2016年 · 第52卷第10期

This issue focuses on the clinical and basic research of ocular pathology and ocular tumors. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Li Bin.

Corneal transplantation is one of the important eyesight restoration surgeries in ophthalmology, which has the characteristics of both ophthalmic microsurgery and transplantation, so the probability of complications is high^[1]In particular, penetrating keratoplasty is a full-thickness keratotomy with high surgical risk. Common complications after corneal transplantation include poor incision healing, graft infection, increased intraocular pressure, recurrence of primary disease, immune rejection, etc. In recent years, with the improvement of microsurgery technique, the success rate of surgery has increased significantly, but the postoperative failure rate is still higher than that of other anterior segment surgery^[2]The main reason is that the standardization and accuracy of perioperative and postoperative long-term medication can directly affect the success or failure of surgery and the long-term survival of corneal grafts. At present, there is no standard of medication for corneal transplantation in China, which leads to great differences in perioperative medication by different hospitals and doctors, which affects the rapid and healthy development of corneal transplantation surgery. Therefore, the Keratology Group of Ophthalmology Branch of Chinese Medical Association organized relevant experts to discuss and formulated a consensus on the medication of corneal transplantation in China, which can be used for reference by domestic doctors engaged in the diagnosis and treatment of corneal transplantation.

A 14-year-old child came to the Department of Ophthalmology of Beijing Children's Hospital affiliated to Capital Medical University for the first time because of 3 d of visual loss in his left eye and 1 d of disappearance. The child was diagnosed with non-Hodgkin lymphoma (NHL) (T lymphoblastic type) 11 months ago, and 9 courses of chemotherapy ended 2 months. Physical examination: Left forehead near the midline, vertically arranged 4~5 soybean-sized light red rash, itchy feeling, slight pain (Figure 1), and no obvious abnormalities were observed in the rest. Eye examination: Visual acuity: 1.5 in right eye, no light sensation in left eye. IOP: 17 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye. The corneal reflection of both eyes is in the right position, and the movement in all directions is unlimited. The anterior segment of both eyes was roughly normal under the slit lamp microscope. Round pupils in both eyes, normal direct and indirect response to light in the right eye, dilated and fixed pupil in the left eye, relative afferent pupillary disorder in the left eye (relative afferent pupillary defect, RAPD). Mild papilledema on the right side was seen in the fundus of the eye; The papilla of the left eye is highly raised with unclear boundaries. A lot of deep bleeding can be seen on the surface of the papilla and the surrounding retina, with tortuous and thickened veins, scattered small patches and flame-like bleeding of the retina, and macular edema (Figure 2）。 Orbital MRI: bilateral optic nerve thickening, left optic nerve diameter approximately 5.7 mm, peripheral meninges thickening, rough edges, bilateral muscle cone intra-fat body point linear enhancement. The left eye papilla protrudes into the vitreous body. Cranial MRI (Figure 3): No placeholder seen. PET-CT examination showed that the left maxillary sinus and posterior ethmoid sinus were thickened on the left side with mild abnormal increase in fluorodeoxyglucose (FDG) metabolism. Considering the possibility of inflammation, the left optic nerve was thickened, the posterior wall of the left eye ring was thickened, and there was no obvious abnormality in FDG metabolism, so secondary inflammatory lesions were considered. Laboratory tests: varicella zoster virus (VZV) IgG (+), IgM (+). Bone marrow puncture examination: No naive lymphocytes were found. Herpetic optic neuritis is not excluded as the cause of visual loss in children.

The patient was a 28-year-old male. Due to the redness and swelling of his left eye for 20 days after the fall, he went to the Institute of Orbital Diseases of Armed Police General Hospital on November 14, 2014. The patient accidentally fell on a bicycle 20 days ago, and his left eye was pricked by a branch. He pulled out the branch that pierced the upper lid of his left eye by himself. After the injury, the visual acuity of the left eye decreased, and the exophthalmos was accompanied by conjunctival congestion and edema. He had debridement and suture of eyelid wounds and anti-inflammatory treatment in the local area, and his condition improved but the redness and swelling did not heal. Post-admission examination: the best corrected visual acuity of the left eye was 0.1, the upper lid was congested and swollen, slightly drooped, and the healed skin wound was visible on the outside of the double lid folds of the upper lid. The eyeball was slightly displaced internally, but could not turn externally, and the movement in other directions was obviously limited. Congestion and edema of the temporal bulbar conjunctiva, prolapsing outside the palpebral fissure. The left eye protrudes 5 mm from the contralateral (Figure 1）。 Finger test orbital pressure (+ +). Inferior corneal leukoplakia. The pupils are slightly dilated, and the direct and indirect light reflections are dull. Left frontal, eyelid and facial sensation is dull. No positive signs were found in other ocular and systemic examinations. CT examination (Figure 2) suggest diffuse soft tissue shadows on the lateral side of the left orbit, with unclear boundaries, indistinguishable from the lateral rectus muscle, and spreading to the apex of the orbit. Intracranial strip-shaped low-density shadows are located behind the supraorbital fissure and paracavernous sinus. MRI examination revealed T of intraorbital soft tissue lesions₁and T₂The weighted images are all medium signals, rough edges, T₁Weighted image enhanced lipid suppression imaging can be significantly enhanced. Intracranial strip-shaped space-occupying lesions in T₁and T₂The weighted images are all low signal shadows, not enhanced (Figure 3）。 Clinical diagnosis: left intracranial foreign body residual, left orbital soft tissue injury with foreign body residual, left eye exposure keratitis, left eye traumatic pupillary paralysis, left trigeminal nerve hypoesthesia.

The patient was a 61-year-old male. He was admitted to hospital for more than 50 days due to eye grinding and eye pain in his left eye. More than 50 days ago, my left eye was accidentally scratched by a branch. I went to a local hospital and was diagnosed as "left eye keratitis". Bacterial culture of corneal scraping showed: Pseudomonas aeruginosa (+). I was given systemic and local antibiotics for more than 50 days, and my condition gradually worsened. The patient's left eye grinding and eye pain were intolerable, so he came to the First Affiliated Hospital of Dalian Medical University for treatment and asked for left eyeball enucleation. The patient was diagnosed and treated in this hospital 30 years ago due to "iron chisel injury to his left eye". He complained that he was diagnosed with "penetrating injury to his left eye, foreign body in his left eyeball, and retinal detachment of his left eye" at that time, and underwent surgical treatment (details unknown). After operation, his left eye had no light sensation and the appearance of his eyeball was normal. Ophthalmic examination: visual acuity of right eye 0.8, intraocular pressure 15 mmHg (1 mmHg =0.133 kPa), no abnormalities were found; There was no light sensation in the left eye, the conjunctiva was highly mixed and congested, new blood vessels were visible in the corneal limbus, and a gray-white deep ulcer was visible below the nose in the center of the cornea, about 4 mm ×4 mm in size. The center of the ulcer was nearly perforated, the surrounding cornea was infiltrated, the rest of the cornea was edema, the cornea was stained with blood, and the intraocular structure was not visible (Figure 1), normal intraocular pressure. Diagnosis: Bacterial corneal ulcer in left eye, hyphema, old ocular trauma. After completing the ophthalmological and systemic examinations, enucleation of the contents of the left eye combined with implantation of prosthetic ophthalmic platform was performed under local anesthesia on October 11, 2014. During the operation, the cornea was cut along the limbus, but no lens and vitreous body overflow were observed. The ciliary body was separated in the whole circumference. The ciliary body was tightly connected with the sclera and could not be separated. The whole circumference raised gray-white sclerotic tissue was seen at the serrated margin of the ciliary body, and a gray-white sclerotic object with a complete cap shape was taken out (Figure 2), with two small holes about 1 mm in diameter visible at its posterior pole. During the operation, the intact pigment membrane was closely adhered to the sclera, and the pigment membrane was removed and implanted into the prosthetic eye platform. Postoperative pathological report: A semicircular cystic tissue was submitted for examination, with a size of 1.8 cm ×1.8 cm ×1.2 cm, and the surface was gray and smooth; The cut surface is gray and white, with calcification; The wall thickness is 0.2~0.3 cm, and the inside of the sac is gray and smooth. Microscopically, focal fibrous tissue hyperplasia and hyaline degeneration were observed, and bone cells and trabecular bone formed, with vascular adipose tissue between trabecular bone. Pathological diagnosis: ossification of ocular contents, fibrous tissue hyperplasia and hyaline degeneration (Figure 3）。

The patient was a 26-year-old female. Due to double vision with alternating inward deviation for 1 year, he went to the Optometry Hospital affiliated to Wenzhou Medical University on September 28, 2011. The patient developed diplopia symptoms without inducement 1 year ago, and then his family found that his eye position was inwardly deviated, denying the past history and family history. Ophthalmological examination: naked visual acuity of 0.1 and corrected visual acuity of 1.0 (-3.00 DS) in the right eye and naked visual acuity of 0.1 and corrected visual acuity of 1.0 (-3.00 DS) in the left eye. No obvious abnormalities were observed in the anterior and posterior segments of both eyes. The eyeball moves normally in all directions, and the oblique angle is equal in all directions. Corneal light mapping: +10°, prism plus alternating covering examination: +20 near^△, Distant +20^△。 Visual machine examination: subjective oblique angle +20°, objective oblique angle +20°. Stereoscopic examination: random point stereogram TNO: none; Titmus stereoscopic diagram: greater than 800 arc seconds; Visual function meter OPTEC3500: greater than 400 arc seconds. Worth 4 Point Light Check: 5 Point Near, 5 Point Far. Neurological and systemic examinations showed no obvious abnormalities. Preliminary diagnosis: (1) acute common esotropia; (2) Refractive error in both eyes. "Right medial rectus recession" was performed under local anesthesia on 29 Sep 2011, with a right medial rectus recession of 4.0 mm. On the first day after surgery, I complained that there was no double image of near object, and the double image of far object was better than before. 33 cm corneal photometry was used to check the eye position correctly, and the distance and near of the eye position of both eyes were alternately covered, which showed mild slight movement from inside to middle.

The patient was a 27-year-old male. Because the visual acuity of his left eye decreased for 1 month, he went to Tianjin Eye Hospital. Eye examination: naked visual acuity was 1.0 in the right eye and 0.1 in the left eye (no improvement in corrected visual acuity); Anterior segment examination of both eyes was roughly normal; No obvious abnormalities were observed in the right fundus, but in the left fundusQuintessence Picture 1。 OCT examination is presented inQuintessence Picture 2。 Clinical diagnosis: inner retinal sublimiting membrane hemorrhage in left eye.

The patient was an 18-year-old female. Because of the black shadow floating in front of his left eye for half a month, he went to Beijing Aier Yingzhi Eye Hospital. Hospitalized 3 months ago in an external hospital with suspected viral encephalitis. The patient had eaten tapeworms for weight loss. Eye examination: visual acuity was 1.5 in both eyes; IOP was 18 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye; No abnormalities were observed in the anterior segment of both eyes; Right fundus normal; Left fundusQuintessence Picture 1。 B-ultrasound examination: follicular image of the vitreous cavity of the left eye. Clinical diagnosis: left eye cysticercosis.