Volume 59 · Issue 03 · 2023

Owing to the popularization of fundus screening for high-risk prematurity promoted by the state, the prevention and treatment of retinopathy of prematurity (ROP) in China has achieved remarkable results in recent years. Accordingly, the applicable population scope for newborn fundus screening is under heated discussion. Is it better to screen for all neonates or selective high-risk newborns, who meet the national ROP guidelines, have a history of familial or/and hereditary eye diseases or a systemic disease related to the eye after birth, or show an abnormal eye appearance or suspicious eye diseases in the primary care examination? Despite the advantages of general screening in detecting and treating some malignant eye diseases in a timely manner, the conditions for carrying out general newborn screening are not mature, and there are certain risks in the fundus examination of children. This article points out that the rational use of existing scarce medical resources to carry out selective fundus screening for newborns with high risks of eye diseases is practical in clinical work.

Diabetic retinopathy (DR) is one of the severe complications of diabetes, and also the most common reason of vision loss in Chinese adults over 30 years old. Regular fundus examination and continuous glucose monitoring can prevent 98% of blindness caused by DR. However, due to the irrational allocation of medical resources and the weak awareness of DR patients, only about 50% to 60% of diabetes patients have an annual DR screening. Therefore, it is necessary to build a follow-up system for early screening, prevention, treatment and lifelong monitoring of DR patients. In this review, we discuss the importance of lifelong monitoring, the hierarchical medical system and the follow-up of pediatric DR patients. Novel and multi-level screening methods are cost-saving to patients and cost-effective to healthcare systems, and also can help improve the detection and early treatment of DR.

Retinopathy of prematurity (ROP) is a retinal vascular proliferative disease occurring in premature and low birth weight infants, which is the leading cause of blindness and low vision in children. Laser photocoagulation is still recognized as the gold standard of treatment in ROP. Recently, anti-vascular endothelial growth factor (VEGF) therapy has become a novel alternative approach in clinical practice for ROP. However, there are still many improper and deviations in identifying indications and selecting therapeutic modalities, resulting in generalization and abuse of anti-VEGF drugs in treatment of ROP. The aim of this article is to summarize and objectively evaluate the treatment indications and methods of ROP based on related research at home and abroad, in order to strictly control the theraputic indications and scientifically and rigorously select appropriate therapeutic modalities for the benefit of children with ROP.

Visual electrophysiology is an objective examination method for assessing visual function. As one of the important ophthalmic clinical examinations, it is widely used in the diagnosis, differential diagnosis, follow-up and visual function identification of diseases. Based on a number of standards and guidelines published by the International Society of Clinical Visual Electrophysiology in recent years, in combination with the recent clinical practice and research progress in China, the experts in the Visual Physiology Group of Ophthalmology Branch of Chinese Medical Association and Visual Physiology Group of Chinese Ophthalmologist Association have formed consensus opinions to help Chinese ophthalmologists standardize the use of clinical visual electrophysiologic terminology and to promote the further standardization of clinical visual electrophysiologic examination in China.

To investigate the ultrasonographic features of retinal pigment epithelium (RPE) adenoma.

It was a retrospective case series study. The clinical clata of 15 patients (15 eyes) with pathologically confirmed RPE adenoma after local resection of intraocular tumor was collected at Beijing Tongren Hospital, Capital Medical University from November 2013 to October 2019. The general conditions of the patients and the location, size, shape, internal echo features of the lesions in the ocular ultrasound sonogram were analyzed, and the blood flow in the lesions was checked by color Doppler flow imaging (CDFI).

Of all the patients included in the study, 7 were male and 8 were female. Their age ranged from 25 to 58 years, with a mean age of (45.7±10.2) years. The most common symptom was vision loss or blurred vision (11 cases). Other symptoms included dark shadows or obscuration in front of the eyes (3 cases) and no symptoms (1 case). A history of previous ocular trauma was present in one case, and the rest of the patients had no history of ocular trauma.The location of tumor growth is scattered. The ultrasonographic features were as follows: the average maximum basal diameter was (8.07±2.75) mm and the average height was (4.02±1.81) mm; the ultrasonographic features mostly demonstrated abruptly elevated dome-shaped echo (6 cases); the lesion edge was not smooth, the internal echo was medium or low, and there could be hollow features (2 cases), with no choroidal depression; and the blood flow signal could be seen in the CDFI lesion, which could lead to retinal detachment and vitreous opacification.

The ultrasound imaging features of RPE adenomas mostly demonstrate abruptly elevated dome-shaped echo, unsmooth lesion edge, with no choroidal depression, which may provide valuable evidence for clinical diagnosis and differentiation.

To evaluate the clinical features and outcomes of eyes with peripheral exudative hemorrhagic chorioretinopathy (PEHCR).

It was a retrospective case series study. A total of 12 patients (12 eyes) diagnosed with PEHCR at Peking University People′s Hospital from October 2016 to December 2019 were included. The clinical data of visual acuity, slit-lamp microscopy, indirect ophthalmoscopy, fundus photography, B-ultrasound, optical coherence tomography, fluorescein fundus angiography and indocyanine green angiography, surgical procedures, therapeutic effects and follow-up were analyzed.

Among all 12 patients included, 7 were male and 5 were female. The age was (58.0±8.8) years. All patients had unilateral disease. The right eye was involved in 6 cases and the left eye in 6 cases. All cases presented with vitreous hemorrhage, 9 of which presented with intraocular space-occupying lesions. In the patients with intraocular space-occupying lesions, the maximum basal diameter was (8.3±1.6) mm and the height was (3.5±1.2) mm measured by B-ultrasound. A-scan ultrasonography was characterized by intermediate high reflectivity or intermediate low reflectivity. Fundus fluorescence angiography revealed nonspecific alterations corresponding to the visible fundoscopic changes such as window defects, blockage, staining, but no neovascular membrane. No polyps were found on indocyanine green angiography. All patients received vitrectomy. The intraocular lesions were found to be subretinal bleeding and exudative masses intraoperatively. Two patients had combined cataract surgery; three patients received gas or silicone oil tamponade, and three patients received adjunct intravitreal anti-vascular endothelial growth factor drugs during the follow-up. The follow‐up period was (30.0±12.6) months. At the last visit, the visual acuity was improved in 11 patients and remained stable in 1 patient.

PEHCR is a peripheral hemorrhagic retinal degenerative disorder that simulates choroidal melanoma and lacks characteristic angiography changes. The overall therapeutic effect and prognosis are good.

To analyze the clinical features of patients with sarcoid uveitis.

This was a retrospective case series study. The medical records of 19 086 patients with uveitis admitted to the Department of Ophtalmology, The First Affiliated Hospital of Chongqing Medical University from April 2008 to December 2019 were collected. The general data, medical history, treatment, diagnosis, follow-up, ophthalmic and other auxiliary examinations were retrospectively analyzed. The paired sample Wilcoxon signed rank test was used to compare the best corrected visual acuity (BCVA) of the affected eye at the first visit to the BCVA of the affected eye at the corresponding last visit.

A total of 51 patients (97 eyes) with sarcoid uveitis were included, including 15 males (29.4%) and 36 females (70.6%), with a male/female ratio of 1/2.4. There were 46 patients (88 eyes) with presumed sarcoidosis and 5 patients (9 eyes) with definite sarcoidosis. The age of onset was 48 (40, 55) years and 90.2% of patients (46 cases) were involved in both eyes, while 88.2% of the patients (45 cases) were chronic, and only 11.8% (6 cases) showed acute inflammatory response. Anterior uveitis was the most common type (50.5%, 49 eyes). Ophthalmoscopy revealed retinal vasculitis in only 2 eyes (2.1%) and fundus fluorescence angiography (FFA) revealed diffuse vascular leakage of fluorescein in 64 eyes (66.0%). Thirty-one patients (59 eyes) were followed up for≥3 months. Cataract was the most common ocular complication, accounting for 44.1% (26 eyes), and the inflammatory response was controlled in 45 eyes (76.3%) treated with combination of corticosteroids and immunosuppressive agents. The patients were followed up for 21.5 (13.7, 29.3) months. Among 31 patients (59 eyes) followed up for≥3 months, BCVA was≥0.8 in 25 eyes (42.3%) and<0.3 in 15 eyes (25.4%) at the last follow-up, BCVA of 59 affected eyes of 31 patients was better than that at the first visit, the difference was statistically significant (Z=-2.76, P=0.006).

Uveitis associated with sarcoidosis or presumed ocular sarcoidosis mainly manifests as a bilateral, chronic anterior uveitis with a subclinical retinal vasculitis. FFA shows subclinical retinal vasculitis in most patients. Glucocorticoid therapy in combination with other immunosuppressive agents can control inflammatory responses and improve visual acuity in most patients.

To observe the changes of pulley locations and muscle volumes of extraocular rectus muscles in dissociated vertical deviation.

This was a cross-sectional study. Data was collected from January 2020 to December 2020 in Tianjin Eye Hospital. The pulley locations and muscle volumes of extraocular rectus muscles in DVD patients and healthy volunteers were observed and calculated by continuous coronal MRI scan. One-way ANOVA and independent sample T test were used for statistical analysis. According to the examination results, Groups were divided into A (symmetric DVD), B (asymmetric DVD) and C (healthy volunteers). Data of symmetric DVD patients were divided into dominant eye (A-D) and non-dominant eye (A-nD), while that of asymmetric DVD patients were divided into severe DVD (B-s) and mild DVD (B-m). Volume of 4 rectus muscles and superior oblique muscle were calculated and compared to Group C, respectively.

Group A included 5 patients (10 eyes), 2 males and 3 females, aged (22±4) years; Group B included 4 patients (8 eyes), 2 males and 2 females, aged (28±8) years; Group C included 10 patients (20 eyes), including 4 males and 6 females, aged (25±6) years. There was no significant differences in age(F=0.45,P=0.648)or gender(χ²=0.78;P=0.833)among the three groups. There was no significant difference in pulley locations of extraocular rectus muscles between the three groups (F_MR=0.52,F_LR=0.62,F_SR=0.72,F_IR=1.16;all P>0.05). Among the four exterocular rectus muscles, the muscle volume of MR [A-D: (562.8±64.4) mm³,A-nD: (560.6±53.2) mm³,B-s: (557.0±48.7) mm³,B-m: (551.5±45.8) mm³], LR [A-D: (519.8±44.5) mm³,A-nD: (511.0±49.4) mm³,B-s: (501.0±35.6) mm³,B-m: (498.3±45.3) mm³] and SR [A-D: (472.8±66.9) mm³,A-nD: (449.4±41.7) mm³,B-s: (433.0±60.8) mm³,B-m: (412.5±54.5) mm³] in group A and group B was higher than that in group C [MR: (423.3±51.9)mm³,LR: (439.7±35.3)mm³,SR: (328.1±36.5)mm³], and the difference was statistically significant (All P<0.05). The inferior rectus muscle volume of dominant eye in group A and mild DVD eye in group B was significantly different from that of healthy volunteers in group C [(453.8±46.8) and (463.0±16.6) vs. (380.4±59.7) mm³, respectively], and the difference was statistically significant (all P<0.05).

There are no significant changes in pulley locations of extraocular rectus muscles in patients with symmetric and asymmetric DVD, and the muscle volumes of medial, lateral and superior rectus muscle are greater than those of healthy people. However, the muscle volumes of inferior rectus muscle of dominant eye in symmetric DVD and mild DVD eye are significantly greater.

To analyze the clinical and pathological characteristics and prognosis of 35 cases of solitary fibrous tumor of ocular adnexal (SFT).

This was a retrospective case series study. The clinical data of 35 cases of ocular adnexal SFT was collected in Tianjin Eye Hospital from January 2000 to December 2020. The clinical manifestations, imaging examination results, pathological characteristics, treatment of patients were analyzed, and patients were followed up. All cases were classified according to the 2013 classification of World Health Organization of tumors of soft tissue and bone.

There were 21 males (60.0%) and 14 females (40.0%). The age range was 17 to 83 years, and the median age was 44 (35, 54)years. All patients were unilateral, with 23 (65.7%) in the right eye and 12 (34.3%) in the left eye. The course of disease ranged from 2 months to 11 years, with an a median duration of 12(6,36)months. Clinical manifestations included exophthalmos, limited eye movements, diplopia, and tearing. All patients underwent surgical treatment of complete resection of the tumor. Ocular adnexal SFT mostly occurred in the upper orbit (19 cases, 73.1%). On imaging examination, the tumor showed well-circumscribed space occupying lesion that heterogeneously enhanced with contrast, and abundant blood flow signals in the tumors. MRI showed isointensity or low signal on T1WI, and significantly enhanced on T2WI, presenting intermediate-to-high heterogeneous signals. The tumor diameter was 2.1 (1.5, 2.6) cm. There were 23 cases (65.7%) of classic subtype, 2 cases (5.7%) of giant cell subtype, 8 cases (22.9%) of myxoid subtype, and 2 cases (5.7%) of malignancy. Immunohistochemical staining showed that Vimentin, CD34 and STAT6 were positively expressed in all patients. Twenty-one cases (60.0%) showed positive expression of BCL-2, and Ki-67 positive index ranged from 1.0% to 10.0%. Tumors in this group were all low-risk according to the Demicco risk stratification. Follow-up was available for 25 patients with a duration of 2 years to 14 years and 7 months, and the median follow-up time was 88 (61, 124) months. Two patients relapsed, and no distant metastasis or death was observed.

Ocular adnexal SFT mainly presents as a painless, slow-growing mass. And most of them are typical SFT. The imaging manifestations are varied Ocular adnexal SFT generally follows a benign course, with a good prognosis after complete excision. Recurrence could occur many years after surgery which requiring careful and long-term follow-up.

A young woman who complained of visual acuity decreased in the right eye for 12 days visited the Department of Ophthalmology. A solitary and occupancy lesion was seen in the posterior pole of the fundus of the patient′s right eye, accompanied by intracranial and pulmonary tuberculosis. The diagnosis was choroidal tuberculoma, intracranial tuberculoma, and invasive pulmonary tuberculosis. After anti-tuberculosis treatment, the lesions of lung were better, but the lesions in the right eye and brain were paradoxical worsening. Finally, the lesion was calcification and absorption after combined glucocorticoid therapy.

We report a case of adult-onset dystonia presenting with chronic progressive external ophthalmoplegia. The patient had ptosis in both eyes, particularly the left eye, for no obvious reason since the age of 10, which was progressively aggravated. The clinical diagnosis was chronic progressive external ophthalmoplegia. However, whole gene sequencing revealed the mitochondrial A3796G missense mutation, so the patient was clearly diagnosed as adult-onset dystonia and given treatment to reduce blood glucose and improve muscle metabolism. The A3796G mutation in the ND1 subunit of the mitochondrial complex leading to ophthalmoplegia is relatively rare, requiring a combination with genetic testing for confirmation of diagnosis.

A male neonate who was unable to open both eyes with the adhesion of upper and lower palpebral margins since birth was clinically diagnosed as bilateral ankyloblepharon filiforme adnatum. The fused eyelids were divided surgically under general anesthesia. The neonate can open and close eyes normally with right positions of eyelids and flexible movements of eyeballs to follow light after the surgery.

Proliferative vitreoretinopathy (PVR) is an avascular fibroproliferative disease that occurs in the retina. The main pathological changes are the proliferation and traction of retinal pigment epithelial cells (RPE) and glial cells on the vitreous and retina. Basic research has confirmed that the formation of PVR is related to multiple signaling pathways, including NK-κB signaling pathway, MAPK and its downstream signaling pathways, JAK/STAT signaling pathway, PI3K/Akt signaling pathway, thrombin and its receptor pathway, TGF-β and downstream signaling pathway, North signaling pathway and Wnt/β-catenin signaling pathway, etc. This review summarizes the research progress of the main signaling pathways in the formation mechanism of PVR, and provides the basis and support for the research of PVR drug therapy.

Pediatric uveitis accounts for 5% to 10% of all uveitis, most of which are noninfectious. Most cases have an insidious onset and are accompanied by many complications, which may lead to poor prognosis and intractable treatment. At present, traditional drugs that are commonly employed to treat pediatric noninfectious uveitis include local and systemic corticosteroids, methotrexate and other immunosuppressants. In recent years, the application of various biological agents has provided new means for the treatment of this kind of disease. This article reviews the progress of medication treatment of pediatric noninfectious uveitis.

Orthokeratology (Ortho-K) is one of the effective methods to control the development of myopia in children and adolescents. The mechanical pressure of eyelids on the Ortho-K lens and the hydraulic effect of tears under the Ortho-K lens can alter the curvature or shape of the cornea, which can correct refractive error and control myopia development progress. The tear film is a thin layer of liquids evenly distributing in the conjunctival sac. Wearing an Ortho-K lens can decrease the tear film stability, which will influence the Ortho-K. In this article, the relevant domestic and overseas research results are summarized and analyzed, aiming to sort out and discuss the effection of tear film stability on the fitting, shaping, safety, and visual quality of the Ortho-K, as well as to provide suggestions for clinicians and researchers.

Fundus disease is the most important eye disease causing blindness in infants and young children, and the prevention and treatment of infant fundus disease has its particularity and urgency. In order to improve the attention and understanding of clinical ophthalmologists on infant fundus disease, this paper divides infant fundus disease into three categories according to the urgency of diagnosis and treatment needs and whether there are effective intervention measures at this stage, and summarizes the characteristics of the disease, basic prevention and treatment strategies, screening and diagnosis, treatment and prognosis.

This issue focuses on the research progress in the diagnosis and treatment of fundus diseases. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Wang Yusheng.