midnight 1 mg dexamethasone suppression test combined with adrenocorticotropic hormone (ACTH) stimulation test in the diagnosis of primary aldosteronism (PA) subtypes.

A cross-sectional study. Clinical data of patients diagnosed with PA at the First Medical Center of Chinese PLA General Hospital from January 2020 to September 2022, who completed the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test, were analysed retrospectively. The clinical characteristics and trial results of patients with aldosterone-producing adenoma (APA) and idiopathic hyper aldosteronism (IHA)were compared. The efficacy of the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test in distinguishing APA and IHA was evaluated by drawing receiver operating characteristic (ROC) curves, and the cut-off value of the diagnostic indicator was determined with the maximum Youden index.

A total of 82 patients with PA were included, including 43 males and 39 females, aged (50.8±11.4) years old. They were divided into APA group (n=49) and IHA group (n=33) based on PA subtype. There was no statistically significant difference in body mass index, systolic and diastolic blood pressure between the two groups (all P>0.05). The blood potassium and orthostatic renin levels in the APA group were lower than those in the IHA group, and the differences were statistically significant (all P<0.001). The orthostatic plasma aldosterone concentration (PAC), orthostatic aldosterone to renin ratio (ARR), PAC before and after captopril challenge test(CCT), ARR after CCT, PAC before and after saline infusion test (SIT), and the proportion of unilateral lesions in the APA group were all higher than those in the IHA group, and the differences were statistically significant (all P<0.001). After the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test (30, 60, 90, 120 min), the PAC and PAC/cortisol levels in the APA group were significantly higher than those in the IHA group (all P<0.05). The PAC at 90 min showed the highest diagnostic capability according to the area under the ROC(AUC) (0.930,95%CI:0.874-0.986), and the Youden index was the highest at a PAC cut-off value of 39.05 ng/dl(0.766). The sensitivity and specificity for distinguishing APA from IHA were 91.8% and 84.8%, respectively.

The midnight 1 mg dexamethasone suppression test with ACTH stimulation test could be useful for differentiating the subtypes of PA. Among them, the PAC and PAC/cortisol at 90 min showed best diagnostic efficacy.

To investigate the characteristics and trends of spontaneous subarachnoid hemorrhage (SAH) in Shandong province.

In this study, SAH incidence data of residents from 2012 to 2021 were collected from the chronic disease monitoring information management system of Shandong province, including the basic information of outpatient, emergency or inpatient cases and out-of-hospital deaths (name, gender, ID number, address, etc.) and disease diagnosis information (disease diagnosis, date of onset, date of diagnosis, etc.). The crude incidence rate and age-standardized incidence rate were used as indicators to describe the incidence of SAH in different gender, age groups and regions (urban and rural areas). Joinpoint regression was used to analyze the variation of incidence rate and age by year. The rate difference decomposition method was used to estimate the contribution of population aging to the increase of SAH incidence. Global and local spatial autocorrelation analysis was performed using DeoDa 1.12 software.

From 2012 to 2021, a total of 11 629 cases of SAH were reported from 19 provincial monitoring sites in Shandong province. Among them, 54.11% (6 293 cases) were female and 91.87% (10 684 cases) were≥45 years old. The reported crude incidence rate increased from 5.26/100 000 to 9.50/100 000, with an average annual increase of 7.75% (Z_trend=7.30, P_trend<0.001), and the standardized incidence rate also showed an upward trend (Z_trend=3.92, P_trend=0.004). The crude incidence rate of women was higher than that of men in all years (all P values<0.05), and the standardized incidence rate of women was higher than that of men in all years except in 2012 and 2021 (all P values<0.05). In 2012, the crude incidence and standardized incidence of urban residents were lower than those in rural areas (P<0.05); from 2013 to 2017, the urban incidence was higher than that in rural areas; and after 2018, the rural incidence exceeded the urban incidence again (all P values<0.05). The median age of onset of SAH increased from 61.9 years in 2012 to 67.2 years in 2021. The age of onset of SAH in men was lower than that in women in all years (all P<0.05), and there was no significant difference between urban and rural residents in most years (P>0.05). The incidence of SAH increased with age (P_trend<0.001), with a low incidence reported in residents aged<45 years and a rapid increase in residents aged≥45 years. According to the seasonal decomposition, the incidence of SAH had three small peaks in January, March to May and October to November. From 2013 to 2021, the contribution of aging population to the increase of crude incidence of SAH increased from 27.86% to 43.68%. The global spatial autocorrelation analysis showed that the incidence of SAH was in an obvious spatial aggregation distribution (Moran′s I>0, P<0.05). Local spatial autocorrelation analysis showed that the counties with high incidence were mainly concentrated in Dezhou City in northwest Shandong Province and Heze city in southwest Shandong province.

The crude incidence rate of SAH in Shandong province is increasing, with spatial clustering and seasonal clustering. Residents aged 45 years and older, female residents, and rural residents are at high risk of developing SAH, so targeted prevention and control measures should be taken for high-incidence seasons, high-risk groups, and high-incidence clustered areas.

The clinical manifestations, biochemical and metabolic data, genetic variations and treatment data of children with MTHFR gene variant induced hyperhomocysteinemia admitted to Hangzhou Children′s Hospital and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2015 to September 2021 were analysed retrospectively. A total of 15 pediatric patients were included, including 10 males and 5 females, with onset ages ranging from 6 days to 18 years old and confirmed ages ranging from 40 days to 18 years old. One confirmed case was detected through neonatal screening, and the remaining 14 cases were all diagnosed through genetic diagnosis after onset. The main clinical manifestations were feeding difficulties, hypotonia, epilepsy, developmental delay. All patients had elevated levels of blood homocysteine, with blood homocysteine levels before and after treatment being (151.46±57.44) μmol/L and (69.96±32.88) μmol/L, significantly decreased after treatment compared with before treatment, with a statistically significant difference (P<0.001). The blood methionine level before the treatment was 9.40 (6.20, 11.96) μmol/L, normal or slightly decreased compared to the reference range. The methionine level returned to normal after treatment. A total of 19 MTHFR gene variants were detected, with 6 being unreported variants and 13 being known variants. c.1316C>T (p.L439P) was the most common variant(16.6%,5/30). All the patients had varied neurological damages, with 7 patients improved after metabolic therapy by carnitine and folinic acid, 8 patients experiencing developmental delay, and 1 patient experiencing frequent epilepsy. The clinical manifestations of MTHFR gene variation-related hyperhomocysteinemia are complex and variable. Early-onset and homozygous variants often have a poor prognosis. Blood homocysteine, blood amino acid analysis, serum total homocysteine assay and gene testing are helpful for early diagnosis.

This study aims to explore the possibility and bottleneck of clinical translation for an artificial intelligence (AI) diagnosis system for bladder cancer based on cystoscopy.We retrospectively collected videos of 101 bladder cancer patients from January to November 2023, at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Among these patients, with a median age of 63 years and 81.0% were male. The bladder cancer AI diagnosis system was utilized for diagnosis, and the accuracy of diagnoses from the videos was assessed. Additionally, a surgical evaluation scale was formulated to evaluate the quality of the videos, simulating clinical usage.The final test results showed a system sensitivity of 97.8%, a positive predictive value of 81.7%, specificity of 54.2%, and a negative predictive value of 92.3%. Furthermore, the surgical evaluation scale scores ranged from 3.96 to 4.69, indicating the feasibility of clinical application for this system.This study further quantitatively validated the accuracy of an artificial intelligence system using cystoscopy videos and assessed the potential for clinical application.

This article reports a patient with fever, recurrent stroke and multiple left ventricular mass occupation as clinical features. The patient was admitted to Peking Union Medical College Hospital on February 21, 2023 due to "intermittent fever for 3 weeks and left limb hemiplegia for 1 week". During the course of the disease, he had repeated fever and stroke, and had a history of painful oral ulcers. Echocardiography showed the presence of two neoplasms of different nature and activity in the left ventricle and the mitral valve. Multiple blood cultures were negative, and anti-infective treatment was ineffective. The left ventricular space-occupying resection and mitral valve replacement were performed. The left ventricular space-occupying pathology was inflammatory granulation tissue, and the mitral valve neoplasm pathology showed fibrotic necrosis and abscess formation. Behcet's disease was diagnosed, and infectious endocarditis was not excluded. After operation, anti-inflammatory, anticoagulant and anti-infective treatment were given, and the body temperature and inflammatory indexes returned to normal. Behcet's disease can involve the cardiovascular system, mainly the right heart system, and left heart thrombosis is extremely rare, which is easy to be misdiagnosed as infectious endocarditis. Young men with fever and heart occupation should be highly alert to the possibility of this disease.

This paper reports the diagnosis and treatment of an elderly rheumatoid arthritis (RA) with cryoglobulinemia, acute cerebral infarction and multiple infections. A 66-year-old female was admitted to Guizhou Provincial People's Hospital on August 18, 2023 due to "joint pain for half a year, aggravated with left chest pain for 3 days". The patient has developed facet joint pain in both upper limbs since March 2023, secondary to left chest pain, decreased left limb muscle strength, fever, and cough. After using tocilizumab combined with plasma exchange and symptomatic management, the condition improved significantly, and no adverse reactions were observed. After nearly 4 months of follow-up, the patient took medication as directed by the doctor, and RA was gradually controlled.

This paper reports a case of ectopic pleural breast cancer with abdominal pain as the first symptom. A 47-year-old female patient went to an external hospital for "intermittent abdominal pain for 1 month and aggravated for 5 days". The external hospital diagnosed cholecystitis and gave anti-inflammatory treatment, but the treatment effect was poor, so she went to the First Affiliated Hospital of Zhengzhou University. After further improving the relevant imaging examination and pathological examination, it was considered that it was rare pleural ectopic breast cancer, and the patient was recommended to undergo surgery or chemotherapy. The patient refused and asked to be discharged, so he was given out-of-hospital oral drug treatment for regular review. Due to timely diagnosis and treatment, the patient's symptoms improved significantly. Ectopic breast cancer is very rare. If the patient's symptoms do not match the signs, it is easy to cause missed diagnosis and misdiagnosis. Therefore, attention should be paid to avoid delaying the patient's treatment.

A case of adrenal metastasis from broad ligament leiomyosarcoma is reported. The patient was diagnosed with left ovarian mass 3 years before admission, and postoperative pathology revealed left broad ligament leiomyosarcoma. Postoperative CT revealed space-occupying lesions of the right adrenal gland. Open right adrenal tumor resection by abdominal approach was performed. Combined with the patient's medical history and postoperative pathology, right adrenal metastasis of broad ligament leiomyosarcoma was established. Postoperatively, adriamycin monotherapy was performed for 6 cycles. At present, the patient was followed up for 1 year, and there was no recurrence.

A case of vitelloid macular dystrophy complicated with choroidal neovascularization in an adult is reported. A 64-year-old female was admitted to our hospital 6 months after phacoemulsification and aspiration of cataract in the left eye combined with intraocular lens implantation + goniotomy + intravitreal drug injection due to "painless progressive vision loss in the left eye for 2 years and aggravation for 3 months". Ophthalmic examinations such as fundus photography, optical coherence tomography and fundus angiography were performed in the outpatient clinic, and a round yellow-white yolk-like lesion with a size of about 1PD (optic disc diameter) was found in the macular area and subretina, with small bleeding and hard exudation around it, a large number of hyperreflective neovascularization near the fovea, and abundant blood flow in the pigment epithelium. Finally, it was diagnosed as a rare adult vitelloid macular dystrophy with choroidal neovascularization. After the diagnosis and timely treatment, the visual acuity of the left eye was significantly improved, the retina returned to normal anatomical structure, and the exudate in the macular area disappeared. For patients with initial manifestations of similar fundus lesions, we should be alert to the occurrence of adult vitelloid macular dystrophy combined with choroidal neovascularization, and take timely and effective treatment to avoid serious visual damage.

Growth phenomenon independent of growth hormone (GWGH) refers to the phenomenon that the spontaneous growth rate is normal or even increased in the case of growth hormone deficiency. The specific mechanisms of GWGH may include hyperinsulinemia, hyperprolactinemia, elevated serum leptin levels and delayed epiphyseal closure due to sex hormone deficiency. The phenomenon of GWGH can occur after resection of some hypothalamic-pituitary tumors and in patients with disrupted pituitary stem syndrome. The use of growth hormone replacement therapy in these patients improves metabolism. This paper summarizes the phenomenon of GWGH after hypothalamic-pituitary tumor surgery and in patients with disrupted pituitary stem syndrome, and explores its mechanism in depth.

In recent years, with the deepening of tumor research, various new ideas and methods devoted to anti-tumor have emerged. Among the many factors that affect tumor progression, the nervous system plays a vital role in all links from tumor development to metastasis and spread. This paper focuses on the intersection of neuroscience and oncology and the concept of "tumor neuroscience", and expounds the mechanism of nerve-tumor interaction and the current research progress from the perspective of the interaction between tumor, central nervous system and peripheral nervous system, respectively, and discusses the problems that need to be solved at present, so as to provide new ideas, new methods and new progress for overcoming tumor.

Patients with acute chest pain clinically require electrocardiogram, high-sensitivity cardiac troponin and non-invasive imaging to assess myocardial ischemia in order to quickly identify the cause and provide appropriate treatment. In recent years, coronary CT angiography (CCTA) has developed rapidly, and research in patients with acute chest pain has been emerging continuously. Therefore, this paper combs the diagnostic, decision-making and prognostic value of CCTA and its derived plaque analysis, CT flow reserve fraction (CT-FFR) and CT perfusion imaging (CTP) functional assessment methods in patients with acute chest pain. For patients with low-to-medium-risk acute chest pain, CCTA is of great value in prognosis in addition to guiding precise clinical diagnosis and treatment; In patients with high-risk chest pain, CCTA may play the role of a creative gatekeeper, but it is still necessary to be cautious whether to add CCTA to the diagnosis path of patients with high-risk acute chest pain, and the purpose should be whether it can bring the most benefits to patients. In the future, many studies are needed to verify its advantages and disadvantages. With the supplement of high-level evidence and the continuous development of artificial intelligence medical imaging, the future research and application of CCTA in patients with acute chest pain still has great prospects.

The patient, 80 years old, went to the glaucoma clinic of Beijing Tongren Hospital affiliated to Capital Medical University because of "blurred vision in his left eye for more than half a year". The patient experienced visual acuity decrease in the left eye more than half a year before the visit, and the intraocular pressure reached a maximum of 42 mmHg (1 mmHg =0.133 kPa), and the left eye was treated with latanoprost spot. Lost blindness from right eye trauma for 32 years. Visual acuity: no light sensation in right eye, 0.1 in left eye; Intraocular pressure: T-1 in right eye (slight decrease in intraocular pressure, digital measurement), 19 mmHg in left eye. Slit lamp examination showed that the cornea of the right eye was opaque and the remaining structure was unclear. The left eye has slight conjunctival hyperemia, clear cornea, shallow anterior chamber, and lower peripheral anterior chamber is shallower than upper; The iris matrix is loose, especially the lower part. At 4: 00~7: 00, the iris matrix tissue is separated between layers, the superficial tissue is broken, and the loose split tissue of the iris floats in the anterior chamber (Figure 1). After illumination, the lower and 12:00 iris transmission was clearly visible (Figure 2). The pupil is round, approximately 5 mm in diameter, obtuse to light reflection, and the lens is opaque. Fundus: The disc edge of the left eye is obviously narrowed, with a cup-to-disc ratio of about 0.9, and diffuse retinal nerve fiber layer defect. Gonioscopy: Only the Schwalbe line is seen in both static and dynamic, and the angle of the chamber is closed around the whole circumference. Diagnosis: "Iridoschisis in left eye, secondary angle-closure glaucoma in left eye, cataract in left eye". Iridoschisis is a relatively rare disease, usually occurring in the elderly, mostly in both eyes, but the disease can be seen in one eye in the early stage. There is a certain genetic susceptibility to this disease, but it can also be seen in sporadic cases, or secondary to ocular trauma, syphilis, etc. About 2/3 of iridoschisis can be combined with different types of glaucoma, and its relationship with glaucoma and its role in the mechanism of glaucoma are still controversial. The cause of secondary glaucoma in this patient is related to narrow and closed chamber angle. Irischisis is iris fibrosis and atrophy leading to separation of the anterior and posterior stromal layers of the iris. The typical feature is separation of the iris stromal layer and rupture, and loose sheet-like and cord-like split tissue of the iris floats in the anterior chamber, which may be accompanied by a decrease in the number of corneal endothelial cells. This patient had typical iris manifestations and the diagnosis was clear.