老年性黄斑变性(Age-related maeular degeneration，AMD)是老年人视力损伤和致盲的主要原因。视网膜的高耗氧性，高长链多不饱和脂肪酸含量，作为氧自由基的靶点和暴露于可见光的特性使其易产生氧化应激。大量研究均显示抗氧化营养素有助于老年性黄斑变性的防治，本文就其最新研究进展进行综述。

Age-related macular degeneration ( AMD)is the leading cause of irreversible visual impairent and blindness in elderly people. The retina seems particularly susceptible tooxidative stress because of its high concentration ofoxygen,polyunsaturated fatty acids, targets as oxygen free radical, and exposure to visible light.Multiple studies have suggested that antioxidative nutrients can play a role in slowing the onset or limiting the effects of AMD. The article has reviewed the latest research progress of antioxidative nutrients and age-related macular degeneration. 

目的：探讨上睑提肌缩短术和额肌肌瓣悬吊术后眼表改变和恢复的差异。

方法：对2007 年1 月至2007 年4 月在中山眼科中心住院的42例(62只眼)先天性上睑下垂患者，按手术方式和术后是否加用局部用药进行随机分组，观测各组术后2 d、5 d、7 d和2周患者泪液的分泌、泪膜破裂时间、结膜充血、角膜荧光染色、睑板腺功能、瞬目次数、上睑睫毛角度和眼睑闭合情况，并分析其观察结果的差异是否有统计学意义。

结果：3名患者(7.1 ％)因需要加用其它促角膜上皮生长的药物而退出本研究，其中1例(2.3 ％)因倒睫刺激角膜上皮水肿缺损需行手术调整，其余所有患者眼表检测项目的结果均显示不同程度地受到了手术影响，但是随着术后炎症的逐渐消退，这些受影响的眼表异常均会逐渐恢复正常。泪膜破裂时间、瞬目次数、眼睑闭合情况的影响在两种术式之间的差异有统计学意义，而在术后是否局部用药之间没有统计学差异；角膜荧光素染色在是否加用局部用药组之间有统计学差异，而不同术式之间没有统计学差异；泪液分泌量、结膜充血、睑板腺功能、睫毛角度则在所有组别之间均没有统计学差异。

结论：两种上睑下垂的矫正术均会引起患者眼表的改变，额肌肌瓣悬吊术对泪膜破裂时间、瞬目次数、眼睑闭合情况影响的程度较大，而局部用药只能改善角膜荧光素染色异常、对其它眼表因素影响不大。上睑睫毛角度异常是引起角膜损害最危险的因素。

Objective : To investigate the difference of ocular surface change and restoration after ex-ternal levator advancement and frontalis suspension.

Methods : Forty-two patients (62 eyes) with congenital ptosis hospitalized in ZhongshanOphthalmic Center from Jaruary to April in 2007 were randomly divided into four groups according to different surgery types and with or without post surgery ophthalmic medica-tion. Sehirmer test, tear film break-up time , conjunctiva congestion , cornea fluorescentpigmentation , tarsal gland function , winking frequency, angle of eyelash and eyelid clo-sure were all observed and statistically analyzed in all groups 2 days , 5 days , 7 days and 2 weeks after surgery.

Results : Except 3 patients needed advanced ophthalmic medicine, one of whom waswith corneal ulceration and needed another surgery, all the others were observed withocular surface items altered in varied degrees and gradually returned to normality as theinflammation caused by surgery recovered. Break-up time , winking frequency and eyelid closure were statistically diferent between the two types of surgery but not betweengroups with and without post surgery ophthalmic medication. Cornea fluorescent pigmen-tation was statistically different between groups with and without post surgery ophthalmicmedication but not between the two types of surgery. The other items did not have statis-tical difference in all groups.

Conclusion : The two types of surgery for ptosis correction could alter the ocular surface ,but frontalis suspension affect tear film break-up time , winking frequency and eyelid clo-sure much more than levator advancement. Ophthalmic medication after the surgerycould only ameliorate cornea fluorescent pigmentation but was not necessarily to restora-tion of normal ocular surface. Abnormality of eyelash angle was the most dangerous fac-tor to the corea injury.

       双眼自发晶状体悬韧带松弛，导致前房波动，进行性近视加重，继发闭角型青光眼的病例在临床比较少见。本病例报道了1例25岁女性双眼自发晶状体悬韧带松弛不伴有晶状体脱位及形态异常，出现双眼前房波动，近视加重，最终继发双眼闭角型青光眼。经过局部抗炎、散瞳处理和“PHACO+IOL(Phacoemulsification+intraocular lens)植入+前段玻璃体切除术”将IOL置于睫状沟后，患者眼压得到控制、视力基本矫正至正常。

Changeable anterior chamber depth due to spontaneous zonular laxity of thelens is a rare abnormality in clinic. Here is a 25 -year-old female with changeable anteri.or chamber depth due to bilateral spontaneous zonular laxity which also finally led toprogressive myopia and angle-closure glaucoma is deseribed. After using local anti-in-fammation and dilation of the pupil, and carrying out “ Phacoemulsification + anteriorvitrectomy" putted intraocular lens ( IOL) into the ravine of ciliary body , the womansintraocular pressure was controlled and visual acuity was corrected to 20/20. 

Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among adults worldwide. However, aside from pathological damage, the traditional laser and multi-needle operation treatments required for more advanced disease can cause further damage to the visual field and increase the operation risk. Therefore, the development of new therapeutic strategies for the prevention and treatment of DR is essential. Some emerging evidence now indicates that pigment epithelium-derived factor (PEDF),  a multifunctional protein, can target multiple pathways to exert neurotropic, neuroprotective, anti-angiogenic, anti-vasopermeability, anti-inflammation, anti-thrombogenic, and anti-oxidative effects against DR. This review addresses the functions of PEDF in different pathways that could lead to potential therapeutics for the treatment of DR.

Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among adults worldwide. However, aside from pathological damage, the traditional laser and multi-needle operation treatments required for more advanced disease can cause further damage to the visual field and increase the operation risk. Therefore, the development of new therapeutic strategies for the prevention and treatment of DR is essential. Some emerging evidence now indicates that pigment epithelium-derived factor (PEDF),  a multifunctional protein, can target multiple pathways to exert neurotropic, neuroprotective, anti-angiogenic, anti-vasopermeability, anti-inflammation, anti-thrombogenic, and anti-oxidative effects against DR. This review addresses the functions of PEDF in different pathways that could lead to potential therapeutics for the treatment of DR.

Purpose: To investigate the correlation of various corneal hysteresis (CH) factors in Chinese adults．

Methods: From January 2009 to November 2011, the healthy right eyes of a total of 292 adults were recruited into the study.  Goldmann-correlated intraocular pressure (IOPG) and CH were measured using an ocular response analyzer (ORA). Central corneal thickness was measured using the ORA’s integrated handheld ultrasonic pachymeter. The IOLMaster was used to obtain the ocular biometric measurements including axial length, anterior chamber depth, and keratometric values. The Pearson correlation coefficient was used to test correlations between CH and quantitative factors. The chi-square test was used to detect differences in categorical values.

Results: Longer axial length (P=0.0001), lower IOPG (P=0.03),  older age (P=0.003), and thinner central corneal thickness (P=0.0001) were significantly associated with lower CH. The anterior chamber depth (P=0.34), gender (P=0.23), and corneal curvature (P=0.18) had no relationship to CH.

Conclusion: Various factors including axial length, intraocular pressure, age, and central corneal thickness can affect measurement of corneal biomechanical properties in Chinese adults. But the anterior chamber depth, gender, and corneal curvature were irrelevant to CH.

Purpose: To investigate the correlation of various corneal hysteresis (CH) factors in Chinese adults．

Methods: From January 2009 to November 2011, the healthy right eyes of a total of 292 adults were recruited into the study.  Goldmann-correlated intraocular pressure (IOPG) and CH were measured using an ocular response analyzer (ORA). Central corneal thickness was measured using the ORA’s integrated handheld ultrasonic pachymeter. The IOLMaster was used to obtain the ocular biometric measurements including axial length, anterior chamber depth, and keratometric values. The Pearson correlation coefficient was used to test correlations between CH and quantitative factors. The chi-square test was used to detect differences in categorical values.

Results: Longer axial length (P=0.0001), lower IOPG (P=0.03),  older age (P=0.003), and thinner central corneal thickness (P=0.0001) were significantly associated with lower CH. The anterior chamber depth (P=0.34), gender (P=0.23), and corneal curvature (P=0.18) had no relationship to CH.

Conclusion: Various factors including axial length, intraocular pressure, age, and central corneal thickness can affect measurement of corneal biomechanical properties in Chinese adults. But the anterior chamber depth, gender, and corneal curvature were irrelevant to CH.

目的:探讨眼铁质沉着症(ocularsiderosis)的临床特点及治疗方案。
方法:对我院2002年1月至2006年12月的64例眼铁沉着症患者进行回顾性分析。
结果:56例手术取出残留的异物，其中33例异物最大长径<2.0 mm，位于下方睫状体扁平部或锯齿缘附近26例；眼眶X光正侧位照片联合薄骨位照片异物显影阳性率76.56%，超声生物显微镜(Ultrasound biomicroscope，UBM)异物显影阳性率47.62%；晶状体前囊铁锈沉着发生率100%；继发性青光眼发生率7.69%；视网膜脱离发生率13.84%；视网膜电流图(Electroretino-gram，ERG)karpe分期亚期占7/10和I期占3/10；56例患者作了眼内异物取出，异物取出率100%，术中发现16.07%病例异物磁性消失。
结论:眼铁质沉着症残留的异物以最大长径≤2.0 mm为主，主要位于下方睫状体扁平部或锯齿缘附近；眼眶X光照片为首选的检查方，UBM可作为眼前段异物影像学检查辅助手段；ERG改变以karpe分期的Ⅲ期和期为主；玻璃体手术是取出眼内异物最有效的治疗手段。

Purpose : To study the clinical characteristics of ocular siderosis and discuss the way for treatment.

Methods : Sixty-four patients (64 eyes) with ocular siderosis treated in Ophthalmic Cen-ter of Zhongshan University from January 2002 to December 2006 were retrospectivelyanalyzed.

Resuls: The intraocular foreign body( IOFB)was found in 56 cases, with maximum length<2.0 mm in 33 cases; 26 eyes with foreign body located on pars plane or near the ora serrate. The positive rate of foreign body was 76.56% by orbital posteroanterior and lateral radiogram combined with Belot 's radiogram and 47.62% by ultrasound biomicroscope( UBM). The occurrence rate of iron deposits in the epithelial cells of the anterior capsule was 100% , secondary glaucoma was 7. 69% and retina detachment was 13.84% respectively.Electroretinogram (ERG) was abnormal in 10 case , 7 cases withstage Il and 3 cases with stage IV. The intraocular foreign body extraction was done in 56 cases and the success rate was 100%. The magnetism of the intraocular foreign body disappeared in 16.07% of the cases.
Conclusions : The intraocular foreign body <2.0 mm was most frequently found in ocu-lar siderosis and mainly located on pars plane or near the ora serrate. Orbital radiogram has advantage to diagnose the intraocular foreign bodies, and UBM can be used as an assistant image-related approach for checking the intraocular foreign body on the anterior segment. Most cases were in $tage lll and IV by ERG. Vitrectomy is the most effective approach to remove the intraocular foreign bodies.

Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道，通过调节房水外排来维持眼内压的平衡，其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径，从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前，对SC发育和功能的调节机制的认识仍然有限，缺乏针对SC的特异性治疗策略。近年来，关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示，功能调控的关键分子靶标也相继被发现，这促进了对SC结构和功能调控的深入理解。此外，作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究，总结关键的分子和细胞学调控机制，归纳SC相关药物和手术疗法的最新进展，为青光眼的临床诊治提供了新的思路。

Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道，通过调节房水外排来维持眼内压的平衡，其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径，从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前，对SC发育和功能的调节机制的认识仍然有限，缺乏针对SC的特异性治疗策略。近年来，关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示，功能调控的关键分子靶标也相继被发现，这促进了对SC结构和功能调控的深入理解。此外，作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究，总结关键的分子和细胞学调控机制，归纳SC相关药物和手术疗法的最新进展，为青光眼的临床诊治提供了新的思路。

Purpose: The surgical risk and complication rate after cataract surgery are extremely high in patients with nanophthalmos. This study is designed to compare the visual and refractive outcomes before and after coaxial micro-incision phacoemulsification and evaluate postoperative complications．

Methods: Fifty nine patients (89 eyes) with axial length (AL)＜21 mm diagnosed with nanophthalmos were enrolled in this retrospective study. All patients underwent coaxial micro-incision phacoemulsification and IOL implantation. The main outcome measures included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), intraocular pressure (IOP) and best corrected visual acuity (BCVA). Wilcoxon signed rank test or Mann-Whitney test, and Chi-square test and logistic regression analysis were performed for statistical tests as appropriate．

Results: The median AL was 19．63 mm. Sixty-six eyes (74.16％) had a history of surgical intervention. Postoperative ACD, ACV and ACA were increased significantly (all P＜0.001), whereas postoperative IOP was decreased significantly. (P＜ 0.001) after surgery. Previous surgical intervention was related to a reduction in the postoperative ACD and ACA (P＜0.01), and both preoperative and postoperative IOP (P＜0.001). Postoperative BCVA was improved in 94．38％ of the cases. Intraoperative complications mainly included iridoschisis (6 eyes, 6.74％). Early postoperative complications included temporary corneal edema (TCE) (23 eyes, 25.84％), anterior inflammatory response (AIR) (19 eyes, 21.35％), cystoid macular edema (CME) (14 eyes, 15.73％), and uveal effusion (4 eyes, 4.49％). Late postoperative complications included CME (8 eyes, 8.99％),  uveal effusion (8 eyes, 8.99％), malignant glaucoma (2 eyes, 2.25％) and posterior capsular opacification (PCO)(10 eyes, 11.24％). The majority of complications (80％) were successfully resolved by pharmacotherapy or operation. The risk of surgical complications was greater in patients with lower AL, ACD, ACV or ACA and higher nuclear hardness or mean keratometry (Km).

Conclusion: With reasonable preoperative management, prudent selection of the lens, rigorous surgical technique and unerring cognition of potential complications, coaxial microincision phacoemulsification lens surgery can be performed in patients with nanophthalmos and yield favorable outcomes and a low incidence of complications.

Purpose: The surgical risk and complication rate after cataract surgery are extremely high in patients with nanophthalmos. This study is designed to compare the visual and refractive outcomes before and after coaxial micro-incision phacoemulsification and evaluate postoperative complications．

Methods: Fifty nine patients (89 eyes) with axial length (AL)＜21 mm diagnosed with nanophthalmos were enrolled in this retrospective study. All patients underwent coaxial micro-incision phacoemulsification and IOL implantation. The main outcome measures included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), intraocular pressure (IOP) and best corrected visual acuity (BCVA). Wilcoxon signed rank test or Mann-Whitney test, and Chi-square test and logistic regression analysis were performed for statistical tests as appropriate．

Results: The median AL was 19．63 mm. Sixty-six eyes (74.16％) had a history of surgical intervention. Postoperative ACD, ACV and ACA were increased significantly (all P＜0.001), whereas postoperative IOP was decreased significantly. (P＜ 0.001) after surgery. Previous surgical intervention was related to a reduction in the postoperative ACD and ACA (P＜0.01), and both preoperative and postoperative IOP (P＜0.001). Postoperative BCVA was improved in 94．38％ of the cases. Intraoperative complications mainly included iridoschisis (6 eyes, 6.74％). Early postoperative complications included temporary corneal edema (TCE) (23 eyes, 25.84％), anterior inflammatory response (AIR) (19 eyes, 21.35％), cystoid macular edema (CME) (14 eyes, 15.73％), and uveal effusion (4 eyes, 4.49％). Late postoperative complications included CME (8 eyes, 8.99％),  uveal effusion (8 eyes, 8.99％), malignant glaucoma (2 eyes, 2.25％) and posterior capsular opacification (PCO)(10 eyes, 11.24％). The majority of complications (80％) were successfully resolved by pharmacotherapy or operation. The risk of surgical complications was greater in patients with lower AL, ACD, ACV or ACA and higher nuclear hardness or mean keratometry (Km).

Conclusion: With reasonable preoperative management, prudent selection of the lens, rigorous surgical technique and unerring cognition of potential complications, coaxial microincision phacoemulsification lens surgery can be performed in patients with nanophthalmos and yield favorable outcomes and a low incidence of complications.

目的:探讨羊膜移植联合自体角膜缘干细胞移植术治疗复发性翼状胬肉的效果及其影响因素。

方法:对复发的翼状胬肉患者行胬肉切除+羊膜移植+自体角膜缘干细胞移植术，观察术后植片情况、角膜创面愈合时间、取材区愈合情况和患者症状；随诊观察术后复发率。

结果:28 例(32 只眼)复发翼状胬肉患者行胬肉切除+羊膜移植+自体角膜缘干细胞移植，随诊6~12个月，平均7.6个月，角膜创面上皮愈合时间为3~7d，平均(4.4+1.5)d；最后复诊时 28例(32 只眼)患者中4只眼复发,复发率为12.5%；所有患者取材区实现上皮化愈合。

结论:翼状胬肉切除联合羊膜移植和自体角膜缘干细胞移植能有效地减少复发性翼状胬肉的术后复发；对角膜缘受累范围大的患者应注意医源性角膜缘干细胞损害的风险。

Object: To evaluate the effect of amniotic membrane transplantation and limbal auto-graft transplantation for recurrent pterygium.

Methods: Patients with recurrent pterygium underwent pterygia excision with amnioticmembrane transplantation and limbal auto-graft transplantation. The condition of grafts .the coral surface and the recurrent rate were observed.

Resuls :Twenty-eight patients (32 eyes ) with recurrent pterygium underwent pterygiaexcision with amniotic membrane transplantation and limbal auto-graft transplantation.The mean time of corneal epithelial healing was 4.4 + 1. Sdays. The recurrent rate was12.5% with the mean follow-up of 7. 6 months.

Conclusion: Amniotic membrane transplantation and limbal auto-graft transplantationcan reduce the recurrence in patients with recurrent pterygium. The decompensation ofthe limbal stem cells should be considered to the severe patients. 

目的：探讨胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的远期效果。

方法：2003年12月－2008年12月在我院就诊的原发性翼状胬肉患者55例57眼，均采用胬肉切除联合自体角膜缘干细胞移植治疗，术后随访2～8年，平均5.3年。观察创面愈合情况、治疗效果和并发症情况。

结果：术后早期患者均有不同程度的充血、水肿和异物感，3～5d 后症状逐渐减轻，一周左右完全消失。角膜创面完全上皮化时间为4～7d，平均4.83d。术后有持续性眼表刺激症状者7例，术后残留纤维组织者1例，角膜浅层瘢痕者4例。术后随访2～8年，平均5.3年，复发8例8眼 (复发率13.11％)。术后1年时复查OSDI 评分，所有患者较术前评分均有不同程度的降低，与术前相比，两组评分和构成比差异有统计学意义(P＜0.05)。术后5年时复查OSDI评分较1年前稍有降低，但差异没有统计学意义(P＞0.05)。术后1、5年时泪液基础分泌[(12.95±4.03) mm，(12.68±4.77) mm]和泪膜破裂时间 [(10.55±4.13)s, (10.03±4.64) s] 较术前[(9.48±3.34)mm，(8.14±3.57)s] 明显改善，差异有统计学意义(P＜0.05)。

结论：应用胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉，术后早期症状轻、消失快，远期复发少，效果良好。

Purpose: To evaluate the long-term efficacy of pterygium excision combined with autologous corneal limbal stem cell transplantation in the treatment of pterygium．

Methods: Fifty five patients (57 eyes) diagnosed with primary pterygium undergoing pterygium excision combined with autologous corneal limbal stem cell transplantation between December 2003 and December 2008 were enrolled in this study. Postoperative follow-up endured for 2-8 years, 5.3 years on average. The wound healing, clinical efficacy and postoperative complications were observed．

Results: During early stage after surgery, all patients presented with varying degree of hyperemia, edema and sense of foreign body, which were gradually mitigated 3-5 d later and completely recovered in approximately 1 week. The corneal wound was completely epithelized within 4-7 d, 4.83 d on average. Seven patients had persistent ocular surface irritation symptoms after surgery, one case had residual fibrous tissues and four patients developed superficial corneal scars. Postoperative follow-up endured for 2-8 years, 5.3 years on average. Eight patients (8 eyes) recurred with a recurrence rate of 13.11％. In all patients,  postoperative OSDI score was significantly decreased at 1-year reexamination. OSDI score and constitution ratio significantly differed between two groups (both P＜0.05)．At postoperative 5 years, OSDI score was slightly lower compared with that in last year with no statistical significance(P＞0.05)．At post operative 1- and 5-year, basic tear secretion was (12.95 ±4.03) mm and (12.68 ±4.77) mm, tear film break-up time was (10.55±4.13)s and (10.03±4.64)s. Both indexes were significantly improved compared with (9.48±3.34) mm and (8.14±3.57)s before surgery (all P＜0.05)．

Conclusion: Pterygium excision combined with autologous corneal limbal stem cell transplantation is an efficacious treatment of pterygium with mild postoperative symptoms, rapid recovery, low long-term recurrence rate and high efficacy．