Volume 51 ·  Issue 01 ·  2015

When the first sunshine of 2015 shines into the title page of Chinese Journal of Ophthalmology, all our journal runners have started to embark on the journey of the new year with vigorous steps, to look forward to and imagine the dreams that spring will bring us, and to face and meet the challenges of external competition to the journal.

The patient was a 47-year-old male. He was hospitalized to Tianjin Eye Hospital on July 10, 2012 due to progressive vision loss in his left eye for 1 1/2 years, eye pain for 7 months and vision loss for 4 months. The patient had been seen in an eye hospital on February 22, 2011 due to blurred vision. At that time, the visual acuity of his left eye was 0.1. The edema and fine hard exudation of the macular area were found by OCT, and the edema and detachment of the macular neuroepithelial layer of the left eye were found. Central serous chorioretinopathy of the left eye was considered. Treatment such as aescin and digitalis diglycoside eye drops was given. By December 7, 2011, the left eye was painful, the vision was manual in front of the eye, and the fundus of the eye could not be peeped in. The intraocular pressure was 13.8 mmHg (1 mmHg =0.133 kPa) in the right eye and 32.6 mmHg in the left eye. Vitreous hemorrhage in the left eye and secondary glaucoma were considered, and anti-glaucoma drugs such as brinzolamide eye drops were given. Intraocular pressure continued to rise to 49.3 mmHg. In order to relieve the left eye pain, the left eye ciliary body diode laser photocoagulation was performed twice in December 2011 and January 2012, and the eye pain improved slightly. In March 2012, I went to the original hospital. The visual acuity of my left eye was no longer light sensing, the iris was neovascularized, and the intraocular pressure was 44.9 mmHg. For further treatment, I came to see a doctor. Eye examination: Right eye visual acuity 0.8, left eye amaurosis. Multiple black flat protuberances can be seen from 1 to 5 o'clock in the temporal sclera of the limbus (Figure 1), shallow anterior chamber, atrophic iris, dilated pupil, responsive to light (–), IOP 35.8 mmHg. B-mode ultrasound showed that the choroid of the left eye was highly thickened and uneven in thickness, with retinal detachment (Figure 2)。 Color Doppler flow imaging showed a weak point echo in the vitreous body and a band echo connected to the optic head, and a choroidal thickening area with blood flow signals. CT showed uneven thickening of the left eye ring and increased density CT value +55~ +108 HU. MRI showed that the left choroid membrane was obviously thickened, and the lateral side was flat and protuberant, with abnormal signal, high signal in T1WI and low signal in T2WI (FIG. 3A，FIG. 3B), considering choroidal melanoma in the left eye with retinal detachment, and was admitted to hospital to prepare for surgery. Upper abdominal enhanced CT was performed, and several slightly lower density spots in the right lobe of the liver were found, the nature of which is to be determined. Considering the extraocular spread of disseminated choroidal melanoma in the left eye, the eyeball and part of the orbital contents were removed. Pathological diagnosis: Diffuse melanoma of the choroid (mixed cell type) in the left eye, involving one side of the ciliary body, with tumor cells invading the scleral wall and optic nerve after the sieve plate 2 mm (Figure 4，Figure 5)。 After operation, he was transferred to a cancer hospital. After multiple examinations, it was determined that he had intrahepatic metastasis of choroidal melanoma. He was treated with drug intervention, but the effect was not significant. He died in November 2013.

The patient was a 46-year-old female. On April 24, 2012, he went to the Department of Ophthalmology of the No.161 Hospital of the People's Liberation Army due to prolapse of eyeball and loss of vision for 4 hours due to right eye trauma. The patient's right eye was accidentally injured by a dump truck during construction at 9:00 a.m. on the same day, resulting in prolapse of the right eyeball from the orbit and loss of vision. The outpatient department was admitted to the hospital with "traumatic dissection of optic nerve in right eye and prolapse of right eyeball". Physical examination: General condition is good, conscious, general condition is normal. Eye examination: visual acuity: no light sensation in the right eye, 0.08 in the left eye. Irregular "Y"-shaped wounds about 4 cm and 2 cm long can be seen on the skin above the lateral side of the right orbit. The wound is deep, with a small amount of bleeding, and the tissue structure of the upper and lower eyelids is normal. The right eyeball was intact and unbroken, the eyeball and optic nerve completely prolapsed out of the orbit, the cornea was transparent, the anterior chamber was normal, the pupil circle diameter was 6 mm, the light reflection was direct and indirect (–), the lens cortex was opaque (+ + +), and the fundus was blurred. The remaining part of the conjunctiva and fascia of the right eyeball wall, the medial rectus, lateral rectus, inferior rectus, superior and inferior oblique muscles are completely disconnected, only the superior rectus muscle and part of the fascia are connected to the orbit, and the optic nerve about 5 cm long can be seen at the base of the eyeball is completely disconnected, free and prolapsed outside the orbit (Figure 1)。 The external eye of the left eye is normal, the cornea is transparent, the anterior chamber, iris and pupil are normal, and the light reflection exists directly. The lens cortex is gray-white and turbid (+ + +), and the fundus is blurred. Orbital CT scan showed that the right eyeball prolapsed out of the orbit, no fracture was found in the bone wall of both orbits, and the optic nerve canal was normal (Figure 2)； Laboratory tests: Blood, urine and stool routine were normal, and 6 items of hepatitis C and hepatitis B were negative. Admission diagnosis: Traumatic dissection of optic nerve in right eye; Right eyeball and optic nerve prolapse; Congenital cataracts of both eyes. At 15:00 pm on the same day, right eyeball enucleation and debridement and suture were performed in an emergency department under local anesthesia. Intraoperative exploration showed that the superior rectus muscle and upper fascia were connected to the eyeball, and the soft tissue in the orbit was mildly contaminated, bleeding and edema. The cornea and eyeball were structurally intact, and the retrobulbar optic nerve was disconnected. The measured length was about 5 cm (Figure 3)。 Place eyeballs in an insulated bucket and store in a wet room of a refrigerator at – 4 ℃. The conjunctival sac and orbital trauma were debrided and sutured, and the skin wound of the lateral wall of the orbit communicated with the orbital tip along the lateral wall of the orbit. After debridement and suture, a drainage strip was placed, and the postoperative compression bandage was performed. Anti-inflammatory and symptomatic treatment was performed, and the patient was discharged after 1 week.

The patient was a 79-year-old female. He went to the Department of Ophthalmology of Peking Union Medical College Hospital because of the decrease of visual acuity in both eyes for 3 months. Eye examination: the visual acuity of both eyes was 0.8, the corneas of both eyes were transparent, and the cortex around the lens was mildly opaque; Dilated pupils examined the fundus, the papilla of both eyes was normal, and the macular condition was shown inQuintessence Picture 1。 For the OCT examination, seeQuintessence Picture 2。 Clinical diagnosis: drusen in the macular area of both eyes.

The patient was a 60-year-old female. He went to Tianjin Eye Hospital due to sudden vision loss in his left eye for 2 weeks. Eye examination: naked eye visual acuity was 0.1 for the right eye and 0.05 for the left eye; The corrected visual acuity was 0.6 for the right eye and 0.05 for the left eye (both eye diopters were-15.00 D); Anterior segment examination of both eyes was roughly normal; The fundus of both eyes showed leopard print changes in high myopia, and no obvious abnormalities were observed in the rest of the right fundus. About 1/2 PD round subretinal hemorrhage was observed in the macular area of the left fundus, and the surrounding retina showed a gauze mist-like appearance (Quintessence Picture 1)； IOP was normal in both eyes. OCT examination is presented inQuintessence Picture 2。 Because the patient's blood pressure level was higher than normal and the drug control was unstable, FFA examination was not performed. Clinical diagnosis: high myopia in both eyes; Left eye maculoschisis; Macular hemorrhage in the left eye.