2015年 · 第51卷第04期

China is one of the countries with the most extensive development of laser corneal refractive surgery. In order to further standardize the clinical application of laser corneal refractive surgery and ensure the quality and safety of medical care, the expert members of the Keratology Group of Ophthalmology Branch of Chinese Medical Association reached the following consensus in combination with the actual situation in China.

pigment dispersion syndrome (PDS) is a group of syndromes in which a large number of pigment particles in the pigment epithelium layer on the posterior surface of the iris are shed and deposited in the anterior segment of the eye due to the contact and friction between the posterior fovea of the iris in the middle periphery and the suspensory ligament of the lens. Pigment particles circulate with the aqueous humor and can be deposited on the posterior cornea, the anterior surface of the iris, the anterior and posterior surfaces of the lens, the suspensory ligament of the lens, and the angular crypts, especially the trabecular meshwork. Excessive pigment particles deposited in the trabecular meshwork can cause increased aqueous outflow resistance, increased intraocular pressure, and glaucoma, that is, pigmented glaucoma, which is the natural outcome of pigment dissemination syndrome and the cause of blindness.

Posterior chamber IOL ciliary sulcus fixation is the most commonly used IOL implantation method without capsule support in clinic^[1,2]。 Because most cases without capsule are caused by ocular trauma or surgery, the individual differences of surgical cases undergoing posterior chamber IOL ciliary sulcus fixation are large. So far, there is a lack of large sample, multi-center, randomized and controlled studies. However, its clinical application time in ophthalmology is longer, the indication range is wide, and the clinical effect is positive. Compared with iris fixation anterior chamber IOL, ophthalmologists have a larger audience and richer clinical experience. Therefore, posterior chamber IOL ciliary sulcus fixation technology has greater advantages in the current ophthalmology clinical practice.

At this stage of the development of cataract surgery, IOL intracapsular implantation is recognized as the safest and most effective implantation method. However, there are many cases where the posterior chamber IOL cannot be implanted in the capsular bag, such as lens dislocation caused by various reasons, including ocular trauma and surgery, and the complete or most missing lens capsule. How to safely and effectively correct the refractive error of aphakic eyes without capsule support, minimize the surgical injury and improve the visual quality is an urgent problem for ophthalmologists. In addition to wearing glasses or contact lenses, the main methods at present are to implant iris clamping IOL or ciliary sulcus suture to fix posterior chamber IOL.

The patient was a 41-year-old female. The right exophthalmos was significantly aggravated for 3 months, and he went to Xingtai Eye Hospital on April 10, 2013. One and a half years ago, the patient developed right exophthalmos without a clear trigger, and the effect of drug treatment was not good. He went to the local hospital one year ago. Orbital CT examination revealed the right orbital space-occupying lesion, and the right orbital mass biopsy was performed. The pathological diagnosis of right orbital Rosai-Dorfman disease was made in Zhejiang Cancer Hospital. Immunohistochemical staining: S100 (+), CD68 (+), CD79a (-), CD20 (-), Ki67 (+) (partial cells), Epstein-Barr virus encoding small RNA negative in situ hybridization; The pathological consultation of Fudan University Cancer Hospital considered that it was consistent with right orbital Rosai-Dorfman disease. Immunohistochemical staining: S100 (+), CD68 (+), CD1a (-), CD20 (-), CD3 (-); No other special treatment was done, and the patient felt significantly worse in the past 3 months. Admission: The patient was in good general condition and no enlarged lymph nodes were found; The visual acuity of the right eye is 1.0, the exophthalmos is obvious, the internal rotation is slightly limited, the eyelid is swollen, a skin scar about 2 mm long can be seen on the inner side of the lower eyelid 2 mm outside the eyelashes, and a hard mass can be palpable at the inner lower orbital margin, the size is about 2.5 cm ×2.0 cm. The mass is closely connected to the inner and lower wall of the orbit, with poor mobility, and no obvious abnormalities are found in the rest; The visual acuity of the left eye was 1.0, and there was no obvious abnormality in the anterior segment and fundus of the eye; Exophthalmos: right eye 20 mm, left eye 14 mm, orbital distance 92 mm; Orbital pressure: right side T +1, left side Tn; Lacrimal duct irrigation: patent on both sides. Orbital CT examination: the mass in the lower quadrant of the right orbit, the boundary is basically clear, the bone below the inner wall of the orbit is discontinuous, the mass protrudes into the nasal cavity through this place, and the right eyeball protrudes (Figure 1）； Orbital MRI: Right orbital space-occupying lesion, the tumor showed irregular T1 shorter T2 shadow, the boundary was not clear, the tumor protruded into the right ethmoid sinus and nasal cavity, and the enhanced scan showed that the lesion showed obvious contrast enhancement, and the enhanced signal was still uniform; The clinical diagnosis was a space-occupying lesion of the right orbit. On the third day after admission, the right orbital mass was resected under general anesthesia. The right eye mass was found to be located in the inner lower quadrant of the orbit, irregular in shape, tough in texture, and slightly gray-yellow in color (Figure 2), which is closely connected with the periosteum of the orbital wall, and all tumors in the orbit are removed outside the periosteum, and part of the bone in the inner wall of the orbit is destroyed; Because the pathology in the outside hospital showed benign lesions 1 year ago, and the nasal cavity lesions were greatly damaged by intraorbital resection, and may damage the lacrimal duct, resulting in complications such as dacryorrhea, so no treatment was done, and postoperative endoscopic nasal resection was recommended. Postoperative histopathological diagnosis was still considered as right orbital Rosai-Dorfman disease, immunohistochemical staining: S100 (+), CD68 (+), CD1a (-), CD20 (-), CD3 (-) (Figure 3）。 The patient was discharged 1 week after operation and followed up for 4 months. Because there were no obvious symptoms in the nose, the patient did not undergo nasal lesion resection, but there was no recurrence of intraorbital mass.

The patient was a 59-year-old male. He went to Xiamen Eye Center because of redness and pain accompanied by disappearance of vision for 5 h after his left eye was injured. Clinical diagnosis: left eyeball rupture (scleral rupture); Traumatic aphakia and aniris in left eye; traumatic vitreous hemorrhage of left eye; Retinal detachment in the left eye. Scleral debridement and suture were performed in the emergency department. One week later, vitrectomy, heavy water application, gas-liquid exchange, intraocular laser and silicone oil filling were performed. In order to avoid corneal band degeneration caused by long-term contact of silicone oil with corneal endothelium after operation, after filling the vitreous cavity with silicone oil during operation, the scleral incision was closed, the upper and lower bulbar conjunctiva were cut along the corneal limbus, and 3 groups (6) of parallel sutures were made near the ciliary sulcus with 10-0 polypropylene suture, so as to construct a fence structure with 6 sutures. After operation, the surface tension between silicone oil and water was used to intercept silicone oil at the interface between silicone oil and aqueous humor. Postoperative eye examination: visual acuity in the left eye was 1 m index (uncorrectable), intraocular pressure was 18 mmHg (1 mmHg =0.133 kPa), conjunctiva was mixed congested, the cornea was transparent, aqueous humor was visible behind the cornea, the cornea was not contacted with silicone oil, and six vertical sutures were visible in the plane of the ciliary sulcus to form an interface to intercept silicone oil (Quintessence Picture 1), the vitreous cavity is clearly filled with silicone oil, the residual retina in the fundus is in place, and the laser spot is clearly visible. For UBM inspection, seeQuintessence Picture 2。

Discovery of patients with trinitrotoluene occupational toxic cataract stage I in cataract screening work. The opacity of the lens was observed by slit lamp examination and fundus red light reflection after illumination. It was seen that there were most gray-yellow fine dot-like opacities of different sizes gathered around the lens, which were located in the anterior and posterior cortex of the lens and the adult nucleus, and the transparency of the lens cortex was reduced. Its black-and-white picture resembles the surface of the moon (Quintessence Picture 1）。 (The picture in this article won the Excellent Picture Award of the 9th Topcon Cup Ophthalmology Photo Exhibition of the 19th National Ophthalmology Academic Conference in 2014)

The patient was a 27-year-old male. Because of red eyes, eye swelling and visual acuity decrease for 3 days, he was seen in Beijing Tongren Eye Center. History of eye trauma denied. General physical examination: general condition is good, stature is slender, electrocardiogram examination shows no obvious abnormality. Eye examination: the naked visual acuity of the right eye was 0.2 and the corrected visual acuity was 0.6; The naked visual acuity of the left eye was 0.3 and the corrected visual acuity was 0.7; IOP in both eyes normal; Mild conjunctival hyperemia in both eyes, corneal edema in the central area of the right eye, endothelial folds, and complete dislocation of the lens in the anterior chamber and adherence to the corneal endothelium (Quintessence Picture 1）； Left eye iris tremor, clear aqueous humor, round pupil, presence of light response, incomplete lens dislocation; Fundus examination of both eyes is blurred. The OCT examination of the anterior segment is shown inQuintessence Picture 2。 Clinical diagnosis: Lens dislocation in both eyes (total dislocation in the right eye located in the anterior chamber).

15 September 2014 Professor Yuen Ka-qin (Figure 1) passed away at the age of 95. The bad news came, and the grief was indescribable. Although Professor Yuan left us forever, but this lifelong pursuit of bright old man has left us precious spiritual wealth, her voice and smile will always remain in our hearts.