2017年 · 第53卷第07期

This issue focuses on the research progress of ophthalmic epidemiological investigation. Professor Zou Haidong is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

Eye health is an important part of national health. Visual impairment, including blindness, seriously affects people's physical health and quality of life, increases the burden of families and society, threatens social and economic production activities, and is a major public health and social problem involving people's livelihood. In 1999, the World Health Organization (WHO) and the International Association for the Prevention of Blindness (IAPB) put forward the global strategic goal of "eliminating avoidable blindness by 2020". In accordance with the overall requirements of building a healthy China, deepening the reform of the medical and health system and the resolution of WHO's "Facing Universal Eye Health: 2014-2019 Global Action Plan", this plan is formulated in order to continue to promote the cause of eye health in China during the 13th Five-Year Plan period and further improve the people's eye health level.

The average altitude of Qinghai-Tibet Plateau in China is over 4 000 m, the intensity of ultraviolet irradiation is extremely strong, the oxygen content in the air is low, the natural environment factors and the backward medical conditions make the incidence of cataract in Tibet Autonomous Region about 60% higher than that in other areas of China^[1]It has become one of the regions with high prevalence and blindness rate of cataract in China. Facing the current situation of cataract incidence in Tibet Autonomous Region, as a grass-roots medical worker in Tibet Autonomous Region, I have a deeper understanding of the problem and the focus of clinical work, and put forward relevant coping strategies, hoping to get everyone's attention.

The patient was a 50-year-old female. He complained of decreased visual acuity in both eyes for 1 year and deformed vision in his left eye for 1 day. He came to the ophthalmology clinic of Peking Union Medical College Hospital on August 31, 2016. Previous: History of hypertension, diabetes, refractive error, laser exposure denied. Ophthalmic examination: Best corrected visual acuity: 0.6 in right eye and 0.4 in left eye. The cornea of both eyes is transparent, the front is deep, there is no plankton and aqueous humor flash, the pupil is round, the light reflection is good, and the lens is slightly opaque. Both eyes were dilated to check the fundus: the optic discs of both eyes were normal, and scattered yellow-white dots and clusters of crystalline substances were seen in the retina on the temporal side of the optic disc and around the fovea. The reflection of the fovea of the right eye was visible, but the reflection of the fovea of the left eye was not visible, and the rest was roughly normal (Figure 1）。 Frequency domain OCT showed thinning of retinal nerve fiber layer in both eyes, loss of optic nerve fiber in foveal macula showed pseudocystoid vacuolar change, accompanied by rupture and loss of ellipsoid band, and crystalline substance showed hyperreflective signal (Figure 2）。 Autofluorescence revealed hypofluorescence in the crystalline substance deposited areas of both eyes, accompanied by punctate hyperfluorescence, and clustered hypofluorescence in the concave spots in the center of the macula (Figure 3）。 The results of FFA examination showed fluorescein leakage in the macular area of both eyes in the early stage, high fluorescence in the crystal-like substance deposition area, dye accumulation in the macular area in the late stage, and fluorescence decreased in the crystal-like substance deposition area (Figure 4), suggesting mild cystoid edema of the macula in both eyes. The 30° visual field shows a relatively dark spot below the left eye, and the visual field of the right eye is roughly normal. Further inquiry about the medical history showed that the patient had undergone breast cancer resection 3 and a half years ago, and started to take tamoxifen 20 mg/d orally after the operation, with a cumulative total of 25.6g in 3 and a half years. Diagnosis: Tamoxifen retinopathy in both eyes, complicated cataract in both eyes. Then ask an oncologist for consultation, give medication, stop tamoxifen, and change to toremifene tablets for oral administration.

The patient was an 82-year-old male. Because of blurred vision in his right eye for more than 1 year, he went to Fuzhou Southeast Eye Hospital. Previous 2 years ago acute primary angle closure glaucoma in both eyes, the right eye underwent compound trabeculectomy, and the left eye underwent peripheral iridectomy. Ocular examination: Right eye naked visual acuity 0.12, corrected visual acuity 0.4, intraocular pressure 12 mmHg (1 mmHg =0.133 kPa), mild conjunctival hyperemia, large and crystal clear filter vesicles visible above (Quintessence Picture 1), thin-walled, overhanging, approximately 4 mm ×4 mm in size, fluorescein staining (-); The cornea is transparent, retrocorneal sediment (-), the central anterior chamber is deep, the aqueous humor flashes (-), the periiris incision is faintly visible above, the pupil is dilated and underround, the reflection of light is slow, the lens is moderately opaque, the fundus optic disc is pale in color, the cup-to-disc ratio is 0.8, the arteriovenous diameter ratio is 1:2, and the foveal reflection is visible. Clinical diagnosis: Primary angle closure glaucoma in both eyes after anti-glaucoma surgery; Complicated cataract of the right eye.