2017年 · 第53卷第09期

This issue focuses on the research progress of ocular surface diseases. Professor Sun Xuguang is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

Pterygium is a benign proliferative ocular surface disease characterized by hyperplasia of the bulbar conjunctiva in the palpebral fissure area and the fibrovascular tissue underlying it growing across the limbus into the cornea^[1]。 As a common ocular surface disease in China, pterygium can not only affect the appearance, but also cause eye discomfort, vision loss, eye movement disorder, etc. The pathogenesis of pterygium is currently unclear and surgery is the only effective treatment. Common clinical procedures are based on pterygium removal, combined with autologous conjunctival transplantation, limbal stem cell transplantation, amniotic membrane transplantation, etc^[2]。

meibomian gland dysfunction (MGD) is a common ocular surface disease in clinic. Due to the lack of specificity of symptoms, missed diagnosis and mistreatment often occur in clinic. Since the International MGD Research Group published a series of research reports on MGD in 2011^[1]All countries have attached great importance to the clinical diagnosis and treatment of MGD, and formulated corresponding treatment guidelines according to the disease characteristics of each country, making the diagnosis and treatment of MGD more standardized. The incidence of MGD in China is high, which is the main cause of dry eye. Long-term meibomian gland lesions will cause inflammatory reactions on the ocular surface, which will lead to corresponding changes in the cornea and conjunctiva. In severe cases, visual acuity will decrease, resulting in poor prognosis. In order to further standardize the diagnosis and treatment of MGD in China, the China Branch of Asian Dry Eye Association and the Ocular Surface and Tear Diseases Group of the Ophthalmology Committee of Cross-Strait Medical and Health Exchange Association have formulated the expert consensus on the diagnosis and graded treatment of MGD in China according to the clinical characteristics of MGD in China and the research progress at home and abroad for clinicians' reference.

meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian gland, usually characterized by obstruction of the terminal duct of the meibomian gland and/or changes in the amount or substance secreted by the meibomian gland, often causing ocular irritation symptoms, abnormal tear film, inflammatory reaction and injury of the ocular surface^[1,2]。 This concept was developed by Gutgesell et al.^[3]It was first proposed in 1982 that obstruction of meibomian gland duct, which may be related to abnormal keratosis, is an important role in the pathogenesis of meibomian gland dysfunction. The main clinical manifestations are red eyes, watery eyes, burning sensation, foreign body sensation, dryness, irritation, itching, visual fatigue, visual fluctuation and other symptoms, which are very common in oily skin and the elderly, and are the main cause of excessive evaporation or lipid deficiency dry eye. In recent years, clinical studies have found that the incidence of MGD in the population is high. Foreign literature has reported that the prevalence of MGD in the European population has reached 20%, and that in the Asian population has exceeded 60%^[4,5]。 At present, the related research of MGD has become one of the hot spots of ophthalmology research.

Blepharokeratoconjunctivitis (BKC) refers to a series of conjunctival and corneal lesions secondary to Blepharokeratoconjunctivitis, mainly including: alveolar keratoconjunctivitis, corneal punctate erosion, punctate keratitis, marginal keratitis, corneal ulcer and corneal neovascularization^[1]。 The author clinically applied intense pulsed light (IPL) to treat 3 cases of BKC, which are reported as follows.

fungal keratitis (FK) is a severe blinding eye disease caused by fungal infection^[1]。 Especially in underdeveloped countries such as Asia and Africa, it is the main eye disease causing blindness. In recent years, its incidence has increased year by year, and it has ranked second among infectious keratitis^[2]The pathogenic bacteria of this disease are highly resistant to drugs, and the treatment is quite difficult. Therefore, it has been paid more and more attention by clinicians. According to the statistics, there are more than 70 pathogenic bacteria that can cause FK^[3]However, the pathogenic strains isolated in clinical practice are mainly concentrated in a few species. According to literature reports, the main pathogenic species of FK in northern China are Fusarium, Aspergillus and Alternaria^[4,5]。 In clinical practice, fungal keratitis caused by Zygomycetes is very rare, and the reported in this paper is one of the species of Zygomycetes, and there are few reports of keratitis caused by it in Chinese literature. This article focuses on the clinical manifestations, treatment methods and biological characteristics of the bacteria, in order to help the early diagnosis and treatment of the mycous keratitis.

Child female, 2 years old, fraternal twins, 34⁺²Weekly cesarean section, because right eye mass found from birth admitted to hospital. There was no family history, parents had no history of intimate marriage, mother took levothyroxine sodium tablets during pregnancy, no history of taking other drugs, no history of toxic substances, radiation exposure, no history of infection, no pregnancy complications such as hypertensive disorder during pregnancy and diabetes during pregnancy. The fraternal twin brother of the child suffered from neonatal necrotizing enterocolitis and underwent surgical treatment. He recovered well after operation, and no abnormalities were found. Physical examination: suffering from right external auditory canal atresia (Figure 1), which is microtia with short ipsilateral face (Figure 2,Figure 3), a yellowish-white mass of the cornea and conjunctiva in the inferior temporal area of the right eye, about 7.0 mm in diameter, invading the cornea about 3.5 mm, with clear borders and visible hairs (Figure 4）。 Auxiliary examination: Cardiac ultrasound showed dextrocardiac rotation, coronary sinus dilatation, and persistent left superior space. The thoracic orthogonal position shows multiple deformities of the spine (Figure 5）。 MRI of the head showed no obvious abnormality, and the developmental quotient was normal. Admission diagnosis: Goldenhar syndrome. After admission, the right eye corneal dermoid tumor resection and lamellar keratoplasty were performed under general anesthesia. Postoperative pathological report: Dermoid tissue, surface lined with squamous epithelium, hair follicle structure in subcutaneous fibrous tissue (Figure 6)。 Tobramycin and dexamethasone eye ointment were given to the eyes after surgery, 3 times/d for 1 week, 2 times/d for 1 week, and 1 time/d for 1 week for 3 weeks. The corneal graft was reexamined 7 days after surgery and the suture was removed 1 month after surgery. Retrospective 3 months after surgery: corneal graft was transparent in place (Figure 7，Figure 8）。

The patient was a 63-year-old male. Because of blurred vision in his right eye for 2 years, he went to the Department of Ophthalmology, Affiliated Hospital of Jining Medical College. No previous systemic diseases such as hypertension and diabetes. Eye examination: visual acuity was 0.15 for the right eye and 0.6 for the left eye; IOP was 16 mmHg (1 mmHg =0.133 kPa) in the right eye and 15 mmHg in the left eye; The corneas in both eyes are transparent, the pupil diameter is approximately 2.5 mm, and it is sensitive to light, with mild opacity of the lens in the left eye and fan-shaped opacity of the lens in the right eye (Quintessence Picture 1）。 Clinical diagnosis: Age-related cataract in both eyes (opacity of the fan lens in the right eye).