2017年 · 第53卷第01期

Looking back at the past 2016, the journal indicators of this journal ranked first among ophthalmology journals, which is the result of the joint efforts of all readers, authors and editors of this journal! We will continue to adhere to the tenet of respecting science, seeking truth and being pragmatic, and adhere to the review system of "three reviews and five determinations" to provide better academic content for the majority of ophthalmologists.

Blindness and visual impairment seriously affect people's physical health and quality of life, increase the burden on families and society, and are major public health problems. In 1999, the World Health Organization and the International Association for the Prevention of Blindness put forward the global strategic goal of "eliminating avoidable blindness by 2020". By 2020, avoidable blindness caused by cataract, trachoma, river blindness, childhood blindness, refractive errors and low vision should be eliminated worldwide. My Government is committed and actively involved in achieving this goal.

Cataract is the leading blinding eye disease worldwide, and surgery is the only effective treatment at present. In recent years, with the increasing improvement of cataract extraction technology and the application of a variety of new functional IOL in clinic, patients have higher requirements for visual quality after cataract extraction, including postoperative naked eye vision and de-lens rate. Therefore, cataract extraction has entered the era of refractive surgery from the era of blindness prevention surgery.

The patient, a 36-year-old man, had blurred vision after being injured by boxing in his left eye on October 1, 2014. He did not see a doctor at that time. Seven days later, he found that the visual acuity of his left eye decreased significantly, and he was diagnosed as "choroidal rupture of his left eye" in another hospital (Figure 1), follow-up observation is recommended. Since then, he consciously fixed the black shadow in front of his left eye and visual deformation, and went to Shanxi Eye Hospital on November 8, 2014. The patient was healthy in the past and had a history of trauma in his right eye when he was young; Eye examination: right eye visual acuity 0.4, corrected visual acuity +0.50-2.00 DC x 90° =0.6; The visual acuity of the left eye was 0.12, which could not be improved by correction. IOP: 15 mmHg (1 mmHg =0.133 kPa) in the right eye and 13 mmHg in the left eye. No obvious abnormalities were observed in the anterior and posterior segments of the right eye; The anterior segment of the left eye was normal, and fundus examination showed a longitudinal crescent-shaped gray-white lesion in the macular area, with membrane-like reflex on the retinal surface with radial retinal folds. OCT examination showed a full-thickness macular hole in the left eye, with an aperture diameter of 237 μ m. The pigment epithelial layer was bulged in the macular area, local rupture, and membrane-like reflex on the retinal surface (Figure 2）。 Diagnosis: traumatic macular hole, epiretinal membrane, choroid rupture in left eye. 25G vitrectomy combined with epiretinal membrane and internal limiting membrane exfoliation and 14% C was performed in the left eye at Shanxi Eye Hospital on Nov. 21, 2014₃F₈Gas internal pressurization. One month after surgery, the visual acuity of the left eye was 0.3, and OCT examination showed that the macular hole was closed (Figure 3）。 Four months after surgery (April 1, 2015), during reexamination, he complained that the dark shadow and visual deformation in front of his left eye were more obvious than before, and the visual acuity of his left eye was 0.2. OCT examination showed that CNV in the macular area of his left eye and subretinal fluid were obvious (Figure 4）。 FFA examination showed: CNV in the macular area of the left eye (Figure 5）。 Approved by the Ethics Committee of Shanxi Eye Hospital, the patient signed the informed consent form and received intravitreous injection of ranibizumab injection 0.05 ml (containing ranibizumab 0.5 mg) in the left eye on April 6, 2015. After reexamination 1 month after injection, the visual acuity of the left eye was 0.5. OCT showed that the CNV in the macular area of the left eye was reduced, the subretinal fluid was absorbed but still existed, and the retinal neuroepithelium was edema between layers. The intraocular injection of 0.05 ml ranibizumab injection was readministered on 11 May 2015. After reexamination 4 months after the second injection (22 September 2015), the patient's visual acuity in the left eye was stable at 0.5. OCT examination showed that CNV and edema were significantly improved compared with those before injection. FFA examination showed that spotty and strip-shaped hyperfluorescence could be seen in the macular area of the left eye, and no obvious diffusion was seen in the late stage (Figure 6）。 On 30 June 2016, the patient was re-examined and the visual acuity of the left eye was 0.5. OCT examination showed that CNV lesions were stable with no obvious changes in activity (Figure 7）。 At present, the patient's visual acuity and fundus condition remain stable.

The patient was a 37-year-old male. On September 6, 2015, he went to the Department of Ophthalmology of Peking Union Medical College Hospital with no obvious trigger for fluttering dark shadows in front of his eye and visual acuity decrease for 3 days. The patient has been myopic in both eyes for more than 10 years. Prior health, no history of trauma, no family history of disease. Eye examination: visual acuity: right eye-4.75 DS corrected to 1.0, left eye-6.25 DS corrected to 0.5; Non-contact IOP: 17 mmHg (1 mmHg =0.133 kPa) in the right eye and 18 mmHg in the left eye. Physical examination of the right eye showed no obvious abnormalities. The conjunctiva of the left eye is not congested, the cornea is clear, the retrocorneal deposit (-), the anterior chamber is middle-deep, the aqueous humor flashes (-), the planktonic body (-), the iris is clear, the pupil is equal size and round, the diameter is 3 mm, the light reflection is slightly retarded, the lens is clear, and the vitreous body is mildly opaque. Fundus examination: leopard-like fundus, unclear optic disc boundary, red color, flake or flame-like bleeding on the surface and its periphery, thickening and tortuosity of the central retinal vein, scattered spots and flake-like bleeding of the retina, wedge-shaped white lesions with unclear boundaries can be seen next to the macula (Figure 1）。 FFA: Left ophthalmic artery filling was roughly normal (17 s), central vein filling was slow (venous filling completion time was 30 s), and the capillaries were mildly dilated. The temporal optic disc and posterior pole are scattered with fluorescence occlusion (Figure 2）。 OCT examination showed that there were multiple hyperreflective bands scattered between the inner plexiform layer (IPL) and the outer plexiform layer (OPL) in the nasal and paratemporal central regions of the fovea of the left eye (Figure 3）。 There was no abnormal appearance on FFA in the macular band-like hyperintensity area on OCT (Figure 2）。 Clinical diagnosis: acute paracentral acute middle maculopathy (PAMM) in left eye, central retinal vein occlusion (CRVO) non-ischemic type. Auxiliary examination: There were no obvious abnormalities in blood routine, liver and kidney function, antinuclear antibody, erythrocyte sedimentation rate, human leukocyte antigen B27 and anterolateral chest X-ray. He was given oral prednisone 60 mg once/d and ginkgo biloba leaves 19.2mg 3 times/d. The drug was regularly reduced, and the patient's symptoms gradually improved after regular outpatient review. After 3 months, the patient was reviewed in the ophthalmology clinic of Peking Union Medical College Hospital. The corrected visual acuity of his left eye recovered to 1.0, and the fundus examination was roughly normal (Figure 4), visual field examination revealed a local visual field defect around the nasal side (Figure 5), OCT showed that the local inner nuclear layer in the paracentral macula was thinner than before treatment (Figure 6）。

The ciliary process is the main place of secretion of aqueous humor, located behind the angle of the chamber. Because the ciliary process is located behind the iris, it is a blind spot in routine ophthalmic examination. The whole picture of the ciliary process is rarely seen in daily clinical examination. In ophthalmic surgery, the ciliary process morphology of different diseases under different examination conditions can be seen by pressing the peripheral sclera or using video capture technology, anterior segment photography, Retcam photography, fundus angiography, UBM and endoscopic methods (Quintessence Picture 1）。