ObjectivesFungal keratitis (FK) is a kind of serious corneal infection and penetrating keratoplasty (PKP) is needed when medical therapy fails. Although Nectria haematococca is found as endophytes in the roots of some plant species, there has been no report of N. haematococca infection in human.MethodsWe reviewed 46 patients who underwent PKP due to FK in our hospital from July 2021 to December 2021, and there were three patients who had relapsed. The next-generation sequencing revealed that all three corneas were infected with N. haematococca.ResultsBased on the ocular manifestation and treatment course of three cases, we summarize the characteristics of N. haematococca FK: the scope of corneal infection was widespread with severe hypopyon. The effect of local use of fluconazole and voriconazole was not ideal, and PKP was the main treatment. Even after a large-scale corneal lesion resection, the lesion may recur. The recurrence occurred primarily in the second week after PKP.ConclusionThis is the first clinical report of N. haematococca infection in humans. Compared with the other currently known FK caused by the Fusarium solani species complex, N. haematococca keratitis is more severe and more likely to recur.

Objective:To analyze the clinical traits of ocular injury brought on by hidden foreign body on the ocular surface.Methods:This was a retrospective case series study.The clinical data of 24 eyes of 24 patients with ocular suface injury induced by hidden foreign body treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from Jan.2019 to Oct.2020 were included.The common characteristics of clinical manifestations, signs and diagnosis methods were analyzed.Results:In this study, there were 11 eyes of 11 males and 13 eyes of 13 females, aged from 4 to 71 years, with an average of (42.29±19.37) years. The disease course was from 7 to 245 days, with an average of (53.21±62.03) days.All patients had at least twice visits with no declaration of trauma history on their appointments. The main complaints of the patients included foreign body sensation in 16 cases, pain in 5 cases, tearing in 4 cases, decreased vision in 4 cases, and increased discharge in 1 case. The main signs included conjunctival hyperemia in 13 cases, blepharospasm in 3 cases, corneal ulcer in 5 cases, conjunctival granuloma in 2 cases. Twenty patients (83.33%, 20/24) were positive for corneal fluorescein sodium staining, and 3 patients (12.50%, 3/24) were positive for conjunctival fluorescein staining.Foreign bodies were found in areas corresponding to corneal ulcers or positive corneal fluorescein staining.Eyelashes (45.83%, 11/24) were the most commonly found hidden foreign bodies on the ocular surface, while conjunctival/superior fornix of the upper eyelid (45.83%, 11/24) was the most common location for hidden foreign bodies. Among 5 patients with corneal ulcer, Staphylococcus aureus was cultured from conjunctiva sac secretions and corneal scraping in 1 patient with rice husk removed from his conjunctiva sac, while bacteria and fungi cultures from corneal scrapings were negative in the other 4 patients.After the removal of foreign bodies, the symptoms of all patients were significantly released, and the corneal fluorescein staining was negative 1 week later.Conclusion:Patients with ocular surface injury caused by hidden foreign bodies almost have no history of trauma.The clinical manifestations are mostly foreign body sensation, some with tears, congestion or increased secretions, blepharospasm and decreased vision in patients with corneal ulcers, and conjunctival granuloma in patients with long course. Corneal fluorescein staining is helpful for diagnosis.The results are good after removal of the foreign bodies.

Purpose The purpose of this study was to investigate trabecular meshwork (TM) and Schlemm's canal (SC) morphology in Posner-Schlossman syndrome (PSS). Methods Forty-five patients with PSS were recruited. TM thickness and length as well as SC area and diameter of both affected and fellow eyes were assessed using swept-source optical coherence tomography. Results TM thickness (108.24 ± 28.29 µm vs. 89.36 ± 25.82 µm, P = 0.014), SC area (6010.90 ± 1287.54 µm2 vs. 5445.69 ± 1368.89 µm2, P = 0.003), and SC diameter (239.38 ± 60.17 µm vs. 217.76 ± 60.79 µm, P = 0.010) were significantly greater in the affected eyes. Furthermore, TM thickness (113.32 ± 30.03 µm vs. 89.00 ± 26.99 µm, P = 0.046), SC area (6216.32 ± 1267.87 µm2 vs. 5476.40 ± 1390.15 µm2, P = 0.001), and SC diameter (246.82 ± 64.12 vs. 212.53 ± 64.29 µm, P = 0.001) were significantly greater in the affected eyes than in the fellow eyes in the ocular hypertension (OHT) subgroup (affected eye with intraocular pressure [IOP] > 21 mm Hg). However, those differences were not noted in the ocular normal tension (ONT) subgroup (affected eye with IOP ≤ 21 mm Hg, all P > 0.05). Conclusions TM edema might play a role in the IOP elevation in PSS. The edematous TM could make controlling IOP of the affected eyes difficult. When TM edema is relieved, IOP of the affected eyes can reduce to normal spontaneously or with IOP-lowing medications.

Purpose To investigate the anterior scleral thickness (AST) and its associations with Schlemm’s canal (SC) area, trabecular meshwork (TM) thickness and length, and scleral spur (SS) length in healthy and primary open-angle glaucoma (POAG) groups. Methods Thirty-five eyes of 35 healthy subjects and 23 eyes of 23 patients with POAG were included. The AST, SC area, TM thickness and length, and SS length were measured using swept-source optical coherence tomography. AST was measured at 0 mm (AST0), 1 mm (AST1), 2 mm (AST2), and 3 mm (AST3) from SS. Associations between AST and SC area, TM thickness and length, and SS length were also estimated. Results AST0 (728.84 ± 99.33 vs. 657.39 ± 67.02 μm, p < 0.001), AST1 (537.79 ± 79.55 vs. 506.83 ± 57.37 μm, p = 0.038), AST3 (571.09 ± 79.15 vs. 532.13 ± 59.84 μm, p = 0.009), SC area (6304.26 ± 1238.72 vs. 4755.64 ± 1122.71 μm 2 , p < 0.001), TM thickness (107.21 ± 31.26 vs. 94.51 ± 24.18 μm, p = 0.035), TM length (736.20 ± 141.85 vs. 656.43 ± 127.03 μm, p = 0.004), and SS length (219.89 ± 50.29 vs. 174.54 ± 35.58 μm, p < 0.001) were significantly greater in healthy group than in POAG group. In addition, SC area, TM thickness, and SS length were significantly and positively associated with AST0 in the healthy group, whereas no similar associations were observed in the POAG group. Conclusions Compared with the healthy group, AST was significantly thinner in the POAG group, which also had smaller SC and TM dimensions. Moreover, the SC area, TM thickness, and SS length were significantly and positively associated with AST in the healthy group. Thus, AST might play an important role in maintaining TM and SC morphology and further in the pathogenesis of POAG.

目的 检验回弹式眼压计Icare与非接触式眼压计(non-concact tonometer,NCT)对角膜病患者眼压测量值的一致性.方法 收集在华中科技大学同济医学院附属同济医院住院治疗的角膜病患者32例(64只眼),其中2例是双眼患角膜病,根据是否有角膜病变分为正常角膜组(30眼)和角膜病组(34眼),分别采用Icare和NCT眼压计测量眼压.根据测量能否获得数据判断两种仪器的测量成功率.根据NCT测量的结果,在正常角膜组及角膜病组内又分为高眼压(>21 mmHg)和正常眼压(10～21 mmHg),比较Icare眼压计与NCT测得眼压值的差异,数据进行配对t检验.结果 两种眼压计对正常角膜眼测量成功率均为100％;对于角膜病眼,Icare眼压计成功率为100％,而NCT为53.7％,原因是严重的角膜溃疡、瘢痕、睑裂缝合术后患者无法采用NC T测量,而Icare眼压计仍可正常测量.在正常角膜组内,高眼压眼NCT比Icare眼压计测量结果平均高(6.2±3.5)mmHg(P<0.05),正常眼压眼NCT比Icare眼压计测量结果平均高(2.0±3.4)mmHg(P<0.05);在角膜病组内,高眼压眼NCT比Icare眼压计测量结果平均高(8.4±6.8)mmHg(P<0.05),正常眼压眼NCT比Icare眼压计测量结果平均高(2.5±4.9)mmHg(P<0.05).结论 角膜病眼眼压测量成功率Icare眼压计高于NC T;无论是正常角膜眼还是角膜病眼,Icare眼压计测量的数值均低于NC T,这种偏移在眼压高于21 mmHg的情况下更加显著.

病例1患者男性,57岁。因左眼被板栗砸伤红痛20 d后于2020年9月27日就诊于华中科技大学同济医学院附属同济医院眼科。患者右眼裸眼视力0.8,左眼0.4;右眼眼压18 mm Hg（1 mm Hg=0.133 k Pa）,左眼23 mm Hg。左眼睑高度肿胀,球结膜弥漫性充血水肿,部分颞上方结膜脱出至睑裂外,压痛（+）,角膜中央可见一根板栗刺扎入深层,伤口周围角膜水肿混浊,前房深度正常,房水闪辉（+）,瞳孔不圆,直径约2.5 mm,瞳孔区见少许渗出,对光反射迟钝,晶状体轻度混浊。使用SW-2100型眼部B型超声诊断仪（天津索维公司生产）检查双眼,结果显示左眼玻璃体轻度混浊。

目的 评价前房穿刺时限对药物不可控制、持续高眼压状态下的原发性急性闭角型青光眼大发作的预后影响.方法 回顾性分析2014年1～12月收治于华中科技大学同济医学院附属同济医院眼科的原发性急性闭角型青光眼大发作患者27例(28眼),发作眼急诊行前房穿刺放液术,术后按眼压情况即房水外流通道是否有效恢复分为A、B两组,对两组前房穿刺时限及视力转归情况进行比较.结果 A组前房穿刺时限明显低于B组,差异有统计学意义(t=-7.30,P<0.01);A组视力恢复情况明显优于B组,差异有统计学意义(t=6.15,P<0.01).结论 原发性急性闭角型青光眼大发作行前房穿刺后,对房水外流通路能有效恢复、眼内压短期下降的患者,穿刺放液时限较短,视力恢复较好.

目的 了解我国中部地区角膜移植手术患者的原发疾病谱及流行病学特征,并比较手术方式选择的变化趋势.方法 回顾性分析2014年1月～2018年12月在同济医院眼科接受角膜移植手术的角膜病患者资料.对其年龄、性别、原发角膜疾病及手术方式进行统计,并与已发表的国内、外相关研究进行比较.结果 5年间共有719例角膜病患者接受角膜移植手术,平均年龄(44.49±1.70)岁,患者的年龄最小33 d,最大89岁,其中518例(72％)在18～65岁之间;男女比例为1.68:1.感染性角膜炎是其中占首位的角膜疾病(306例,42.6％),其余依次为角膜白斑(154例,21.4％)、圆锥角膜(85例,11.8％)、大泡性角膜病变(63例,8.8％),角膜变性与营养不良(39例,5.4％)、角膜皮样瘤(32例,4.5％)及其他(如化学伤、热烧伤、外伤后角膜瘢痕及角膜植片混浊等,38例,5.3％).在306例感染性角膜炎中按病因依次排序为:真菌性角膜炎(149例,48.7％)、病毒性角膜炎(98例,32.0％)、细菌性角膜炎(59例,19.3％).按照角膜移植手术方式分类,最多的是穿透性角膜移植术(443例,61.6％),其余为板层角膜移植术(243例,33.8％)、角膜内皮移植术(32例,4.5％).结论 我国中部地区角膜移植术患者的原发角膜病中,感染性角膜炎占首位,其余依次为角膜白斑、圆锥角膜和大泡性角膜病变,而真菌则是感染性角膜炎的首位病因.穿透性角膜移植仍为角膜移植的主要术式,板层及角膜内皮移植手术量的上升趋势不容忽视.

AIM: To explore the effect of persistent high intraocular pressure(IOP)on cataract surgery in eyes with acute primary angle-closure glaucoma(PACG)and its correlative factor, and to discuss the choice of treatment for persistent high IOP.METHODS: Totally 284 cases(293 eyes)were diagnosed as acute PACG and underwent cataract surgery. According to preoperative IOP, these patients were divided into three groups: Group 1(188 eyes), Group 2(61 eyes)and Group 3(44 eyes). Group 1 was defined that preoperative IOP can be controlled within the normal range under systemic and local drug. Group 2 was defined that preoperative IOP higher than 40 mmHg after drug therapy, which can be controlled after an anterior chamber puncture treatment. Group 3 was defined that preoperative IOP higher than 40 mmHg after multiple anterior chamber puncture. Group 1 underwent cataract extraction and intraocular lens(IOL)implantation. Group 2 and Group 3 underwent cataract extraction and IOL implantation with goniosynechiolysis. The preoperative and postoperative visual acuity, IOP, anterior chamber depth(ACD)and subfoveal choroidal thickness were obtained, and gonioscopic measurement of chamber angle was recorded. Preoperative and postoperative measurements were compared using non-parametric tests.RESULTS: After surgical treatment, the rate of postoperative one-week IOP control rate was respectively: Group 1(100%), Group 2(95%), Group 3(82%)(the rate of Group 2 is higher than Group 3, χ2=4.795, P<0.05). The rate of the improved postoperative vision was respectively: Group 1(92%), Group 2(84%)and Group 3(52%). Postoperative central anterior chamber depth of each group deepened obviously compared to preoperative, but the postoperative goniosynechia range of Group 3 was significantly wider than that of Group 1 and Group 2. Group 1 and Group 2 did not record postoperative hyphema, while 18% of Group 3 had recorded hyphema.CONCLUSION: Acute PACG eyes with persistent high preoperative IOP had good effects after cataract surgery, but demonstrated wider goniosynechia range and higher risk of hyphema compared to eyes with normal preoperative IOP.

Objective To investigate the distribution of intraocular pressure (IOP) and its relationship with central corneal thickness (CCT) in healthy people. Methods Participants included 1 715 persons undergoing health check‐up during January 1 to December 31, 2018. They were enrolled according to the randomized digital table into this investigation by simple random sampling method; 879(51%) persons were male with an average age of 48.0±13.6 and 836 (49%) persons were female with an average age of 48.0±12.7. Participants were divided into different groups according to ten‐year intervals. Each personal data, IOP and CCT were obtained; IOP was obtained by non‐contact tonometer and CCT was obtained by optic coherence tomography. The data were analyzed by SPSS 25 statistical software. Results The average IOP in this study was 15.04± 3.08 mmHg (1mmHg=0.133kPa) and the average CCT was 535.01±31.76 μm. The average IOP of each group showed an increase with age, and in the 50‐59 years group it reached the highest level (15.47±3.11 mmHg), after which, it decreased again. The average CCT values in all groups decreased with ageing and the highest level was in the 18‐30 years group (540±32.68 μm). The average IOP and CCT in males was higher than that in females. Multiple regression analysis adjusted for potential confounders such as age and gender implied that CCT is positively related to IOP (P<0.01). The IOP appeared to increase by 0.044 mmHg with the increase of every 1 mm of CCT (95% CI: 0.040~0.048, P<0.01). Conclusion IOP is closely related to CCT. More attention should be paid to CCT during the measurement of IOP to avoid misjudgment of a higher IOP for a higher CCT value as a pathological IOP or a pathological IOP among normal statistical range as a normal one, otherwise an opportunity for good treatment may be lost.

目的 评估色素性青光眼患者接受小梁切开联合周边虹膜切除术治疗效果.方法 对小梁切开联合周边虹膜切除术的色素性青光眼患者8例(15眼)行手术前后眼压、房角开放距离500,小梁网虹膜间面积500和虹膜曲率比较.结果 相较术前眼压(26.63±3.61)mmHg,术后3 d(17.58±3.93)mmHg,1周(18.39±2.88)mmHg和1个月(17.63±1.99)mmHg眼压显著降低(所有P<0.05);同时相比术前房角开放距离500(1.317±0.393)mm,小梁网虹膜间面积500(0.498±0.199)mm2和虹膜曲率(-0.034±0.016)mm,术后房角开放距离500术后3 d(0.782±0.200)mm,1周(0.798±0.233)mm,1个月(0.807±0.227)mm,小梁网虹膜间面积500术后3 d(0.296±0.087)mm2,1周(0.303±0.098)mm2,1个月(0.307±0.100)mm2和虹膜曲率术后3 d(0.008±0.002)mm,1周(0.010±0.011)mm,1个月(0.010±0.012)mm变化显著(所有P<0.05).结论 小梁切开联合周边虹膜切除术不仅可以解除反向瞳孔阻滞,避免色素播散的继续发展,还能及时有效控制色素性青光眼患者眼压.

AIM:To investigate the influence factors of phacoemulsification combined with anterior vitrectomy for treating malignant glaucoma.METHODS:Totally 23 cases (25 eyes) of malignant glaucoma patients,who were in-patient in ophthalmology of Wuhan Tongji Hospital from June 2011 to June 2016,underwent phacoemulsification combined with anterior vitrectomy,were involved in this study.The intraocular pressure and related ocular anatomy parameter change and its correlation were analyzed pre-and post-operatively. RESULTS:There were 15 cases (16 eyes),average 51±6.7 years old,had deepened anterior chamber and intraocular pressure within the normal range (reffered as effective) post-operatively,in the other 8 cases (9 eyes),average 45±7.8 years old,postoperative anterior chamber formation were poor (referred as ineffective).Surgery effective rate was 64%.As for the effective group,the postoperative anterior chamber depth (2.13±0.82mm),significantly deepened compared with preoperative (0.76±0.53mm),and postoperative intraocular pressure (15.4±4.5mmHg) significantly declined compared with preoperative (26.4±8.7mmHg).The effective group had larger preoperative scleral spur distance and ocular axial length than ineffective group,11.25±0.39mm vs 10.86±0.49mm and 22.16±1.16mm vs 20.98±0.62mm respectively,and the difference was statistically significant (P<0.05).Age and the ocular axial length were statistically significant between effective and ineffective group by using single factor analysis results (P<0.05).By logistic regression analysis,age and ocular axial length were independent risk factors for poor postoperative treatment effect (P<0.05).CONCLUSION:The younger age and the ocular axial length is risk factors for poor postoperative treatment effect of malignant glaucoma by phacoemulsification combined with anterior vitrectomy.

患者女性,52岁,农民.于2015年1月在华中科技大学同济医学院附属同济医院眼科接受入院治疗.患者主诉左眼视力半年内逐渐下降,且右眼红肿、疼痛半个月.患者10年前因左眼慢性闭角型青光眼行小梁切除术,术后发生恶性青光眼,故再行透明晶状体囊外摘除联合前段玻璃体切除和人工晶状体植入术.患者左眼近10年来的眼压波动在4~10 mmHg(1mmHg=0.133kPa)之间,且视力在半年内逐渐下降.询问该患者的既往史后发现,患者右眼失明10余年,近10年来的右眼眼压波动在30~40 mmHg之间,且无眼胀、眼痛等自觉症状.

Objective To evaluate the effect of posterior continuous curvilinear capsulorrhexis (PCCC) for preventing capsule contraction after phacoemulsification and intraocular lens implantation.Methods Fifty eyes of 25 patients were enrolled in this study.The left eyes received cataract surgery with PCCC (the PCCC group),and all the right eyes received ordinary phacoemulsification surgery without PCCC (the control group).Foldable aspherical IOLs of the same type were implanted in both groups.All patients were followed up for 3 months after the surgery.The best-corrected visual acuity (BCVA) and the depth of the anterior chamber (ACD) were observed.Results The ACD increased gradually in both two groups during the follow-up of 3 months.The ACD was increased by (0.01 ±0.1)mm in the PCCC group 3 months after the surgery,and the difference was not statistically significant (t =0.86,P =0.78) compared with the ACD 1 month after the surgery.But in the control group the ACD was increased by (0.13 ±0.19) mm three months after surgery,and the difference was statistically significant (t =3.08,P =0.02) compared with that 1 month after surgery.The difference in postoperative BCVA between the two groups was not statistically significant (t =1.09,P =0.26).Conclusion The ACD increased gradually after cataract surgery in both of the two groups.PCCC is useful to minimize postoperative ACD increase caused by capsule contraction.

Objective To evaluate the efficacy of anterior chamber paracentesis for acute primary angle-closure glaucoma ( APACG ) , with persistent ocular hypertension which could not be controlled by drugs. Methods Fifteen eyes of 14 patients with APACG were collected and given anterior chamber paracentesis in our hospital from January 2014 to June 2014. Patients were divided into two groups according to if their aqueous humor outflow pathway could recover effectively. The two indepedent samples t-test was applied to compare the duration of ocular hypertension between two groups, and the student t-test was applied to compare the visual recovery between the two groups. Results The duration of ocular hypertension between two groups showed statistically significant difference(t=5. 661,P=0. 000). The visual recovery between the two groups also showed statistically significant difference(t= -4. 155,P=0. 003). Conclusion For the patients with APACG which could not be controlled by anti-glaucoma medicine, ending the persistent state of ocular hypertension as soon as possible by anterior chamber paracentesis can minimize the damage of vision and restore aqueous humor outflow pathway.

Introduction: True exfoliation of lens capsule is a relatively rare disorder that has a thin, fluttering membrane in the anterior chamber, mainly located in the pupil area, which is believed to have split from the anterior lens capsule.Case Report: The authors present here a patient with true exfoliation and primary angle closure glaucoma in both eyes, the ultrastructure of one eye revealed that the delaminated membrane was composed of more than two layers in itself.Conclusion: Lens capsule true exfoliation could happen in patient with primary angle closure glaucoma, with more than two layers in itself.

AIM:To look back and analyse clinical effect of free cataract operation on poor cataract patients by Fuming No.9 car of Hubei Province staying in Xiantao for 25 days.·METHODS:The poor cataract patients who were strictly selected and suitable to operation were performed small incision non-phacoemulsification cataract extraction and intraocular lens implantation.·RESULTS:The 270 eyes' post-operation vision in our group:1.2 (2 eyes),1.0 (25 eyes),0.8 (21 eyes),0.6 (48 eyes),0.5 (33 eyes),0.4 (33 eyes),totally 162 eyes and account for 60.00%.Low vision:second low vision 0.3 (46 eyes),0.2 (33 eyes),first low vision 0.1 (4 eyes),0.09-0.05 (2 eyes),totally 85 eyes and account for 31.48%.Blindness:second blindness 0.04-0.02 (15 eyes),first blindness (8 eyes),totally 23 eyes and account for 8.52%.Off-blind rate:91.48%.Off-remnant rate:77.03%.·CONCLUSION:Only through careful pre-operation selection,standard holding suitability,proficient operation skills and strictly controlling infection,can the quality of mass operation be guaranteed in operation car in a short time.However,the high and low of off-blind rate and off-remnant rate are primarily decided by the composite factors of patients themselves.

目的 原发闭角青光眼小梁切除术后白内障超声乳化吸除术的临床效果.方法 对 原发性闭角型青光眼小梁切除术后白内障50例患者行连续环形撕囊,充分水分离,囊袋内超声乳化,囊袋内或睫状沟内植入折叠式人工晶状体.结果 所有患者术后视力比较术前均有所提高.术后视力34只眼(70%)>0.5;6只眼(14%)视力≤0.1.结论 抗青光眼滤过术后,视功能未严重损害者行白内障手术可明显改善视力.