Purpose To analyze the utility of isolated-check visual evoked potential (icVEP) for discriminating between eyes with dysthyroid optic neuropathy (DON) and eyes with thyroid-associated ophthalmopathy (TAO) but not DON. Methods Forty-three eyes with TAO but not DON (as non-DON), fifty-three eyes with DON, and sixty healthy eyes (as controls) were included. Comprehensive ophthalmic examinations, including best-corrected visual acuity, refraction, color vision test, intraocular pressure measurement, slit-lamp biomicroscopy, ophthalmoscopy, RAPD, exophthalmometry measurements, pVEP test, icVEP test, standard automated perimetry, and clinical activity score classification of TAO, as well as demographic information, were collected and analyzed. Results In the DON group, the signal-to-noise ratio (SNR) value of icVEPs decreased significantly compared with that of the non-DON group as well as control ( p < 0.05). The SNR values under 8%, 16% and 32% depth of modulation (DOM) were significantly negatively correlated with BCVA ( p < 0.05, r = − 0.9 ~ − 0.6), papilledema (Y/N) ( p < 0.05, r = − 0.8 ~ 0.4) and DON (Y/N) ( p < 0.001, r = − 0.7 ~ − 0.5). The 8% DOM of icVEP had the largest area under the receiver operating characteristic curve (AUC) (0.842) for discriminating DON from non-DONs. Meanwhile, decision curve analysis (DCA) showed that patients clinically benefit most from 8% DOM of icVEP. Furthermore, the 8% DOM of icVEP combing with papilledema (Y/N) and BCVA (Model 1) has significantly larger AUC than the 8% DOM of icVEP ( p = 0.0364), and has better clinical benefit in DCA analysis. Conclusions The SNR of 8% DOM from icVEP may represent a significant ancillary diagnostic method for DON detection. Furthermore, icVEP combined with papilledema (Y/N) and BCVA should be considered as a diagnostic model in future clinical practice.

目的 探讨眼眶海绵状血管瘤经不同手术入路摘除的手术效果和术后并发症发生情况.方法 回顾性分析2020年1月至2023年1月在华中科技大学同济医学院附属同济医院眼科和武汉科技大学附属天佑医院(同济天佑医院)眼科经手术治疗并经病理学确诊的眼眶海绵状血管瘤患者资料98例.对这些患者的手术入路、选择标准、手术效果及术后并发症进行总结.结果 所有98例眼眶海绵状血管瘤患者均经一次手术摘除,其中96例完整摘除,2例大部分切除.经结膜入路者9例;经皮肤入路前路开眶者12例;外侧开眶入路共42例;内侧开眶(经结膜、鼻腔)入路共22例;经骨膜下入路13例.手术并发症包括视力下降甚至丧失15例;上睑下垂12例;瞳孔向心性扩大18例;眼球运动受限和/或复视24例;眼部皮肤麻木和/或感觉异常28例;球结膜和/或眼睑水肿出血45例.结论 眼眶海绵状血管瘤应该根据病变位置、范围和粘连程度选择合适的手术入路,位置较深者尤其眶尖部海绵状血管瘤容易出现相关手术并发症.

Objective To evaluate the correlations between Single-Photon Emission Computed Tomography (SPECT) parameters of salivary glands and dry eye parameters in patients with Sjögren's syndrome (SS). Methods A total of 28 patients with SS participated in this prospective study. Dry eye assessments include tear film break-up time (TBUT), corneal fluorescein staining scoring (CFS), Schirmer's I test (SIT) examination and SPECT of salivary gland. The following quantitative parameters were derived from SPECT imaging for salivary glands: Uptake index (UI), the time needed to achieve the minimum counts after Vit C stimulation (Ts), and excretion fraction (EF). The relation between the aforementioned parameters and TBUT, CFS and SIT were analyzed with SPSS 22.0 software. Results All the 28 eyes of the 28 subjects were examined. The mean SIT was 6.04 ± 4.64 mm/5 min (0–18 mm/5 min); the mean CFS was 3.07 ± 2.65 (0–10) and the mean BUT was 2.11 ± 1.97 s (0–9 s). The mean EF value was 0.52 ± 0.12 (0.26–0.75) in parotid glands and 0.45 ± 0.10 (0.30–0.67) in submandibular glands, respectively. The mean UI value was 9.33 ± 1.68 (6.03–13.20) in parotid glands and 9.92 ± 1.48 (7.08–12.60) in submandibular glands, respectively. The mean Ts (min) was 5.32 ± 3.01 (2.00–12.00) in parotid glands and 11.09 ± 7.40 (2.00- 29.00 min) in submandibular glands, respectively. It was found that EF positively correlates with SIT in patients with SS (r = 0.499 and 0.426 in parotid glands and submandibular glands, with P < 0.05), while no significant correlation was found between the UI, Ts and CFS, TBUT (P > 0.05). Conclusions The EF was positively correlated with SIT in patients with SS, it could reflex the dysfunction of salivary glands in SS patients. So, EF may be a valuable parameter for the diagnosis of SS patients with lacrimal gland secretion dysfunction.

BACKGROUND:The correlation between intraocular pressure (IOP) and the magnetic resonance imaging (MRI) parameters in thyroid-associated ophthalmopathy (TAO) patients was explored.METHODS:This study included 82 eyes in 41 TAO patients who had a large difference in the IOP between each eye. We measured the T2 relaxation time (T2RT) of the extraocular muscles (EOMs), the orbital fat, and the area of the EOMs.RESULTS:There was a positive correlation between IOP and exophthalmos, the clinical activity score (CAS), the T2RT (of the medial rectus (MR)), the area of the MR, inferior rectus (IR) and lateral rectus, and the mean area. We established a regression model with IOP as the dependent variable, and the area of the IR was statistically significant.CONCLUSIONS:High IOP in TAO patients was positively correlated with the degree of exophthalmos and EOM inflammation (especially the inferior rectus). The state of the EOMs in an orbital MRI may partially explain high IOP and provide the necessary clinical information for subsequent high IOP treatment.

目的 了解人各段泪道黏膜及上皮干细胞的解剖及免疫学特征.方法 从捐献尸体取泪道组织,显微镜下解剖获得厚约1 mm的泪道黏膜及黏膜下组织,将不同部位的泪道黏膜组织制成病理切片,行苏木精-伊红(HE)染色及VIM、p63α、c-Kit、CK19、PCK染色.显微镜下观察染色情况.结果 人的上下泪点、上下泪小管、泪总管这几个部位的HE染色表现一致,显示其黏膜上皮为复层扁平上皮,表层细胞为扁平状,中间的数层细胞为多角形,最深层的基底细胞为矮柱状.泪囊和鼻泪管的HE染色表现一致,显示其黏膜上皮为两层,表层的柱状上皮和基底层的扁平上皮.不同部位的泪道黏膜免疫荧光染色均显示:上皮细胞全层PCK及CK19染色阳性,c-Kit及VIM染色阴性;基底层细胞p63α染色阳性.结论 人的上泪道与下泪道的黏膜组织结构不同,但其黏膜上皮基底层细胞均p63α染色阳性,为潜在的上皮干细胞.

Purpose To investigate the association between serum immunoglobulin G4 (IgG4) levels and laboratorial parameters. Moreover, the ocular manifestations were compared in Graves' ophthalmopathy (GO) patients.Methods Fifty-seven GO patients and fifty sex- and age-matched euthyroid subjects were enrolled. Serum IgG4 and immunoglobulin G (IgG) levels, thyroid hormones and thyroid autoantibodies were measured in all participants. Ophthalmologic examinations were performed to GO patients.Results Serum IgG4 levels were increased in GO patients compared with euthyroid subjects (p<0.001). Multivariate analysis showed that TRAb levels were correlated with IgG4 levels in GO patients (β=1.45, p = 0.024). There were eight GO patients with IgG4 levels ≥ 135 mg/dL. They all had both eyelids swelling and the differences of HER were less than 2mm. Seven patients (7/8) showed bilateral symmetrical thickening of the extraocular muscles.Conclusions Bilateral symmetry of ocular manifestation was observed in GO patients with IgG4 levels ≥135 mg/dL. IgG4 levels may be helpful in monitoring GO and diagnosing a new subtype of GO.

Background: To investigate the microbiologic spectrum of dacryocystitis in adult and pediatric groups, specifically the microbiologic differences between chronic dacryocystitis with nasolacrimal duct obstruction (NLDO) and acute dacryocystitis in pediatric group. Methods: This retrospective study was reviewed for demographic and microbiologic profile of dacryocystitis. The culture results were reported. Results: Sixty-four adults and one hundred and five pediatrics with dacryocystitis were included in this study. Of all adults, only chronic dacryocystitis with NLDO was observed. Of all pediatric patients, 89 had chronic dacryocystitis with NLDO and 16 had acute dacryocystitis. Gram positive and negative isolates were numerically equal in adult group (both 36(48.65%)), while gram positive isolates were the major organism in pediatric group (71(58.68%)). Streptococcus pneumonia was the most common isolate in both adult (11(14.86%)) and pediatric (30(24.79%)) dacryocystitis. For both pediatric subgroups, gram positive isolates were the major organism (59(57.84%) for chronic dacryocystitis with NLDO and 12 (63.16%) for acute dacryocystitis). However, the leading isolates in those two subgroups were distinct, with Streptococcus pneumonia (29(28.43%)) being most common in chronic dacryocystitis with NLDO and Staphylococcus aureus (8(42.11%)) being most common in acute dacryocystitis. Conclusions: In adult group, gram negative isolates were more common in dacryocystitis than before. In pediatric group, gram positive isolates were still the major infection pathogen. Moreover, the more virulent organisms were more common in acute dacryocystitis than chronic dacryocystitis with NLDO.

目的 调查婴幼儿泪囊炎的微生物检出率和感染谱,为临床合理使用抗生素提供参考.方法 纳入华中科技大学同济医学院附属同济医院2018年10月—2019年12月婴幼儿泪囊炎患儿198例(其中双眼患儿32例),男115例,女83例,男女比为1.391.所有患儿均行鼻泪管探通治疗,收集患儿泪囊冲洗液标本,进行细菌培养及药物敏感性试验.根据药敏试验结果,分析致病菌药敏和耐药情况.结果 婴幼儿泪囊炎的致病菌平均检出率为69.2％(137/198),各年龄段致病菌的检出率无明显差异,有15例患儿同时检测出2种或2种以上致病菌.婴幼儿泪囊炎致病菌菌种种类多,革兰阳性球菌构成婴幼儿泪囊炎的主要致病菌,包括肺炎链球菌(眼睛43只,28.9％)、金黄色葡萄球菌(眼睛15只,10.1％)、缓症链球菌(眼睛13只,8.7％)等.革兰阴性致病菌主要包括:卡它(黏膜炎)摩拉菌(眼睛12只,8.1％)、流感嗜血杆菌(眼睛7只,4.7％)、嗜麦芽窄食单胞菌(眼睛7只,4.7％)等.还包含少见的致病菌,其中真菌包括:近平滑念珠菌(眼睛9只,6.0％)和黄曲霉(眼睛1只,0.7％).药敏试验结果发现,大多数致病菌对左氧氟沙星、头孢曲松和万古霉素敏感.结论 革兰阳性球菌仍为婴幼儿泪囊炎的主要致病菌,左氧氟沙星滴眼液可作为首选眼部抗感染用药,能有效控制致病菌感染.

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.

Purpose To investigate the microstructure of the lacrimal canaliculus and the characteristics of lacrimal canalicular diseases by 80-MHz ultrasound biomicroscopy (UBM). Methods This study included 33 participants: 20 normal subjects (40 eyes), 2 patients with chronic lacrimal canaliculitis (4 eyes), 10 patients with chronic dacryocystitis (16 eyes), and 1 patient with lacrimal punctum atresia (2 eyes). All participants underwent 80-MHz UBM; disease-specific features were noted. Results On 80-MHz UBM of the lacrimal canaliculi (vertical section) in normal subjects, low echo of the lacrimal canalicular lumen and high echo of the lacrimal canalicular wall were observed. The uniform low echo near the wall was the mucosal epithelium. The outermost layer of medium-to-high echo was the subepithelial elastic fibrous layer. In the horizontal section, the lumen was continuous. Two linear high echoes parallel to the canalicular wall could be observed at the center of the lacrimal canaliculus, which were sometimes attached and sometimes separated. When separated, the center of the lacrimal canaliculus was a low echo area (lumen). Lacrimal canaliculitis (vertical section) showed obvious ectasia of the lacrimal canalicular lumen, with a high echo mass shadow, which might have been calculi, and uneven thickness of the mucosal epithelium with a slightly high echo shadow. In the horizontal section, the lumen varied in size with clear boundaries of medium and high echoes. The central linear high echoes of the lumen were absent, and the echoes of the mucosal epithelium were discontinuous. In chronic dacryocystitis, the lacrimal canalicular lumen was extensively enlarged, with continuous echoes and uniform thickness of the mucosal epithelium and homogeneous patches of slightly higher echoes. Lacrimal punctum atresia indicated that the lacrimal canaliculus existed in both eyes and its structure was normal. Conclusions The 80-MHz UBM is a new non-invasive technique that can be used for clear visualization of the fine structure of the lacrimal canaliculus, including the mucosal epithelium and subepithelial elastic fiber layer. The use of this approach will improve understanding of the hierarchical structure of the lacrimal canaliculi and provide a comprehensive basis for diagnosis, differential diagnosis, and treatment plan in patients with lacrimal passage diseases.

Abstract Rational: Cavernous hemangiomas are one of the most common benign primary orbital lesions. These tumors are insidious in onset, slowly progressive and present more often in middle aged women. Multiple orbital cavernous hemangiomas are extremely rare, and only a few cases have been reported in the published literature. Patient concerns: Here, we report the diagnosis and treatment of multiple cavernous hemangiomas in the right orbit of a female patient with impaired visual acuity and proptosis of the eye for more than 10 years. Diagnosis: Magnetic resonance imaging of the orbit showed a giant and irregular soft mass filling the intraconal and extraconal space of the right orbit, compressing the right optic nerve. After tumor resection, histopathological examination confirmed the diagnosis of cavernous hemangioma. Interventions: A lateral orbitotomy was performed and a total of 13 tumors were excised, with the largest tumor measuring approximately 2.5 × 3.0 cm. Outcomes: The visual acuity of the patient was preserved, with only a slightly dilated pupil of the right eye. The follow-up period was 6 months with no signs of recurrence. Lessons: Multiple cavernous hemangiomas in the orbit is rare and should be excised surgically as soon as possible.

Rational: Cavernous hemangiomas are one of the most common benign primary orbital lesions. These tumors are insidious in onset, slowly progressive and present more often in middle aged women. Multiple orbital cavernous hemangiomas are extremely rare, and only a few cases have been reported in the published literature. Patient concerns: Here, we report the diagnosis and treatment of multiple cavernous hemangiomas in the right orbit of a female patient with impaired visual acuity and proptosis of the eye for more than 10 years. Diagnosis: Magnetic resonance imaging of the orbit showed a giant and irregular soft mass filling the intraconal and extraconal space of the right orbit, compressing the right optic nerve. After tumor resection, histopathological examination confirmed the diagnosis of cavernous hemangioma. Interventions: A lateral orbitotomy was performed and a total of 13 tumors were excised, with the largest tumor measuring approximately 2.5 x 3.0 cm. Outcomes: The visual acuity of the patient was preserved, with only a slightly dilated pupil of the right eye. The follow-up period was 6 months with no signs of recurrence. Lessons: Multiple cavernous hemangiomas in the orbit is rare and should be excised surgically as soon as possible.

Objective To determine the diagnostic ability of isolated-check visual evoked potential (icVEP), pattern visual evoked potential (pVEP), and standard automated perimetry (SAP) between dysthyroid optic neuropathy (DON) and thyroid-associated ophthalmopathy (TAO) without DON (non-DON). Methods This is a case-control study, 49 bilateral patients (26 DON and 23 non-DON) were included. icVEP, pVEP, and SAP were conducted in all the subjects, icVEP parameters compared were signal-to-noise ratios (SNRs) under 8, 16, and 32% depth of modulation (DOM). pVEP parameters compared were amplitude and latency. SAP parameters were mean deviation (MD) and pattern standard deviation (PSD). The area under the receiver operating characteristic (ROC) curve (AUC), net reclassification index (NRI), integrated discrimination index (IDI), and decision curve analysis (DCA) were applied for analysis. Results In icVEP, values of SNR in DON were significantly smaller than non-DON (p < 0.05). In pVEP, P100 latent time in DON was significantly larger than non-DON (p = 0.0026). In SAP, value of PSD in DON was larger than non-DON (p = 0.0006), and value of MD in DON was smaller (p = 0.0007). AUC, NRI, and IDI among the three tests were not significantly different. DCA showed that SNR of icVEP under 8% DOM was the farthest from the two extreme curves. Conclusions icVEP, pVEP, and SAP have equal diagnostic capabilities to discern between DON and non-DON. In addition, icVEP may represent a significant ancillary diagnostic approach to DON detection, with more clinical benefit.

目的 研究小梁切除术联合醋甲唑胺片对青光眼的治疗效果及对患者眼压、眼血流动力学的影响.方法 选取2016年3月-2018年3月我院收治的青光眼患者160例,210只眼,分为手术组和联合组,手术组采用复合式小梁切除术治疗,联合组在手术组的基础上联合醋甲唑胺片治疗.对患者生存质量、自我评价、眼压、舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)和阻力指数(RI)、治疗效果和眼压控制率分析.结果 联合组患者治疗后的CLVQOL、自我评价得分、EDV、PSV水平、治疗总有效率、眼压控制率高于手术组(P<0.05);眼压、RI水平低于手术组患者(P<0.05).结论 复合式小梁切除术联合醋甲唑胺片可有效改善青光眼患者症状及眼血流水平,降低眼压,效果显著.

AIM: To explore a new method to induce the animal model of rabbit partial limbal stem cell deficiency(LSCD).METHODS: LSCD was induced through corneal alkali burn, C57 mice and New Zealand rabbits were used to establish the animal models. Corneal alkali burn manipulation was accomplished in experimental animals under general anesthesia combined with surface anesthesia in the operated eye. Specifically, mice(n=30)were used to induce complete LSCD model. In brief, the filter paper(diameter of 3mm)that immersed in 1mol/L potassium hydroxide solution was placed on the central corneal surface of the left eye for 30s, followed by washing with saline. In addition, rabbits(n=19)were utilized to establish the partial LSCD model. Briefly, the nictitating membrane(third eyelid)was resected, and the filter paper(diameter of 5mm)that immersed in 1mol/L potassium hydroxide solution was placed on the superior temporal peripheral corneal surface of the left for 30s, followed by washing with saline. After surgery, the model eyes were treated with 0.5% Levofloxacin Hydrochloride Eye Drops four times a day. In addition, the slit-lamp microscope was adopted for observation and photo-taking before burn, as well as at 1, 2, 4wk and 2mo after burn; meanwhile, complications such as corneal ulcer and perforation were recorded. 2mo after surgery, the corneal goblet cell distribution was detected with impression cytology, and the severity of LSCD was classified according to slit-lamp microscopic findings and corneal impression cytology. The animals were sacrificed 2mo after surgery, cornea and conjunctiva sections were made to observe angiogenesis and goblet cell distribution in cornea. Animals died accidentally were not counted into the total number, and the successful induction rates of complete LSCD and partial LSCD models were compared.RESULTS: Six out of the 30 mice died accidentally, while 2 developed corneal perforation after burn, and the remaining 22 had developed complete LSCD only, yielding the successful induction rate of 92%. 2mo after burn, extensive angiogenesis distribution in the superficial and deep corneal stromal layers could be observed, and pathological sections revealed corneal angiogenesis. Seven out of the 19 rabbits died accidentally, while the remaining 12 had various degrees of LSCD only(partial LSCD, average involving 1.17±0.39 quadrants). Additionally, no corneal perforation was observed, and the successful induction rate was 100%. The result of Fisher's exact test P value is 0.543, without statistical difference. No goblet cells were observed in the normal corneal region, while goblet cells were observed in the LSCD region, with the average density of 58.60±12.58 cell/HP.CONCLUSION: Central corneal alkali burn can induce complete LSCD; however, some animals will experience failure in model induction due to corneal ulcer and perforation, LSCD is generally serious and may be combined with angiogenesis in deep cornea. Alkali burn in superior temporal cornea can induce partial LSCD, which may be combined with relatively minor corneal lesion, and the corneal angiogenesis is located in the superficial layer.

Purpose: To investigate whether lacrimal canaliculus epithelial stem cells (LCESC) could be isolated and expanded in vitro. Methods: The lacrimal canaliculus epithelium of 6 patients with limbal stem cell deficiency (LSCD) caused by alkali burn or Stevens Johnson Syndrome were examined by lacrimal endoscope. Cadaveric eyelids were fixed and prepared for cross section and stained with HE and antibodies against PCK, Vim, p63α, SCF and c-Kit. Canaliculus tissue was separated under an operating microscope using a lacrimal probe as an indicator and digested with collagenase A. The clusters of epithelial cells with closely associated stroma were further digested with Trypsin/EDTA to obtain single cells for culture on Matrigel-coated plastic plates in MESCM media. The expression of SCF, c-Kit and p63α was determined by immunostaining. The colony-forming efficiency on 3T3 feeder layers was also measured by calculating the percentage of the clone number divided by the total number cells seeded. Results: The epithelial layers of five out of six inferior lacrimal canaliculi and all the six superior lacrimal canaliculi were visually normal in appearance. Five to fifteen layers of the epithelium in the human lacrimal canaliculi were present with a small, tightly compacted basal layer of cells expressing PCK, p63α, SCF and c-Kit. LCESC were isolated by collagenase A and obtained clonal growth in MESCM. The colony-forming efficiency of LCESC holoclones on a 3T3 feeder layer was 3.2%, compared to 1.9% for those of limbal stem cells (LSC). Conclusions: Herein, we first report that LCESCs can be isolated and have stem cell characteristics, similar to those of LSCs. Such a discovery raises a promising substrate resource of stem cells for LSC reconstruction in LSCD patients.

PurposeThe aim of this study was to explore the pathological changes of the nasolacrimal duct in rabbits with experimentally induced obstructive dacryocystitis in correlation with lacrimal endoscopic findings.MethodsThe rabbit model of obstructive dacryocystitis was created by injecting 0.15ml of self-curing resin into the lacrimal duct. The control group received 0.15ml of normal saline. Within 16weeks after the obstructive, lacrimal endoscopy and pathological examination of the nasolacrimal duct were conducted at different time points of 1, 2, 4, 8, and 16weeks.ResultsIn the control group, lacrimal endoscopy revealed pink and smooth mucosa; and the pathological analysis revealed an epithelial layer that was composed of superficial columnar cells and a deep basal epithelial layer. The experimental rabbits showed clinical manifestations of obstructive dacryocystitis a week after the injection of self-curing resin. At weeks 1 and 2, the lacrimal endoscopy showed mucosal hyperemia and hemorrhagic spots on the nasolacrimal duct; and the pathological features included epithelial cell swelling and inflammatory cell infiltration. At weeks 4 and 8, the experimental group showed alternatively red and white mucosa under the lacrimal endoscopy, and the pathological features included proliferative epithelium accompanied by papillary hyperplasia. At week 16, the experimental group showed pale and coarse mucosa and white membrane-like layer covering the mucosal surface, and the pathological features included epithelial necrosis, squamous metaplasia, and sub-epithelial fibrosis.ConclusionThe mucosa of the nasolacrimal duct showed different pathological features at different time points after lacrimal duct obstruction, which was well correlated with the endoscopic findings. It is possible to predict the pathological stages by the endoscopic observation in NLOD patients.

Objective: To identify the primary disease spectrum and trends of surgical procedure of keratoplasty patients. Methods: Retrospective case series study. To review all patients who underwent keratoplasty at Department of ophthalmology in Tongji Hospital from January 1, 2012 to December 31, 2015. The data collected included age, sex, birthplace, and primary corneal disease and associated surgical procedures. Then the data were compared with similar papers domestic and foreign. Results: A total of 315 keratoplasties were performed during this 4-year period. The average age of patients at time of surgery was (42.0± 1.8) years, range from 33 days to 89 years, 229 cases (72.7%) were from 18 to 65 years; male: female ratio was 2.06:1. Totally 289 cases (91.8%)came from Hubei province, 26 cases (8.2%) were from other provinces. The leading indications for corneal transplantation were keratitis in 125 cases (39.7%), followed by corneal scar in 71 cases (22.5%), keratoconus in 41 cases (13.0%), pseudophakic bullous keratopathy in 26 cases (8.3%), corneal dermoid in 18 cases (5.7%), corneal dystrophy and degeneration in 16 cases (5.1%), and others (including chemical injuries, thermal burns, post-traumatic corneal scar and corneal opacity) in 18 cases (5.7%). Of the 125 keratitis cases, 51 cases (40.8%) were associated with fungus, 43 cases (34.4%)were associated with virus, and 24 cases (19.2%)were associated with bacterial. In accordance with the classification of corneal transplant surgery, penetrating keratoplasty was performed in 212 cases (67.3% ), lamellar keratoplasty was completed in 87 cases (27.6% ), corneal endothelial transplantation was made in 16 patients (5.1%). Conclusions: Infectious keratitis was the leading indication for corneal transplantation followed by corneal scar, keratoconus and pseudophakic bullous keratopathy in Tongji hospital patients who underwent keratoplasty. And fungus was the first cause of infectious keratitis. Penetrating keratoplasty was still the main part of corneal transplantation. (Chin J Ophthalmol, 2017, 53: 460-463).