2016年 · 第52卷第07期

This issue focuses on the research progress of refractive surgery. Professor Zhang Fengju is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

laser treatment for open-angle glaucoma was first proposed by Wise and Witter in 1979 as argon laser trabeculoplasty (ALT)^[1]。 American scholar Latina found that trabeculoplasty using Q-switched 532 nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser^[2], can reduce intraocular pressure without causing coagulative damage to the trabecular meshwork, and clinical pre-trial results were published in 1998. This method was named selective laser trabeculoplasty (SLT)^[3]。 SLT has no local thermal coagulation damage to trabecular tissue, but produces biological effects through selective photopyrolysis, which activates endothelial cells in trabecular tissue and secretes some cell active factors, such as IL-1 and TNF, which activates trabecular meshwork cell redifferentiation and induces macrophages in trabecular meshwork to exert digestive transport or phagocytosis effects on extracellular substances deposited in trabecular meshwork space, thus remodeling trabecular meshwork extracellular matrix and reducing aqueous humor outflow resistance^[4,5]。 At present, SLT has become the most common method to replace ALT in the treatment of early open-angle glaucoma due to its unique safety and operational advantages.

In 2007, the International Dry Eye Workshop (DEWS) made a detailed review on the definition, classification and diagnosis of Dry Eye, which laid the foundation for in-depth research on Dry Eye in recent years. In the past eight years, some scholars have challenged the misunderstandings of dry eye in the past through research, among which the symptoms and signs of dry eye and their relationship are particularly prominent and become the focus topic.

The bubbles generated by femtosecond laser in the process of making corneal flap will not only appear under the corneal flap, but occasionally some bubbles will migrate to the surrounding tissues. If the bubbles enter the anterior chamber, anterior chamber bubbles will be formed. The effects of anterior chamber bubbles on the inner eye have been observed in some studies, but the results have not found that the production of anterior chamber bubbles will affect the number and morphology of endothelial cells in patients^[1,2]。 In January 2015, a patient with loss of corneal endothelial cells after anterior chamber bubbles occurred in Jinan Mingshui Eye Hospital with femtosecond laser flap, which is reported as follows.

The patient was a 78-year-old male. In 2015, he was first diagnosed in Tianjin Eye Hospital due to the growth of remaining meat in his right eye with no vision for 2 years and aggravation for 2 months. The left eye had undergone left eye pterygium resection 40 years ago, and there was no pathological examination after operation. A history of hypertension with a history of cerebrovascular disease for more than 20 years. Ocular examination: The visual acuity of the right eye was manual before the eye, the conjunctiva was not congested, and the subconjunctival tissue was hyperplasia and hypertrophy in the bulbar conjunctiva of the palpebral fissure, showing a wedge-shaped fibrovascular membrane, which traversed the whole cornea, about 17 mm ×5 mm. Clear borders on both sides, smooth surface, soft texture, poor mobility, tight adhesion to underlying tissues, no tenderness (Figure 1）。 The posterior segment of the eye is invisible, indicating that the intraocular pressure measured is normal, and the external turnover of the eyeball is limited. The visual acuity of the left eye was 0.8, the nasal subconjunctival fibrovascular tissue proliferated into the limbus 2 mm, the lens cortex and nucleus were opaque, the intraocular pressure was 15 mmHg (1 mmHg =0.133 kPa), and the rest were not abnormal. Preoperative B-ultrasound showed mild vitreous opacity in both eyes, but no obvious abnormality in retina (Figure 2）。 First diagnosis: corneoconjunctival mass of the right eye. In November 2015, I underwent right eye corneal conjunctival mass resection combined with conjunctival transplantation + corneal multilayer amniotic membrane transplantation under local anesthesia. During the operation, it was found that the tumor adhered tightly to the anterior elastic layer of the cornea and invaded the superficial stromal layer. The conjunctival defect was transplanted with an upper conjunctival sheet, and the corneal wound was covered with 3 layers of amniotic membrane, and a therapeutic bandage lens was given after operation (Figure 3), 0.5% levofloxacin eye drops 4 times/d, prasifen, epidermal growth factor eye drops 4 times daily eye drops to prevent infection and promote wound healing. The resected tissue was sent to pathological examination, and the results showed irregular hyperplasia of conjunctival epithelium, hyperplasia of subconjunctival fibrovascular tissue, striated muscle tissue with differentiated mature adipose tissue (Figure 4)。 Immunohistochemical staining confirmed that the tumor tissue mainly contained adipose tissue, striated muscle tissue, abnormal thick-walled blood vessels and a large number of new blood vessels (Figure 5，Figure 6，Figure 7）。 Pathological diagnosis: corneal maltumas.

The patient, a 23-year-old female, was seen in the ophthalmology clinic of Peking University First Hospital in December 2014 due to 4-month fundus bleeding in her right eye. Four months ago, the patient had sudden occlusion of vision in his right eye without obvious trigger, accompanied by dark shadows fluttering in front of his eyes. He went to a local hospital. The physical examination corrected the visual acuity of 0.8 in the right eye and 1.0 in the left eye, and the intraocular pressure of 12 mmHg (1 mmHg =0.133 kPa) in the right eye and 15 mmHg in the left eye. No abnormalities were found in the anterior segment examination of both eyes. Fundus photography showed hemorrhage in the vitreous cavity and preretinal cavity of the right eye, radial hemorrhage on the surface and around the optic papilla, and an arc-shaped dark red subretinal hemorrhage on the nasal side of the optic papilla (FIG. 1A）。 The left eye papilla was bulged with unclear boundaries, and no abnormalities were observed in the rest (Figure 1D）。 FFA at the onset of the patient shows bleeding in the right eye blocking fluorescence, and strong fluorescence staining at the optic papilla (FIG. 1B,Figure 1C）。 The local diagnosis was "right eye papilla vasculitis", and he was treated with oral glucocorticoid for 3 months. Past physical health, myopia degree of both eyes about-3.75 DS, denied history of trauma, surgery, and family genetic history. For further diagnosis and treatment, the patient went to the ophthalmology department of our hospital. Physical examination at this visit: the corrected visual acuity of both eyes was 1.0, no abnormalities were found in the anterior segment examination of both eyes, and the fundus examination showed that the bleeding on the surface of the optical papilla, pre-retinal and subretinal hemorrhage of the right eye had been absorbed, the optical papilla was small, there was no physiological depression, the nasal side of the optical papilla was red, and it was slightly raised (FIG. 2A）。 Left fundus papilla bulge, unchanged from fundus photography 4 months ago (Figure 2B）。 FFA examination at this visit showed no retinal vascular abnormalities and no fluorescein leakage on the surface of the optic papilla (Figure 2C，Figure 2D，Figure 2E）。 spectral-domain optical coherence tomography (SD-OCT) showed that the retinal nerve fiber layer on the nasal side of the binocular papilla was highly raised, and a type of circular intensely reflected light cluster could be seen below it (Figure 3）。 B-ultrasound examination did not show strong echo shadow in front of optic nerve. In addition, the patient's visual field examination showed no abnormalities. According to the clinical manifestations and the findings of ophthalmic examination, the patient was diagnosed as binocular buried papilla drusen.

The patient was a 30-year-old female. Because the eyelash liquid of the left eye mistakenly entered the eye, the eyes were red and painful for 1 day, and he went to Beijing Tongren Eye Center. There was no history of other disease. Eye examination: 1.0 for right eye and 0.8 for left eye; Massive melanosis in the nasal conjunctiva of the left eye and reactive congestion in the surrounding conjunctiva (Quintessence Picture 1In a); The corneas of both eyes were transparent, and there were no abnormalities in the anterior chamber, pupil, lens and fundus. When a large amount of normal saline was given to rinse the conjunctival sac of the left eye, the melanin on the surface of the conjunctiva was lost, some pigment was deposited under the conjunctiva, and the conjunctiva was reactively congested (Quintessence Picture 1In B). Clinical diagnosis: conjunctival pigmentation of the left eye.