2016年 · 第52卷第09期

This issue focuses on the research progress of ocular surface diseases. The responsible editorial committee responsible for the planning, composition and review of the key contents of this issue is Professor Pan Zhiqiang.

Corneal epithelial injury refers to the pathological state in which the function and integrity of corneal epithelial barrier are destroyed due to various factors, resulting in partial or full loss of corneal epithelial cell layer. Clinically, it can be manifested as diffuse punctate loss or erosion of corneal epithelium, repeated exfoliation and defect of corneal epithelium, accompanied by different degrees of ocular surface inflammatory reaction, and in severe cases, it can lead to corneal stromal disease and affect visual function.

Pterygium is a common and frequently occurring disease in ophthalmology, especially in the Tibet Plateau (above 3 000 m above sea level). The chronic inflammatory reaction of conjunctiva caused by ultraviolet irradiation, wind and sand, dry climate, etc. may damage the limbal epithelial tissue and the incidence is high. Surgery is the main treatment method at present, and the choice of surgical procedure is particularly important, because surgical treatment must achieve three main objectives (1) The pterygium should be safely removed clean. (2) Good optical effect is achieved. (3) Avoid recurrence. There are many traditional methods to treat pterygium, but the recurrence rate is high. Vaniscotte reported in 1986 that the success rate of different surgical methods was 59% with one resection, 82% with bulbar conjunctival transplantation, and 87.5% with autologous conjunctival metastasis^[1]。 The establishment and development of the theory of limbal stem cells in recent years pointed out that the root cause of the occurrence and recurrence of pterygium lies in the dysfunction of limbal stem cells. Conjunctival transplantation with limbal stem cells is an effective method to reconstruct ocular surface function. It can not only effectively provide bulbar conjunctiva, but also provide a healthy epithelial source for the limbus in the diseased area, and restore the function of normal limbus in the diseased area, thus effectively preventing abnormal limbal tissue proliferation, preventing pterygium recurrence, and achieving the purpose of treatment. Since 2011, the Department of Ophthalmology of Lhasa People's Hospital has carried out pterygium resection combined with autologous corneal epithelial tissue transplantation to treat 78 patients (86 eyes) with primary and recurrent pterygium, and achieved ideal results, which are reported below.

Fungal keratitis accounts for 62% of infectious keratitis, ranking first in China. The pathogens are mainly Fusarium and Aspergillus, about 70% of which are Fusarium^[1]。 In the past, due to the lack of high-efficiency commercial antifungal eye drops, the therapeutic effect is poor and the blindness rate is high. Antifungal drugs are classified into polyene antifungal drugs, azole antifungal drugs, echinococcin antifungal drugs, pyrimidines, immunosuppressive antifungal drugs, etc.

Keratoconus is a non-inflammatory corneal disease characterized by corneal dilation. deep anterior lamellar keratoplasty (DALK) has a low incidence of rejection and is currently the first choice for the treatment of completed keratoconus. There are no reports of recurrence after keratoconus surgery in China, but there are few reports after PK and DALK surgery abroad. A case of recurrence of keratoconus after deep lamellar keratoplasty of keratoconus was treated in the Department of Keratology of Hebei Eye Hospital, which is reported as follows.

The patient was a 40-year-old male. Admitted for 4 months due to visual loss in the right eye. The patient experienced visual loss in the right eye without obvious trigger 4 months ago, without other discomfort; One month ago, the visual acuity of my right eye decreased to the point that I could only see the things placed in front of my eye clearly, and at the same time, I obviously felt the linear objects swimming in front of my eye. I went to the ophthalmology clinic of the Fourth Hospital of Xi' an. My intraocular pressure was measured at 56 mmHg (1 mmHg =0.133 kPa), and I was admitted with glaucoma in my right eye. Have a history of close contact with dogs, cats and other animals; The sanitary conditions in mountainous areas are poor, and "dry toilets" are used daily. Past history: 3 years ago, my left eye was injured by a branch, but I was not treated. Now I am blind in my left eye. Ophthalmological examination: visual acuity of right eye 0.6, intraocular pressure 49.8 mmHg, conjunctival hyperemia, corneal edema, about 4 CT in the center of the anterior chamber and 1 CT in the periphery, wide angle, clear iris texture, round pupil, about 5 mm in diameter, slow reflection of light, transparent lens, migrating translucent linear worms can be seen in the upper vitreous cavity, pale papilla color, cup-to-disc ratio 0.9, flat retina, foveal reflection diffuse. There was no light sensing in the left eye, intraocular pressure was 51.6 mmHg, conjunctiva was congested, scleral staphyloma was seen on the nasal side of the sclera, the cornea was porcelain white, and the remaining structure was unclear. Auxiliary examination: Photographic examination of the fundus of the right eye, see the translucent thread-like living worm body in the upper vitreous cavity (Figure 1)； The B-ultrasound examination of the right eye showed vitreous opacity, showing a strip-shaped strong echo (Figure 2)。 Right eye field examination: tubular field, MD-32.58 dB, PSD 4.00 dB; CT and abdominal B-ultrasound of the skull and lungs showed no abnormalities.

The patient was an 89-year-old female. On April 3, 2015, he went to Tianjin Eye Hospital because he found that the tumor on the right eye surface had grown with no vision for more than 20 years. On March 27, 2015, he went to the Department of Ophthalmology, Xiqing Hospital, Tianjin, and underwent a biopsy of right conjunctival mass. The histopathological diagnosis was: squamous epithelial papilloma of right conjunctiva. He had suffered from hypertension for 15 years and coronary heart disease for 10 years, and no obvious abnormalities were found in the systemic physical examination. Eye examination: binocular vision examination cannot cooperate; There is no congestion in the conjunctiva of the right eye, and papillary neoplasms can be seen on the surface of the cornea and bulbar conjunctiva. The medial edge originates from the medial canthus, with a volume of about 20 mm ×8 mm ×3 mm, pink color, smooth surface, and a large number of tortuous blood vessels can be seen, which are soft in texture, with poor borders and cannot be pushed (Quintessence Picture 1)； Other structures in the eye cannot be peeped into. CT examination of both eyes in transverse axis: bilateral eyelids were thickened, and circular soft tissue density shadow was visible in front of the cornea of the right eye, with poor border and homogeneity, and the CT value was about 44 HU. Clinical diagnosis: squamous epithelial papilloma of the conjunctiva of the right eye.

The usual method of checking blepharitis patients for Demodex infection is to remove eyelashes, observe them under a light microscope and count them (Quintessence Picture 1)。 The invasiveness of this method, the pain caused by sampling, and the inability to take out all Demodex mites at the sampling site often limit the doctor's grasp of the overall situation of infection. Laser confocal microscopy can directly observe the infection of Demodex mite at the site of Demodex mite infection and the meibomian gland, and clearly show the number and morphology of Demodex mite (Quintessence Picture 2), which makes up for the lack of traditional examination methods, and has the characteristics of non-invasive, convenient and comprehensive.

The 17th National Conference on Cataract and Intraocular Lens of Chinese Medical Association, sponsored by the Ophthalmology Branch of Chinese Medical Association and the Cataract and Intraocular Lens Group of the Ophthalmology Branch of Chinese Medical Association, and jointly organized by Shaanxi Medical Association and the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University School of Medicine, was held in Xi' an from May 26 to 28, 2016. This session was attended by dozens of ophthalmologists, more than 1,800 registered representatives and more than 500 manufacturer representatives from home and abroad.