This study aims to investigate the effectiveness of Intense Pulsed Light (IPL) therapy for chalazion treatment while also exploring potential variations in sensitivity among different types of chalazion. A total of 149 patients were selected to receive tobramycin combined with IPL treatment and tobramycin combined with hot compress. The treatment groups were divided into cystic type and granulomatous type according to different clinical manifestations. The course of treatment was 3 weeks. The improvement was based on the ultrasound measurement of the masses reduction of more than 50% or disappearance. In the IPL group, 17 (22.67%) cases were cured, 39 (52.00%) were effective, and 19 (25.33%) were ineffective. This includes: cystic type was cured in 3 (15.79%), effective in 5 (26.32%) cases, ineffective in 11 (57.89%) cases; granulomatous type was cured in 14 (25.00%) cases, effective in 34 (60.71%) cases, ineffective in 8 (14.29%) cases. In the hot compress group, 5 (6.76%) cases were cured, 16 (21.62%) cases were effective and 53 (71.62%) cases were ineffective. The cystic type was cured in 2 (8.00%) cases, effective in 3 (12.00%) cases and ineffective in 20 (80.00%) cases; the granulomatous type was cured in 3 (6.12%) cases, effective in 13 (26.53%) cases and ineffective in 33 (67.35%) cases. The cure rate and efficacy rate of IPL treatment is higher than that of hot compress treatment, the treatment effect of IPL treatment on granulomatous chalazion is better than that on cystic type.

Objective:To analyze the clinical characteristics of ocular trauma in infants from Shijiazhuang region.Methods:A cross-sectional study was conducted. The clinical data of 167 eyes of 152 children admitted with ocular trauma from Jan.2016 to Dec.2020 in the Children’s Hospital of Hebei Province were reviewed and analyzed. The trauma type, age, gender, eye, causes and visit time were observed.Results:Among the 152 cases of infants with ocular trauma in this study, 43 cases were of corneal or conjunctival foreign body (28.29%), 39 cases were of eyelid or conjunctival laceration (25.66%), 23 cases were of eyeball contusion (15.13%), 12 cases were of ocular perforation (7.89%), 18 cases were of chemical eyeball injury (11.84%) and 17 cases were of orbital fracture(11.18%). The causes of injuries were complex, including falling, knocks from toys and stationery, contact with chemicals, sand and iron products, stabbing from plants, etc. The ratio of male to female was 2.04∶1, and the incidence of monocular disease was 90.13% (137/152). Children aged 2 years old had the most common ocular injuries (25.66%, 39/152). The shortest mean visit time was (2.25±1.55)h after chemical injury and (24.45±18.92)h from kerateconjunctival foreign body.Conclusion:Eyelid or conjunctival foreign bodies, eyelid or conjunctival laceration are common, while ocular perforation is rare in infants with ocular trauma. The incidence in boys is significantly higher than that in girls, mostly monocular. Children aged 2 years are more common. The visit time of patients with chemical eyeball injuries are the shortest, while those with foreign bodies are the longest.

目的 观察强脉冲光治疗儿童睑板腺囊肿的疗效.方法 选取2021年6月至2021年12月就诊于我院的睑板腺囊肿患儿58例,分为热敷组和强脉冲光治疗组.热敷组采用热敷联合加替沙星眼用凝胶点眼,强脉冲光组采用强脉冲光联合加替沙星眼用凝胶点眼.治疗时间为3周,观察两组患者睑板腺囊肿治愈率、总有效率.结果 强脉冲光组和热敷组治愈率分别为26.67％、14.28％;总有效率分别为60.00％、32.14％.强脉冲组的治愈率、总有效率高于热敷组,且总有效率差异有统计学意义.结论 强脉冲光与热敷对睑板腺囊肿均安全有效,且强脉冲光疗效优于热敷.强脉冲光可以作为睑板腺囊肿保守治疗的物理手段之一.

Objective To investigate refractive development and prevalence of myopia in children aged 3-6 years in Hebei Province, China, and to explore the developmental law of refraction, so as to clinically guide the prediction and intervention of myopia. Methods In May 2019, a total of 6120 people were inspected in 68 kindergartens in 11 cities in Hebei Province. Child refractive refraction was checked under noncycloplegia using a handheld binocular vision screener (SW-800, SUOER, Tianjin, China). Axial length (AL) and corneal radius of curvature (CR) were measured using an ocular biometry (IOLMaster 500, Carl Zeiss, Germany). Myopia was defined as spherical equivalent (SE) ≤ −0.75 D. Results A total of 5506 children aged 3-6 years met the criteria and were included in the statistical analysis. The prevalence of myopia was 3.49% (1.93% at age 3, 2.90% at age 4, 3.78% at age 5, and 3.88% at age 6). Overall, the mean SE was +0.67 ± 1.05 D (+0.81 ± 1.00 D at age 3, +0.79 ± 1.05 D at age 4, +0.67 ± 1.08 D at age 5, and +0.13 ± 1.01 D at age 6); the mean CR was 7.76 ± 0.26 mm (7.78 ± 0.26 mm at age3, 7.75 ± 0.25 mm at age 4, 7.77 ± 0.26 mm at age 5, and 7.76 ± 0.25 mm at age 6); the mean AL was 22.31 ± 0.73 mm (21.98 ± 0.63 mm at age 3, 22.12 ± 0.69 mm at age 4, 22.34 ± 0.73 mm at age 5, and 22.49 ± 0.73 mm at age 6). Conclusions Prevalence of myopia increases with age in children aged 3-6 years in Hebei, China. With the increase of age, CR is basically stable, and AL increases gradually. AL/CR, which is closely related to SE, can be used as an indicator to predict myopia and guide clinical work.

目的 探究Best卵黄样黄斑营养不良(Best vitelliform macular dystrophy,BVMD)一家系的基因突变表型及临床特点 方法 回顾性分析BVMD一家系所有患者详细病史资料及检查结果,眼部检查包括视力、色觉、裂隙灯、散瞳眼底检查、光学相干断层扫描等,根据眼底表现对BVMD病变进行分期,了解BVMD中儿童及成人发病特点的相关差异.对家系中有关直系亲属取外周静脉血行基因分析,通过靶向捕获高通量测序,对BVMD致病基因进行分析,寻找可能致病突变.结果 8名家庭成员中5例为BVMD患者,其中1例2眼为Ⅱ期,3例5眼为Ⅲ期,1例1眼为Ⅳ期,1例2眼为V期.基因检查结果为常染色体显性遗传,BEST1 (OMIM 607854)基因c.238T＞C;p.Phe80Leu杂合突变.结论 此家系呈现常染色体显性遗传,基因检测对于BVMD的诊断及遗传学咨询具有重要作用.在同一分期中儿童患者眼底表现较重,需更密切的随访监测.OCT可作为此类疾病随访的监测指标.

We aimed to evaluate the clinical effect and safety of orthokeratology in controlling the development of myopia. We assessed the changes in visual acuity, diopter change, axial length, corneal endothelium count, intraocular pressure, and corneal Q value in 30 adolescents with 60 years of wearing an orthokeratology lens. In this study, no significant difference was observed between the naked eye vision and corrected visual acuity before wearing the lens (t = –0.23, P = 0.59); furthermore, no significant difference was observed in diopter, axial length, corneal endothelium count, and intraocular pressure 1 year before and after wearing the lens (t = 1.24, P = 0.45; t = –0.89, P = 0.25; t = –0.43, P = 0.57; t = 1.43, P = 0.61); by contrast, there was a significant difference in the corneal Q value before and after wearing the lens (t = –8.37, P = 0.001). These results suggest that the fluorosilicone acrylic breathable material corneal orthopedic lens is safe and effective in controlling myopia, and has little effect on the physiology of the eye.

目的 探讨3～6岁儿童等效球镜屈光度、眼球生物学参数情况及屈光发育异常影响因素.方法 选取符合纳入及排除标准的3～6岁儿童500例作为研究对象,观察3～6岁儿童屈光发育异常检出情况,比较不同性别、年龄及屈光状态3～6岁儿童等效球镜屈光度及眼球生物学参数情况,并采用单因素和多因素Logistic回归分析对3～6岁儿童屈光发育异常的影响因素进行分析.结果 500例屈光异常检出率14.00％,其中远视52例,近视18例.屈光异常检出率3～4岁明显高于5～6岁,差异有统计学意义(P<0.05).3～6岁儿童中男孩眼轴和角膜直径均长于女孩,差异有统计学意义(P<0.01).与3～4岁比较,4～5岁和5～6岁等效球镜屈光度降低,眼轴增长;与4～5岁比较,5～6岁等效球镜屈光度降低,眼轴增长,差异有统计学意义(P<0.01).远视患儿等效球镜屈光度高于正视儿童和近视患儿,眼轴短于正视儿童和近视患儿;正视儿童等效球镜屈光度高于近视患儿,眼轴短于近视患儿,差异均有统计学意义(P<0.01).单因素分析结果显示,与屈光发育正常儿童比较,屈光发育异常儿童年龄相对较小,非足月生产、出生体质量<3 kg、每天户外活动时间<2 h以及每天近距离用眼时间≥2 h所占比例较高,差异有统计学意义(P<0.05或P<0.01).多因素Logistic回归分析结果显示,非足月生产、出生体质量<3 kg、每天户外活动时间<2 h以及每天近距离用眼时间≥2 h为3～6岁儿童屈光发育异常的独立危险因素(P<0.05或P<0.01);年龄5～6岁是3～6岁儿童屈光发育异常的保护因素(P<0.05).结论 不同性别、年龄及屈光状态下,3～6岁儿童等效球镜屈光度和眼球生物学参数分布存在差异.非足月生产、出生体质量<3 kg、每天户外活动时间<2h以及每天近距离用眼时间≥2h为3～6岁儿童屈光发育异常的独立危险因素.

目的 探讨中医耳穴贴压对3～16岁近视儿童眼调节功能的改善作用.方法 选取2017年1月至2019年3月河北医科大学附属河北省儿童医院收治的100例3～16岁近视儿童,采用随机数字表法将其分为对照组和研究组各50例,对照组给予0.01％阿托品治疗,研究组在对照组基础上给予中医耳穴贴压治疗,均治疗2周.对比两组治疗后临床疗效;治疗前后裸眼视力、屈光度、眼调节功能指标水平及视神经传导功能;观察并统计两组治疗期间不良反应发生率.结果 研究组总有效率为80.00％,显著高于对照组的58.00％(P<0.05).治疗后2周,两组裸眼视力、调节幅度、调节灵敏度均较治疗前升高,且研究组显著高于对照组(P<0.05);近视屈光度、调节滞后量均下降,且研究组均显著低于对照组(P<0.05).治疗后2周,两组P100潜伏期均较治疗前降低,且研究组P100潜伏期低于对照组;P100振幅均升高,且研究组P100振幅高于对照组(P<0.05).研究组不良反应发生率为4.00％,显著低于对照组的12.00％(P<0.05).结论 中医耳穴贴压治疗3～16岁近视患儿,可显著改善其裸眼视力及屈光度,增强眼部调节功能,提高临床疗效,且具有较高安全性.

目的 探讨儿童眼部蜂窝织炎的临床特点及治疗效果.方法 回顾性分析2015年1月至2018年2月收治的50例眼部蜂窝织炎患儿的临床资料,对其性别、年龄、发病季节、致病途径、治疗效果进行分析.结果 50例患儿中,男30例,女20例;年龄10 d～8岁,3岁以下年龄组患儿多见;第2和第4季度为高发季节.致病途径以周围组织炎症蔓延最多见,其他包括血行感染3例、眼部外伤1例并发感染,另外4例(8％)患者无明确外伤史或其他部位感染史.11例患儿进行了脓肿切开引流并行脓液细菌培养,其中9例细菌培养为阳性.致病菌有3类:金黄色葡萄球菌最多见(7例,其中MRSA有3例),肺炎链球菌1例、奴卡氏菌1例.治疗以第一代头孢菌素类抗生素静点,局部广谱抗生素滴眼液及眼膏点眼.患儿外周血白细胞计数及血清C-反应蛋白(CRP)经治疗后明显下降且基本正常.住院天数平均(8±3)d,除1例因并发脑膜炎转入重症科继续治疗外,其余患儿均治愈.结论 儿童眼部蜂窝织炎的发病年龄集中在3岁以下,第2和第4季度为高发季节,鼻窦炎和上呼吸道感染是主要病因.本病可发生严重并发症,抗生素应覆盖葡萄球菌及链球菌,并根据微生物学检查结果调整用药,必要时实行手术切开引流以加快治愈.

To the Editor: Infection is one of the causes of death after chemotherapy in children with leukemia. About 20% to 30% acute lymphocytic leukemia (ALL) patients die from infection after chemotherapy.[1] Patients with immune deficiency, under chemotherapy, or treated with immunosuppressor are more inclined to be infected with human cytomegalovirus (HCMV) which leads to severe systematic disorders.[2] Cytomegalvirus retinitis (CMVR) is a major sight threatening disease which mainly occurs in patients with immune deficiency and results in blindness if treatment is delayed. The decrease of CD4+ T cells has been related to CMVR in immune deficiency syndrome like AIDS.[3] However, little is known about the relation between the level of T cells with different markers and the onset of CMVR in ALL patients under chemotherapy. Therefore, this study was designed to investigate the diagnostic value of T cells with different markers for cytomegalovirus retinitis after chemotherapy in patients with ALL. One hundred twenty-eight children with ALL who were under chemotherapy in the department of hematology from our hospital from January 2015 to September 2017 were included in this study. Inclusion criteria: (1) ALL was diagnosed by bone marrow examination; (2) ALL patients were under moderate risk and under uniform chemotherapy regimens; (3) Medical record was complete; (4) No HCMV infection before chemotherapy; (5) Patients were under ocular examination at regular intervals. All participants were divided into three groups based on whether they were infected with HCMV and whether they were present with CMVR. Group A included 99 patients who were HCMV negative. Group B included 18 patients who were HCMV positive but absent of CMVR. Group C included 11 patients who were HCMV positive and meanwhile present with CMVR. Polymerase chain reaction (PCR) for CMV was used to determine blood CMV-DNA and urine CMV-DNA. When CMV-DNA<500U/mL, it was considered as CMV negative. When CMV-DNA>500U/mL, it was considered as CMV positive. After chemotherapy, blood sample was obtained from all patients and flow cytometry was used to determine the number of T cells with different markers, including CD3, CD4, CD8. In 128 ALL patients, 11 patients showed CMVR after chemotherapy. Among them, three patients underwent vision loss (3/11), eight patients did not undergo eye discomfort and were diagnosed as CMVR when ophthalmologic examination was performed (8/11), seven patients underwent eye lesion in binoculus (7/11), and the other fourpatients underwent single eye lesion (4/11). Lesion in three eyes in two patients occurred in the center (3/18), seven eyes in five patients in the rim (7/18), and eight eyes in four patients both in the center and in the rim (8/18). Lesion in seven eyes in four patients involved in yellow spot (7/18). Four eyes in two patients were involved in retinopathy and optic neuritis (4/18). In these two patients, hyperaemia and diffused hemorrhage could be seen in optic disk with obscure boundary, as shown in Figure 1A. Nine eyes in five patients showed extensive retinal vasculitis (9/18) and the vagina vasorum in retina was obvious [Figure 1B and 1C]. Two eyes in one patient showed preretinal hemorrhage (2/18) [Figure 1D].Figure 1: Photos of fundus disease in CMVR patients. (A) hyperaemia and diffused hemorrhage could be seen in optic disk with obscure boundary; (B and C) extensive retinal vasculitis and the vagina vasorum in retina; (D) preretinal hemorrhage. CMVR: Cytomegalvirus retinitis.Table 1 showed the counting results of T cells with different markers after chemotherapy in three groups. Except CD4+ T cells/CD8+ T cells ratio, the number of CD3+ T cells, CD4+ T cells, and CD8+ T cells were significantly different among three groups. Notably, the number of CD4+ T cells in group A was remarkably higher than that in group B, and remarkably higher in group B than in group C (A>B>C).Table 1: T cells counts with different markers after chemotherapy in three groups of ALLFor all sample, when the number of CD4+ T cells was higher than 200/μL, 100–200/μL, and lower than 100/μL, the CMVR positive rate was 6/7, 26.31% (5/19), and 0 (0/102). In the 29 patients with HCMV infection, when the number of CD4+ T cells was higher than 200/μL, 100–200/μL, and lower than 100/μL, the HCMV infection rate was 0 (0/11), 45.45% (5/11), and 54.55% (6/11). The number of CD4+ T cells was negatively related to CMVR positive rate, and it showed a significant difference when χ2 was performed (χ2 = 70.187, P<0.01). That is to say, as the number of CD4+ T cells decreased, the positive rate of CMVR increased. After chemotherapy, 11 out of 128 ALL patients showed CMVR positive, which count for 8.59% in all sample. The range of CD4+ T cells in CMVR positive patients was 32–192/μL, and the average was 113.72 ± 59.36/μL. Among these 11 patients, the number of CD4+ T cells in six patients was lower than 100/μL, and 100–200/μL in five patients. When the number of CD4+ T cells was higher than 200/μL, no patients were CMVR positive. Based on the relationship between the number of CD4+ T cells and CMVR positive rate, we would like to further determine the diagnostic value of CD4+ T cells for CMVR after chemotherapy in ALL patients, ROC curve analysis was performed. As shown in Figure 2, the area values under the curve of the number of CD4+ T cells was 0.920 ± 0.029, which indicated that the number of CD4+ T cells possessed a high diagnostic value for CMVR after chemotherapy in ALL patients.Figure 2: ROC curve of the number of CD4+ T cells for CMVR after chemotherapy in 128 ALL patients. The number of CD4+ T cells possessed a high diagnostic value for CMVR after chemotherapy in ALL patients, the area values under the curve of the number of CD4+ T cells was 0.920 ± 0.029, P < 0.001. ALL: Acute lymphocytic leukemia; CMVR: Cytomegalvirus retinitis; ROC: Receiver operating characteristic curve.Cell-mediated immunity is the main force for anticancer, and T type lymphocytes play an important role in cell-mediated immunity. In our study, we measured the number of T cell subpopulation with different markers, including CD3, CD4, CD8, and investigated the relationship between CMVR positive rate and T cell-mediated immunity. We found that compared to the HCMV negative patients, HCMV positive patients showed a significantly lower level of CD3+, CD4, CD8+ T cells. And in patients with CMVR, those indexes were lower than patients without CMVR. Among that index, the level of CD4+ T cells was significantly lower in patients with CMVR than HCMV positive patients without CMVR, and the former was significantly lower than HCMV negative patients. It is well known that CD4+ T cell and CD8+ T cell are two important subpopulations of T type lymphocytes.[4] CD4+ T cells can activate phagocytes and CD8+ T cells and thus enhance the ability to combat cancer.[5] In this study, comparing to the HCMV negative patients, the HCMV positive patients showed a lower level of CD3+ T cells, CD4+ T cells and CD8+ T cells and a lower ratio of CD4+ T cells to CD8+ T cells. This indicated that the decreased cell-mediated immunity might cause HCMV infection or HCMV from the status of inertia to activation. What is more, comparing to the HCMV negative patients and HCMV positive patients without CMVR, the patients with CMVR showed a significantly lower level of index discussed above. This indicated that the occurrence of CMVR might be caused by the further decreased immunity after HCMV infection. The diagnosis of CMVR is mainly based on ophthalmologic examinationand medical history. When clinical feature shows no significant evidence of CMVR, laboratory examination is needed.[6] On the one hand, CMV-IgM from the blood is the diagnostic index normally used for HCMV infection at present.[7] However, for ALL patients who receive chemotherapy, their immunity has been impaired. When CMV-IgM can be detected in the blood, it is always found that CMVR is under a very severe condition. Therefore, its diagnostic value is evaluated. On the other hand, although sample from vitreous body and aqueous humor is much more accurate than that from blood, it becomes very unrealistic to obtain them because anesthesia or surgery is needed and the risk is comparatively high. CMVR is an opportunistic infectious disease which can be normally found in ALL patients after chemotherapy.[8] Lack of cytotoxic T lymphocytes and a low CD4+ lymphocyte count as considered to be risk factors for CMV disease.[9] In this study, we found that the number of CD4+ T cells in CMVR was extremely low comparing to the other 2 groups. When the number of CD4+ T cells was lower than 200/μL, the occurrence of CMVR tended to be significantly higher. What is more, we have another strong evidence that the area values under the curve of the number of CD4+ T cells was 0.920 ± 0.029, and it indicated that the level of CD4+ T cells might be a potential biomarker for CMVR in ALL patients after chemotherapy. The evidence discussed above suggest that when an ALL patient who is under chemotherapy appears eye discomfort and low level of CD4+ T cells, it is highly recommended that CMV-DNA from the blood and urine should be determined as the preliminary diagnosis for HCMV infection. And if the HCMV is positive, the ophthalmologic examination should be performed carefully to determine if CMVR is present and early treatment should be given in order to prevent vision loss. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Conflicts of interest None.

Purpose: Children with acute lymphoblastic leukemia (ALL) are complicated with cytomegalovirus (CMV) retinitis due to the compromised immune function after chemotherapy. Here, we report a case of cytomegalovirus retinitis in a 4-year-old girl with ALL to emphasize the importance of early diagnosis and intravenous administration of antiviral medication in this group of patients. Case Report: A 4-year-old girl with ALL was diagnosed of fulminant CMV retinitis after chemotherapy. Funduscopic examination revealed perivascular sheathing in pole and peripheral retina of right eye. Large areas of yellowish-white edema, hemorrhage and exudation along the vessels were seen in the superior nasal retina. Few perivascular sheathings were found in peripheral retina without obvious hemorrhage and exudation in left eye. With early diagnosis and prompt intravenous administration of ganciclovir,the lesion of the fundus subsided and the vision was restored over 4 months of follow up period. Conclusions: In summary, CMV retinitis can occur in ALL pediatric patients who receive chemotherapy only, especially in the maintenance stage. With routine follow-up, early diagnosis and intravenous antiviral therapy, these patients may have a good prognosis.

社区获得性铜绿假单胞菌感染相对少见.本例报告了一例以眶蜂窝织炎为突出表现的社区铜绿假单胞菌感染. 患儿男,4岁1月,主因“右眼睑红肿5天”入院.患儿4个月前曾因右眼上睑下垂于我院行右眼额肌悬吊术+植入材料(图1).6天前右眼被抛出的塑料桶盖砸伤,当时无红肿,表皮无破损等表现.入院查:右侧额部可触及质韧硬结,右眶周及眼睑皮肤高度肿胀,表皮薄弱,睁眼困难,触质韧,皮温高,睑球结膜充血,角膜清,前房、瞳孔正常(图2).左眼外眼及眼前节未见明显异常.眼眶CT示:右眶周软组织肿胀,上眼睑及眶上部皮下异物(图3).

1 临床资料 患者,男,55岁,主因右眼视物模糊5年,加重1周于2013年11月12日入院.既往糖尿病12年,右眼小梁切除术后7年,左眼曾行2次小梁切除术(2001于某院首次行左眼小梁切除术,术后1周出现脉络膜脱离,行手术复位,具体术式不详;2004年因眼压控制不佳于某院再次行左眼小梁切除).