Volume 41 ·  Issue 03 ·  2005

This paper briefly expounds the types, development history and present situation of intraocular refractive correction surgery, and summarizes the advantages and disadvantages of intraocular refractive correction surgery; The importance of strict selection of indications and standardized operation was emphasized, and the healthy development of intraocular refractive correction surgery should be promoted positively and steadily.

Objective to investigate the clinical efficacy of phacoemulsification cataract aspiration negative degree intraocular lens implantation in the treatment of cataract complicated with ultra-high myopia. Methods 89 patients (126 eyes) who underwent phacoemulsification cataract aspiration negative degree intraocular lens implantation due to cataract complicated with ultra-high myopia were retrospectively studied. The preoperative axial length, postoperative visual acuity, diopter and their deviation from expected diopter were recorded, and the surgical complications and postoperative ocular conditions were observed. The postoperative follow-up time was 6~25 months. Results The mean preoperative axial length was 32.45 mm. The postoperative best corrected visual acuity was ≥0.2 in 106 eyes (84.1%) and ≥0.5 in 69 eyes (54.8%). The postoperative diopter deviation was<±1.00 D in 71 eyes (56.3%) and<±2.00 D in 114 eyes (90.5%). Only 1 eye had posterior lens capsule rupture; Twenty-eight eyes showed binocular interference symptoms after operation; 15 eyes with posterior cataract, 6 eyes underwent laser posterior capsulotomy; There were no retinal and choroidal detachment, and no intraocular pressure increased. Conclusion Phacoemulsification cataract aspiration and negative degree intraocular lens implantation is a safe and effective method for the treatment of cataract complicated with ultra-high myopia.

Objective to evaluate the visual acuity and binocular visual function of children with cataract extraction and posterior chamber intraocular lens (IOL) implantation. Methods 47 cases (68 eyes) of children with cataract extraction and intraocular lens implantation were treated with cataract extraction and intraocular lens implantation, including 12 cases of traumatic cataract in one eye, 14 cases of congenital cataract in one eye and 21 cases of congenital cataract in both eyes. The preoperative conditions of the patients were recorded, including the type of cataract, the degree of lens opacity, the age of operation and the complications, and the best corrected distance vision (BCDVA), the best corrected near vision (BCNVA) and binocular visual function were examined after operation. The average follow-up time was (41.3 ± 12.3) months. Results 34 eyes (50.0%) had BCDVA ≥0.5 and BCNVA ≥0.5 after operation. 18 patients (38.3%) obtained good binocular visual function after operation. There were statistically significant differences in the age of operation, the degree of lens opacity and the complications (strabismus and nystagmus) of different eyes with BCDVA (P<0.05); There were statistically significant differences in postoperative age, complications (strabismus and nystagmus) and binocular BCDVA among patients with different binocular visual functions (P<Conclusion Posterior chamber IOL implantation in children can obtain better visual acuity and binocular visual function after cataract extraction, but the surgical effect is closely related to the timing of operation, the degree of lens opacity and complications (strabismus and nystagmus).

Objective to investigate the reasons why the senile cataract patients in urban residents of Qingdao did not receive surgical treatment in time.Methods A questionnaire survey was conducted on 104 senile cataract patients in mature and overmature stages who were hospitalized. The contents included four aspects: medical related factors,economic factors,social family factors,personal psychological factors,to understand the various reasons for delaying surgical treatment of patients. Results Medical related factors accounted for 44.3% (62/140); Economic factors accounted for 7.1% (10/140); Social and family factors accounted for 20.7% (29/140); Personal psychological factors accounted for 27.9% (39/140). Among the various causes, the top three were 17.1% (24/140) who thought that the cataract was immature and could not be operated, 14.3% (20/140) who did not know that the cataract was suffering, and 10.0% (14/140) who still could see and did not require surgery. Whether they had undergone cataract extraction surgery, age, education level, time after knowing that the cataract could be treated and income level had an influence on the distribution of causes of delayed surgery for cataract (P<0.05). Conclusion Strengthening the propaganda of cataract scientific knowledge in the whole society, correctly guiding cataract patients to receive surgical treatment in time, correcting the mistaken understanding of surgical treatment of cataract in society, and expanding the coverage of vision restoration surgery are important measures to make the majority of cataract patients receive surgical treatment in time and improve their quality of life.

Objective to study the surgical characteristics and clinical efficacy of mechanical excimer laser subkeratomileusis (Epi-LASIK) in the correction of high myopia. Methods the epithelial flaps were made by automatic rotating Epi-LASIK knife, and the epithelial flaps were cut with Zeiss Mel-80 excimer laser, and the bandage contact lens was worn for 3~5 days after operation. The follow-up time was 3~6 months. The postoperative symptoms, healing characteristics of corneal epithelial flaps, visual quality and Haze formation were studied. Results A total of 30 patients (52 eyes) with high myopia underwent Epi-LASIK, including 36 eyes with pathological myopia and 16 eyes with simple high myopia. The average equivalent spherical lens was (-12.82±4.38) d. Epithelial flaps were made in 49 eyes, with a diameter of 8~9 mm, and the pedicle of the epithelial flap was located above. The epithelial flap in 1 eye contained part of stromal tissue, and the epithelial flap in 2 eyes was free. On examination 1 d after operation, the epithelial flap was basically transparent in 36 eyes, mild edema in 15 eyes, and moderate edema in 1 eye. When the contact lens was taken, the corneal epithelium in 50 eyes was well healed. At 3 months after surgery, 44 eyes (84.61%) had no decrease in the best corrected visual acuity within ±1.00 D of the expected value, and 10 eyes (19.23%) had improved the best corrected visual acuity by 1 or 2 rows. At 3 months after surgery, 8 eyes (15.38%) had corneal Haze grade 0.5, 2 eyes (3.84%) had Haze grade 1, and the rest of the patients had transparent corneas. In 28 eyes followed up for 6 months, 3 eyes had corneal Haze grade 0.5, and the rest of the patients had transparent corneas. The contrast sensitivity decreased at 1 month after surgery, but gradually recovered at 3 months after surgery, and the postoperative high-order aberrations increased compared with those before surgery. Conclusion Epi-LASIK has the advantages of mild postoperative irritation symptoms, good epithelial healing and mild degree of Haze.

Objective to dynamically analyze the changes of macular visual function in patients with diabetic macular edema (DME) before and after vitreous surgery. Methods Sixteen patients (17 eyes) with DME who did not improve after retinal photocoagulation were followed up for 7 months after vitreous surgery. The results of central visual acuity, multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) before and after surgery were dynamically compared to investigate the changes of macular visual function before and after surgery and its correlation with the changes of macular morphology. Results The results of mfERG showed that the visual function of DME patients after surgery mainly changed with P1 wave, and the visual function gradually increased with time. Compared with the results of mfERG before surgery, the amplitude of P1 wave and incubation period wave showed that the visual function of patients improved significantly 4 to 5 months after surgery (P<0.05); The comparison of the amplitude of P1 wave in each time period after operation also showed that the visual function of patients improved significantly from 4 months after operation (P<There was a linear positive correlation between the increase of P1 wave amplitude and the decrease of foveal thickness (P<0.01). Conclusion the improvement of macular visual function in DME patients after vitreous surgery is progressive; The improvement of visual function in the macular area after surgery was consistent with the resolution of edema.

Objective to investigate the sensitivity and specificity of frequency doubling field detection (FDP) program in screening glaucoma in natural people over 40 years old. Methods From May to October 2001, 4439 residents over 40 years old in 3 natural villages and 4 communities in the north of Yufa Township, Daxing District, Beijing were screened for glaucoma. All subjects were tested for visual field by C-20-1 screening program of frequency doubling field meter. The suspected glaucoma patients were examined by Octopus threshold field, gonioscope and stereopapillary photography on non-screening days. According to the average defect (MD) value of Octopus visual field detection, the screened glaucoma was divided into mild, moderate and severe. The analysis indexes of FDP included FDP detection time, number of abnormal sites, FDP score, FDP score of 4 quadrants, etc. The data of one eye of normal subjects were randomly selected for analysis; The results showed that 4330 cases (97.5%) were used for FDP analysis. Taking the abnormal results of FDP ≥1 point as the critical point, the population was divided into two groups: normal subjects and glaucoma. The sensitivity of FDP was 50.7% (72/142), the specificity was 96.6% (2260/2340), the area under the operating characteristic curve (AUC) was 0.7, the positive predictive value was 47.7%, the negative predictive value was 96.9%, the positive likelihood ratio was 14.8, and the negative likelihood ratio was 0.5. The sensitivity of FDP was 76.4%, AUC was 0.9, the positive predictive value was 40.7%, the negative predictive value was 99.2%, the positive likelihood ratio was 22.3, and the negative likelihood ratio was 0.2. The sensitivity of detecting mild, moderate and severe glaucoma was 54.2%, 76.0%, and 100.0%, respectively. It has good sensitivity to patients with moderate and severe glaucomatous visual field defects.

Objective to investigate the ultrasound diagnostic characteristics of complex vitreoretinal diseases by color Doppler flow imaging (CDFI). Methods 518 cases (678 eyes) of complex vitreoretinal diseases including vitreous hemorrhage, posterior vitreous detachment, vitreoschisis, retinal detachment, choroidal detachment and diabetic retinopathy were examined with special B-ultrasound and CDFI diagnostic apparatus for ophthalmology. The diagnosis was made according to the diagnostic criteria of B-ultrasound and CDFI respectively, and then confirmed by surgery, the accuracy of B-ultrasound and CDFI was finally judged. Results The number of positive eyes detected by CDFI in complex vitreoretinal diseases was higher than that of B-ultrasound diagnostic apparatus. The results of B-ultrasound and CDFI in the retinal detachment and posterior vitreous detachment groups, and the results of B-ultrasound and CDFI in the choroidal detachment and vitreous organized membrane groups were statistically significant (all P<0.05). Conclusion The combination of morphological observation and blood flow characteristics of CDFI can significantly improve the diagnosis of complex vitreoretinal diseases Provide reliable diagnostic basis for clinical practice.

Objective to observe the clinical effect of local injection of pingyangmycin in the treatment of eyelid xanthoma, and to investigate the histopathological and ultrastructural changes of xanthoma before and after treatment. Methods Thirty patients (44 eyes) with eyelid xanthoma diagnosed and treated in outpatient clinic were randomly selected and divided into treatment group and histopathological observation group. 25 cases (34 eyes) in the treatment group were injected 0.2ml of 0.4% pingyangmycin solution directly into the xanthoma body with a skin test needle, once/10 d, and the reaction in the tumor body after injection was observed. In the histopathological observation group, 5 cases (10 eyes) were both eyes with upper eyelid xanthoma, one eye was injected with pingyangmycin 0.2ml in vivo according to the above method, and the other eye was the control group. The other half was cut into 1.0 mm ×1.0 mm ×1.5 mm tissue slices and examined under electron microscope. The ultrastructure of the tumor was observed under transmission electron microscope and photographed. Results After 3~45 months of observation in the treatment group, all 25 cases of eyelid xanthoma disappeared, the skin color returned to normal, and the normal shape and function of eyelid were maintained. A large number of xanthoma cells (foam cells) infiltrated in the superficial dermis of the control group were observed by electron microscope: the number of lipid droplets in foam cells of the treatment group decreased; Conclusion Pingyangmycin can rapidly inhibit the proliferation of foam cells and make xanthoma regress, and its treatment method is simple, safe and effective, and worthy of clinical application.

Objective to investigate the expression of leukocyte antigen-associated tyrosine phosphatase (LAR) in human keratoconus and its clinical significance. Methods the total RNA of 15 human keratoconus, 7 normal corneas, 6 bullous keratopathy, 3 leukoplakia without neovascularization and 2 corneal dystrophy samples were collected and analyzed by agarose gel electrophoresis by reverse transcription polymerase chain reaction (RT-PCR). The total proteins of 6 keratoconus, 3 normal corneas, 3 bullous keratopathy, 3 leukoplakia without neovascularization and 2 corneal dystrophy samples were extracted from the corneal sections of 6 keratoconus, 3 normal corneas, 3 bullous keratopathy, 3 leukoplakia without neovascularization and 2 corneal dystrophy samples were extracted by Western blot method. RNA and protein bands of LAR were analyzed by relative quantitative RT-PCR and Western blot, respectively. Results After RT-PCR with equal amount of total RNA, strong signal bands were detected in LAR amplification products of keratoconus samples, while only weak signal or no signal was detected in samples of normal and other corneal diseases. Sequencing of LAR amplification products of keratoconus showed that exon 13 was deleted in mRNA. Western blot analysis with equal amount of total protein showed that there were clear signal bands in keratoconus samples, while only weak signal or no signal was detected in samples of normal and other corneal diseases. Conclusion The expression of LAR mRNA and protein was significantly enhanced in keratoconus, but very weak in normal cornea, bullous keratopathy, neovascular leukoplakia and corneal dystrophy, It is not even detectable. The enhanced expression of LAR in keratoconus may be significantly related to the development of keratoconus. The deletion of LAR exon 13 in keratoconus may be related to its own function.

Objective to investigate the mutation characteristics of TGFBI gene in Chinese patients with Reis-Bücklers corneal dystrophy and its relationship with clinical manifestations. Methods Genetic analysis was carried out on 10 patients and 2 normal members of two unrelated families. The genomic DNA of peripheral blood leukocytes was prepared from 10 ml of peripheral blood. The 4th and 12th exons of TGFBI gene were amplified by synthetic specific primers and polymerase chain reaction (PCR), respectively. The gene products were directly sequenced and the corresponding gene sequences were analyzed. Results Both families showed autosomal dominant inheritance. The clinical manifestation was fine granular turbidity in corneal subepithelium and anterior elastic membrane, which gradually fused and expanded with age to appear map-like, which was consistent with the diagnosis of Reis-Bücklers corneal dystrophy map pattern. Conclusion R124L gene mutation was shown in both families of patients with Reis-Bücklers corneal dystrophy in China. Gene analysis will provide a reliable basis for the diagnosis of Reis-Bücklers corneal dystrophy.

Cataract extraction and intraocular lens implantation is a routine surgical method for cataract treatment at present. Although the surgical technique, material and design of intraocular lens have been improved obviously, postoperative vision-related problems, such as glare and poor night vision, are still difficult to avoid, which affect the surgical effect. Wavefront aberration technology can help reveal the causes of related visual problems after surgery. This paper reviews the application achievements of wavefront aberration technology in human eye research in recent years, and summarizes the role and research progress of this technology in improving the curative effect of cataract extraction surgery.

China Press and Publication News, published on November 19, 2004, published the list of 60 illegal newspapers and periodicals that were banned for the second time by the General Administration of Press and Publication and the Office of the National Working Group on Anti-pornography and Anti-illegality. Adding the first batch of 30 periodicals that used overseas issue numbers to engage in illegal publication announced on July 13, 2004, the number of illegal newspapers and periodicals that were banned has reached 90.

The Chinese Journal of Ophthalmology was founded on October 1, 1950. It was sponsored by the Chinese Medical Association and edited by the editorial committee of the Chinese Journal of Ophthalmology. The editorial committee consists of 61 well-known ophthalmologists in China, including Zhao Jialiang, the current editor-in-chief, and Zhao Hongmei, the director of the editorial department. The main readers of this journal are ophthalmologists from all over the country, and it is publicly distributed at home and abroad. China Standard Issue Number: ISSN0412-4081, CN 11-2142/R; Postal code: 2-60; National map code: BM93.

Since the copyright law of our country was promulgated, it has been paid widespread attention by all circles of society. As a medical scientific and technological journal, the copyright law must be implemented to the letter. Therefore, the relevant requirements of this journal for author's signature and thanks are reiterated as follows.

In order to reflect the innovative scientific research achievements and clinical experience of ophthalmology in China as soon as possible, this journal has opened up a "fast track" to publish excellent academic papers in 2002, simplifying the procedure from review to official publication of papers, and shortening the publication cycle. In view of the increasing number of authors applying for the "fast track" at present, the editorial board of this journal has supplemented and improved the specific conditions for applying for the "fast track" on the basis of the operation of some time ago, and reiterated the relevant regulations of the "fast track" once again, so that academic papers with innovative content can be published as soon as possible.

The latest experimental studies showed that the content of tumor necrosis factor (TNF) in the aqueous humor increased after intraocular lens implantation, and TNF played an important role in postoperative intraocular inflammatory reaction [1-3]. In order to further explore its mechanism, we observed and studied the regularity of TNF α mRNA expression in iris and ciliary body tissues after intraocular lens implantation in rabbits, and discussed its effect on postoperative intraocular inflammatory reaction.

The application of vitreoretinal surgery to treat patients with early idiopathic macular hole has good anatomical and visual function recovery effect.In recent years, through the pathological histological examination of the membrane-like substance components in the anterior area of macular hole, people's understanding of the formation and development of the hole has changed from "foveal tissue loss" to "mainly the process of gradual enlargement of the hole after foveal tissue tear". Therefore, microscopic vitreoretinal surgery with the purpose of relieving the anterior-posterior and tangential traction of the macular hole has become the main method for the treatment of idiopathic macular hole at present. However, there is no unified understanding of the occurrence, development process and treatment methods of traumatic macular hole at present. Based on the maturity of the surgical treatment technology of idiopathic macular hole, some foreign scholars generally choose the surgical treatment of traumatic macular hole, but there are many clinical reports of spontaneous healing of the hole. Therefore, since 2001, the author, A group of consecutive patients with traumatic macular hole were followed up and observed, and the clinical data of 7 patients with spontaneous healing of macular hole at different time periods were retrospectively analyzed, in order to provide theoretical basis for clinical choice of treatment of macular hole.

Although the ordinary intraocular lens (IOL) used in the past can improve the refractive state and visual acuity of patients, because of the lack of adjustment force, patients cannot obtain good far and near vision at the same time after surgery, and can only be in hyperopia or myopia for a long time, and need to be corrected by the lens to obtain the best visual function. Although the multifocal IOL can improve part of near vision, the clinical application effect is not ideal because of its defects such as reduced contrast sensitivity and glare. In order to solve the clinical problem that affects the effect of cataract extraction, an adjustable posterior chamber IOL designed according to the principle of optical zone displacement proposed by a limited element computer simulation model began to be applied in clinic. The IOL can simulate the adjustment changes of the lens in physiological state in the lens capsular bag, and the adjustment force can be dynamically controlled by ciliary muscle. Our hospital began to use the IOL in August 2003. In order to evaluate its efficacy, we conducted a prospective study with the ordinary folding IOL as a control. The results are reported as follows.

Lymphangioma is one of the common benign tumors in children, which often occurs in the neck and chest. Cystic lymphangioma is more common, which cannot regress by itself and grows at different speeds [1]. Although the fornix conjunctiva of the eye rarely occurs, it compresses the eyeball to affect its normal development, and the tumor body is easy to rupture, secondary complications such as infection and bleeding, which is difficult to manage. Traditional surgical treatment is difficult to completely resect, and the injury area is large, and there are many sequelae, which are easy to relapse [2]. Since June 1994, the author has treated 15 cases (16 eyes) of conjunctival cystic lymphangioma in children with intratumoral injection of pingyangmycin (PYM) combined with acetone-acetone-quetosone, with satisfactory results. The report is as follows.

laser in situ keratomileusis (LASIK) is a common method for surgical treatment of refractive errors at present. With the extensive development of LASIK, its complications have been paid more and more attention by clinicians. diffuse lamellar keratitis (DLK) is a common complication after LASIK, and its incidence rate has been reported differently, most of which are mild self-limiting, and severe cases are rare. A case of severe DLK after LASIK recently diagnosed and treated in our department is reported as follows.

The patient was an 8-year-old male with poor left eye vision accompanied by esotropia since childhood and blurred left eye vision for nearly 6 months. He came to our hospital in October 2003. The patient was the third fetus delivered naturally at full term. There was no similar disease in his family, and his parents were not close relatives. His mother had multiple upper respiratory tract infections from 2 to 4 months of pregnancy. No abnormalities were found in physical examination. Ocular examination: visual acuity of right eye 0.4, wear +1.25 DS () 0.75 DC ×75° =0.7; visual acuity of left eye was manual before eye.

An 18-year-old female patient came to our hospital in January 1998 due to intermittent cough with blood in sputum for 3 years and aggravated for 1 month. Chest plain X-ray and CT examination showed that there was an irregular nodular shadow in the dorsal segment of the right lower lobe and the bronchial opening, protruding inward and outward of the lumen, the lumen was obviously narrowed, and a narrow and long consolidated shadow was seen at the distal end. The volume of the right lower lung was obviously smaller, the oblique fissure moved backward, and an enlarged lymph node was seen under the carina. Bronchoscopy showed that a cauliflower-like new organism was seen 1 cm below the bronchial opening of the right middle lobe, completely obstructing this segment of the lumen, suggesting central lung cancer of the right lower lung with distal obstructive atelectasis.

A 13-year-old male was admitted to our hospital on May 8, 2003 due to redness and pain in the left eye and visual acuity decreased for 7 days. No abnormalities were found in the whole body physical examination, and no abnormalities were found in the chest X-ray and abdominal B-ultrasound examinations. The intraocular pressure was 16 mm Hg (1 mm Hg =0.133 kPa) in the right eye and 13 mm Hg in the left eye. The anterior segment and fundus of the right eye were normal.