2015年 · 第51卷第08期

Duane retraction syndrome (DRS) is a congenital abnormal eye movement disease. Clinically, according to the eye movement, it can be divided into 3 types^[1]: Type I external rotation is severely limited or unable, while internal rotation is normal or mildly limited, the first eye position is orthogonal or esotropic, the palpebral fissure becomes smaller and the eyeball retreats during internal rotation, and the palpebral fissure becomes larger when attempting external rotation. Type II internal rotation is obviously limited, but external rotation is not obviously limited, and the first eye position is orthopedic or exotropia; Type III internal and external transfers are obviously limited. Some patients may have rapid upward and downward turning when the eyeball turns inside^[2]。 The traditional surgical method only corrects strabismus and improves the compensatory head position. There are few reports in China on what kind of surgical method to use for DRS patients who have no obvious strabismus but are accompanied by rapid upward and downward turning of the affected eye and symptoms of regression. Therefore, we boldly innovated and adopted a new surgical method of medial and lateral rectus retrogression combined with W-shaped splitting of lateral rectus, which effectively improved the above problems, which are reported below.

The child was a 10-year-old male. Due to the intermittent attack of right exophthalmos with eyelid redness and swelling for 1 year, he went to the Department of Ophthalmology of Guizhou Provincial People's Hospital for treatment. One year ago, the child developed right eye protrusion without obvious trigger, accompanied by redness and swelling of the upper eyelid, without eye pain, vision loss and other discomfort. The child had no general discomfort, no abnormal crying, and the ocular symptoms gradually worsened. The local hospital once gave intravenous infusion of cefazolin sodium to the whole body, and the exophthalmos and eyelid redness and swelling were significantly improved, and the attacks recurred after stopping the drug. Being in good health. He denied eating raw meat, frogs and snakes, denied the history of parasite contact, and did not keep chickens, dogs and other animals at home. Physical examination after admission: binocular visual acuity 1.0, axial protrusion of the eyeball, right exophthalmos of 12 mm and left exophthalmos of 10 mm. The upper and lower eyelids were mildly red and swollen, the movement of eyeballs in all directions was not obviously restricted, the eyelids opened and closed freely, and the conjunctiva was mildly congested. No obvious abnormalities were found in the rest of the examinations. Orbital CT examination showed that the right orbit occupied space, located on the lateral side of the lateral rectus muscle and below the outside of the muscle cone. The lateral rectus muscle was slightly thickened and slightly displaced upward, and the lesion boundary was unclear and the shape was irregular (Figure 1)。 Orbital MRI examination showed that the lesions were uneven and enhanced, and the lesions were closely related to the lateral rectus muscle (Figure 2)。 Blood examination: white blood cells, red blood cells, neutrophils and eosinophils were all normal. Routine stool examination was normal. Preoperative diagnosis: space-occupying lesion of right orbit, considering that inflammatory lesion may be large. The right lateral orbital mass was explored under general anesthesia. During the operation, a ductile mass was detected on the lateral side of the lateral rectus muscle, which could be separated from the lateral rectus muscle. The surface was wrapped with degenerated fat, and the boundary with the surrounding normal fat was not clear. The mass was separated and incised. A living parasite, white and linear, about 30.0 mm ×0.6 mm, was removed from the mass. The parasite peristalsis was obvious when placed in normal saline, and the head and tail could be clearly distinguished. The adipose tissue wrapped in the parasite was sent for pathological examination. Pathological report: Acute and chronic inflammatory cell infiltration in fibroadipose tissue (right orbit), more eosinophil infiltration, focal eosinophil abscess formation with granulation tissue hyperplasia, consistent with parasitic infection (Figure 3)。 The parasite was identified as Sparganus mansoni (Figure 4)。 Final diagnosis: right orbital parasitosis. Anti-inflammatory and hemostatic therapy was routinely given after operation, but systemic anti-insect therapy was not performed. Reexamination after 1 month: visual acuity was the same as before surgery, no exophthalmos or eyelid redness and swelling, eyelids opened and closed freely, and eyeball movement in all directions was unlimited. The whole body examination showed no obvious abnormalities. There was no abnormality in the routine of the child's reexamination, and the blood image was normal.

A 43-year-old male was admitted to the Department of Ophthalmology of Qingdao University Affiliated Hospital on October 29, 2013 due to prolapse of eyeball after left eye trauma and disappearance of vision for 2 h. When the patient was fighting with someone 2 hours ago, his left eye was stabbed by the other party with a wooden brush handle, and then he lost sight and his eyeball prolapsed out of the orbit. The patient reported no history of ocular trauma. Ophthalmological examination: visual acuity of left eye without light perception, intraocular pressure Tn, orbital pressure T +2. Full-thickness skin laceration in the middle of the upper eyelid, medial canthus and temporal side of the lower eyelid, eyeball prolapse outside the palpebral fissure, ruptured medial rectus muscle, lateral rectus muscle and inferior rectus muscle stumps can be seen on the sclera surface, and partial rupture of the inferior oblique muscle can be seen vaguely (Figure 1)。 The conjunctiva was totally lacerated 1 mm from the corneoscleral margin, with a large defect of corneal epithelium, and the pupil diameter was about 5.0 mm. The direct and indirect response to light disappeared. Fundus: Papilla edema, bleeding, pale and edema of the posterior pole retina. No abnormalities were observed in the right eye. Orbital CT revealed left eyeball prolapse, unclear optic nerve display, except optic nerve rupture, fracture of orbital inner wall and inferior wall (Figure 2)。 Admission diagnosis: (1) dislocation of eyeball (left); (2) extraocular muscle rupture (left); (3) Optic nerve contusion (left); (4) Eyelid laceration (left); (5) Orbital fracture (left); (6) Corneal epithelial abrasion (left).

In recent years, the incidents of killing doctors have occurred frequently, and the tension between doctors and patients has reached its peak since the founding of New China. Although there are still many aspects that need to be reformed in the medical system, the lack or even blank of communication skills education between doctors and patients in traditional medical education makes medical students lack of favorable communication methods before stepping into clinical practice. The busy clinical work and the lack of strong technical training make our doctors often exchange their honesty for harsh words and even killing patients. Therefore, it is urgent to introduce psychological treatment methods education in medical students' education and provide effective communication skills tools.

The patient was a 26-year-old male. Because of left eye pain with visual acuity loss for 1 week, he went to the Department of Fundus Disease of Tianjin Eye Hospital. Has a history of high fever before the onset of the disease, denying other ocular and systemic diseases. Eye examination: the visual acuity was 0.8 in the right eye and 0.5 in the left eye, both of which could not be corrected; IOP was 12.5 mmHg (1 mmHg =0.133 kPa) in the right eye and 13.0 mmHg in the left eye; Unlimited binocular movement; Examinations of both external eyes and anterior segments were roughly normal; Pigment particles were visible in the vitreous body of both eyes, serous detachment of the posterior pole retina, folds in the macular area, and patchy gray-white lesions in the middle peripheral retina (Quintessence Picture 1)。 Clinical diagnosis: acute posterior multifocal squamous pigment epithelial lesions in both eyes. Intravenous glucocorticoid was given for about 4 months, and the ocular condition was reviewed: patchy pigmentation of the retina in both eyes, the lesions resolved, and the detached retina gradually flattened (Picture Quintessence 2)。

Healthy macaque, male, 5 years old, weighing 6.2 kg. After anesthesia, the macaques were placed on the experimental operating table, taken a prone position, placed their heads on the jaw rest of the examination table, and placed soft cushions under the jaw. Compound tropicamide drops are applied to the eyes after dilated pupils, and the eyelids are opened with an eyelid opener. The artificial tears were dropped into a rigid contact lens, and the contact lens was carefully placed on the cornea of the macaque monkey. The head position of the macaque was adjusted to an ideal angle, and the fundus of the eye was scanned and photographed using an RTVue XR OCT scanner (equipped with an OCT angiography working platform) manufactured by Optovue Company of the United States, and the blood flow perfusion area was measured. The distribution of superficial and deep capillaries and blood perfusion in the macular area are shown inQuintessence Picture 1。

The patient was a 20-year-old female. Due to the decrease of visual acuity in his right eye, he was seen in Nanyang Eye Hospital of Henan Province on December 6, 2013. Ocular examination: visual acuity was 0.6 (-3.50 DS) in the right eye and 1.0 (-3.50 DS) in the left eye; The refractive interstitium in both eyes was clear; The fundus examination was normal except that the foveal reflection in the macular area of the right eye was slightly darker. There were no abnormalities in visual field and electrophysiological examination. The results of the OCT examination are presented inQuintessence Picture 1。 Diagnosis: Segmental absence of the foveal ellipsoid zone in the right eye. After systemic treatment with neurosupporting agents, vitamins and drugs to improve microcirculation, he was followed up on January 13, 2014. The patient felt that the symptoms disappeared, and the corrected visual acuity of the right eye was 1.0. The results of OCT examination were shown inQuintessence Picture 1。

The patient was a 12-year-old male. Because the red laser pen shook in front of his right eye, he felt a dark shadow in front of his eyes and lost sight, so he went to the Department of Ophthalmology of Cangzhou Central Hospital. Eye examination: visual acuity was 0.15 for the right eye and 1.2 for the left eye; The anterior segment of the right eye was normal, the vitreous body was normal, the reflection of the fovea of the fundus disappeared, and small patches of bleeding were seen in the macular area. OCT examination: Moderate density reflection was observed in the macular area, but no internal and external segment connection structural layer of retinal photoreceptor was observed (Quintessence Picture 1)。 Clinical diagnosis: traumatic macular hemorrhage in the right eye. Yunnan Baiyao was administered orally and the right eye was treated with aesculus and digitalis eye drops. After reexamination 2 weeks later, the visual acuity of the right eye was 0.6, and the fundus bleeding was basically absorbed. OCT examination showed that the light band continuity of the internal and external segment connection structure of the foveal retinal photoreceptor was poor, and small reflections were visible (Quintessence Picture 1)。

From July 3 to 5, 2015, the first Huaxia Ophthalmology Forum and National Clinical Visual Electrophysiology Technology Application Forum, co-sponsored by the Visual Physiology Group of Ophthalmology Branch of Chinese Medical Association and Huaxia Eye Hospital Group, and hosted by Xiamen Ophthalmology Center affiliated to Xiamen University, were grandly held in Xiamen. More than 500 famous ophthalmologists from home and abroad gathered together to discuss the cutting-edge theories and technologies in the field of ophthalmology and exchange with each other.