2018年 · 第54卷第01期

At the beginning of 2018, Editor-in-Chief Wang Ningli wrote the foreword "Protecting Healthy Eyes and Lighting a Beautiful China" in this issue, pointing out that China's ophthalmology challenges and opportunities coexist, and difficulties and hopes coexist. We should expand the intersection of medicine and industry and the combination of medicine and enterprise research, attach importance to high-quality clinical research and basic research based on clinical needs, do a good job in the top-level design of ophthalmology talents, cultivate outstanding talents in grades and layers, and then comprehensively improve China's eye health level. With the national strategy of "Healthy China" as the goal, we should strive to achieve eye health for all.

At the National Health and Wellness Conference held recently, * put forward the concept of "Healthy China". He believed that "people's health should be placed in a strategic position of priority development", and to achieve a moderately prosperous society for the whole people, it is necessary to achieve health for the whole people. Eye health is an important part of universal health. The World Health Organization also mentioned in "Vision 2020" that by 2020, the goal of eye health accessible to everyone in the world should be achieved. Protecting healthy eyes is an important task to achieve the strategic goals of General Secretary's "Two Centenaries" and "Healthy China".

Preamble

In "Expert Consensus on Clinical Diagnosis and Treatment of Laser Corneal Refractive Surgery (2015)"^[1]On the basis of, the Optometry Group of Ophthalmology Branch of Chinese Medical Association reached this consensus through collective discussion on the specific personalized laser ablation technology guided by corneal topography.

A 5-year-old female child went to Beijing Tongren Hospital affiliated to Capital Medical University for treatment because she was "found to tilt her head for 2 years". In the past 2 years, the parents of the patient found that the patient liked to tilt his head to see objects, without diplopia, dizziness, headache and obvious numbness and weakness of the limbs. Past history: The patient weighed 3 kg and was 50 cm long at birth, and had a term cesarean section. Physical examination: clear consciousness, slightly poor expression ability, lack of cooperation in physical examination. The vital signs are stable, the bilateral pupils are equal size and round, about 3 mm in diameter, and they are sensitive to light. The limbs moved normally, physiological reflexes existed, and the pathological signs were not drawn out. The naked eye visual acuity examination of both eyes did not cooperate, and the corrected visual acuity of the right eye was 0.7⁺0.7 in left eye^-。 Compensatory head position: head tilted towards right shoulder (Figure 1), there was no relief in head position after monocular covering. Eye position: The straight angle of the left eye gaze and the right eye gaze is equal by corneal photomapping, with the left high and the right 5°; Triangular prism method check: 10 high left and right when sitting^△When fixing horizontally and laterally, the strabismus degree of the second fixation eye position is both left and right 10^△。 Left high right 5 in recumbent position^△。 Bielschowsky cephalic skew test was negative. Eye movement: the right eye turns up and falls slightly, and the left eye turns down; The adduction and abduction movements of both eyes were basically normal. Isoscopic machine: Ⅰ: -2°, Ⅱ: none, Ⅲ: (-), no near stereoscopic vision; Objective angle: -5°, left high and right 2°. The fundus image suggests that the patient has external rotation of the right eye and internal rotation of the left eye (Figure 2）。 Preliminary diagnosis: Skew deviation. MRI of the brain was performed in our hospital, and it was found that the left cerebellar hemisphere and bridge arm were swollen, showing flaky isometric, long T1, mixed with slightly longer T2 signal shadows, with unclear edges, about 35.6 mm ×25.9 mm in size, and the enhanced scan showed mild and uneven enhancement; The left bridge arm was thickened, and the fourth ventricle was compressed and deformed; Consider the possibility of glioma (Figure 3）。

The patient was a 28-year-old female. Because of the poor vision of both eyes since childhood for more than 20 years, I went to Xiamen Eye Center. Eye examination: right eye visual acuity was 0.08 in the naked eye and 1.0 in the corrected eye (-6.00 DS); The left eye visual acuity was 0.05 in the naked eye and 0.6 in the corrected eye (-5.25 DS); IOP was 17.0 mmHg (1 mmHg =0.133 kPa) in the right eye and 18 mmHg in the left eye; The cornea of both eyes was transparent, there was no sediment behind the cornea, the depth of the anterior chamber was normal, the aqueous humor was clear, the pupil was round, the diameter was 3 mm, the direct and indirect reaction to light was present, and the lens was transparent; The vitreous body of both eyes was mildly opaque, the optic disc was reddish in color with clear borders, and the retinal and choroidal absence was visible near the macular area (Quintessence Picture 1，Quintessence Picture 2), deletion region edge pigmentation. Clinical diagnosis: congenital macular defect in both eyes.