2018年 · 第54卷第04期

This issue focuses on the research progress of fundus diseases. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Xu Xun.

After more than two years, the international Tear Film and Ocular Surface Association (TFOS) published the first edition of the international dry eye workshop (DEWS) Ⅰ Based on the method of evidence-based medicine, combined with the new understanding of dry eye in the past 10 years, the definition and classification, pathogenesis, epidemiology, diagnostic criteria and treatment principles of dry eye were systematically and comprehensively revised^[1,2]。 DEWS II was officially released in July 2017. In this paper, the definition and classification of dry eye in DEWS Ⅱ are interpreted.

In 2007, the international Tear Film and Ocular Surface Association (TFOS) published the first edition of the international dry eye workshop (DEWS) I. Unlike the American Academy of Ophthalmology, which compiles relevant guidelines only by ophthalmic clinicians, DEWS invited scholars and optometrists in the basic research field of dry eye to participate in the discussion and writing work at the time of compilation. The compilation of the new edition of DEWS (DEWS II) in 2017 carries on this tradition. At the end of 2015, the author of this article was invited by TFOS to participate in the revision of DEWS II with Professor Liu Guoguo of the Institute of Ophthalmology of Xiamen University on behalf of mainland China. During the compilation process, I deeply realized that the research in the field of dry eye treatment has developed rapidly in the past 10 years, and the research and development of small molecule drugs, diet and behavioral intervention oriented to individualized treatment are bound to change the existing dry eye treatment model in the future. This time, TFOS has comprehensively revised the chapter on the treatment and treatment of dry eye. Compared with DEWS Ⅰ, the content and text structure have changed greatly, which fully reflects the research progress in the field of dry eye treatment in recent years^[1]。 It should be noted that DEWS II is different from the general clinical diagnosis and treatment guidelines (guideline) and the recommended practice pattern (preferred practice pattern). The former is completed by clinicians, optometrists and basic research scholars, so some of them are still in the basic research or preclinical research stage, and cannot be used as a direct basis to guide clinicians' work.

The patient was a 6-year-old male. The abnormal fundus of his right eye was found for nearly 1 month, and he went to Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University on August 10, 2017. Two months ago, the patient suffered from chickenpox, and his eyes were red and itchy, which improved after antiviral treatment in the local hospital. One month ago, after a cold and fever, both eyes appeared red and itchy again, and the local hospital examination found that the right fundus was abnormal. Perinatal condition was good with no other previous medical history and no family history of related ophthalmopathy. Eye examination: visual acuity of right eye 1.0, left eye 0.8; IOP was 9 mmHg (1 mmHg =0.133 kPa) in the right eye and 9 mmHg in the left eye. Anterior segment examination showed no abnormalities. Fundus photography showed a flat, torpedo-shaped lesion about 1 PD on the temporal side of the macula in the right eye, pale and internally uneven, with clear boundaries, its tip pointing to the macula, with a transverse diameter of about 3 PD and a longitudinal diameter of about 2 PD (Figure 1), the retinal vessels on the surface of the lesion were normal. No abnormalities were observed in the left fundus (Figure 2）。 Fundus autofluorescence shows that the right eye lesion is uniformly hypofluorescent, and a circle of hyperfluorescence can be seen around it, and the left eye is normal (Figure 3）。 OCT examination showed that the neuroepithelial layer in the lesion area of the right eye was detached, there was a small interlaminar cystic cavity in the inner retina, the structure of the outer retina was disordered, the RPE layer was missing, the lower choroid was depressed and thinned, and the reflex was slightly enhanced (Figure 4）； No abnormalities were observed in the macular area (Figure 5）。 OCT examination of left eye showed no abnormalities. Diagnosis: torpedo-like maculopathy in the right eye. It is recommended that the patient be reviewed regularly and undergo laser treatment if necessary.

A 15-year-old male was admitted to the Department of Urology of the 309th Hospital of the People's Liberation Army due to dizziness and fatigue with increased serum creatinine for 2 weeks. The blood urea nitrogen was 34.22 mmol/L, creatinine was 981 μ mol/L, occult blood +, urine protein + + +, and hemoglobin was 105 g. Urinary tract ultrasound examination showed that the size of both kidneys was reduced, the left kidney was about 3.4 cm ×3.7 cm ×6.1 cm, and the right kidney was about 3.2 cm ×3.5 cm ×6.3 cm, the cortex was thinned, the diffuse echo of the parenchyma was enhanced, the cortex and medulla were unclear, and the collective system was disordered, suggesting kidney atrophy and diffuse kidney lesions. He was diagnosed as a renal insufficiency uremic stage and came to an ophthalmologist consultation to rule out Alport syndrome. There was no hearing loss in the otolaryngology consultation. The patient had poor vision since childhood. When he was 3 years old, he went to a hospital and was diagnosed with optic nerve dysplasia in his right eye. He was treated with short-term oral traditional Chinese medicine. There was no history of ocular trauma, kidney disease and family history of ocular disease. Ophthalmic examination: the visual acuity of the right eye was 0.1 and the visual acuity of the left eye was 0.4, both of which could not be corrected. Both eyes had horizontal nystagmus, normal anterior chamber, equal size and round pupils, and no abnormal morphological changes in the lens. Fundus examination: Both eyes have large optic discs, deep depression of optic discs, defect of central blood vessels, replaced by ciliary blood vessels located at the edge of optic discs, and normal retinal blood vessels. Fundus changes are similar to those of optic nerve head defect or morning glory syndrome fundus changes (Figure 1）。 OCT showed that the foveal thickness of the right eye was normal, the reflection was visible, the omentum around the fovea was atrophied and thinned, the IS/OS light band was discontinuous, and the RPE reflection light band was normal. The shape and thickness of the macular area in the left eye were normal, the foveal reflection was visible, the IS/OS layer and the RPE reflected light band were normal (Figure 2）。 Diagnosis: papillorenal syndrome (PRS) in both eyes. There is no special treatment in ophthalmology, and the nephrology department is recommended to treat renal insufficiency. The patient underwent renal transplantation of relatives, and the renal function recovered well after operation. Genetic analysis showed that the patient's PAX2 gene had a known pathogenic mutation c.69_70insG (p.Leu23LeufsX31; Het) (Figure 3）。

Since Jensen reported the first case of intraocular lens opacity in 1994^[1]Current reports cover several major materials used on the market, including silicone gels, polymethyl methacrylate, hydrophobic and hydrophilic acrylate intraocular lenses^[2]and is the most common cause of hydrophilic acrylate lens removal^[3]。 At present, most of the reported intraocular lens opacity is simple cataract extraction surgery. A relatively rare case of intraocular lens opacity (Akreos, Bausch & Lomb, USA) in patients undergoing cataract extraction combined with vitrectomy admitted to Sir Run Run Shaw Hospital Eye Center affiliated to Zhejiang University School of Medicine is reported as follows.

The patient was a 54-year-old male. He was treated in the Department of Ophthalmology of Peking Union Medical College Hospital on April 13, 2017 due to high fever for more than 20 days, swelling and pain in his left eye with visual acuity loss for 10 days. Previous type 2 diabetes for 10 years, without regular control and monitoring of blood glucose.

Perfluorocarbon liquid, also known as heavy water, is an extremely useful auxiliary tool in clinical vitreoretinal surgery. Heavy water can remain in different locations in the eye after surgery (Quintessence Picture 1）。