2018年 · 第54卷第11期

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

Example 1The child was a female, 3 years old. He was admitted to Lanzhou General Hospital of the People's Liberation Army in December 2012 due to tearing in both eyes for half a year, aggravation and significant decrease in visual acuity for 2 weeks. The patient's visual acuity in both eyes was lower than that of children of the same age since childhood. He visited the local hospital in March 2011 and was diagnosed with corneal dysplasia in both eyes. Medication was ineffective. One year ago, he was diagnosed with mucopolysaccharidosis type 1 (Hurler-Sheie syndrome) in our pediatric department due to growth retardation and deformity of both hands. Admission examination: The patient's general condition was good, and there was no significant difference in weight and development between them and children of the same age. Distal enlargement of the long bones of the extremities; Chest X-ray showed that the upper end of the right humerus was slightly wider, the surgical cervical cortex was not smooth, the residual bone density was normal, and there were no signs of bone destruction and fracture. The epiphysis of the distal shaft of the right ulnar flexural bone is wide and slightly rough, and the cortex of the 1st to 5th metacarpal bones is twisted; Brain CT revealed supratentorial ventricle enlargement (Figure 1）。 Eye examination: visual acuity was 0.05 in the right eye and 0.01 in the left eye, and both eyes did not receive correction; IOP was 33 mmHg (1 mmHg =0.133 kPa) in the right eye and 29 mmHg in the left eye. Moderate opacity of the whole thickness of cornea in both eyes, mild edema of corneal endothelium, and corneal thickness measured by A-ultrasound was 490-510 μ m; The axial depth of the anterior chamber is 1.5~2.0 CT, the texture of the iris is not clear, the pupil is 3~4 mm under natural light, and the light response is slightly dull. The parent of the child refused UBM examination. Admission diagnosis: secondary glaucoma in both eyes; Mucopolysaccharidosis. Treatment strategy: The anterior and posterior diameter of the lens of the patient is significantly enlarged. Therefore, the patient is given atropine sulfate ophthalmic gel to improve ciliary muscle tone. Brinzolamide eye drops and betalolol hydrochloride eye drops were given for eye treatment. After treatment, the intraocular pressure of the patient was 20~24 mmHg in the right eye and 19~23 mmHg in the left eye, and the corneal edema in both eyes was improved. Anterior chamber depth and axial length remained unchanged.

Example 1The patient was a 47-year-old male. Due to the discovery of bilateral orbital masses for more than 20 years, he went to the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University on January 10, 2017. The patient developed orbital masses in both eyes more than 20 years ago. He underwent surgical resection in a local hospital 18 years ago. More than 15 years ago, the orbital masses in both eyes reappeared. Recently, he felt that the masses increased progressively, so he came to see a doctor. The patient had a 15-year history of hypertension and no family genetic history. There were no obvious abnormalities in the whole body examination. Laboratory test: peripheral blood eosinophils 1.01×10⁹/L, total IgE: 617 000 U/L. Eye examination: visual acuity in the right eye was 0.8 and visual acuity in the left eye was 1.0. Multiple masses can be accessed above and below both eyelids, with a maximum of about 10 mm ×15 mm ×30 mm. The surface is smooth, medium in quality, clearly defined, mobile, and no tenderness (Figure 1）。 No obvious abnormalities were observed in the rest of the eye. Ultrasound of superficial soft tissue masses showed that multiple hypoechoic nodules were detected around the parotid glands on both sides, the larger one on the right side was 17 mm ×10 mm, and the larger one on the left side was 16 mm ×9 mm. Orbital magnetic resonance plain scan showed that the upper eyelids of both eyes were thickened, T₁The weighted image showed low signal, T₂The weighted image showed a slightly high signal; Approximately 15.2 mm ×29.7 mm long T was seen in the anterior wall of the left maxillary sinus₁Long T₂Mass, still uniform signal, clear boundary, slightly compressed depressed anterior wall of maxillary sinus (Figure 2）。 Preliminary diagnosis: orbital tumor in both eyes (eosinophilic lymphogranuloma considered); Hypertensive disease. After admission and complete relevant examinations, bilateral upper eyelid tumor removal + pathological biopsy + upper eyelid reconstruction were performed under local anesthesia. Postoperative pathology: lymphoproliferative lesions with lymphoid follicular formation, hyperplasia of interstitial collagen fibers, fibrosis, eosinophilic deposition, small eosinophil infiltration (Figure 3）； Immunohistochemical results: CD20+, CD3+, CD79a +, CD21 follicle +, CD23 follicle +, B-cell lymphoma (Bcl) -2+, Bcl-6 germinal center +, κ light chain +, λ light chain +, Ki-67 50% +, cytokeratin (CK) (AE1/AE3) -, CD10+, CD5+, cyclin D1 scattered in individual cells +, CD138+, multiple myeloma oncogene 1 (MUM1) +, IgG +, IgG4-, CD56-. Pathological diagnosis: eosinophilic lymphogranuloma. The patient was discharged on the first postoperative day, and no recurrence was observed after 3 months of follow-up.

The patient was a 29-year-old male. He was admitted to the Department of Ophthalmology of the Third Hospital of Peking University because of painless visual loss in both eyes and night blindness for 2 years. A family history of illness is denied. There were no obvious abnormalities in the whole body examination. Eye examination: visual acuity was 0.2 in the right eye and 0.1 in the left eye, both of which were corrected without improvement; IOP was 18.6 mmHg in the right eye and 16.2 mmHg in the left eye (1 mmHg =0.133 kPa), and no structural abnormalities were observed in the anterior segment of both eyes. Fundus examination seeQuintessence Picture 1。 Octopus static visual field examination showed defects in the right lateral central, inferior and temporal visual fields within 60° of the right eye; Most of the visual fields of the left eye were defective except the peripheral area of the nasal side. The amplitudes of the five responses of flash electroretinogram were moderately to severely reduced, especially in the left eye. The genetic test report showed a heterozygous mutation in the cyp4v2 gene: c.802-8_810del17bpinsGC. Diagnosis: Bietti crystalline retinal degeneration in both eyes.

Professor Zhang Chengfen left us on 20 July 2018. We feel sorry and sad about her departure. We always felt that she was still in the ophthalmology department of Peking Union Medical College Hospital and was still with us. After she died of serious illness, many experts of her own generation in the national ophthalmology community, such as Professor Zhang Shiyuan and Professor Fan Xueding, as well as many young and middle-aged doctors who had studied with her or read her works, and the patients she had treated, all wrote eulogies and memorial articles, which made us feel her academic influence and personality strength. In her body embodied the spirit of the Concord, the style of the Concord, the style of the Concord, the pursuit of the Concord! It is her strong characteristics of "Xiehe person" that make her image and personality sublimate, and she becomes a "Xiehe famous doctor" and is highly respected by the national ophthalmology circle. After her death, I have been wondering why she has such strong Concord characteristics in her body. What inspiration does her life have for us to train excellent ophthalmologists in the future?