2017年 · 第53卷第11期

This issue focuses on the research progress of cataract diagnosis and treatment. Professor Yao Ke is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

In order to standardize the anti-infection process of cataract perioperative period and the treatment process of infectious endophthalmitis after cataract extraction surgery in China, the Cataract and Intraocular Lens Group of Ophthalmology Branch of Chinese Medical Association successively published "Expert Consensus on the Treatment of Acute Bacterial Endophthalmitis after Cataract Surgery in China (2010)" in the Chinese Journal of Ophthalmology^[1]and "Expert Recommendations on Standardization of Preventive Measures for Cataract Infection in Perioperative Period (2013)"^[2]。 Expert consensus and expert suggestions were welcomed by clinicians at all levels, and promoted the standardized prevention and treatment of endophthalmitis after cataract extraction surgery in hospitals at all levels. However, there is still a big gap in the medical level of hospitals at all levels in China. The incidence rate of acute infectious endophthalmitis after cataract extraction in large ophthalmology institutions in China is 0.033%^[3]While the incidence of acute infectious endophthalmitis after cataract extraction surgery in small and medium-sized ophthalmology institutions is as high as 0.11%^[4]It is more than three times the incidence rate of large ophthalmology institutions in China. According to related research reports, the incidence rate of infectious endophthalmitis after cataract extraction is 0.012% ~0.053% in developed countries^[5,6,7,8]There is still a gap between China's overall level and it. The level of prevention and treatment of endophthalmitis after cataract extraction in China needs to be further improved. Following the first promulgation of guidelines for the prevention and treatment of endophthalmitis after Cataract extraction surgery in 2007, the European Society of Cataract and Refractive Surgeons (ESCRS) further revised the prevention and treatment guidelines in 2013, and put forward new guidelines on the key and details of prevention and treatment^[9]。 Combined with the 2013 ESCRS guidelines and the latest international research results, the Cataract and Intraocular Lens Group of Ophthalmology Branch of Chinese Medical Association revised the principles and details of prevention and treatment of infectious endophthalmitis after cataract extraction in China after careful, comprehensive and sufficient discussion according to the current situation of intraocular infection after cataract extraction in China and the actual medical situation in China, for the reference of clinicians.

The child was a 12-year-old male. Mainly due to painless progressive visual loss in his right eye for 1 year, he went to the Department of Ophthalmology of Peking University First Hospital in August 2015. History of eye trauma denied. Ophthalmological examination: Right eye naked eye visual acuity manual/1 m, Jr7 invisible, light sensing 6 m, light localization normal, visual acuity correction not improved. Left eye naked eye vision 0.3, Jr1, plus-3.50 DS-4.00 DC x 180 to 0.6. Lens cortical debris can be seen in the anterior chamber and the pupil margin of the right eye, the lens is opaque, the lens cortex overflows, and the fundus is invisible (FIG. 1A,FIG. 1B,Figure 1C）。 The center of the anterior surface of the lens of the left eye is slightly convex into the anterior chamber (Figure 1D), and no abnormalities were observed in the fundus of the left eye. Ultrasound biomicroscopy showed that the right eye lens was structurally confused, and the left eye lens anterior surface central confinement was convex forward (Figure 2）。 The child was delivered naturally at term with no history of asphyxia or oxygen inhalation after birth. Hematuria, proteinuria, renal function damage and hearing loss were found in previous physical examination. Alport syndrome was diagnosed after transmission electron microscopy and immunofluorescence staining of renal tissue puncture.

The patient was a 58-year-old male. Due to progressive visual acuity loss in both eyes for 2 years and poor intraocular pressure control with two intraocular pressure lowering drugs (carteolol hydrochloride eye drops and brinzolamide eye drops), he went to Sun Yat-sen Ophthalmology Center of Sun Yat-sen University on August 5, 2015. Specialist examination: visual acuity 0.4 in the right eye and 0.1 in the left eye; IOP was 20 mmHg in the right eye (1 mmHg =0.133 kPa) and 21 mmHg in the left eye; External eye of both eyes (-), clear cornea, pigmented retrocorneal deposit (kp) (-), deep anterior chamber, planktonic pigment particles in anterior chamber (-), circular and centered pupil, 3 mm in diameter, pigment on pupil margin (-), opacity of lens (right cortex 2, nucleus 2, posterior capsule 1; left cortex 2, nucleus 2, posterior capsule 1), punctate opacity of vitreous body, pale color of optic discs in both eyes after mydriasis, C/D>0.9. Auxiliary examinations: (1) Gonioscopy: wide angle of the right eye, trabecular meshwork pigmentation grade II. The left eye was wide-angled throughout the circumference, and the trabecular meshwork pigmentation was grade 0 or I, which was sparsely light brown. (2) UBM examination: Anterior chamber depth: 2.54 mm in right eye and 2.67 mm in left eye, with open angles in both eyes. (3) OCT examination: diffuse thinning of retinal nerve fiber layer thickness in both eyes: 42 μ m in the center of the right eye, 60 μ m in the superior temporal, 29 μ m in the superior nose, 41 μ m in the inferior temporal, 50 μ m in the inferior nose, 33 μ m in the temporal side and 44 μ m in the nasal side; The left eye was 40 μ m central, 54 μ m supranasal, 66 μ m supratemporal, 46 μ m subnasal, 39 μ m subtemporal, 25 μ m nasal and 32 μ m temporal. (4) Visual field examination: central tubular visual field of both eyes. (5) Corneal thickness examination: 582 μ mm in right eye and 579 μ m in left eye. (6) Corneal endothelial cell density: 2 496.2 cells/mm in right eye²2 692.8/mm in left eye²。 (7) B-ultrasound examination: sound image of vitreous opacity in both eyes, sound image of small depression of optic disc in both eyes. (8) A-ultrasound examination: the axial length of the eye is 23.88 mm in the right eye and 23.23 mm in the left eye.

The patient was a 77-year-old male. Due to painless visual loss in his left eye for 2 months, he was admitted to the Department of Ophthalmology of the First Affiliated Hospital of Suzhou University on May 9, 2016. Four months ago, phacoemulsification and IOL implantation were performed in our hospital due to senile cataract in the right eye, and recovered well after operation. A history of systemic disease and previous ocular disease is denied. No abnormalities were found on the whole body examination. Eye examination: the naked eye visual acuity of the left eye was 60 cm index in front of the eye, and there was no improvement in correction; The intraocular pressure (measured by non-contact tonometer) was 12.0 mmHg (1 mmHg =0.133 kPa), there was no redness, swelling, entropion and trichiasis in the eyelids, clear meibomian gland structure, no conjunctiva congestion and edema, senile ring was visible in the cornea, no corneal pannus was seen, superficial nodular gelatinous bulge was visible at 3:30 in the temporal side, with unclear boundaries, negative fluorescein sodium staining, no retrocorneal deposition, deep anterior chamber, clear aqueous humor, no aqueous humor flash, clear iris texture, round pupil, 3 mm in diameter, sensitive to light, opaque lens, no abnormalities in the fundus (Figure 1）。 OCT examination of the anterior segment of the left eye: slightly higher density nodules located under the corneal epithelium and before the Bowman layer (Figure 2）。 Corneal topography examination: highly irregular astigmatism of the cornea of the left eye (Figure 3）。 The naked eye visual acuity of the right eye was 0.6, the intraocular pressure was 14.0 mmHg, the cornea was transparent, the anterior chamber was deep, the iris texture was clear, the pupil was round, the pupil diameter was 3 mm, the response to light was sensitive, the IOL was in place, and no obvious abnormalities were observed. Clinical diagnosis: Salzmann's nodular degeneration (SND) in the left eye, senile cataract in both eyes, and cataract removal and IOL implantation in the right eye. Due to the patient's strong request for cataract extraction surgery, after full communication with the patient and his family, he underwent a keratectomy on the surface of the left eye on May 13, 2016. He wore a bandage lens after the surgery, and the tissue was removed during the surgery for pathological examination (Figure 4,Figure 5,Figure 6,Figure 7）。 Three weeks after surgery, phacoemulsification and IOL implantation were performed in the left eye. One month after surgery, the left eye naked eye visual acuity was 0.5.

The patient was a 28-year-old male. He went to the Department of Ophthalmology of the General Hospital of the People's Liberation Army because his left eye was blurred for 16 days after being injured by a badminton ball. No abnormalities were found on the whole body examination. Eye examination: the naked visual acuity of the right eye was 0.3 and the corrected visual acuity was 0.5; The naked eye visual acuity of the left eye was manual in front of the eye, and the corrected visual acuity was 0.3; IOP was 18 mmHg (1 mmHg =0.133 kPa) in the right eye and 34 mmHg in the left eye; The conjunctiva of both eyes was mildly congested, and the cornea of both eyes was transparent; The pupil of the left eye was moderately dilated, underrounded, approximately 4.0 mm in diameter, directly and indirectly unresponsive to light, and the lens was completely dislocated in the anterior chamber, in contact with the corneal endothelium (Quintessence Picture 1）； Fundus examination of both eyes showed no definite abnormalities. For Pentacam inspection, seeQuintessence Picture 2。 Admission diagnosis: traumatic total lens dislocation in left eye; Traumatic cataract of left eye; Secondary glaucoma of the left eye.

The "30th Asia-Pacific Society of Cataract and Refractive Surgeons Annual Meeting and the 18th National Annual Conference on Cataract and Intraocular Lens" was co-sponsored by the Asia-Pacific Society of Cataract and Refractive Surgeons, Chinese Medical Association, Ophthalmology Branch of Chinese Medical Association and Cataract and Intraocular Lens Group of Ophthalmology Branch of Chinese Medical Association, and hosted by the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University School of Medicine. This conference was attended by more than 110 invited speakers, 2,800 registered representatives (more than 600 foreign representatives) and nearly 500 manufacturer representatives from Asia-Pacific, Europe and the United States.

Professor Zhang Wenhua, a well-known expert on keratopathy and external ophthalmology in China, a pioneer scholar of keratopathy and external ophthalmology, and a member of the editorial board of Chinese Journal of Ophthalmology, died in Beijing at 20: 45 on October 11, 2017 at the age of 81 due to ineffective treatment.