Table of Content

25 November 2016, Volume 25 Issue 6

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Orbital scintigraphy with somatostatin analogue for the diagnosis of thyroid associated ophthalmopathy

SUN Bin

2016, 25(6):  361-364.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.001

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Orbital scintigraphy with ⁹⁹Tc^m-somatostatin analogue plays an important role in the diagnosis and treatment of patients with thyroid associated ophthalmopathy(TAO). It can be used to determine the orbital inflammatory activity, early diagnose the diseases, determine the need for treatment and select treatment options. At the same time, it also provides an important objective evidence for the evaluation of curative effect, prognosis prediction and related clinical research. Therefore, the application of orbital scintigraphy with ⁹⁹Tc^m-somatostatin analogue in TAO not only helps to standardize the diagnosis and treatment of the disease and obtain the best curative effect and prognosis, but also can effectively improve the overall level and efficiency of clinical diagnosis and treatment. (Ophthalmol CHN, 2016, 25: 361-364)

Clinical features and orbital imaging diagnostic values for pediatric thyroid associated ophthalmopathy

BAO Chun-li1, LI Ting2, SUN Bin2

2016, 25(6):  366-370.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.002

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Objective  To investigate the clinical characteristics and the ⁹⁹Tc^m-octreotide scintigraph orbital imaging diagnostic values for pediatric thyroid associated ophthalmopathy (TAO). Design Retrospective case series. Participants During October 2008 to July 2015, 20 children were diagnosed as TAO in First Hospital of Shanxi Medical University. Methods We reviewed clinical manifestations, and medical records of 20 children in whom TAO was diagnosed. To evaluate the diagnostic value of the ⁹⁹Tc^m-octreotide scintigraph tomography, 13 children had TAO served as experimental group, 25 adult patients diagnosed as TAO and 30 healthy adult volunteers were involved as control group. The orbital ⁹⁹Tc^m-somatostatin analogues uptake ratio were compared among the groups. Main Outcome Measures Thyroid function，ophthalmic signs, exophthalmometry, ocular movement, B-mode ultrasound, 99Tcm-octreotide scintigraph tomography. Results Among 20 patients with a mean age of 10.85±1.42 years old with TAO, 5 of them were male and 15 female (F:M=3:1). 18(90%) cases had hyperthyroidism and 2(10%) were euthyroid. The mean duration of dysthyroid symptoms was 12.48±10.33 months (10 days~36 months) while the mean duration of ocular symptoms was 10.40±10.17 (1~36) months. TAO occurred bilaterally in 18 patients. Eyelid retraction was presented in 17 patients (85%), whereas the approximate frequency of exophthalmos was 19 patients (95%). Restrictive extraocular myopathy happened in 2 patients (10%). Extraocular enlargement was detected on B-mode ultrasound in 10 of 13(76.9%) patients who were evaluated. The frequencies of two enlarged muscles, three enlarged muscles and four enlarged muscles were 38.5%, 30.8% and 7.7%, respectively. Medial, inferior, superior and lateral rectuses enlarged in 75%, 65%, 40% and 10% of the orbits respectively. The UR level was not significantly different in children patients and adult patients (P=0.294), while in both patient group it was significantly higher compared to the normal adult control group (P＜0.01). UR did not show difference between bilateral eyes (P=0.372). Conclusion Bilateral eye involvement, eyelid retraction and exophthalmos were the most common clinical signs of pediatric TAO. Pediatric patients with abnormal thyroid function should be routinely followed up for at least 1 year by eye doctorts. The ⁹⁹Tc^m-somatostatin analogue orbital imaging has diagnostic value for pediatric TAO. (Ophthalmol CHN, 2016, 25: 366-370)

Value of conventional MRI, DWI and DCE-MRI in the diagnosis of primary orbital lymphoma

DONG Yang, QU Xiao-feng, LIU Wei, CHEN Hong-hai

2016, 25(6):  371-375.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.003

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Objective To analyze characteristics and diagnostic value of conventional Magnetic Resonance Imaging (MRI) combined with Diffusion Weighted Imaging (DWI) and dynamic contrast-enhanced MRI for the orbital lymphoma. Design Retrospective case series. Participants Twenty-one orbital lymphoma patients confirmed by pathology. Methods All patients underwent MR T1-weighted, T2-weighted and enhanced T1-weighted examinations, three patients underwent DWI and eight patients underwent dynamic contrast enhanced （DCE） MR imaging. Main Outcome Measures Focal location and extents, shape, boundary, relationship with the adjacent structures, the characteristics of MR signal (general sequence and DWI) and the time-intensity curve （TIC）. Results 17 patients had unilateral orbital lesions and 4 cases had bilateral orbital lesions. 16 orbits' lesions were local and 9 orbits were diffuse. The lesions involved anterior compartments in six orbits, lacrimal areas in seven, intraconal spaces in six, orbital muscles cones in four, extraconal spaces in twelve, optic nerve areas in two and subperiosteal area in one. Ten lesions' shapes were nodosity, nine lesions grew as "casting mould", two were pacity, and the exteaocular muscles or optic nerves were enlarged or wrapped in seven orbits. The lesions' margins of thirteen orbits were sharp and of twelve orbits were indistinct. The masses appeared iso-intensity in twenty-three orbits and slightly lower in two orbits on T1WI. The masses appeared iso-intensity in nineteen orbits, slightly higher signal in one orbit and slightly lower in five orbits on T2WI. The lesions in four orbits appeared iso-intensity on DWI. The lesions were enhanced markedly and homogeneously in twenty-four orbits but one. The TIC showed platform pattern in seven orbits, inflow-outflow pattern in nine and mixed pattern in one.  Conclusion Conventional MRI can show the orbital lymphoma's location, shape, internal characteristics and the relationship with the surrounding structures. DWI and DCE-MR imaging provide the benign and malignant information about the lesion. （Ophthalmol CHN， 2016, 25: 371-375）

Characteristics and risk factors of bilateral nonarteritic anterior ischemic optic neuropathy

WANG Lei1, HUANG Hou-bin1, WANG Wei2, TAN Shao-ying1, WEI Shi-hui1

2016, 25(6):  377-380.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.004

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Objective To compare the clinical characteristics and risk factors of unilateral and bilateral onset in non-arteritic anterior ischemic optic neuropathy (NAION) patients. Design Retrospective case series. Participants A total of 201 patients of NAION were recruited in Department of Ophthalmology of PLA General Hospital from October 2009 to March 2015. Methods Differences in clinical characteristics, including disease history, laboratory tests, carotid artery ultrasound, brain magnetic resonance imaging (MRI), polysomnography (PSG) and ambulatory blood pressure monitoring (ABPM), between groups were analyzed using Chi-square test or t-test. Main Outcome Measures Age, gender, systemic disease, medications taken and anatomy of optic disc. Results Among the 201 NAION patients, 67 patients were bilateral onset (6 of them happened bilaterally simultaneously or with an internal less than 1 week between the two eyes) and the other 134 patients were unilateral onset. There was no difference found between the two groups in age (54.69±10.43 vs 54.47±9.90 years old, P=0.988) and gender (Male: Female: 1.34:1 vs 2.05:1, P=0.22). Compare to the unilateral group, the bilateral group showed a higher percentage of hypertension (52.2% vs 37.3%, P=0.04), lower percentage of noctural hypotension (19.2% vs 37.2%, P=0.026), more frequent using of hypotensors (65.7% vs 40.3%, P=0.03) , more frequent coexisting with obstructive sleep apnea syndrome (OSAHS) (35.4% vs 21.2%, P=0.036), and more frequent of obesity(17.9% vs 9.7%, P=0.031). There were no significant differences in smoking and drinking status, diabetes, dyslipidemia, carotid atherosclerosis, cerebral infarction, homocysteine serum cystine, crowded disc, or precipitating factor. Conclusions Hypertension, hypotensive medications, obesity and coexist with OSAHS may be risk factors for the development of bilateral NAION. (Ophthalmol CHN, 2016, 25: 377-380)

Ocular manifestations of 45 cases with Stevens-Johnson syndrome

HE Yan1, ZHANG Ai-xue2, WANG Zhi-qun2, ZHANG Yang2, SUN Xu-guang2

2016, 25(6):  382-386.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.005

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Objective To report the clinical ocular features of patients with Stevens- Johnson syndrome (SJS). Design Retrospective case series. Participants 90 eyes in 45 patients with a history of SJS and ocular involvement between August 2010 and June 2014 at Beijing Tongren Eye Center. Methods The clinical charactristics of 45 patients with a history of SJS were reviewed, and the data were analyzed with statistical software. Main Outcome Measures  The information collected for analysis included the ophthalmological history, visual acuity, adjunct treatments, and complications. Results A total of 45 patients (90 eyes) were recorded, 21 males (46.7%), with the average age of 28.0±20.2 years old. Average onset-treatment interval wsa 43.2±75.9 months. In the 90 affected eyes, 15 eyes (16.6%) were mild affected with an average BCVA LogMAR 0.55±0.91, 25 eyes (27.8%) were moderately affected with an average BCVA LogMAR 0.52±0.82, and 50 eyes (55.6%) were severely with an average BCVA LogMAR 1.33±1.05. Difference in BCVA between severe and other two groups were significant (P=0.038), and the differences of affected age and affected interval between severity groups had no statistical significance (P=0.47, 0.143 respectively). Sixty-eight eyes(75.6%) were complicated with dry eye disease, 63 eyes(66.7%) had cornea involvement, and 70 eyes (77.8%) experienced dysfunction of eyelids and meibomian glands. Conclusions SJS is potential vision threatening general disease. Severity of ocular surface lesion does not associated with age, gender, and duration. With careful patient care for secondary dry eye disease, eyelid abnormality and corneal neovascularization, reasonable life quality may frequently be achieved. (Ophthalmol CHN, 2016, 25: 382-386)

Correlation between infection with demodex folliculorum of eyelid margin and meibomian gland dysfunction

ZHANG Xiao-yu, WANG Zhi-qun, ZHANG Yang, SUN Xu-guang

2016, 25(6):  387-390.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.006

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Objective To analyze the correlation between demodex infection and meibomian gland dysfunction(MGD). Design Prospective case series. Participants 60 patients (60 eyes) diagnosed with MGD in Beijing Tongren Hospital between September 2015 and March 2016 were included. The average age was 43.10±12.64 years-old. Methods Patients were divided into MGD with inflammation (group A, 38 cases) and MGD without inflammation (group B, 22 cases) according to congestion of lid margin. According to the number of demodex per eye, the group A patients were divided into 3~6 (group a), 7~10 (group b) and ＞10 (group c). The positive rate of demodex and its correlation with sign scores were analyzed. Main Outcome Measures Positive rate of demodex, manifestation of lid margin and the secretion function of meibomian gland. Results The positive rate of demodex in group A was 86.84%, significantly higher (P=0.001) than that of group B 18.18%. All sign scores of group A were significantly higher than group B(P＜0.01) except meibomian gland dropout (P=0.09). The scores of lid margin scales and meibomian gland secretion were significantly different among group a, b and c. There were significant positive correlations between the number of demodex and lid margin scales, and meibomian gland secretion (P=0.001), while no correlations between the number of demodex and congestion of lid margin, the characters of meibum or meibomian gland dropout (P=0.197; P=0.114; P=0.988). Conclusions Demodex may cause or aggravate the degree of MGD by causing eyelid inflammation. It is noteworthy to detect Demodex for MGD patients with blepharitis. (Ophthalmol CHN, 2016, 25: 387-390)

Clinical and OCT image characteristics of acute macular neuroretinopathy

TENG Yu-fei1, ZHENG Yi2, YU Xu-hui2, TENG Yan2

2016, 25(6):  391-395.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.007

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Objective To investigate the clinical and image features of acute macular neuroretinopathy (AMN). Design Retrospective case series. Participants Five eyes of 5 patients with AMN recruited from First Clinical Medical College Affiliated Hospital of Harbin Medical University from 2009 to 2015. Methods The clinical data and ocular examination results were collected for comprehensive analysis. Main Outcome Measures Clinical features, ocular fundus changes, spectral-domain optical coherence tomography (SD-OCT) images. Results 4 patients were young women, who had an acute onset of visual symptoms at presentation, including blurred vision and shadows. One patient had a preceding cold and fever. Fundoscopic examination revealed a round-shape, dark reddish-brown lesion at posterior area in 3 affected eyes, circular light orange pigmentary changes at the macula in 1 eye; a dark-red lobulated intraretinal subtle irregularities in inferior temporal macula in 1 eye. SD-OCT at presentation disclosed the focal loss of the ellipsoid zone and interdigitation zone in all affected eyes. Two patients showed a high reflective lesion in lateral outer nuclear layer. One patient showed a complete disruption of the ellipsoid zone and a focal disruption of the interdigitation zone, a hyperreflectivity in the outer side of the external limiting membrane and the outer nuclear layer was thinner. In one case with unknown onset time, SD-OCT exhibited the end of the disrupted external limiting membrane was connected to the RPE layer. The outer nuclear layer was thinned with the thickened inner and outer plexiform layers overlying. A focal depression in inner and outer plexiform layer and inner nuclear layer was found as well. Conclusion The 4 cases of AMN happened in young women. Fundus examination showed a dark-red lesion in macular area. SD-OCT revealed the focal loss of the ellipsoid zone and interdigitation zone with hyperreflectivity in photoreceptor layer in early stage. And late stage showed the loss and damage of the ellipsoid zone and interdigitation zone. (Ophthalmol CHN, 2016, 25: 391-395)

The effects of refractive errors on stereoacuity in patients with intermittent exotropia

HONG Jie, FU Jing, ZHAO Bo-wen, ZHAO Guo-hong, WANG Jing-hui, SUN Xing-li, LI Lei

2016, 25(6):  396-399.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.008

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Objective To evaluate and compare stereoacuity with respect to refractive error in intermittent exotropia (IXT). Design Retrospective case series. Participants 238 patients with IXT undergoing strabismus surgeries in Beijing Tongren Hospital from Jul 2014 to Aug 2015 were involved. Methods All patients were divided into four groups according to preoperative refractive error: IXT with hyperopia (binocular spherical equivalent (SE)≥+1.00 D ), IXT with emmetropia (-1.00 D＜binocular SE＜+1.00 D), IXT with myopia (binocular SE≤-1.00 D), and IXT with anisometropia (binocular SE difference≥1.00 D). The stereoacuity at distance and near were compared among the four groups. Main Outcome Measures Stereoacuity at distance and near. Results  (1) The mean near deviation of 238 IXT patients was (45.71±18.81)△ and mean distant deviation was (43.98±19.55)△. The ratio of having distant stereoacuity in IXT with hyperopia, IXT with emmetropia, IXT with myopia and IXT with anisometropia were 23.3%, 15.5%, 19.7% and 18.8%. There was no significant different in distance stereoacuity among the four groups. The ratio of having near stereoacuity in IXT with hyperopia, IXT with emmetropia, IXT with myopia and IXT with anisometropia were 66.7%, 79.8%, 81.6%, 64.6%. The near stereoacuity was most serious damaged in IXT with anisometropia while slightest in IXT with myopia. There was significant difference in near stereoacuity between IXT with anisometropia and IXT with myopia (P=0.033). (2) The prevalence of IXT with anisometropia was 20.1%, and myopia anisometropia had highest prevalence while hyperopia anisometropia had lowest prevalence (12.6% vs 1.3%).  (3) The mean difference in SE between each eye in IXT with anisometropia with and without distant stereoacuity were 2.35±0.75 D and 2.34±1.75 D(P=0.21). The mean difference SE in between each eye in anisometropia without near stereoacuity was significantly bigger than in that with near stereoacuity (3.11±2.29 D vs. 1.93±0.83 D, P=0.002). Conclusion For the IXT patients with large deviation, refractive errors have little effect on distant stereoacuity, but anisometropia damages the near stereoacuity. The greater degree of anisometropia, the more serious damage of near stereoacuity occurred. (Ophthalmol CHN, 2016, 25: 396-399)

Using targeted sequence capture and high throughput sequencing to detect pathogenic genes of congenital fibrosis of extraocular muscles

JIA Hong-yan1, JIAO Yong-hong1, CHANG Qing-lin2, HUA Lin3, WANG Hui1, GUO Rui1

2016, 25(6):  400-404.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.009

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Objective To identify the pathogenic genes of  congenital fibrosis of extraocular muscles (CFEOM) in Chinese pedigrees and sporadic patients. Design Experimental study. Participants Six Chinese families and four sporadic patients with CFEOM were enrolled. Methods Clinical data and magnetic resonance imaging (MRI) of the ocular motor nerves were collected. Genomic DNA was isolated from peripheral blood samples of family member. Mutation analyses of eleven candidate genes were performed to detect the potential mutation by using targeted exome sequencing. After bioinformatic analysis, the nucleotide substitutions of candidate genes were verified by polymerase chain reaction (PCR) and Sanger sequencing in 100 unrelated normal control individuals, then the analysis for genotype-phenotype correlation was performed. Main Outcome Measures Gene sequences. Results We identified two heterozygous KIF21A mutations c.2860C>T(p.R954W) and c.2861G>A(p.R954Q) in 80% (8/10) probands；two heterozygous TUBB3 mutations c.784C>T (p.R262C) and c.1138C>T (p.R380C) in 20%(2/10) probands. These changes were not found in normal family members and 100 normal control individuals. The patients with KIF21A mutations showed phenotypes of CFEOM1A and CFEOM3B, however the patients with TUBB3 mutations showed CFEOM3A. Conclusions KIF21A gene mutations are the leading cause of Chinese CFEOM patients. High throughput gene screening could assist clinical diagnosis and phenotyping quickly and accurately. (Ophthalmol CHN, 2016, 25: 400-404)

Primary culture of human corneal limbal epithelial cells on poly(ethylene glycol)-based hydrogel films

GUO Yi-yuan1, SHI Yan1,JIN Xin1, XIAN Hui-min2, LUAN Gui-xia3， ZHANG Hong1

2016, 25(6):  405-408.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.010

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Objective  To observe the biological characteristics of corneal limbal epithelial cells (CLEC) and compare the cell proliferation rate on common culture dish and poly(ethylene glycol)-based hydrogel films(PHF). Design  Experimental study. Participants  Human corneal limbal epithelial cells. Methods  CLEC were cultured by explant culture method in vitro and placed on common culture dish or PHF until growth to exponential phase. The growth characteristics of the cultured cells were observed under inverted microscope and using immunostaining method. The cell proliferation rate between the two groups was analyzed using CCK-8 assay. Main Outcome Measures The CLEC growth under light microscope, AE1 staining, the optical density(OD) of CCK-8 assay. Results The two groups of CLEC can migrate，amplify and become confluent. The proliferation speed of PHF group was the same as common culture dish group under optical microscope. AE1 positive rate of PHF group(73.26±8.84%) was the same as common culture dish group(70.84±3.51%). There was no statistically significant difference of the OD between PHF group (0.89±0.06, 1.13±0.10, 1.24±0.03, respectively)and common culture dish group(0.89±0.03, 1.08±0.04, 1.28±0.09, respectively) at 12h、24h、48h (P=0.79, 0.36, 0.76, respectively). The relative growth rate of PHF group at 12h、24h、48h (99.12±4.81%, 103.74±5.55%, 97.83±13.37%,  respectively) were all higher than 75% (P=0.37, 0.90, respectively). Conclusion PHF is a good carrier for amplification of corneal limbal epithelial cells. (Ophthalmol CHN, 2016, 25: 405-408)

Influence factors of Fr2 double-passage silicone intubation for lacrimal duct obstruction

XIE Lai-qing, XU Guo-xu, ZHANG Ji, WEI Xiao-hong, JI Xiao-yan, WEI Jing

2016, 25(6):  409-413.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.011

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Objective To evaluate associations of the success rate of Fr2 silicone intubation for lacrimal duct obstruction. Design Retrospective case series. Participants 332 lacrimal duct obstruction cases (394 eyes). Methods 332 lacrimal duct obstruction cases (394 eyes) were analyzed based on obstructed severity and location, with dacryocystitis or not, previous probing, the operational method, the post-operative irrigation, the timing of silicone tube removal and the number of operations. The success rate of Fr2 silicone intubation was assessed based on the complaints of the patient, the silicone tube removal at post-operative 1 month and the presence of complications. Main Outcome Measures The success rate of silicone intubation. Results Total success rate of intubation was 87%, among which the success rate for the mono-segmental blocking group (n=257) was 92.61%, while it was only 75.91% in the multi-segmental occlusion group (n=137) (χ2＝21.741, P＝0.001 ). The effective rate of intubation in the canaliculusocclusional cases (92.07%) was higher than in the nasolacrimal occlusional cases(84.34%) (χ2＝3.502, P＝0.047). There is no significant difference in effective rate for the nasolacrimal occlusional cases with chronic dacryocystitis (87.72%) and for the cases without dacryocystitis (76.92%) (χ2＝1.576, P＝0.175). With the increase number of pre-operative probing, the efficiency of intubation decreased (χ2＝30.252, P<0.001). The efficiency was only 64.92% in cases with pre-operative probing more than 10 (P<0.05). YAG lacrimal duct formation combined silicone intubation was better than simple silicone intubation in obstruction of canaliculus (χ2＝6.505, P＝0.012). The effective rate was 90.10% in the irrigation1~4/mon group but it was 85.50% in the irrigation ＞4/mon group and 74.47% in the irrigation ＜1/mon group (χ2＝8.219, P＝0.016). Early (<6 weeks, 47.62%) or late (＞6 months, 66.67%) tube removal significantly reduced catheter intubation efficiency (91.63% in the 6 weeks to 3 months group and 88.16% in the 3 to 6 months group) (χ2＝38.880, P＝0.000). The effective rate for the first-surgery group was higher than that of reoperation cases (χ2＝15.548, P＝0.006). Conclusion The obstructed severity, obstructed location, chronic dacryocystitis, pre-operational probing, post-surgery irrigation and the extubation time affect the success rate of Fr2 intubation. YAG lacrimal duct formation combined silicone intubation is better than simple silicone intubation in obstruction of lacrimal canaliculus. (Ophthalmol CHN, 2016, 25: 409-413)

Comparative study on the main academic index of the Chinese ophthalmology journals in 2010-2014

FANG Hong-ling, DONG Jian-jun, SHENG Li-na, FU Zhong-jing, LIU Xue-li

2016, 25(6):  413-417.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.012

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Objective To explore the trend of the development of academic influence of the major ophthalmology journals in China in 2010-2014. Design Retrospective data analysis. Participants The major ophthalmology journals in China. Methods Based on the citation reports of the science and technology of China in 2011-2015, we compared the citation rates, impact factors, grant supported rates of the papers published in ophthalmology journals in China. Main Outcome Measures Impact factor, total cited frequency, others citation rate, number and proportion of funded papers and comprehensive evaluation score. Results From 2010 to 2014, the Chinese Journal of Ophthalmology had the highest total citation frequecy (2318, 2584, 2717, 2616 and 2278 respectively), followed by the International Ophthalmology Review with 12 336 papers published in the journal. The top five journals of impact factor were the Chinese Journal of Ophthalmology, Chinese Journal of Ocular Fundus Diseases, Recent Advances of Ophthalmology, Chinese Journal of Strabismus and Pediatric Ophthalmology, Ophthalmology in China. And their comprehensive evaluation score were 79.58, 41.28, 45.20, 26.24, 38.88 respectively.  Conclusion Development of journals in the field of Chinese ophthalmology is imbalanced. （Ophthalmol CHN， 2016, 25： 413－417）

Analysis of articles on ophthalmology published in JAMA from the year 2000 to 2014

SUN Yun-yun1, MENG Bo2, LI Shi-ming1, KANG Meng-tian1, WANG Jia-nan1, RAN an-ran1, WANG Ning-li1

2016, 25(6):  418-422.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.013

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Objective To understand the hot spots and breakthrough on ophthalmology by searching and reading articles published in The Journal of American Medical Association（JAMA） from the year 2000 to 2014.  Design Literature search and analysis．Participants Articles on ophthalmology were published from Jan. 2000 to Feb. 2014 in JAMA. Methods In Pubmed database, we chose the database “JAMA” and then selected “MeSH Terms” and inputted “eye” and all its inferior MeSH terms. Further screening was done by reading titles and abstracts of the articles as well as reading the necessary part of the full article. Main Outcome Measures Literature types. Results Among 92 included articles, 26 (28.3%) were original articles，38 (41.3%) were comments, 6 (6.5%) were letters, 10(10.9%) were reviews and 12(13.0%) were case reports． When classified by research content, 30 (32.6%) articles were mainly about etiology and risk factors, 14 (15.2%) were about treatment and 21(22.8%) were about comprehensive evaluation of disease. According to research type of the 26 original articles, 8 articles were cohort study, 6 articles were longitudinal study, 5 articles were cross-sectional study, 3 articles were case-control study, 3 articles were RCTs (including one multicenter randomized controlled trial) and another one paper. In terms of the nationality of authors, American accounted for 58 (63.0%) pieces, Britain and Canadian both accounted for 6 (6.5%) pieces, Chinese accounted for 1 (1.1%) comment, Chinese in Taiwan accounted for 1 (1.1%) case report and others accounted for 20 (21.7%) pieces. As for disease types, the most concerned disease was age related macular degeneration (AMD), accounting for 14 (15.2%) pieces and 6 articles of them were about etiology and risk factors of AMD. Following was about cataract, accounting for 13 (14.1%) pieces and 7 articles were about prognosis of operation. Retinal detachment accounted for 10 (10.9%) pieces while diabetic retinopathy accounted for 9 (9.8%) pieces.  Conclusion The focus of JAMA in ophthalmology was on etiology and treatment of retinal disease like AMD and prognosis of cataract operation. While in methodology, cohort study, longitudinal study and cross-sectional study were most often used. What’s more, it showed obvious local characteristics that most papers were published by American authors. (Ophthalmol CHN， 2016, 25： 418-422)

Evaluation of slit lamp microscope imaging system and operative microscope video acquisition system in clinical education

PAN Zhi-qiang, DONG Xiao-juan, ZHANG Ying-nan

2016, 25(6):  423-425.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.017

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The diagnosis of ocular surface disease is one of the most important courses for residents. It is easy to grasp the ocular surface operation skill. However, because of the restriction of the patient and the operation condition, it is very difficult for teaching. Slit lamp microscope imaging system and operative microscope video acquisition system can help residents to observe the ocular surface and save the patients’ data. It makes the diagnosis and operation to be specific. Imaging and video system combined with the other teaching methods, make the training of residents comprehensive. (Ophthalmol CHN, 2016, 25: 423-425)

The significance of step-by-step training in the education of graduate students of the department of ophthalmology

DONG Zhe, SONG Xu-dong

2016, 25(6):  425-426.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.018

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Ophthalmology has its own style compared with other clinical specialties, such as the intricately detailed scale. Because of the complicated relationship between eye diseases and general diseases, the ophthalmologists should focus both on the eye and the general system. So during the training of graduate students of ophthalmology, we should pay attention to both the systemic  knowledge and independent clinical ophthalmologic skills. (Ophthalmol CHN, 2016, 25: 425-426)

Treatment of coexisting glaucoma and cataract

YANG Xin-guang

2016, 25(6):  427-429.  doi:10.13281/j.cnki.issn.1004-4469.2016.06.019

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Cataract and glaucoma frequently occur in elderly patients． And they are often comorbidities that need to be managed simultaneously. It is important for clinicians to evaluate the severity of the diseases and to choose the optimal treatment of these individuals, which can both control the intraocular pressure and improve the visual acuity. (Ophthalmol CHN, 2016, 25: 427-429)