Ophthalmology in China

Deepen the understanding of the ocular finding related with sella region lesions

ZHANG Xiao-Jun, Wei-Wen-Bin

2012, 21(5): 289-291.

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The tight anatomic relationship between sella region and visual pathway makes the ocular findings caused by lesions in sella region pretty common clinically, some of which are hard to distinguished with the features of some conditions traditionally considered as primary eye diseases. Different types of visual field defects such as bi-temporal hemianopia, vision loss and optic nerve atrophy are common findings due to optic chiasm lesions caused by sella region mass. In addition to ocular findings, getting familiar with the systemic symptoms and sign of different kind of sella region tumors are helpful to early diagnosis and treatment. Optic neuropathy can be similar with glaucomatous optic neuropathy in some conditions. Should we distinguish them mainly based on typically clinical features or routinely perform image study for the patients diagnosed as normal tension glaucoma? The empty sella found by brain MRI can co-exist with some ocular findings, but these two findings can both be the result of long-existing intracranial hypertension, instead of one can cause the other. The controversies about the relationship between sella region lesions and ocular finding require us take a comprehensive way considering the aspects of research, clinical practice, medical ethic and economics to provide a good diagnostic and treatment stratagem for benefiting the patients most. (Ophthalmol CHN, 2012, 21: 289-291)

Treatment strategies of congenital blepharoptosis in children

YU Gang, WANG Yuan

2012, 21(5): 292-296.

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Congenital blepharoptosis is one of the common eye diseases during childhood. It can affect the children on appearance and more importantly, on visual and psychological development. Currently, there are much controversy and mistakes on the diagnosis and treatment of congenital blepharoptosis in children. Close attention should be put to the assessment of visual development, determination on the time of surgery, choice of surgical strategy and the material of suspension, and the improvement of visual acuity and function after surgery. （Ophthalmol CHN, 2012, 21: 292-296）

The neuronal mechanism of clinical binocular visual function

LU Wei

2012, 21(5): 297-301.

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There are interrelation among psychophysics, neuronal anatomy neurophysiology and clinical binocular vision phenomena. Based on neuronal anatomy, there are two corresponding area bilateral retina projecting at fixate direction of Vieth-Müller circle. There are corresponding area between binocular fovea, the temporal area of retina in right eye and nasal area of retina in left eye, the nasal retina in left eye and the temporal retina in right eye. The two separated corresponding area projecte to the brain via different pathway. The parvocellular pathway is mostly dealing with formcolor and fine stereopsis. The magnocellular pathway is mostly dealing with movement space sign and granulate stereopsis. It is very helpful for our practice to understand the clinical binocular vision phenomena more deeply based on this neuronal anatomy. （Ophthalmol CHN，2012, 21：297-301）

Sellar tumors with glaucoma-like optic neuropathy

WANG Jian, WANG Ya-Xing, YANG Hua, XU Liang, LIU Feng-Jun, LU Wen, QU Yuan-Zhen

2012, 21(5): 302-305.

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Objective To study the prevalence of glaucoma-like optic neuropathy with sellar tumors. Design Retrospective control study. Participants 501 patients diagnosed with sellar tumor from year 2008 to 2009 in Beijing Tiantan Hospital were chosen consecutively. Methods All the patients had undergone fundus photography and automatic visual field examination. A total of 454 age-matched controls were randomly chosen from the population-based Beijing Eye Study. The type and size of the tumors were assessed on neuroradiological images(MRI). Main Outcome Measures Prevalence of glaucoma-like optic neuropathy in tumor group and control group, and its associations. Results The prevalence of glaucoma-like optic neuropathy was 6.8%(34 cases) (disc-glaucoma) and 6.3%(31 cases) (field-glaucoma), which was significantly more frequent than that in the population-based control group of the same ethnicity (1.3%; P<0.001). In multivariate analysis, the presence of glaucoma-like optic neuropathy was significantly associated with tumor location (suprasellar > parasellar > intrasellar, P=0.010 and P=0.001) and tumor width (P=0.003). Conclusions The prevalence of glaucoma-like optic neuropathy in sellar tumor patients was higher than that of population-based control group. Glaucoma-like optic neuropathy in sellar tumors patients was associated with tumor width and tumor location. （Ophthalmol CHN, 2012, 21: 302-305）

Clinical characteristics of nonglaucomatous optic disc cupping

HUANG Hou-Bin, MEI Xiao-Bai, Wei-Shi-Hui, Yin-Zheng-Qin

2012, 21(5): 306-309.

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Objective To analyze the etiology of nonglaucomatous optic disc cupping and the differentiation with glaucomatous optic disc cupping. Design Retrospective case series. Participants Twelve cases with 19 eyes of nonglaucomatous optic disc cupping. Methods The morphology of optic disc and clinical data of these cases were analyzed. Main Outcome Measures Etiology, morphological characteristics of optic disc and visual function. Results Of the 12 cases, four were with optic neuritis, one with Devic disease, one with Leber hereditary optic neuropathy, two with pituitary adenoma, one with cerebral hemorrhage in basal ganglia, one with ciliary artery obstruction and central retinal vein occlusion, one with central retinal artery occlusion, and one with optic nerve injuries. In all patients the optic cupping shows diffuse excavation or focal notch with pale rim. The visual field defect was corresponding to the primary diseases. Conclusions Both optic nerve diseases and retinal diseases can cause nonglaucomatous optic disc cupping. The key points to differentiate nonglaucomatous optic disc cupping with glaucomatous lie in the color of optic disc rim, notched disc and the correlation between visual field defect and disc appearance. （Ophthalmol CHN, 2012, 21: 306-309）

The ocular appearance of empty sella syndrome

WANG Hong-Tao, LI Shu-Ning, Wang-Ning-Li, Yang-Ben-Tao

2012, 21(5): 309-312.

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Objective To analyze the ocular appearance of primary empty sella syndrome (ESS) patients. Design Retrospective case series. Participants 32 patients diagnosed as empty sella and partial empty sella after brain MRI examination in Beijing Tongren Hospital. Methods All patients underwent ocular examination, and the ocular characteristics of patients were analyzed. Main Outcome Measures Visual acuity, intraocular pressure(IOP), fundus, visual fields, angle of anterior chamber. Results In the 32 patients, a chief complaint of blurred vision happened in 20 cases. The best corrected visual acurity (BCVA) was less than 0.8 in 45 eyes, and among these 45 eyes, BCVA less than 0.1 in 5 eyes, 0.1～0.3 in 14 eyes, 0.4～0.7 in 26 eyes. In 13 eyes(20.3%), the IOP varied from 21 to 29 mm Hg. Papillary edema was found in 13 eyes(20.3%). Optic nerve atrophy was found in 19 eyes(29.7%). Among the 48 eyes(75.0%)which had visual field defect, 9 eyes had similar visual field defect with glaucoma. Bitemporal hemianopia was found in 10 cases. 28 cases had wide or open angle. 4 cases had narrow or closed angle. We found ESS combined with primary angle closed glaucoma in 3 cases, with primary open angle glaucoma in 1 cases, with normal tension glaucoma in 2 cases. BCVA of 3 ESS patients progressed after operation of neurosurgery. Conclusions The findings indicate the ocular appearance of empty sella syndrome could be decreased visual acuity, optic disc edema, optic nerve atrophy, and visual field defect. If the clinical appearance could not be explained by eye disease and suspected the ESS, we should discuss with neurologist for denifite diagnosis and treatment.（Ophthalmol CHN, 2012, 21: 309-312）

The ophthalmic manifestation of germinoma in sellar region

LEI Kun, Qu-Yuan-Zhen, Wang-Jian, Wang-Li-Na

2012, 21(5): 313-315.

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Objective To study the ophthalmic manifestation of patients with germinoma in sellar region. Design Retrospective case series. Participants 43 patients with germinoma in sellar region were collected from 2005 to 2010 in Beijing Tiantan Hospital. Method The visual acuity, fundus photographs and visual fields of patients were analyzed. The correlation analysis was performed between the vision, age and course of disease. Main Outcome Measures Visual acuty, visual field and fundus manifestation. Result The average age of patients was 15.7±6.5(4~31) years-old. The median of corrected visual acuity was 0.15. There were 74.3% (52/70) eyes with decreased visual acuity, 74.2% (46/62) with the visual field defects, 39.7% (27/68) with fundus changes. A statistically significant correlation was found between the visual acuity and age(r=0.384, P=0.023). There was no statistically significant correlation between the visual acuity and the course of disease. Conclusion Germinoma in sellar region could cause severe eye dysfunction and the rate of blindness was very high. The younger the patient was, the heavier the impairment of vision was. （Ophthalmol CHN, 2012, 21: 313-315）

The effect of lowering intraocular pressure on PVEP in anterior ischemic optic neuropathy

XUE Shang-Cai, Li-Hui-Rong

2012, 21(5): 316-318.

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Objective To study the influence of intraocular pressure(IOP)-lowering treatment on visual evoked potential (VEP) in eyes with anterior ischemic optic neuropathy(AION). Design Retrospective comparative case series. Participants From 2008 to 2011, a total of 68 cases of AION in the Second People's Hospital of Gansu were enrolled. The participants were randomly divided into control group (non-IOP-intervention) with a total of 30 cases (30 eyes) and lowering IOP group (IOP intervention) with a total of 38 cases (38 eyes). Methods The patients in IOP intervention group underwent an IOP lowering treatments to reduce IOP≥8 mm Hg or lower the IOP≥30%. All the eyes underwent pattern visual evoked potential (PVEP) test. The PVEP characteristies were analyzed both groups before and after treatment. Main Outcome Measures P100 latency, P100 amplitude of the PVEP. Results P100 latency in the intervention group (93.82±1.97 ms) was significantly shorter than non-IOP intervention group (112.38±1.45 ms) (t=46.36, P<0.001); P100 amplitude in the intervention group(3.64±0.23 μv) was significantly higher than non-IOP intervention group (3.14±0.23 μv) (t= 8.76, P<0.001). Conclusion Intraocular pressure-lowering treatment in AION eyes was benifitrial to PVEP. （Ophthalmol CHN, 2012, 21: 316-318）

The contrast visual acuity and its associations in myopic eyes

CHEN Yun-Yun, Zhang-Bei-Lei, Wang-Qin-Mei

2012, 21(5): 319-322.

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Objective To investigate the associations of the contrast visual acuity in myopic eyes. Design Prospective non-controlled case series. Participants 123 right eyes of 123 subjects aged from 17 to 47 years-old with a spherical equivalent refraction (SE）varied from -0.5 D to -10.00 D were enrolled in this study. Methods MFVA-100 was used to measure contrast visual acuity. 100%, 25%, 10% and 5% contrast visual acuity under bright and dark backgrounds, and the pupil size for corresponding conditions were recorded. The relationship between contrast visual acuity and age, SE, pupil size under bright and dark backgrounds were analyzed. Multiple linear regression analysis was performed to determine the correlations between those variables. Main Outcome Measures Different contrast visual acuity, age, spherical equivalent, pupil size. Result At bright background, 100% contrast visual acuity was significantly correlated with spherical equivalent (t=2.551, P1=0.012, R2=0.043), but not with age and pupil size(all P>0.05); and contrast visual acuity (25%, 10%, 5%) was significantly associated with pupil size (t1=-4.111, P1<0.001, R21=0.123; t2=-4.434, P2<0.001, R22=0.14; t3=-5.766, P3<0.001, R23=0.216), but not with age (all P>0.05) and SE(all P>0.05). At dark background, 100%, 25% contrast visual acuity was significantly correlated with spherical equivalent (t1=2.695, P1=0.008, R21=0.057; t2=2.429, P2=0.017, R22=0.047), but not with age(all P>0.05) and pupil size(all P>0.05); and contrast visual acuity (10%, 5%) was significantly associated with pupil size (t1=-2.305, P1=0.023, R21=0.042; t2=-2.424, P2=0.017, R22=0.046), but not with age (all P>0.05) and SE (all P>0.05). Conclusion 100% contrast visual acuity was negatively correlated with SE under either bright or dark background, but no relationship with pupil size. While the 10%, 5% contrast visual acuity was negatively associated with pupil size. Under bright background, the effect of pupil size on visual acuity increased as the contrast reduced. The relationship between pupil size and 10%, 5% contrast visual acuities was less close under dark background than under bright background. （Ophthalmol CHN, 2012, 21: 319-322）　

Relationship between myopia and accommodative parameters in 9~10 years old children

FENG Yi, Liu-Li-Juan, Tang-Ping, Guo-Yin, Meng-Meng

2012, 21(5): 323-326.

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Objective To study the relationship between myopia and accommodative parameters in 9~10 years old children and explore a program for myopia treatment and prevention. Design Cross sectional study. Participants 114 children (223 eyes) aged 9~10 years, with visual acuity(VA)≤0.9 and refraction≤-0.25 D were enrolled in this study. Methods The participants were investigated a comprehensive examination including VA, slip lamp, cycloplegia refraction and fundus, amplitude of accomodation(AMP), positive relative accomodation(PRA), negative relative accomodation(NRA) and accomodative facility(AF) were measured in all children. Participants were divided into 3 groups according to the refraction: Group A (-0.25～-1.25 D), Group B (-1.50～-2.50 D) and Group C (-2.75～ -4.50 D). Data was analyzed in each group with Pearson correlation and ANOVA. Main Outcome Measures Myopia refraction, accommodation（AMP, AF, PRA, NRA）. Results The mean refractive error was -1.57±1.03 D(range:-0.25~-4.50 D). Refraction was correlate with AMP (r=0.22, P=0.001), PRA（r=-0.25，P=0.00）, and not associated with NRA(r=0.03, P=0.65), AF (r=0.06, P=0.34). Compared three groups of accommodative parameters, AMP were significant different in Group A from Group B and C (F=2.16, 2.21; P=0.00, 0.00) , and PRA were significant different in Group A from Group B and C (F=-0.45, -0.53; P=0.01, 0.02), no significant difference between Group B and C（F=0.06, -0.09; P=0.95, 0.72）. Conclusion In this survey, AMP and PRA were both correlated with myopia progression. It is supposed that visual training may improve the accommodative abnormality at the onset of myopia, and then get certain auxiliary therapeutic effect in children with partial accommodative lag. （Ophthalmol CHN, 2012, 21: 323-326）

Comparison of the effectiveness of common visual parameters for myopia screening in school-age sample

LIU Peng-Fei, Xiao-Lin, Lu-Zhi-Min, Wang-Feng-Lei, Jin-En-Zhong

2012, 21(5): 327-330.

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Objective To compare the accuracy of common visual indexes, uncorrected distant visual acuity(UCDVA), axial length/mean corneal redius(AL/CR), refractive state with cycloplegia and non-cycloplegia in school-age large sample myopia for screening, and to put forward a suitable method to replace cycloplegic refractometry. Design Cross-sectional study based on school-age children. Participants School-age children in Suning Country, Hebei Province were selected. Those students who had the informed consent and had no ocular diseases took part in this study. There were 232 children (123 boys and 109 girls), aging from 6 to 12 years old enrolled. Methods All the students received examinations including UCDVA with standard logarithmic visual acuity chart, <0.9 defined as visual impairment; axial length (AL) and corneal redius (CR) with Optical coherence biological measuring instrument (IOL Master), AL/CR>3 defined as suspicious of myopia; refractometry with automatic refractor (Nissan RM-8000) both in the condition of cycloplegia and non-cycloplegia(≤-0.50 D defined as myopia). 1% cyclopentolate was applied for cycloplegic refraction. The sensitivity, specificity and Youden index of each method was analyzed using the cycoplegic refractometry as gold standard. Main Outcome Measures UCDVA, AL/CR, diopter by refraction with cycloplegia and non-cycloplegia; sensitivity, specificity and Youden index. Results The sensitivity, specificity and Youden Index of UCDVA and non-cycloplegic refractometry in myopia screening was 86.8%, 59.3%, 0.46, and was 94.3%, 66.6%, 0.61 respectively, while those of AL/CR were 90.6%, 81.3%, and 0.72. Conclusion In a large-scale myopia screening, AL/CR could be used as an effective and accurate method instead of cycolplegic refractometry. （Ophthalmol CHN, 2012, 21: 327-330）

Efficacy of Ritleng lacrimal intubation for congenital nasolacrimal duct obstruction after unsuccessful probing

WU Qian, YU Gang, QUAN Xiao-Jie, CAO Wen-Hong, FAN Yun-Wei, CUI Yan-Hui, ZHANG Cheng-Yue, LIN Qi, WANG Yuan, CUI Jie, HU Man, LIU Wen, LI Cheng, ZHANG Yan

2012, 21(5): 331-335.

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Objective To investigate the clinical efficacy of Ritleng lacrimal intubation for congenital nasolacrimal duct obstruction after unsuccessful probing. Design Retrospective case series. Participants 300 patients(387 eyes) with congenital nasolacrimal duct obstruction who underwent unsuccessful probing. Methods Different anaesthesia methods were applied in Ritleng lacrimal intubation. Different anaesthesia methods, infection and times of probing that may influence successful rate of the surgery were analyzed retrospectively. Operation complications were also analyzed. The followed-up period varied from 12 to 34 months. Main Outcome Measures Patient number and percentage of cure, and the complications. Results Operation was successful in 87.08% (337/387 cases) of all the eyes. Operation under topical anesthesia was successful in 87.33% (255/290 cases) of eyes. Operation under general anesthesia was successful in 86.31% (82/95 cases) of eyes. Operation was successful in 90.70% (273/301) of eyes without dacryocystitis. Operation was successful in 74.41% (64/86) of eyes with dacryocystitis. The difference was significant (P=0.00). Operation success rate was 94.37% (201/213), 86.11% (93/108), and 65.15% (43/66) in eyes that had undergone probing once, twice and more than two times respectively. Conclusion Ritleng lacrimal intubation has high cure rate and low complications. So it is the suitable operation method for congenital nasolacrimal duct obstruction after unsuccessful probing. （Ophthalmol CHN, 2012, 21: 331-335）

The short-term comparison of three kinds of cortisteriod eye drops for the provention of DLK after LASIK

MAO Wei, Lu-Bin, Zhang-Zhe, Li-Cheng

2012, 21(5): 336-339.

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Objective To compare the effects of three kinds of cortisteriod eye drops after laser in situ keratomileursis (LASIK) for myopia. Design Retrospective case series. Participants 300 patients (600 eyes) who accepted LASIK and were followed up for three month or more from Dec. 2009 to Feb. 2010 in Ningbo Eye Hospital were included. Methods The patients were divided into three groups according to the different post-operative medicines: Loteprednol group, Dexamethasone group and Flumetholon group. There were 100 patients in each group. For all the three groups, uncorrected visual acuity(UCVA), spherical equivalent(SE), diffuse lamellar keratitis (DLK), the sensation of dry eye, intraocular pressure (IOP) were observed preoperatively and at 1st day, 1st week, 3rd week, 3rd month postoperatively. Main Outcome Measures UCVA, SE, the grade of DLK, the score of sensation of dry eye, and IOP. Results It was similar on the changes of UCVA and SE, the score of eye dry sensation and IOP after operation among three groups at different time point (all P>0.05). At 1st week after LASIK, the incidence of DLK was similar between Loteprednol group（1%） and Dexamethasone group（2%）, but significantly lower than Flumetholon group（15%, χ2=26.6 and 21.7, respectively, both P <0.01）. Corticosteroid-induced ocular hypertension happened in 2 cases in Dexamethasone group, while there was none in Loteprednol group and Flumetholon group. Conclusion Comparing with the Flumetholon eye drops, transient usage of Loteprednol eye drops after LASIK for myopia is effective to reduce DLK, which had similar effects as Dexamethasone eye drops, and corticosteroid-induced ocular hypertension was not observed. （Ophthalmol CHN， 2012，21： 336-339）

Effect of negative pressure suction during femtosecond laser assisted LASIK on retinal nerve fiber layer thickness

DANG Guang-Fu, Lei-Yu-Lin, Zheng-Xiu-Yun, Meng-Xiao-Li, Zhang-Jian-Hua

2012, 21(5): 340-343.

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Objective To investigate the influence of the negative pressure suction during femtosecond laser assisted LASIK on the macular retinal thickness and retinal nerve fiber layer thickness in myopia eyes. Design Prospective, comparative case series. Participants One hundred and forty three myopia patients (279 eyes) were enrolled in the study． Methods The thickness of macular central fovea and retinal nerve fiber layer thickness were measured using optical coherence tomography(OCT) before and after femto second laser assisted LASIK． The myopic eyes were divided into two groups, the high myopia(<-6.00 D) group and medium to low myopia (≥-6.00 D) group. The macular (or RNFL) scan pattern come from three 3 mm (or 3.4 mm) diameter circular scans centered on macular central fovea (or the optic nerve head ) acquired in rapid succession. Main Outcome Measures Macular and RNFL thickness. Results Before surgery there were no statistical difference between the two groups（P>0.05）. After 1 year, in the low and medium myopia group and the high myopia group, the average thickness of fovea and average RNFL thickness in superior, nasal, inferior, and temporal were (147.2±18.3)μm, (62.4±15.7)μm, (94.3±20.2)μm, (136.4±17.6)μm, (131.3±21.7)μm;（149.3±18.7）μm, (59.3±19.0)μm, (90.7±17.2)μm, (129.2±25.1)μm, (123.3±21.8)μm respectively. None of the macular thickness and RNFL thickness parameters were found to have a significant change between preoperation and 1 year after surgery. Conclusions Negative pressure suction during femtosecond laser LASIK dont't significantly affect the macular retinal thickness and RNFL thickness parameters postoperatively. （Ophthalmol CHN, 2012, 21: 340-343）

The characteristics of OCT in follow-up of Vogt-Koyanagi-Harada disease

SHI Xue-Hui, Wei-Wen-Bin, Yang-Li-Hong, Ding-Ning, Tian-Bei

2012, 21(5): 344-348.

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Objective To analyze the optical coherence tomography（OCT）characteristics of acute Vogt-Koyanagi-Harada disease(VKH) with standard corticosteroid treatment, and to evaluate the possibility of using OCT to monitor the progress and to predict the prognosis in acute and recovering phase of VKH. Design Retrospective case series. Participants 26 eyes of 13 patients with acute-phase VKH disease treated and followed up in out-patient department of Beijing Tongren Hospital between Oct. 2010 and Aug. 2011 were included. Methods All the patients were treated with prednisone 1.5 mg/kg/d for three to seven consecutive days, and then the dose of prednisone was reduced gradually. Best corrected visual acuity (BCVA) was checked, and HRA-OCT images were obtained at the initial visit and 4 days to 8 months periodically after corticosteroid treatment. Follow-up technique was used to make sure the same scan line in every OCT checkup time. BCVA，retinal morphological characteristics and central retinal thickness(CRT) were analyzed before and after the treatment. Main Outcome Measures BCVA, retinal morphological characteristics and CRT. Results The mean BCVA at 4-7 days, 1 month, 3 months and 6-8 months after treatment was 0.55±0.24, 0.64±0.20, 0.62±0.15, 0.64±0.14 respectively, improved significantly than that before treatment（0.21±0.13, F=23.47， P=0.000). The mean BCVA improved significantly in the first 4-7 days, and had little change in 1 month, then kept steady in 3 months. OCT showed serous retinal detachment and destruction in the outer part of neuro-retina in acute-phase of VKH. All of the sub-retinal exudates were absorbed 1 month after systemic corticosteroid treatment. IS/OS reflex recovered in 57.69% of the eyes in 1 to 3 months. The mean CRT was 535.29±287.70 μm before treatment, and 252.33±54.02, 177.25±22.39, 188.25±25.50, 176.43±21.35 μm respectively at 4-7 days, 1 month, 3 months and 6～8 months post-treatment, the difference had statistics significance (F=13.01，P=0.00) . The differences of CRT between pre-treatment and 4-7 days after treatment, 4-7 days and 1 month after treatment were statistically significant （P=0.010, 0.005 respectively）. The difference among the 1 month and 3 months post-treatment, 6～8 months post-treatment was not significant（P=0.984, 1.000）. The BCVA was significantly inversely correlated with CRT（r=－0.380, P=0.04）. Conclusion OCT may show the progress of neuro-retinal recovery and CRT changes, thus provide a valuable method to monitor the diagnosis and predict the prognosis of VKH. （Ophthalmol CHN, 2012, 21: 344-348）

The influence of ocular hypertension to corneal endothelium in eyes of endophthalmitis with forward migration of silicone oil into the anterior chamber

ZHENG Peng-Fei, Liu-Jing-Hua

2012, 21(5): 348-351.

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Objective To evaluate the influence of ocular hypertension to corneal endothelium cell density in eyes with forward migration of silicone oil into the anterior chamber in treated endophthalmitis with vitrectomy. Design Retrospective case series. Participants 19 eyes of 19 cases with endophthalmitis after surgery of lens extraction, vitrectomy and silicone oil tamponade from Nov. 2006 to Nov. 2011 in Beijing Tongren Hospital. Method All the eyes were filled with silicone oil after vitrectomy. According to intraocular pressure before silicone oil removal from Nov 2006 to Nov 2011 in Beijing Tongren Hospital, 19 eyes were classified into two groups: group A (IOP＞21 mm Hg) 12 eyes and group B (IOP≤21 mm Hg) 7 eyes. The corneal endothelial cell densities of 19 eyes were observed 1 month after removal of silicone oil. Main Outcome Measures IOP and corneal endothelial cell densities. Results One month after removal of silicone oil, corneal endothelial cell densities≥1000/mm2 was found in 2 cases of group A (2/12, 16.7%), 5 cases of group B(5/7, 71.4%); corneal endothelial cell densities <1000/mm2 was found in 10 cases of group A(10/12, 83.3%), 2 cases of group B(2/7, 28.6%). The difference was significant (P=0.045). The corneal endothelial cell densities≥1400/mm2 was found in 1 case of group A (1/12, 8.3%), 5 cases of group B (5/7, 71.4%) respectively; corneal endothelial cell densities<1400/mm2 was found in 11 cases of groupA (11/12, 91.6%), 2 cases of group B(2/7, 28.6%). The difference was significant (P=0.01). Conclusion The high ocular hypertension in eyes with forward migration of silicone oil into the anterior chamber may cause great damage to corneal endothelial cell densities. （Ophthalmol CHN, 2012, 21: 348-351）

The therapy and the risk factors for ocular adnexal mucosa-associated lymphoid tissue lymphoma transformation into DLBCL

LI Yu-Zhen, WEI Rui-Li, CAI Ji-Ping, LI You, CHENG Jin-Wei

2012, 21(5): 352-356.

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Objective To study therapy and the risk factors for ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma transformation into diffuse large B cell lymphoma (DLBCL) so as to find suitable operation to reduce the incidence of postoperative complications as well as to improve the survival rate of patients. Design Retrospective case series. Participants 79 patients with biopsy-proven ocular adnexal MALT lymphoma in Changzheng hospital affiliated to Second Military Medical University from January 1997 to June 2010. Methods The clinical features, therapy (including surgery and radiation therapy) and prognosis of 79 patients were retrospectively reviewed. Surgery included complete excision and partial excision. Prognosis including survival rate and the risk factors for transformation to DLBCL was assessed.　Main Outcome Measures The clinical features, surgery therapy, radiation therapy, survival rate, the risk factors for transformation to DLBCL. Results All cases were treated by operation. Fifty eight cases were treated with complete excision tumorectomy, while 21 cases with partial excision. All the patients received local radiotherapy on the eyes. There were 6 cases transformed from ocular adnexal MALT lymphoma into DLBCL. Radiotherapy was found to be benefitial for the controlling local symptoms of ocular adnexal MALT lymphoma. Bilateral onset （P=0.0221） and the initial reaction to radiotherapy （P=0.0033） were found to be correlated with the transformation from ocular adnexal MALT lymphoma into DLBCL. Nonetheless, gender, age, locations, tumor size and surgical procedures had no effects on the transformation. Conclusions Bilateral onset and the initial reaction to radiotherapy are correlated with the transformation from ocular adnexal MALT lymphoma into DLBCL. Nonetheless surgical procedures are of no effect on the transformation. However, selecting a suitable operation could reduce the incidence of postoperative complications. （Ophthalmol CHN, 2012, 21: 352-356）

Cultivating the thinking mode of evidence-based medicine for retinal postgraduate students

ZHANG Xin-Yuan

2012, 21(5): 357-359.

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With the developments in the fields of medicine and biomedicine, physicians are not only required to have a high level of clinical skills, but more emphased to have understanding, analysis, synthesis, inferring and practicing abilities to adapt to the needs of modern medicine. The modern evidence-based practice emphasizes the "student-based, problem-based" educational model. Raising clinical questions using the PICOT (population, intervention, comparator, outcome, time) principle is extremely important for the medical graduates in their clinical practice training, especially for the retinal graduate students. Utilizing the evidence-based medicine resources as much as they can, practicing actively, cultivating the science of clinical thinking are all necessary. Cultivating the evidence-based thinking mode has special significance for those who want to be an excellent retinal specialist. (Ophthalmol CHN, 2012, 21: 357-359)

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