2015年 · 第51卷第12期

This issue focuses on clinical and basic research related to neuroophthalmology. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Wei Shihui.

Keratoplasty is a kind of healthy corneal tissue to replace the patient's turbid, degenerate, infected cornea, to achieve the treatment of corneal diseases, improve the eyesight, restore the anatomical structure and improve the appearance^[1]。 According to different surgical methods, it can be divided into penetrating keratoplasty with full-thickness transplantation, lamellar keratoplasty (full lamellar and partial lamellar), corneal endothelial transplantation (with and without posterior corneal stroma) and other transplantation methods. In recent years, with the active promotion of the Keratology Group of Ophthalmology Branch of Chinese Medical Association, keratoplasty has been continuously promoted. The number of hospitals carrying out keratoplasty in China has increased significantly compared with before, and the number of various kinds of keratoplasty has also increased significantly. According to statistics, the number of corneal transplantations completed every year in the country is about 5 000. Especially the deep lamellar keratoplasty and corneal endothelial transplantation carried out in recent years, the good clinical results prompted their extensive development, but the learning curve of these two surgical methods is long, and the surgical experience and perioperative management of the surgeon are higher requirements.

With the emergence of various macromolecular ophthalmic biological agents, vitreous injection has become an important and even the only effective treatment for many fundus diseases. However, as far as the national ophthalmology industry as a whole is concerned, there is no unified and authoritative quality control standard for intravitreal drug injection, especially on some key issues involving the injection process and quality (such as staffing, equipment guarantee, drug dispensing, injection technology and post-injection follow-up, etc.), there has never been a consensus. The increasing frequency of intravitreal injection in retinopathy and its potential risks, and even the pressure on ophthalmologists caused by potentially blinding infections, all highlight the importance and urgency of quality control. In view of the work foundation of ophthalmology colleagues in major provincial and municipal hospitals and everyone's recognition of the importance of quality work, it is ripe to introduce a unified quality control standard for intravitreal drug injection.

The child was a female, 8 years old. Because of poor vision in his right eye, he went to the Department of Ophthalmology of Peking Union Medical College Hospital. Eye examination: naked eye vision is manual in front of the eye in the right eye and 1.0 in the left eye; The anterior segment of both eyes was normal. A red tumor body, about 2.5 PD in diameter, can be seen in the middle periphery of the upper temporal of the right fundus, which is connected to the thick and tortuous retinal blood vessels, and the retina around the tumor body is scattered with yellow-white exudation; The organic membrane of the vitreous body from the superior temporal of the optic papilla to the tumor body occludes the macular area (Quintessence Picture 1）。 FFA examination: the tumor body is rapidly filled with fluorescence in the arterial phase, and laminar flow can be seen in the vein connected to it; In the arteriovenous phase, the tumor body and the arteries and veins connected to it were completely filled; Tumor fluorescence continues to enhance and leak in middle and late stages, and extensive retinal hyperfluorescence can be seen (Quintessence Picture 2）。 No abnormalities were observed in the fundus of the left eye. Clinical diagnosis: Von Hippel's disease in the right eye.

The patient was a 44-year-old male. He went to Tianjin Eye Hospital because of visual acuity decrease in his left eye and visual object deformation for one and a half months. Eye examination: the visual acuity of the left eye is 0.4, which cannot be corrected; There was no obvious abnormality in the examination of the anterior segment of the left eye; For fundus examination, seeA in 1 of Quintessence Pictures。 The left eye OCT examination was performed using the American Optovue RTVue XR100-2 OCT instrument, as shown inB of 1 in Quintessence Picture。 Ultrasonography of the left eye with MD-2300 A/B ultrasound apparatus revealed a moderately echoic protuberance of the macular retina with a rough surface. Clinical diagnosis: Vitreomacular traction syndrome in the left eye.

The patient was a 19-year-old male. On January 7, 2014, he went to the Department of Ophthalmology, Beijing Friendship Hospital affiliated to Capital Medical University due to blurred vision in both eyes for 10 years. The patient developed dry mouth, polydipsia, polyuria, and emaciation without obvious trigger at the age of 4 years old. He had been seen in another hospital, and his blood glucose was 20.2 mmol/L, urine glucose (+ + + +), urine ketone body (-), fasting C-peptide 0.3 ng/ml (0.8~4.2 ng/ml), and insulin was checked<5 u IU/ml (2-23 u IU/ml), Insulin-related antibodies unknown. Has been diagnosed as "type I diabetes" and given insulin therapy. When the patient was 6 years old, he developed enuresis, increased urine output, clear urine as water, and nocturia 3 to 4 times/day. Water restriction and vasopressin test indicated "central diabetes insipidus". B-ultrasound revealed: double pelvic ureterosis. MRI of the head showed that the posterior pituitary lobe was short, and the T1 signal was not clearly displayed. Lumbosacral X-ray showed discontinuity of the vertebral lamina below sacral 1, which was diagnosed as "spina bifida occulta". The patient's pure tone audiometry showed high-frequency hearing loss. The patient delivered naturally at term, and the mother had no history of special infection or medication during pregnancy. The patient had no special genetic history in the family, denied consanguinity, father was healthy, the patient's mother had suffered from meningioma, which had been surgically removed, poor memory, and no limb mobility disorder. Ophthalmological examination: visual acuity in the right eye 0.1 (no improvement in corrected visual acuity), visual acuity in the left eye 0.1 (no improvement in corrected visual acuity), intraocular pressure in the right eye 12 mmHg (1 mmHg =0.133kPa), intraocular pressure in the left eye 11 mmHg, no abnormalities in the anterior segment of both eyes, atrophy of optic nerves in both fundus, thin retinal arteries, and poor macular reflection in both eyes (Figure 1）。 Dynamic visual field examination indicated: binocular tube vision; Electrophysiological examination showed that both eyes of graphic VEP were extinguished. Diagnosis: Wolfram syndrome (i.e. diabetes insipidus-diabetes-optic atrophy-hearing loss syndrome), also known as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness) syndrome.

The child was a female, 1 year old. Due to the displacement of his right eyeball for more than 2 months, he was hospitalized in the Institute of Orbital Diseases of Armed Police General Hospital on February 4, 2013. The patient has developed right upward eyeball displacement since December 2012 (Figure 1), gradually aggravated, denied the history of ocular trauma, performed orbital CT examination, found right orbital tumor, admitted for treatment. The child had a full-term cesarean section, no abnormalities in the development process, and was in good health in the past. There were no obvious abnormalities in the whole body examination after admission. Ophthalmology: Right eye: visual acuity examination does not cooperate, eyelid is slightly swollen, the lower part of the orbit can be palpable with a mass, the texture is tough, the eyeball is obviously displaced upward, the conjunctiva is congested, the finger test orbital pressure (+), and the rest of the examination does not cooperate. Left eye: eye movement can chase objects, but the rest of the examination does not cooperate. Orbital CT revealed a massive soft tissue density shadow below the right orbit, no normal inferior rectus muscle structure, and the tumor spread to the orbital tip (Figure 2）。 Orbital MRI revealed: mass-like abnormal signal shadow under the right orbit, medium signal in T1 and medium signal in T2, and non-uniform enhancement of tumor after injection of booster. Orbital color Doppler ultrasound showed that there was a hypoechoic mass below the right eyeball, about 3.3 cm ×2.0 cm ×1.3 cm in size, with clear boundaries, uniform internal echoes, and scattered strong echoic spots. Color Doppler blood flow examination showed that there was a rich blood flow signal in it, and spectral Doppler examination showed that it was low impedance spectrum.

optic neuritis (ON) generally refers to various inflammatory reaction lesions involving the optic nerve. It is the blinding optic nerve disease most vulnerable to young and middle-aged people. In the 2014 expert consensus ON the diagnosis and treatment of ON proposed by the Neuroophthalmology Group of the Ophthalmology Branch of the Chinese Medical Association, ON was classified into idiopathic ON, infectious and infection-related ON, autoimmune optic neuropathy and other unclassified ON.^[1]。 The most common of these is idiopathic ON, also known as demyelinating ON. Classification of demyelinating ON: (1) idiopathic demyelinating ON (IDON), also known as classical multiple sclerosis-related ON (MS-ON); (2) neuromyelitis optica-related optic neuritis (NMO-ON); (3) Other central nervous system demyelinating diseases associated ON. A large number of literatures have confirmed that compared with Caucasians, the incidence of neuromyelitis optica (NMO) in Asians is much higher than that of multiple sclerosis (MS). Similarly, the incidence of NMO-ON was also higher than that of MS-ON.

Bloody tears are symptoms of bloody tears coming out of the eyes^[1,2]。 It is not uncommon in clinical work, but because the amount of blood and tears shed by most patients is not large and the color is light, it is often not taken seriously. There are many causes of blood and tears, and the symptoms of blood and tears caused by different causes are also very different. Most patients show blood in tears, and only a few patients show blood. In recent years, reports on blood and tears have increased gradually at home and abroad^[1,2,3]However, due to the complex and diverse causes of blood and tears, the pathogenesis is still unclear, and the diagnosis and treatment are difficult, which often causes trouble for clinicians. It is helpful to understand the etiology, pathogenesis and diagnosis and treatment of blood tears in clinical diagnosis and treatment and further research.