2015年 · 第51卷第07期

The patient was a 47-year-old male. On June 8, 2014, he went to the ophthalmology clinic of Peking Union Medical College Hospital due to sudden nasal dark shadow occlusion of his left eye for 20 days. Previous myopia in both eyes-4.00~ -5.00 D. In 1982, the right eye underwent extrascleral compression due to retinal detachment. Eye examination: visual acuity: light perception in right eye, 0.02 in left eye; IOP: 18 mmHg (1 mmHg =0.133 kPa) in right eye and 6 mmHg in left eye. Anterior segment examination: Retrocorneal deposits (KP) in left eye (-), aqueous humor flash (+), planktonic body (+), opacity of lens, iris tremor in right eye, all white opacity of lens, partial cortical absorption. Fundus mydriasis examination showed opacity and concentration of the vitreous body in the left eye, broad funnel-shaped retinal detachment, and a 180° giant retinal hole on the temporal side (Figure 1）； The fundus of the right eye is invisible. B-mode ultrasound of the eye revealed wide infundibular retinal detachment in the left eye (Figure 2), partial retinal detachment in the right eye. Diagnosis: Giant hiatus retinal detachment in left eye, proliferative vitreoretinopathy, senile cataract. Myopia in both eyes. Cataract overmaturity in the right eye (with concurrent factors), retinal detachment after extrascleral compression, localized retinal detachment.

The patient was an 18-year-old female. Due to refractive errors in both eyes (the power of binocular lens is about-6.00 D), I underwent binocular LASIK operation under topical anesthesia in an external hospital on June 26, 2011. The naked visual acuity was 1.2 in the right eye and 0.25 in the left eye on the first day after operation. Because of the abnormal visual acuity of the left eye after LASIK, he went to the Department of Ophthalmology of the First Hospital of Jilin University 3 days after operation. Ocular examination: The cornea of the right eye is transparent, with a 3/4 ring mark of keratectomy. The corneal flap is intact, about 8.0 mm in diameter, with neat and regular edges, located at the optical center of the cornea, covering the pupil area, and the width of the corneal flap pedicle is appropriate. The corneal bandage piece of the left eye is in place, the cornea is transparent, and a 360° cut mark of keratectomy is visible. The corneal flap is about 6 mm in diameter, with irregular edges and no pedicle, located at the positive optical center of the cornea and covering the pupil area. The corrected visual acuity was 1.2 (0.75 DS) in the right eye and 0.25 (-1.50 DS) in the left eye after 30 min of removing the bandage2.25 DC ×5°). IOP: 9 mmHg (1 mmHg =0.133 kPa) in the right eye and 10 mmHg in the left eye position. The results of the corneal topography of the left eye are shown inFigure 1Middle A. Diagnosis: After LASIK in both eyes; Free corneal flap of left eye; Refractive error. Treatment: Left eye corneal flap-to-flap reduction was performed on June 30, 2011. Preoperative preparation is the same as conventional LASIK surgery. The operation process: under topical anesthesia, a long mark is gently made on the edge of the corneal flap at 12 o'clock and 9 o'clock each with a needle, the periphery of the corneal flap is lifted up with a flushing needle, and the whole corneal flap is separated from the stromal bed while flushing. The 12 o'clock mark of the corneal flap is slowly turned to the 9 o'clock position with a flushing needle, and the corneal flap is flattened and pasted with blood sucking sponge, and a bandage is worn. Tobramycetoxin dexamethasone eye drops point the left eye. After operation, 0.1% sodium hyaluronate and tobramycetoxin dexamethasone eye solution were routinely dripped 4 times/d. For postoperative conditions, seeTable 1The results of corneal topography examination at 1 d and 12 months after surgery are shown inFigure 1Medium B, C.

A 54-year-old female was seen in the Department of Ophthalmology of Peking University First Hospital on August 21, 2013 due to 2 d visual loss in her left eye. The patient had no family genetic history and no previous systemic history. Ophthalmological examination showed: naked visual acuity 1.2, Jr7 in the right eye, 0.1, Jr7 in the left eye, intraocular pressure 14 mm Hg in the right eye and 15 mm Hg in the left eye (1 mm Hg =0.133 kPa); Anterior segment examination of both eyes showed no abnormalities; There was no opacity in the vitreous cavity, the retina was in place, the color, border and shape of the optic papilla were normal, a:V =2:3, the foveal reflex in the right eye was visible, and there was no abnormality in the macular area. Scattered bleeding spots and small patches of bleeding were visible in the retina (FIG. 1A）。 The proliferative vascular membrane growing towards the vitreous body can be seen on the surface of the optic papilla of the left eye. Small tumor-like dilatation of the retinal artery at the optic papilla can be seen, a:V =1:2. The thickness of the arterial tube is uneven, the foveal reflex disappears, the epiretinal membrane with strong reflection can be seen at the posterior pole, and scattered punctate hard exudation and small patches of hemorrhage can be seen at the posterior pole and peripheral retina (FIG. 1B）。 OCT examination showed no abnormalities in the retinal structures in the macular area of the right eye (FIG. 2A）； The fovea of the left eye was flattened, the thickened retinal layer showed a hypo-reflective space, and the inner surface of the omentum showed a strong reflective band, which showed typical macular edema and epiretinal membrane (Figure 2B）。 ultra-widefield fluorescein angiography (UWFA) was performed after consultation. The arteriovenous filling of both eyes was normal, the surface of the optic papilla and the bifurcation of the retinal artery were tumor-like dilated, the posterior pole was scattered with fluorescence leakage foci, and the distal arteriovenous blood vessels were not filled, forming a large capillary non-perfused area. The ends of the blood vessels at the edges of the filling area were anastomosed with each other, and the serrated strong fluorescent edges were formed in the late stage. The late papilla of the right eye showed high fluorescence, and the neovascular membrane at the papilla of the left eye showed high fluorescence (Figure 3，Figure 4）。 Diagnosis: IRVAN syndrome in both eyes, macular edema in left eye, epiretinal membrane in left eye. The patient was consulted in the Department of Rheumatology and Immunology of Peking University First Hospital for blood routine, blood biochemistry, immune-related antibody, urine routine and carotid artery ultrasound. Only the antinuclear antibody (ANA) was positive with a titer of 1:320 (normal value<1:100), and no obvious abnormalities were observed. Consultation opinion: There is no systemic inflammatory reaction, and the increase of antinuclear antibody titer alone is not of diagnostic significance. Prednisone 40mg was administered orally, and binocular retinal laser photocoagulation was performed. Under the guidance of UWFA imaging, the fundus laser was extensively and thoroughly. UWFA reexamination at 2 and 6 months postoperatively showed that there were dense photocoagulation spots in the original non-perfusion area of both eyes, especially the laser spot in the anastomosis area at the end of the blood vessel (Figure 5）。 Reexamination of UWFA at 9 months postoperatively showed no significant progression in both eyes.

The patient was a 41-year-old male. Because my left eye itched for 1 d, I found two small white bugs when rubbing my eyes, and I went to the Department of Ophthalmology, the Second Hospital of Jilin University. The patient keeps farming cattle at home and has no other pets. Ocular examination: No obvious abnormalities were found in the anterior segment of the right eye; The conjunctiva of the left eye was congested, and a transparent linear worm was seen in the conjunctival sac near the lateral canthus of the temporal side, peristalsis and curling under the illumination light (Quintessence Picture 1), remove it with a cotton swab (Quintessence Picture 2), detailed examination of other positions of the conjunctival sac and lacrimal points without abnormalities. According to the parasitic site and morphology of the worm, the clinical diagnosis: Left conjunctival sucking nematode.

The patient was a 57-year-old female. Routine physical examination was performed in Changchun Aier Eye Hospital. Previous health, history of sulfonamide and penicillin allergy. Eye examination: visual acuity was 1.0 in both eyes; IOP was 13 mmHg (1 mmHg =0.133 kPa) in the right eye and 12 mmHg in the left eye; Anterior segment of both eyes normal; Irregular depigmentation of the macular area of the right fundus (Quintessence Picture 1), the autofluorescence image showed low fluorescence at the depigmentation of the macular area, and the OCT examination image was shown inQuintessence Picture 2； Left fundus normal. Clinical diagnosis: retinal pigment epithelial fovea in the macular area of the right eye.