Purpose: To establish if there are different classes of inflammatory lacrimal punctum diseases (ILPDs) and to examine the various strategies by which they can be managed therapeutically.Methods: Two hundred and fifty nine (259) patients with inflammatory punctum lacrimal disease were identified and used as subjects for this study. Each patient was carefully examined for evidence of morphology of lacrimal punctum which was confirmed mainly by lacrimal duct flushing and probing. Appropriate therapeutic managements were adopted for patients with other inflammatory conditions besides ILPD. The clinical effects of the various therapeutic strategies were documented.Results: Eighty-seven (87) patients out of the 259 (32.53 %) suffered from acute or chronic conjunctivitis while 66 patients (5.61 %) suffered from inflammatory lacrimal passage diseases. Patients with both conjunctivitis and lacrimal passage inflammation, patients with dry-eye symptoms, patients with just one of the conditions, and patients with mere evidence of superior punctalacrimalis represented 13.15, 14.19, 14.53, and 33.91 %, respectively. Mere evidence of inferior punctalacrimalis, and presence of acute inflammation were seen in 48.76 and 13.49 % of the 259 patients, respectively, while those with chronic inflammation lasting for 2.97 +/- 0.13 years, comprised 86.51 %. Antibiotic eye drops were used for acute inflammation, while chronic inflammation was treated with antibiotic eye drops, lacrimal punctum expansion, pus elimination, and punctum-sparing canaliculotomy. Both therapeutic methods produced satisfactory curative effects.Conclusion: The results show that satisfactory therapy of lacrimal punctum inflammation can be achieved if the right therapeutic agents and procedures are adopted based on clinical characteristics of the ILPD manifesting in the patient.

Objective To assess the safety and efficacy of self-crosslinked hyaluronic acid hydrogel (PureRegen Gel Sinus) as a postoperative nasal dressing in the entranasal endoscopic dacryocystorhinostomy (EES-DCR).Methods Thirty-two patients with primary chronic dacryocystitis (PCD) underwent bilateral EES-DCR in our hospital.The randomly selected right or left lacrimal ostium was filled with PureRegen Gel Sinus (dressing S) and the other side as the control group received no dressing S.Patients were followed up for 12 weeks.The mucosal epithelialization of the wound,synechiae,edema,granuloma and the success rate of ostial patency were compared between the two groups.Results Thirty patients completed the study.The dressing S group showed significantly better results than the control group in the degree of the mucosal epithelialization at 4 or 8 weeks after the operation (Z =2.21,P =0.027;Z =2.642,P =0.008).The degree of tumescence in the dressing S group was less and the speed of detumescence was faster compared with that in the control group,but the differences were not statistically significant (P ＞ 0.05).Whereas there were no statistically significant differences between the two groups in synechiae,granuloma and the success rate of ostial patency at 12 weeks postoperatively (P ＞ 0.05).Conclusion The dressing S can facilitate mucosal epithelialization and is a safe nasal dressing in EES-DCR.

微小RNA(microRNAs,miRNAs)是近年来发现的普遍存在于生物基因组的非编码蛋白质的单链小RNA,长约22个核苷酸,它们通过在转录后和翻译水平调节基因表达而调控生理和病理过程.视网膜病变是眼科难治性疾病和致盲的重要原因.最新研究表明,MicroRNAs在视网膜病变的发生发展中起到十分重要的调控作用.MicroRNAs用于治疗视网膜病变具有广阔的前景.本文就MicroRNAs的功能及其在视网膜病变中的研究现状进行综述.

Objective To observe the Langerhans' cells in the formation of superficial corneal macula by confocal microscopy.Analyze the role of LC in the superficial corneal macula formation.Methods To consecutively observe the 342 patients(342 eyes)with superficial corneal ulcers or keratitis,mild corneal trauma or chemical burn by confocal microscopy.The confocal microscope images of LC in the forming of the superficial corneal macula were summarized and analyzed.The role of the LC in the recovery time was studied.Results (1)In 342 cases(342 eyes),there were 317 cases(317 eyes)found Langerhans' cells migration from the limbal capillaries or neovascularization by confocal microscopy,accounted for 92.69％.(2)There were 287 cases(287 eyes)found Langerhans' cells migration in the corneal epithelium and Bowman's layer in the repair process,accounted for 83.92％.3.There were 231 cases(231 eyes)found Langerhans' cells continue to shift to the lesions in the peripheral corneal epithelial repair,and Langerhans' cells deformation,extending more synapses,began to participate in the repair process of superficial corneal macula,accounted for 67.54％.4.There were 322 cases(322 eyes)found Langerhans' cells migration accumulation to participate the repair process of superficial corneal macula,accounted for 94.15％.Conclusion Langerhans' cells have an important role in the superficial corneal macula formation.According to our study,the processes will be divided into three stages by confocal microscopy.The first stage leakage transitional period:Capillary or new blood vessels to dilate,Langerhans' cells migration from blood vessels.The second stage of repair corneal epithelium and Bowman's layer of the transitional period:Aggregation transitional Langerhans' cellss to the lesion,participate in the corneal epithelium and Bowman's layer repair repair process.The third stage of formation of shallow layer corneal macula:Langerhans' cells aggregation in the ulcer lesions,involved in the formation of shallow macula.

Objective To analysis the causes of the failure after lacrimal passage intubation operation, and to find the prevention and treatment methods.Methods 80 patients (104 eyes) after lacrimal passage intubation operation were retrospectively analyzed. The causes why the operation failed and the methods of prevention and treatment were investigated.Result There were puncta lacrimalis, canaliculitis or dacryocystitis in 8 eyes(7.7%);granulation proliferation in 8 eyes(7.7%); stump residue in 4 eyes(3.8%);false way in 4 eyes(3.8%).All the cases were cured after given appropriate treatments. Conclusion Irrigation or probing of lacrimal passage and dacryocystography can help us to choose suitable cases for lacrimal passage intubation operation. We should avoid false ways in the operation. Periodic review is important.

Objective To evaluate the clinical efficacy of homologous sclera patch grafting combined with autogenous conjunctival flap covering for sterile scleral melting after ophthalmologic operation.Methods Ten eyes of 10 patients with sterile scleral melting after ophthalmologic operation who underwent homologous sclera patch grafting combined with autogenous conjunctival flap covering were retrospectively reviewed.The necrotic scleral tissue was smeared and cultured,and the serological examination was carried out.The 10 eyes were treated with FK506,rhEGF and artificial tears after the operation.Results Before the operations,no bacteria or fungi were found and there was no evidence of inflammation in the 10 cases.The rheumatoid factor was abnormally high expression in one case.8 patients presented dry eye.About at d 45,8 cases of the necrotic sclera has healed after operation.2 cases of the sclera graft began to melt at d 40 and d 48 after operation because of poor vascularization.Conclusion The immunoreaction caused by systemic immunity and operation may be the main causes of sterile scleral melting after the ophthalmologic operation.The homologous sclera patch grafting combined with autogenous conjunctival flap covering is helpful to treat the scleral melting which can preserve the eyeball integrity.

AIM:To observe the pathological changes of the lower segment of nasolacrimal duct mucosa in rabbits at different stages after retrograde lachrymal dilated drainage tube implantation. <br> METHODS:Totally 14 New Zealand rabbits were used in the present study. One side of nasolacrimal duct was obstructed to produce an experimental model and operated the reverse implantation of nasolacrimal duct intubation. Histological changes of the lower segment of nasolacrimal duct mucosa were observed by routine light microscope at 2, 4, 6, 8, 10, 12 and 14wk after the operation. <br> RESULTS: Compared with the control side, the group of 2 and 4wk after surgery presented the inflammatory cytokine. The group of 12wk after the operation presented isolated granuloma. Group 12 and 14wk presented scattered granuloma. The size of the granulomas was smaller and the density of epithelioid cell and fibroblast were lower in group 12wk than those in group 14wk by HE and Masson trichrome stain. <br> CONCLUSION:Recurrent Silicone Tube is used to treat nasolacrymal duct obstruction. Nasolacrimal duct can be&nbsp;narrowed and blocked again by granuloma, progressive fibrosis and adhesion of surrounding tissues when tube is in the duct more than 12wk.

Objective To analyze special cause and treatment for corneal ulcer after ptosis surgery.Methods 110 eyes of 89 patients who underwent blepharoptosis correction surgery between January 2012 and December 2012 were retrospectively analyzed.Corneal ulcer occurred in 5 cases (6 eyes).The causes and treatment were analyzed.Results In 5 cases (6 eyes),corneal ulcer was caused by entropion and trichiasis in 3 eyes of 3 cases.The corneal ulcer was related to the psychological illness in 2 eyes of 1 case.The nerve nutritional corneal ulcer occurred in 1 eye of 1 case because of meningioma surgery.After the treatments,such as tarsorrhaphy,cornea nutritional therapy and symptomatic treatment,all the corneal ulcer restored transparent and the effect of surgery was satisfactory.Conclusion Before and after ptosis surgery,patients have been taken measures to prevent the occurrence of corneal ulcer,but corneal ulear still occurs.The causes are not common.So improving preoperative examinations and postoperative active treatment are very necessary.

Objective To evaluate the clinical efficacy of rotational autokeratoplasty combined with double-lamellar autokeratoplasty in the treatment of cornea perforation.Methods Eight patients (8 eyes) with cornea perforation who underwent rotational autokeratoplasty combined with double-lamellar autokeratoplasty from June 2010 to December 2012 were retrospectively reviewed.8 cases (8 eyes) with cornea perforation included 5 cases of fungal corneal ulcers with perforation,1 case of pseudomonas ulcer with perforation,1 case of advanced Mooren' s ulcer with perforation,and 1 case of acute perforation of keratoconus.All cases underwent rotational autokeratoplasty combined double-lamellar autokeratoplasty.Results After operation,all patients not only preserved their eyeballs,but also retained the best-corrected visual acuity at 1 month after surgery:hand move in 3 eyes,0.04 in 2 eyes,0.05 in 1 eye,0.08 in 1 eye,0.1 in 1 eye.In two weeks after operation,the grafts epithelium was integrity in 8 eyes.No other postoperative complications developed in all patients.Conclusion Rotational autokeratoplasty combined with double-lamellar autokeratoplasty is an effective method to save eyeballs under the situation of deficiency of cornea donor in the treatment of cornea perforation.

Objective To study the occult perforation in Terrien Marginal Degeneration by anterior segment optical coherence tomography (AS-OCT),and provide the basis for clinical diagnosis and treatment.Methods Defined the inner lesions of Terrien Marginal Degeneration as the occult perforation by AS-OCT,and measured the perforated inner diameter.Results The occult perforation rate of Terrien Marginal Degeneration were 22.2％ (4/18),the minimum inner diameter of occult perforation was 1.5mm,the maximum inner diameter of that was 4.3mm,average of that was 3.1 ± 1.3mm.Conclusions It is helping to identify occult perforation of Terrien Marginal Degeneration by AS-OCT,and has an important role for the assessment of the patient's prognosis and surgery program design.

Objective To research the effect of human fibrin glue on the conjunctival flap graft of pterygium excision.Methods The patients with pterygium were operated with pterygium excision and conjunctival flap transplantation.Group A were transplanted with conjunctival flap adhesive application of human fibrin glue,group B were sutured conjunctival flap directly.After 7 days of taking out stitches,the conjunctival flap graft were observed and measured by anterior segment OCT (AS-OCT).The data were tested statistically.Results The average thickness of conjunctival flap of group A were 437.80±38.70□ m,conjunctival hemorrhage rate was 5％; that of group B were 631.95± 44.97um and 55％ (P ＜0.05),with statistical significance.Conclusions The conjunctival flaps of autologous transplantation are fixed by using human fibrin glue instead of sutures in pterygium surgery partially.It can shorten operation time,reduce edema and bleeding under conjunctival flap postoperatively.AS-OCT can directly measure the thickness of conjunctival flap after operation; thereby indirectly know the degree of the conjunctival edema.

Objective To study the significance of the distances from ICL to lens and iris tension in complicated cataract of ICL.Methods Based on the position changes of ICL in the posterior chamber with complicated cataract patients and with no complicated cataract patients with anterior segment and full-field optical coherence tomography,the data of the two group were analysed with the Independent-samples T Test.Results Under mydriasis,the average minimum distance between ICL peripheral part and the front surface of lens (D3 value) in study group was (77.75 ± 8.70)μm,ranged from 69.05 to 86.45μm,and (145.68 ±28.88)μm,ranged from 116.8 to 174.56μm in control group.The Independent-samples T Test showed the highly significant difference statistically between them (P =0.03＜0.05); The iris tension differential (D2-D1value) was respectively (321 ±21.31) μm(range 299.69 to 342.315μm) and (286.32±60.46)μm (range 225.86 to 346.78μm) in study group and control group.A statistical comparison between the two groups is significant with regard to iris tension (P =0.03＜0.05).Conclusions The minimum distance between the peripheral part of ICL and the front surface of lens (D3 value) and the iris tension (D2-D1 value) is of great significance in the etiology of complicated cataract after ICL implant.D3 value of more than 116.8μm is relatively safe and not easy to cause lens opacity.But D3 value less than 86.45μm and D2-D1 value more than 299.69μm would increase the chance of contact between the ICL and the lens and then the occurrence of post-operative cataract.

Objective To study the occult perforation in Mooren's ulcer by anterior segment OCT,and provide the basis for clinical diagnosis and treatment.Methods Defined the inner lesions of Mooren's ulcer as the occult perforation by anterior segment OCT,and measured the perforated inner diameter.Results The occult perforation rate of Mooren's ulcer were 8.3％,the minimum inner diameter of occult perforation was 1.8mm,the maximum inner diameter of that was 4.5mm,average of that was 3.1 ± 0.97mm.Conclusions It's helping to identify occult perforation of Mooren' s ulcer by anterior segment OCT,and has an important role for the assessment of the patient's prognosis and surgery program design.

AIM: To evaluate the features and clinical outcomes of cataract extraction by phacoemulsification with intraocular lens implantation in primary angle-closure suspect(PACS), primary angle-closure(PAC)and primary angle-closure glaucoma(PACG)with cataract.METHODS:Phacoemulsification with intraocular lens implantation was performed on 86 cases(86 eyes)diagnosed as PACS, PAC and PACG co-existing cataract from January to December 2012. All cases were followed up for 3 months to 1 year. Pre-operative and post-operative visual acuity, intraocular pressure(IOP), gonioscopy, ultrasound biomicroscopy(UBM), visual field and usage of anti-glaucomaous eye drops were recorded.RESULTS:Zonular dialysis existed in 19 eyes(22%). The post-operative visual acuity improved in 84 eyes(98%). The post-operative visual acuity was <0.1 in 7 eyes(8%), 0.1-0.5 in 32 eyes(37%), 0.6-1.0 in 47 eyes(55%). There were 83 eyes(97%)with IOP between 10-15mmHg without any drug at the end of the follow-up period. The central anterior chamber was deepened and the anterior angle opened postoperatively at different extent.CONCLUSION: PACS, PAC and PACG co-existing zonular dialysis is common. Phacoemulsification with IOL implantation can reduce IOP, deepen anterior chamber and open angle.

Objective To observe the therapeutic effect of transplantation of the lateral tarsal conjunctival flap of contralateral eye for reconstruction of the upper eyelid layer defect ＞3/4.Methods Five cases of upper eyelid defect ＞3/4 were taken on the lateral tarsal conjunctival flap transplantation from contralateral eye.Postoperative followed up for 6 months to 1 year.Result The upper eyelid sharp and function were basically normal.The radial and height of bilateral upper eyelid were symmetric,with no angular deformities.Visual function was also normal.Conclusions Transplantation of the lateral tarsal conjunctival flap of contralateral eye for reconstruction of the upper layer eyelid defect ＞3/4 is safe,simple and effective.

目的 观察不同疾病所致黄斑囊样水肿(cystoid macular edema,CME)的光相干断层扫描(Optical coherence tomograph,OCT)特征,并与眼底荧光血管造影结果 对比分析.方法 经FFA确诊的各种原因引起的黄斑囊样水肿患眼进行OCT检查,通过黄斑中心的水平或垂直方向线性扫描.根据眼底荧光血管造影(Fundus Fluorescence angiography,FFA)对CME进行水肿分级,并根据分级情况对比分析其OCT的形态特征.结果 93例CME患者,其中糖尿病视网膜病变(DR)23例,静脉阻塞(RVO)27例,VKH,白塞病10例,AMD8例,白内障摘除及抗青光眼术后8例,视网膜脱离扣带术后5例,玻璃体黄斑牵引综合征3例,视网膜色素变性3例,特发性CME4例,黄斑板层裂孔及脉络膜血管瘤各1例.黄斑囊样水肿分为Ⅲ级.Ⅰ级:小囊泡形成,荧光素渗漏范围约1/4视乳头直径,共9例(9.7%).OCT图像显示,黄斑神经上皮增厚,中心凹变浅或消失,中心凹下神经上皮层内形成一个明显液性囊腔,两侧囊壁增厚,囊腔内淡绿色点状浆液性弱反射,隐约见淡绿色囊壁结构.Ⅱ级:黄斑区荧光素渗漏占黄斑1/2视乳头直径,共50例(53.7%),OCT图像显示:黄斑区呈"丘样"隆起.神经上皮下呈蜂窝状改变,中央囊腔较大,囊壁薄,周围囊壁较厚.Ⅲ级:黄斑荧光色素渗漏占据整个黄斑区,超过1个视乳头直径,共34例(36.6%).OCT图像黄斑区神经上皮高度隆起,囊腔的腔隙互相融合,分隔囊腔的组织断裂,或增厚呈红黄中强反射.结论 根据FFA黄斑囊样水肿分级,Ⅲ级CME的OCT图像显示黄斑区神经上皮高度隆起,水肿波及整个黄斑,神经上皮层反射增强或神经上皮下囊样结构融合消失.OCT提示Ⅲ级CME,又进而推判视力预后不佳.

Objective To evaluate the outcomes of recession of extraocular muscles on restrictive strabismus of patients with thy- roid associated ophthalmopathy.Design Retrospective case series.Participants Fifteen thyroid associated ophthalmopathy(TAO)pa- tients with stationary restrictive strabismus caused by myopathy of one extraocular muscle of one eye.Methods Recession of the dis- eased extraocular muscles was applied.Before and after operation,the areas of binocular vision without diplopia on a acr perimeter mea- sured the movement distances of eyeball from the primary position to the restricted direction,the angles of strabismus in nine directions with synoptophore were measured in all patients.Main Outcome Measures The areas of binocular vision without diplopia,the move- ment distances of eyeball from the primary position to the restricted direction,and the absolute angles of strabismus in primary position and downward 15°direction when the restricted eye gazed target were compared before and after operation.Results Inferior rectus mus- cle recession were performed in nine eyes,superior rectus recession were performed in 4 eyes,and medial rectus recession in 2 eyes. The average areas of binocular vision without diplopia significantly increased from 23.99±19.39°before operation to 2115.72±527.10°after operation.The average movement distances of eyeball from the primary position to the restricted direction significantly increased from 1.53±0.97 mm before operation to 6.03±0.74 mm after operation.The average absolute angles of strabismus in primary position gazed by the restricted eyes significantly decreased from 22.37±6.63°before operation to 1.53±1.47°after operation.The average abso- lute angles of strabismus in downward 15°direction gazed by the restricted eyes significantly decreased from 15.67±11.53°before opera- tion to 2.17±1.90°after operation.Intraocular hypertention in 5 patients before operation decreased among normal range after operation. Compensatory head posture in all patients before operation disappeared after operation.Eyelid retraction was the main surgical compli- cation.Conclusion Recession of extraocular muscles can markdely eliminate diplopia and strabismus,improve eyeball motability. (Ophthalmol CHN,2007,16:414-417)