2018年 · 第54卷第05期

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

Cataract is the first eye disease causing blindness in the world, and phacoemulsification cataract aspiration is the mainstream surgical method recognized in the world today. In recent years, the introduction of femtosecond laser has further developed cataract extraction surgery. The femtosecond laser cataract extraction surgical system can make the transparent corneal incision, limbal release incision, circular anterior lens capsule incision and pre-splitting nucleus more accurate, thus optimizing the position of IOL and the refractive state of the surgical eye, and greatly improving the accuracy, effectiveness and safety of cataract extraction surgery. Meta-analysis results showed that femtosecond laser-assisted cataract surgery (FLACS) used less ultrasound time and lower ultrasound energy compared with traditional phacoemulsification cataract aspiration, reduced corneal endothelial cell loss, reduced corneal edema, and showed superiority in capsulorhexis quality^[1]Better visual effects were obtained at 1 week and 6 months after surgery, but there was no significant difference in the visual effects between the two procedures at 1 to 3 months after surgery and the incidence of intraoperative complications such as anterior lens capsule tear, postoperative macular edema and intraocular pressure increase^[2,3]。 Femtosecond laser surgery system was first introduced in China in 2013, and more than 100 ophthalmology institutions across the country use this technology. In the era of refractive cataract extraction surgery, FLACS has been recognized and popularized by more and more clinicians. In order to further standardize and guide FLACS, the Cataract and Intraocular Lens Group of Ophthalmology Branch of Chinese Medical Association reached the following consensus opinions after careful, comprehensive and sufficient discussion on the basis of reference to domestic and foreign literatures, combined with China's national conditions and actual medical status, for ophthalmologists to use in clinical work.

Acute endophthalmitis after cataract extraction surgery is a complication that seriously threatens vision. It refers to endophthalmitis that occurs within 6 weeks after cataract extraction surgery. It is usually caused by strongly virulent bacteria. The average incidence rate in China is about 0.06% (the incidence rate of literature statistics is 0.01% ~0.4%^[1]）。 Once acute endophthalmitis occurs, the treatment effect is often very poor, which often causes patients' vision to decrease seriously, so it is the surgical complication that cataract doctors are most worried about. Extensive literature evidence shows that although endophthalmitis cannot be completely eliminated, the incidence of endophthalmitis can be reduced to a lower level if appropriate preventive measures are given during the perioperative period.

Cataract extraction surgery is the most common and important vision restoration surgery in ophthalmology. Nowadays, surgery has entered the era of refractive correction, but postoperative endophthalmitis is still one of the few serious complications that can lead to permanent visual impairment, which can be catastrophic once it occurs. In recent years, the European Society of Cataract and Refractive Surgery (ESCRS) has taken the lead in recommending intrachamber injection of antibiotics before Cataract extraction Surgery to prevent endophthalmitis. This method has attracted more and more clinical attention because of its definite effect, but whether it can be used as a routine application of Cataract extraction Surgery is still controversial. Combined with the current situation at home and abroad and its application risk, this paper deeply discusses the clinical application significance of this method.

The patient was a 39-year-old male. Due to the progressive decline of visual acuity in both eyes for several years and the aggravation of left eye for 2 months, he went to the Department of Ophthalmology of the First Affiliated Hospital of Suzhou University in July 2016. The patient reported that his eyesight was good when he was young. In recent years, his eyesight has progressively decreased, and he has no history of red eyes, eye pain, photophobia and tearing. After wearing myopic glasses, his eyesight can be slightly improved, but the degree of wearing glasses is deepening year by year. Two months ago, the patient consciously felt that the blurred vision in his left eye was aggravated, which could not be improved by wearing glasses. The patient had been found to have proteinuria for more than 10 years, and the pathological examination of renal puncture revealed "mesangial proliferative nephritis", which progressed to uremia for 6 years. He was treated with hemodialysis three times a week regularly and used heparin anticoagulation for a long time. The patient complained of progressive hearing decline in both ears in recent years and was diagnosed as sensorineural deafness. The patient is married and has 2 children. The spouse and children are in good health. After asking about the family history, the patient's parents were close relatives, and they gave birth to 6 daughters and 1 son. The parents were in good health, and 3 of the children had a history of "kidney disease", of which 2 female patients had died. General physical examination: clear consciousness, normal body temperature, heart rate 83 beats/min, breathing 16 beats/min, blood pressure 139/87 mmHg (1 mmHg =0.133 kPa), hearing loss in both ears, no special in the rest of the physical examination. Eye Examination: Right eye naked visual acuity 0.12, computerized optometry-8.50 DS-6.00 DC × 110° corrected to 0.5; The visual acuity of the left eye was 0.20, and the correction did not improve. IOP was 11 mmHg in the right eye and 10 mmHg in the left eye. Slit lamp examination after dilated pupil with compound tropicamide eye drops showed that the right eye lens was transparent, and the anterior pole central localized lens capsule and cortex bulged toward the anterior chamber (Figure 1In a), the posterior pole capsule and cortex bulge toward the vitreous (Figure 1B), the slit lamp examination post-imaging showed an oil droplet sign in the right eye lens (Figure 1C in). The central localized anterior capsule and cortex of the lens of the left eye protrude towards the anterior chamber, with prominent folds of the lens capsule and mild opacity of the cortex, surrounded by a circle of white opacity at the base (Figure 1In D, E). Corneal analysis by Scheimpflug imaging (Sirius 3D anterior segment analyzer, CSO, Italy) showed myopic astigmatism in both eyes, 12° axially on the 1.76 D flat axis in the right eye and 5° axially on the 1.19 D flat axis in the left eye. Observation of Scheimpflug tomography showed a localized conical bulge in the central area of the anterior pole of the right eye lens, bulging towards the anterior chamber, and the capsule was intact (Figure 2In a); High-density shadows in the central capsule and subcapsule of the anterior pole of the lens of the left eye, which bulge towards the anterior chamber (Figure 2In B). The fundus photography of both eyes is not clear. OCT showed thinning of the temporal retina in both eyes (Figure 3）。 Combined with the patient's general condition and ocular specific changes, the diagnosis is: (1) Alport syndrome; (2) Anterior and posterior bipolar conic lens of the right eye; (3) Left anterior conical lens complicated with anterior polar cataract; (4) uremia; (5) Sensorineural deafness.

Congenital cataract is a common eye disease that seriously affects the visual development of infants and young children. The etiology is complex, and the location, degree and shape of opacity are different (Quintessence Picture 1）。