To observe the effectiveness of intense pulsed light(IPL) treatment as an adjuvant treatment of refractory seasonal allergic conjunctivitis in children. A total of 31 patients with refractory seasonal allergic conjunctivitis who did not respond well to anti-allergic drug treatment were randomly selected to receive drug therapy combined with IPL treatment (17 patients) and drug treatment alone (14 patients) for 1 week, and the ocular surface symptom questionnaire and ocular surface sign score were performed before and after treatment, respectively. After treatment, the IPL group had significantly lower scores in eye rubbing, blinking, eye itching, discharge, tearing, and total scores than before treatment (P < 0.05), while there was no significant difference in foreign body sense scores before and after treatment (P > 0.05). There were no significant differences in eye rubbing, blinking, eye itching, discharge, foreign body sensation, tearing, and total score between the control group after treatment (P > 0.05). After treatment, the scores of ocular signs in the IPL group and the control group were lower than those before treatment, and the difference was statistically significant (P < 0.01). IPL therapy is effective in improving ocular surface symptoms in children with refractory seasonal allergic conjunctivitis, especially in suppressing eye itching, with good results.

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.

目的 探讨儿童肺炎支原体(MP)相关性视神经炎(ON)的临床特点、诊治和预后.方法 回顾分析1例MP-ON患儿的临床资料,检索分析国内外数据库中MP合并ON病例.结果 患儿为10岁青春前期女童,发热、头痛起病,血清MP抗体滴度>1:1280,予阿奇霉素治疗后发热头痛迅速缓解.病程第23天出现急性视力下降伴眼球转动痛,视野缺损、视乳头水肿及视觉诱发电位异常,无其他神经系统受累表现,无脑病表现.查血髓鞘少突胶质细胞糖蛋白抗体(MOG-Ab)阳性,脑脊液和核磁共振检查结果异常,予以大剂量甲基泼尼松龙联合人免疫球蛋白静滴,视力恢复到发病前水平,3月后随访无复发.结论 MP感染可并发ON,与自身免疫或免疫复合物引起的脱髓鞘改变有关,顽固性头痛有提示意义,中枢神经系统脱髓鞘血清抗体检查有利于临床分型、指导治疗.

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.

ObjectiveThis study examines the distribution and development of intraocular pressure (IOP) in infants aged from 0 to 36 months and analyzes its correlation with corneal diameter.MethodsThe study used a retrospective case analysis methodology. Healthy infants treated in the ophthalmology department of Hebei Children's Hospital from December 2012 to December 2020 were included in the study. Among these infants, 385 had their IOP measured, and 432 had their corneal diameters measured. Furthermore, information such as birth history, growth and development, IOP, and corneal diameter were collected. Their IOPs were measured with an iCare portable rebound tonometer when the child was awake and calm, and the corneal diameter was measured with a Castroviejo caliper under chloral hydrate sedation. The infants were divided into five groups according to age, and SPSS statistical software was used to analyze, compare, and correlate IOP and corneal diameter variations.ResultsThe mean IOP values of 0–1 month, 1–6 months, 6–12 months, 12–24 months and 24–36 months groups were 7.42 ± 1.92, 9.10 ± 2.85, 12.00 ± 3.15, 13.72 ± 3.09, and 15.14 ± 2.67 mmHg, respectively. The differences in IOP of the 0–1 month old infants and the 1–6 months old infants with the other three groups were statistically significant; the difference in IOP between the 6–12 months group and the 24–36 months group was statistically significant. In the studied groups, the horizontal corneal diameters were 9.78 ± 0.14, 10.50 ± 0.29, 10.86 ± 0.23, 11.38 ± 0.07, and 11.72 ± 0.04 mm, respectively, and the vertical diameters of the cornea were 9.28 ± 0.26, 10.07 ± 0.18, 10.28 ± 0.14, 10.56 ± 0.24, and 10.85 ± 0.03 mm, respectively. The differences in the vertical and horizontal diameters of the cornea among the groups were statistically significant.ConclusionInfants' IOP and corneal diameter positively correlate with age, and they peak in the first 12 months.

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 比较自上泪小点和下泪小点进针行泪道探通治疗婴儿鼻泪管阻塞的效果.方法 选取眼科门诊就诊的鼻泪管阻塞的患儿180例(220只眼),90例作为(108只眼)作为A组,采取上泪小点进针行泪道探通术;90例作为(112只眼)作为B组,采取下泪小点进针行泪道探通术,观察泪道探通结果,观察2组患者手术效果、不同月龄患儿探通手术效果及并发症发生率.结果 A组一次治愈率显著高于B组,差异有统计学意义(P<0.05).上泪小点进针>9个月患儿一次治愈率明显低于3个月<月龄<6个月和6～9个月,差异有统计学意义(P<0.05),6～9个月一次治愈率低于3个月<月龄<6个月,但差异无统计学意义(P>0.05).A组假道眼睑肿胀、泪小管撕裂、出血、感染等并发症发生率明显低于B组,差异有统计学意义(P<0.05).结论 从上泪小点进针行泪道探通术对婴儿鼻泪管阻塞的治疗效果优于从下泪小点进针行泪道探通术,且减少假道、眼睑肿胀、泪小管撕裂、出血感染等并发症的发生率.

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.

Objective To investigate the clinical features, treatment and prognosis of children patients with acute lymphoblastic leukemia complicated by cytomegalovirus retinitis after chemotherapy. Methods The clinical data about 17 patients (30 eyes) with acute lymphoblastic leukemia complicated by cytomegalovirus retinitis after chemotherapy who were treated in our hospital from January 2014 to September 2017 were collected to analyze retrospectively the risk factors of pathogenesis of cytomegalovirus retinitis, therapeutic method and prognosis of patients. All the patients underwent slit-lamp ophthalmoscopy, mydriasis fundus examination, color fundus photography and general physical examination including blood CMV-DNA,urine CMV-DNA and CD4+T lymphocyte counts. The patients were once suffered from cytomegalovirus retinitis, they were given systemic antiviral treatment,however, the patients who were intolerant to systemic antiviral treatment and had obvious adverse reactions or continuing progression of lesions were given antiviral drugs by intravitreal injection. Results Among 17 patients (30 eyes) with acute lymphoblastic leukemia who were diagnosed definitely as cytomegalovirus retinitis, there were 8 males (14 eyes),9 females (16 eyes),with age ranges being 5～14 tears [mean age (8. 18 ± 2. 64)years]. The lesions in 76. 5％ of patients were involved in binoculus,and 23. 5％ of patients with unilateral disease,and 13. 3％ of them were central lesions,36. 7％ were peripheral lesions,50％ were mixed lesions,30％ were involved in yellow spot,20％ were combined with optic neuritis and 40％ were with extensive retinal vasculitis. The CD4+ T lymphocyte counts were 20 ～186 cells/μl,with mean counts being (99. 66 ± 49. 1)cells/μl,which in 17. 6％ of patients were less than 50 cells/μl,17. 6％ of patients were 50～100 cells/μl,52. 9％ of patients were 100～150 cells/μl,11. 8％ of patients were more than 150 cells/μl. Moreover the retinopathy was gradually subsided in 9 patients after systemic treatment, however, the active lesion was not relieved in 6 patients after systemic antiviral therapy treatment, then the 6 patients were given ganciclovir by intravitreal injection untill the pathological changes were stopped. In addition 2 patients who did nor receive regular systemic antiviral therapy suffered from retinal detachment. Conclusion Once incidence of cytomegalovirus retinitis, the patients should be treated by systemic antiviral drugs,at the same time,cell immune function of patients should be detected. For the patients whoare intolerant to systemic treatment,with obvious adverse reactions or progression of lesions, can be treated by giving antiviral drugs through intravitreal injection to control the progression of diseases.

Objective To observe the clinical features of retinal arterial occlusion (RAO) in youth.Methods This is a retrospective case review.Nine patients (9 eyes) with RAO were enrolled in this study.There were 6 males (6 eyes) and 3 females (3 eyes).The average age was (14.22± 3.93) years.The best-corrected visual acuity (BCVA),indirect ophthalmoscopy,fundus color photography and fundus fluorescein angiography were performed.All patients underwent systemic evaluation including blood routine,erythrocyte sedimentation rate,blood lipids,vasculitis screening,homocysteine level,antiphospholipid antibody,blood coagulation,neck vascular ultrasound,and cardiac color ultrasound and electrocardiogram examination.All patients received oxygen therapy,blood medications and symptomatic treatment.Meanwhile,the patients with autoimmune diseases were received systemic glucocorticoid therapy.The follow-up was ranged from 6 to 12 months.The visual acuity and fundus change before and after treatment were compared.Results among 9 patients,one patient had systemic lupus erythematosus,one patient had congenital heart disease,one patient had hypergammaglobulinemia,and carotid artery color ultrasonography showed that the internal carotid artery vessels faltered in 2 cases.The BCVA was 0.01-0.12.Among 9 eyes,there were 5 eyes (55.6％) with retinal branch artery occlusion (BRAO),2 eyes (22.2％) with central retinal artery occlusion (CRAO),2 eyes (22.2％) with ciliary retinal artery occlusion (CLAO).CRAO eyes showed positive RAPD (relative afferent pupillary defect),fine retinal artery and the corresponding vein,pale white retinal edema in posterior area and macular cherry-red spot.BRAO eyes manifested as inferior temporal artery occlusion and pale white retinal edema around them.CLAO eyes showed temporal ligulate grey-white retinal edema.At the last follow-up,BCVA improved and retinal vessels returned to normal in 7 eyes (77.8％);BCVA unchanged and no improvement in fundus in 2 eyes (22.2％).Conclusion Adolescent RAO is mostly partial occlusion,the prognosis is generally good after early active treatment.

Objective To investigate types of fundus change in children with acute lymphoblastic leukemia and clinical features of each type, providing the clinical basis for differential diagnosis and timing of treatment. Methods Retrospective case study. The clinical data of 24 patients (39 eyes) with acute lymphoblastic leukemia and clinical features were collected from January 2015 to September 2017. Slit-lamp ophthalmoscopy,indirect oph-thalmoscopy, fundus photography, blood CMV-IgM, blood CMV-DNA, urine CMV-DNA, and T-lymphocyte counts when the lesion changes were measured. Results 39 eyes of 24 patients are reviewed,including 15 males 25 eyes,9 females 14 eyes. The age ranges from 3 to 14 years,the mean age was (7.88±2.61) years old. In-cluding 11 cases 17 eyes (45.83%) of cytomegalovirus retinitis and 13 cases 22 eyes (54.17%) of leukemic retinopathy were included,fundus changes were the first manifestation in 4 cases. All the cytomegalovirus retinitis patients CD4+ T lymphocyte were less than 200 cells/μl. Temporal peripheral lesions are most common,the majori-ty of lesion were quiescence after treatment following with increase of CD4+ T lymphocyte count, more than 200 cells/μl. Bilateral optic disc edema appear in 45.45% of leukemic retinopathy, 36.36% has retinal hemorrhage, 18.18% has both. The prognosis was good after treatment in department of hematology. Conclusions There are vari-ous types of fundus changes in children with acute lymphoblastic leukemia and need to be identified, cy-tomegalovirus retinitis should be notice except of leukemic retinopathy. The progression of cytomegalovirus retinitis is closely related to the decrease in T-lymphocyte counts. For DNA positive and CD4+ T lymphocyte reductions, especially in patients with less than 200 cells/μl, cytomegalovirus retinitis should be highly suspected. The prognosis of fundus disease caused by leukemia is better.