2018年 · 第54卷第03期

This issue focuses on the research progress of glaucoma diagnosis and treatment. Professor Wang Ningli is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

In clinical diagnosis and treatment work, the coverage of descriptive terms is very wide, including patient complaints, medical history, signs, special examinations, laboratory tests, clinical disposition, etc. At present, the number of terms in the international classification of diseases (ICD) 10, ICD-9 and other databases is very small, and the use of many descriptive terms in ophthalmology clinic lacks standardized guidance. Today, with the rapid development of medical informatization, if the basic clinical descriptive terms cannot be unified, it will not only affect the clinical diagnosis and treatment work, but also make the statistical analysis of clinical data deviate, which seriously affects the accuracy and scientificity of clinical research results and clinical decision-making. Therefore, standardizing clinical descriptive terms can effectively improve the speed and efficiency of clinical information collection and data mining, and help maintain the integrity and authenticity of clinical information in multiple work links of collection, storage, transmission and utilization, so as to make clinical scientific research work based on data more scientific.

Despite being the most influential in the worldTHE LANCETpublished Level I evidence, EAGLE (effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma) The results provided by the study still cause great controversy in China.

Recently published inTHE LANCETEAGLE (effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma) The results of the study, that is, clear lens extraction for patients with angular closure with increased intraocular pressure and PACG [intraocular pressure ≥21 mmHg (1 mmHg =0.133 kPa), except for those with mean defect value inferior to-15 by Humphery field 24-2 method and cup-to-disc ratio of optic disc ≥0.9], showed that compared with conventional series of glaucoma treatments, namely laser peripheral iridotomy, trabeculectomy, and anti-glaucoma drug treatment, this surgical method can significantly increase the anterior chamber depth, better visual recovery, lower intraocular pressure and less anti-glaucoma drug use, and the probability of patients undergoing intraocular surgery again is greatly reduced, which has better hygienic and economic benefits in the long term. In terms of safety, the incidence of posterior lens capsule rupture, a major complication of clear lens extraction, is comparable to that of ordinary cataract extraction. Accordingly, the EAGLE study believes that clear lens extraction can be promoted as a first-line treatment for PACG, which will benefit patients^[1]。 However, the authors believe that although the EAGLE study provides important evidence and has important implications for clear lens extraction in the treatment of angular closure with intraocular hypertension and PACG, the study also has limitations and has not yet formed a consensus opinion on the global scale. In view of the uneven socio-economic conditions and medical level in China, blindly promoting this treatment method may cause unexpected adverse consequences.

The patient was a 14-year-old male. On January 20, 2015, he went to Beijing Aier Yingzhi Eye Hospital due to decreased visual acuity in both eyes accompanied by intermittent swelling and pain for more than 1 year and an increase in intraocular pressure for 2 days. The patient had a full-term natural delivery, no history of oxygen inhalation, and denied systemic medical history and trauma history. The parents and brothers in the family are all normal in intelligence and physical development. They deny similar medical history in the family and deny that their parents are intimate married. Full body examination showed no limb abnormalities and spider fingers. He is 174 cm tall, weighs 55 kg, and is emaciated. Eye examination: right eye uncorrected vision acuity (UCVA) 0.1, near vision<Jr7, best corrected vision acuity (BCVA) 0.25, intraocular pressure 31 mmHg (1 mmHg =0.133 kPa); Left eye UCVA 20 cm anterior manual, near vision<Jr7, no improvement in corrected visual acuity, intraocular pressure 35 mmHg; Transparent corneas in both eyes, retrocorneal deposits (-), slightly shallow central and peripheral anterior chambers, about 1/4 corneal thickness on the temporal side, aqueous humor flash (-), iris tremor, obvious swelling, round pupil, about 4 mm, attenuated direct light reflex, severe left side. The lens is transparent, and the equatorial part of the lens and the suspensory ligament are seen after dilated pupil, and the suspensory ligament is relaxed (Figure 1), the vitreous body is transparent, the optic disc edge is clear and pale in color, C/D is about 0.9, the upper and lower disc edges are narrow, and the retina is in place. Auxiliary examination: B-ultrasound showed no obvious abnormality in the posterior segment of both eyes; A-ultrasound showed that the axial length of the eye was 23.74 mm in the right eye, 23.27 mm in the left eye, and the lens thickness of both eyes was 4.58 mm; Corneal endothelial count right eye 2 150/mm²2 637/mm in left eye²； Computerized optometry right eye-7.75 D-3.00 D ×55° =0.25, left eye-7.75 D-2.00 D ×110° with no improvement in corrected visual acuity. UBM showed that the anterior chamber of both eyes was slightly shallow, narrow chamber angle, and ciliary process morphology was abnormal. The central depth of the anterior chamber of the right eye was 1.97 mm, and the central depth of the anterior chamber of the left eye was 1.79 mm. 2 quadrant angles were closed in the right eye and 3 quadrant angles were closed in the left eye (Figure 2）。 Visual field examination revealed a tubular field in the right eye. Preliminary diagnosis: secondary glaucoma in both eyes, high myopia in both eyes, globular lenses in both eyes, subluxation of lenses in both eyes, congenital dysplasia of the suspensory ligament of the lens in both eyes? Marfan syndrome to be excluded.

The patient was a 68-year-old male. On September 28, 2015, he went to the Department of Ophthalmology of Beijing Friendship Hospital affiliated to Capital Medical University due to sudden blurred vision in his left eye for 2 months and aggravated for 1 day. Previous history: Hypertension for 30 years, with high pressure up to 200 mmHg (1 mmHg =0.133 kPa) and low pressure up to 100 mmHg, treated with oral indapamide tablets and nifedipine controlled-release tablets, with stable blood pressure control. Type 2 diabetes for 20 years, oral metformin, glimepiride treatment, now blood sugar control well. Cerebral infarction for 1 year (July 25, 2014), oral aspirin, atorvastatin treatment. One year ago (September 2014), the patient underwent stenting of the left internal carotid artery due to severe stenosis of the left internal carotid artery (90% stenosis). Seven years ago (2008), the patient underwent phacoemulsification aspiration and intraocular lens placement in the left eye due to senile cataract in the left eye. Four years ago (2011), the patient underwent phacoemulsification and aspiration of cataract in the right eye + intraocular lens placement due to senile cataract in the right eye. Three days ago, the patient underwent laser posterior capsulotomy with neodymium-doped yttrium aluminum garnet lens in the left eye due to posterior cataract in the left eye. Smoking and drinking for 30 years, and has quit smoking and drinking for 1 year. Two months ago (August 1, 2015), the patient suddenly experienced blurred vision in the left eye, visual acuity (international standard vision chart) 1.0 in the right eye, 0.25 in the left eye, intraocular pressure (non-contact tonometer) 9 mmHg in the right eye, 11 mmHg in the left eye, no abnormality in the anterior segment of both eyes, thinning of the arteries in both eyes in the fundus, and scattered bleeding spots and hard exudation in the retina in the left eye (Figure 1）； FFA showed a few retinal microaneurysms and small patches of hemorrhagic occlusion in both eyes, prolonged brachioretinal circulation time in the left eye, and fluorescent staining of the late retinal vascular wall (Figure 2，Figure 3）； Diagnosis of diabetic retinopathy stage II in both eyes combined with fundus examination. To improve circulation, protect nerves and other drugs. 1 d ago, the patient felt that the symptoms were aggravated. Reexamination: visual acuity 1.0 in the right eye and 0.08 in the left eye, intraocular pressure 14 mmHg in the right eye and 24 mmHg in the left eye, and massive plexiform neovascularization in the iris of the left eye (+ + +) (Figure 4), no other abnormalities were found in the anterior segment of the eye, and the fundus was unchanged compared with 2 months ago. No retinal non-perfusion area and neovascular growth were found in FFA reexamination.

The patient was a 54-year-old female. The visual acuity of the left eye was reduced with the dark shadow fluttering in front of the eye for 2 months, and he was seen in the Department of Ophthalmology of the First Hospital of Jilin University. Eye examination: left eye naked visual acuity 0.12, corrected visual acuity 0.15; The anterior segment was roughly normal; A round cystic mass of about 7 PD in diameter can be seen at the posterior pole of the vitreous body, and the retinal structure can be seen through. There is brown pigment deposition on the surface, and yellow-white pigment deposition can be seen in the central area. The white strip below the mass is connected to the cyst, and the cyst floats in the vitreous body by rotating the eyeball (Quintessence Picture 1）。 B-ultrasound examination: A circular cystic strong echo was seen in front of the eyeball wall, which was connected to a strong echo light band (Quintessence Picture 2）。 Clinical diagnosis: vitreous cyst in the left eye.