2015年 · 第51卷第01期

When the first sunshine of 2015 shines into the title page of Chinese Journal of Ophthalmology, all our journal runners have started to embark on the journey of the new year with vigorous steps, to look forward to and imagine the dreams that spring will bring us, and to face and meet the challenges of external competition to the journal.

Causes and Progress in Prevention and Treatment of Myopia edited by Song Xinqiang et al.^[1]After in-depth analysis of the anatomy and physiology of the eyeball, this book puts forward unique insights and reasoning on the changes of dynamic anatomical structure and physiological function of the eyeball during near-vision (see pages 131 and 149 of the book), and designs a set of myopia prevention training based on this (see pages 153 and 216 of the book), which is commendable. However, some of the new views derived in the book are still hypotheses, and there is no sufficient support of relevant original research and achievements at home and abroad. In particular, the new views of the natural expansion and contraction of the pupil caused by the change of aqueous humor flow as the main reason for the growth of the axis of the eye and the cause of myopia in the book lack scientific arguments. At the same time, some evaluations of previous studies in the book are biased, or they return to the beginning after deduction, and the relevant inferences are still discussed. For example, the book holds a negative opinion on the view of excessive adjustment of myopia, and finally deduces the need to relax adjustment and eliminate the causes of myopia caused by adjustment (see pages 194 and 213 of the book). The book lacks recent research results, especially the poor credibility of the confirmation of the efficacy in the book, because it lacks four main points: (1) the control group; (2) double-blind or single-blind method; (3) The demonstration of recognized indicators, such as for children with myopia, in addition to adjusting paralytic optometry, axial length and corneal curvature, there should also be adjustment of amplitude and sensitivity, paracentric defocus, etc.; (4) Follow-up.

The patient was a 47-year-old male. He was hospitalized to Tianjin Eye Hospital on July 10, 2012 due to progressive vision loss in his left eye for 1 1/2 years, eye pain for 7 months and vision loss for 4 months. The patient had been seen in an eye hospital on February 22, 2011 due to blurred vision. At that time, the visual acuity of his left eye was 0.1. The edema and fine hard exudation of the macular area were found by OCT, and the edema and detachment of the macular neuroepithelial layer of the left eye were found. Central serous chorioretinopathy of the left eye was considered. Treatment such as aescin and digitalis diglycoside eye drops was given. By December 7, 2011, the left eye was painful, the vision was manual in front of the eye, and the fundus of the eye could not be peeped in. The intraocular pressure was 13.8 mmHg (1 mmHg =0.133 kPa) in the right eye and 32.6 mmHg in the left eye. Vitreous hemorrhage in the left eye and secondary glaucoma were considered, and anti-glaucoma drugs such as brinzolamide eye drops were given. Intraocular pressure continued to rise to 49.3 mmHg. In order to relieve the left eye pain, the left eye ciliary body diode laser photocoagulation was performed twice in December 2011 and January 2012, and the eye pain improved slightly. In March 2012, I went to the original hospital. The visual acuity of my left eye was no longer light sensing, the iris was neovascularized, and the intraocular pressure was 44.9 mmHg. For further treatment, I came to see a doctor. Eye examination: Right eye visual acuity 0.8, left eye amaurosis. Multiple black flat protuberances can be seen from 1 to 5 o'clock in the temporal sclera of the limbus (Figure 1), shallow anterior chamber, atrophic iris, dilated pupil, responsive to light (–), IOP 35.8 mmHg. B-mode ultrasound showed that the choroid of the left eye was highly thickened and uneven in thickness, with retinal detachment (Figure 2)。 Color Doppler flow imaging showed a weak point echo in the vitreous body and a band echo connected to the optic head, and a choroidal thickening area with blood flow signals. CT showed uneven thickening of the left eye ring and increased density CT value +55~ +108 HU. MRI showed that the left choroid membrane was obviously thickened, and the lateral side was flat and protuberant, with abnormal signal, high signal in T1WI and low signal in T2WI (FIG. 3A，FIG. 3B), considering choroidal melanoma in the left eye with retinal detachment, and was admitted to hospital to prepare for surgery. Upper abdominal enhanced CT was performed, and several slightly lower density spots in the right lobe of the liver were found, the nature of which is to be determined. Considering the extraocular spread of disseminated choroidal melanoma in the left eye, the eyeball and part of the orbital contents were removed. Pathological diagnosis: Diffuse melanoma of the choroid (mixed cell type) in the left eye, involving one side of the ciliary body, with tumor cells invading the scleral wall and optic nerve after the sieve plate 2 mm (Figure 4，Figure 5)。 After operation, he was transferred to a cancer hospital. After multiple examinations, it was determined that he had intrahepatic metastasis of choroidal melanoma. He was treated with drug intervention, but the effect was not significant. He died in November 2013.

The patient was a 46-year-old female. On April 24, 2012, he went to the Department of Ophthalmology of the No.161 Hospital of the People's Liberation Army due to prolapse of eyeball and loss of vision for 4 hours due to right eye trauma. The patient's right eye was accidentally injured by a dump truck during construction at 9:00 a.m. on the same day, resulting in prolapse of the right eyeball from the orbit and loss of vision. The outpatient department was admitted to the hospital with "traumatic dissection of optic nerve in right eye and prolapse of right eyeball". Physical examination: General condition is good, conscious, general condition is normal. Eye examination: visual acuity: no light sensation in the right eye, 0.08 in the left eye. Irregular "Y"-shaped wounds about 4 cm and 2 cm long can be seen on the skin above the lateral side of the right orbit. The wound is deep, with a small amount of bleeding, and the tissue structure of the upper and lower eyelids is normal. The right eyeball was intact and unbroken, the eyeball and optic nerve completely prolapsed out of the orbit, the cornea was transparent, the anterior chamber was normal, the pupil circle diameter was 6 mm, the light reflection was direct and indirect (–), the lens cortex was opaque (+ + +), and the fundus was blurred. The remaining part of the conjunctiva and fascia of the right eyeball wall, the medial rectus, lateral rectus, inferior rectus, superior and inferior oblique muscles are completely disconnected, only the superior rectus muscle and part of the fascia are connected to the orbit, and the optic nerve about 5 cm long can be seen at the base of the eyeball is completely disconnected, free and prolapsed outside the orbit (Figure 1)。 The external eye of the left eye is normal, the cornea is transparent, the anterior chamber, iris and pupil are normal, and the light reflection exists directly. The lens cortex is gray-white and turbid (+ + +), and the fundus is blurred. Orbital CT scan showed that the right eyeball prolapsed out of the orbit, no fracture was found in the bone wall of both orbits, and the optic nerve canal was normal (Figure 2)； Laboratory tests: Blood, urine and stool routine were normal, and 6 items of hepatitis C and hepatitis B were negative. Admission diagnosis: Traumatic dissection of optic nerve in right eye; Right eyeball and optic nerve prolapse; Congenital cataracts of both eyes. At 15:00 pm on the same day, right eyeball enucleation and debridement and suture were performed in an emergency department under local anesthesia. Intraoperative exploration showed that the superior rectus muscle and upper fascia were connected to the eyeball, and the soft tissue in the orbit was mildly contaminated, bleeding and edema. The cornea and eyeball were structurally intact, and the retrobulbar optic nerve was disconnected. The measured length was about 5 cm (Figure 3)。 Place eyeballs in an insulated bucket and store in a wet room of a refrigerator at – 4 ℃. The conjunctival sac and orbital trauma were debrided and sutured, and the skin wound of the lateral wall of the orbit communicated with the orbital tip along the lateral wall of the orbit. After debridement and suture, a drainage strip was placed, and the postoperative compression bandage was performed. Anti-inflammatory and symptomatic treatment was performed, and the patient was discharged after 1 week.

The patient was a 79-year-old female. He went to the Department of Ophthalmology of Peking Union Medical College Hospital because of the decrease of visual acuity in both eyes for 3 months. Eye examination: the visual acuity of both eyes was 0.8, the corneas of both eyes were transparent, and the cortex around the lens was mildly opaque; Dilated pupils examined the fundus, the papilla of both eyes was normal, and the macular condition was shown inQuintessence Picture 1。 For the OCT examination, seeQuintessence Picture 2。 Clinical diagnosis: drusen in the macular area of both eyes.

The patient was a 60-year-old female. He went to Tianjin Eye Hospital due to sudden vision loss in his left eye for 2 weeks. Eye examination: naked eye visual acuity was 0.1 for the right eye and 0.05 for the left eye; The corrected visual acuity was 0.6 for the right eye and 0.05 for the left eye (both eye diopters were-15.00 D); Anterior segment examination of both eyes was roughly normal; The fundus of both eyes showed leopard print changes in high myopia, and no obvious abnormalities were observed in the rest of the right fundus. About 1/2 PD round subretinal hemorrhage was observed in the macular area of the left fundus, and the surrounding retina showed a gauze mist-like appearance (Quintessence Picture 1)； IOP was normal in both eyes. OCT examination is presented inQuintessence Picture 2。 Because the patient's blood pressure level was higher than normal and the drug control was unstable, FFA examination was not performed. Clinical diagnosis: high myopia in both eyes; Left eye maculoschisis; Macular hemorrhage in the left eye.

On August 30, 2014, Professor Lin Shaoming, a pioneer of ophthalmology in Singapore, founding director of Singapore National Eye Centre, and a renowned ophthalmology activist internationally and in the Asia-Pacific region, passed away due to illness at the age of 80.

In order to strengthen the publicity of major academic research progress of ophthalmology in China, show the strength and academic level of ophthalmology research in China, stimulate the academic enthusiasm and innovative ability of ophthalmologists and researchers, promote the society's understanding, care and support for ophthalmology academic research work, activate the academic atmosphere, and promote academic construction and discipline development, the 11th Committee of Ophthalmology Branch of Chinese Medical Association decided to organize the selection activities of the top ten research progress of ophthalmology in the past five years. This activity requires that the participating research should be the major discovery and clinical application progress of basic research made by Chinese scholars independently or participating in cooperative research in the past five years (2009 to 2013), and domestic units have independent intellectual property rights. Each professional group of ophthalmology branch selected 2 achievements from the top ten research progress of professional group selected by this group to participate in the selection activities of the top ten research progress of ophthalmology. Through the voting of the 3rd Standing Committee of the 11th Committee of Ophthalmology Branch of Chinese Medical Association, the final results were as follows: (1) Innovative theory and technical application of fungal keratitis, completed by Shandong Institute of Ophthalmology, completed by Xie Lixin, etc. (2) It was found that the increase of cranial pressure gradient was the main cause of optic nerve injury in glaucoma. The completion unit was Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University, and the completion person was Wang Ningli et al. (3) Domestic anti-vascular endothelial growth factor drugs successfully treated choroidal neovascular diseases, completed by Ophthalmology Center and Institute of Ophthalmology, Peking University People's Hospital, and completed by Li Xiaoxin et al. (4) The role of interleukin 23/17 pathway and its regulation in the occurrence of uveitis, completed by the Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, completed by Yang Peizeng et al. (5) The creation of animal models for myopia research and the study of biochemical mechanisms were completed by Optometry Hospital affiliated to Wenzhou Medical University, and completed by Qu Jia et al. (6) Expert consensus on amblyopia diagnosis, completed by Strabismus and Pediatric Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, completed by Zhao Kanxing et al. (7) Human Tenon capsule fibroblasts were induced and differentiated into induced pluripotent stem cells, which was completed by Sun Yat-sen Ophthalmology Center of Sun Yat-sen University, and completed by Ge Jian et al. (8) The research and development and application of endoscopic navigation surgical system for orbital surgery are completed by the Department of Ophthalmology, the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine and the Institute of Ophthalmology and Vision Science, Shanghai Jiaotong University School of Medicine, and completed by Fan Xianqun, etc. (9) Research on the pathogenesis of congenital cataract gene mutation, completed by the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University School of Medicine, completed by Yao Ke et al. (10) The standardization and promotion of the diagnosis and treatment of pediatric retinal diseases in China, completed by the Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, completed by Zhao Peiquan et al. The above research progress is ranked in order of the number of votes received from the most to the least, among which (1) and (2) are tied for the first place; (7) and (8) are tied for sixth.