2018年 · 第54卷第08期

This issue focuses on the contents of ophthalmic epidemiological investigation. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Zhao Jialiang.

Ultra-wide angle fundus imaging is a new fundus image acquisition technique. The imaging range of traditional fundus photography technology focuses on the posterior pole (including the optic disc, macula, and vascular arch), but the retina in the middle periphery (after the equator) and the distal periphery (before the equator to the serrated margin) cannot be imaged. A technique that can reach the range from the anterior equator to the serrated margin by imaging the orthopedic eyeball at one time is called ultra-wide-angle fundus imaging technique. This technology has been widely used in the screening, diagnosis and prognosis evaluation of a variety of fundus diseases, such as diabetic retinopathy, etc., which has significantly improved the screening, diagnosis and treatment level of diseases.

The patient was a 16-year-old male. Due to the decrease of visual acuity in both eyes for more than 2 years and aggravation for 2 months, he came to the outpatient clinic of Hefei Purui Eye Hospital on December 16, 2016. The patient had the habit of frequent blinking since childhood. In April 2014, he was diagnosed with binocular keratoconus in a foreign hospital, and underwent binocular corneal collagen cross-linking therapy (transepithelial, iontophoresis). The preoperative visual acuity was 0.15 in the right eye and 0.4 in the left eye; The corrected visual acuity was 0.5 in the right eye and 0.6 in the left eye; IOP was 13 mmHg (1 mmHg =0.133 kPa) in the right eye and 15 mmHg in the left eye. Corneal endothelial cell count was 2 504/mm in the right eye²2 784/mm in the left eye²。 Fleischer sign (+), Vogt sign (+), Mumson sign (-) in both eyes were observed by anterior segment slit lamp examination, and there was no edema, opacity and scar in the cornea. No abnormalities were observed in the fundus of the eye. Corneal topography examined Kmax 61.20 D in right eye and 55.40 D in left eye; The corneal thickness was 434 μ m in the right eye and 443 μ m in the left eye. In December 2016, the patient came to Hefei Purui Eye Hospital for treatment due to obvious visual loss. The outpatient diagnosis was: keratoconus in both eyes, and he was admitted to the hospital. The naked eye visual acuity was 0.06 in the right eye and 0.2 in the left eye; The corrected visual acuity was 0.1 in the right eye and 0.4 in the left eye; IOP was normal in both eyes. Corneal endothelial cell count was 2 504/mm in the right eye²2 784/mm in the left eye²。 Corneal endothelial cell counts were not measured in both eyes. Fleischer sign (+), Vogt sign (+) and Mumson sign (+) were observed in the anterior segment slit lamp examination; Mild edema and cloud-like opacity in the center of the cornea, heavier in the right eye. The bottom of his eyes could not see clearly. Corneal topography examination Kmax was 84.80 D in right eye and 70.40 D in left eye; Corneal thickness was 308 μ m in the right eye and 372 μ m in the left eye (Figure 1）。 Right eye deep lamellar keratoplasty was performed under general anesthesia on 20 Dec 2016. The visual acuity of the right eye on the first day after surgery: 0.2 in the naked eye (0.3 in small hole), edema of corneal graft, a small amount of air bubbles in the anterior chamber, and unclear remaining vision. Visual acuity on the 7th day after surgery: 0.3 in the naked eye (0.5 in small hole), edema of corneal graft was reduced, the depth of anterior chamber was acceptable, the pupil was round, about 3 mm in diameter, and the anterior segment and fundus of the remaining eye were not clear. Visual acuity on the 14th postoperative day: 0.5 in the naked eye (0.8 in small hole), transparent corneal graft, normal anterior chamber depth, transparent lens, and no obvious abnormality in the fundus. Therapeutically, the surgical eye was pressurized and wrapped for 3 days, and anti-inflammatory, anti-infective, anti-rejection drugs and corneal epithelial repair drugs were given locally throughout the body (Figure 2）。

The patient was a 21-year-old female. Due to blurred vision under his left eye, he came to Changchun Aier Eye Hospital on September 15, 2015 and was hospitalized. The patient reported that on September 14, 2015, he received subcutaneous injection of 5 ml of cosmetic hyaluronic acid into his forehead in a private institution. After 30 minutes, he felt that his vision under his left eye was dark. He was diagnosed with retinal branch artery occlusion in his left eye in a local hospital. After symptomatic treatment, he went to Changchun Aier Eye Hospital. The patient was in good health and had no history of systemic medication, long-term systemic medication and ocular trauma. Condition at admission: Redness and swelling of skin on forehead (Figure 1）。 Visual acuity: 1.0 in right eye, 1.0 in left eye, intraocular pressure: 17 mmHg in right eye (1 mmHg =0.133 kPa), 17 mmHg in left eye. The conjunctiva of the right eye is not congested, the cornea is transparent, the anterior chamber depth is normal, the aqueous humor is clear, the iris texture is clear, the pupil is round, the diameter is 3.0 mm, the straight and indirect light reflection is sensitive, the lens is transparent, the vitreous body is transparent, the optic disc boundary of the right eye is clear, the color is pale red, the retinal blood vessels run normally, and the foveal reflection exists; There was no conjunctiva congestion in the left eye, transparent cornea, normal anterior chamber depth, clear aqueous humor, clear iris texture, round pupil, 3.0 mm in diameter, straight and indirect light reflection sensitivity, transparent lens, transparent vitreous body, clear optic disc boundary and acceptable color in the left eye, thin retinal arteries above the nose and superior temporal, gray-white edema of the retina above the nose and superior temporal, and disappearance of foveal reflection in the macular area (Figure 2）。 FFA: There is no filling of the retinal artery above the nose and above the temporal in the left eye in the early stage, an embolus is seen at the bifurcation of the retinal artery above the optic disc, and retrograde filling of the retinal artery above the nose and above the temporal in the late stage (FIG. 3A、FIG. 3B）。 Visual field examination: semi-annular visual field defect under left eye (FIG. 4A）。 Clinical diagnosis: occlusion of branch retinal artery in left eye. Immediate administration of anisodamine 5 mg/d post-left eyeball injection, urokinase 30×10⁵U/d intravenous drip, low-flow oxygen inhalation, intraocular pressure reduction, eyeball massage and other treatments. After 5 d, the visual field was re-examined, and the semi-annular defect area in the lower central visual field was smaller than before treatment (FIG. 4B), the patient was discharged for studying abroad.

In 1856, Virchow first described retinal medullated nerve fibers (RMNFs), which are feathery or flaky lesions in the fundus of the eye that appear white or off-white along the retinal nerve fibers^[1]。 The vast majority of RMNF patients are asymptomatic, and some patients will be accompanied by severe visual impairment. It is reported that the incidence of RMNF is about 0.98%, of which more than 90% are monocular; It has no genetic predisposition, so familial onset reports are extremely rare^[2]。 This article reports a case of a child and her mother with binocular disease.

The patient was a male, 30 years old. Because of the decline of visual acuity in both eyes for several years, he went to the Department of Ophthalmology of Yunnan Red Cross Hospital. Ocular examination: binocular visual acuity 0.15, intraocular pressure 38.6 mmHg (1 mmHg =0.133 kPa) in the right eye and 40.8 mmHg in the left eye; For the anterior segment of both eyes, seeQuintessence Picture 1。 Diagnosis: Axenfeld-Rieger syndrome in both eyes.