报道一例发生在41岁中年女性左眼上睑的无色素性黑色素瘤，曾在当地医院误诊为霰粒肿。体检见左眼上睑结膜面一大小约2 cm × 2 cm红色肿物，手术切除肿物送病理检查，标本经10%福尔马林固定，常规石蜡包埋切片，HE染色及免疫组织化学染色。光镜下见肿瘤细胞呈片状及巢状排列，瘤细胞圆形及梭形，部分瘤细胞胞浆空泡状呈气球样形，部分细胞核仁明显。免疫组化显示肿瘤细胞S-100、HMB-45阳性，CK及EMA阴性，最终病理诊断为左眼上睑无色素性黑色素瘤。对于临床上患者年龄较大无典型霰粒肿特征的眼睑肿物，术后标本均应送病理检查以除外其它肿瘤的可能。

To report a case of amelanotic melanoma located in the leff upper eyelid misdiagnosed as chalazion in a 41-yearold woman. Examination showed a red 2 cm × 2 cm mass in the left upper palpebral conjunctiva. The tumor was excised and regular fixed in 10% formalin, embedded, sectioned, HE stained and immunohistochemistry stained. Histopathological examination revealed nests of round atypical tumor cells with vacuolated cytoplasm and sheets of spindle atypical tumor cells. Some tumor cells had conspicuous nucleoli. Immunohistochemistry some tumor cells were positive for melanocytic markers S-100, HMB-45 and negative for CK, EMA. So the pathological diagnosis was palpebral conjunctiva amelanotic melanoma in the leff upper eyelid. For the mass in palpebral conjunctiva of senile patients without typical characteristics of chalazion, the surgical specimen should be performed for pathologic examination to rule out other tumors.

A 55-year-old male complained of right eye blurry vision for 3 days. His best-corrected visual acuity (BCVA) was 0.2 for the right eye and 1.0 for the left eye. Anterior segment and vitreous body examinations of both eyes were normal. Yellowish-white focal lesions in the macula of the right eye were observed and subtly changes of lesions were found along the superotemporal and inferotemporal arcades in the macula two days later. Fluorescein fundus angiography (FFA) revealed slight ffuorescent leakage from the lesions in the macula of the right eye, and segmental venous leakage and optic disc hyperffuorescence were observed in both eyes. Indocyanine green angiography (ICGA) demonstrated that the lesions in the macula of the right eye had hypofluorescence at a late stage and spectral domain optical coherence tomography (SD-OCT) imaging of the macula showed focal impairment of the inner segment and outer segment (IS/OS). The blood investigation indicated a positive treponema pallidum hemagglutination assay (TPPA) and a rapid plasma reagin test (RPR) of 1:32. After antisyphilitica treatment for 6 weeks, the yellowish-white lesions had vanished and the BCVA was 1.2 followed by restoration of the IS/OS for the right eye, with an RPR of 1:4. In conclusion, ophthalmologists should alert unilateral focal lesions in the macula may be the ffrst sign of syphilis. Prompt treatment is highly effective in resolving vision.

A 55-year-old male complained of right eye blurry vision for 3 days. His best-corrected visual acuity (BCVA) was 0.2 for the right eye and 1.0 for the left eye. Anterior segment and vitreous body examinations of both eyes were normal. Yellowish-white focal lesions in the macula of the right eye were observed and subtly changes of lesions were found along the superotemporal and inferotemporal arcades in the macula two days later. Fluorescein fundus angiography (FFA) revealed slight ffuorescent leakage from the lesions in the macula of the right eye, and segmental venous leakage and optic disc hyperffuorescence were observed in both eyes. Indocyanine green angiography (ICGA) demonstrated that the lesions in the macula of the right eye had hypofluorescence at a late stage and spectral domain optical coherence tomography (SD-OCT) imaging of the macula showed focal impairment of the inner segment and outer segment (IS/OS). The blood investigation indicated a positive treponema pallidum hemagglutination assay (TPPA) and a rapid plasma reagin test (RPR) of 1:32. After antisyphilitica treatment for 6 weeks, the yellowish-white lesions had vanished and the BCVA was 1.2 followed by restoration of the IS/OS for the right eye, with an RPR of 1:4. In conclusion, ophthalmologists should alert unilateral focal lesions in the macula may be the ffrst sign of syphilis. Prompt treatment is highly effective in resolving vision.

Background: Ophthalmology is an important medical science subject, but it is given with insufficient attention in undergraduate medical education. Flipped classroom (FC) and problem-based learning (PBL) are well-known education methods that can be integrated into ophthalmology education to improve students' competence level and promote active learning.

Methods: We used a mixed teaching methodology that integrated a FC and PBL into a 1-week ophthalmology clerkship for 72 fourth-year medical students. The course includes two major sessions: FC session and PBL session, relying on clinical and real-patient cases. Written examinations were set up to assess students’ academic performance and questionnaires were designed to evaluate their perceptions.

Results: The post-course examination results were higher than the pre-course results, and many students gained ophthalmic knowledge and learning skills to varying levels. Comparison of pre- and post-course questionnaires indicated that interests in ophthalmology increased and more students expressed desires to be eye doctors. Most students were satisffed with the new method, while some suggested the process should be slower and the communication with their teacher needed to strengthen.

Conclusions: FC and PBL are complementary methodologies. Utilizing the mixed teaching meth of FC and PBL was successful in enhancing academic performance, student satisfactions and promoting active learning.

Background: Ophthalmology is an important medical science subject, but it is given with insufficient attention in undergraduate medical education. Flipped classroom (FC) and problem-based learning (PBL) are well-known education methods that can be integrated into ophthalmology education to improve students' competence level and promote active learning.

Methods: We used a mixed teaching methodology that integrated a FC and PBL into a 1-week ophthalmology clerkship for 72 fourth-year medical students. The course includes two major sessions: FC session and PBL session, relying on clinical and real-patient cases. Written examinations were set up to assess students’ academic performance and questionnaires were designed to evaluate their perceptions.

Results: The post-course examination results were higher than the pre-course results, and many students gained ophthalmic knowledge and learning skills to varying levels. Comparison of pre- and post-course questionnaires indicated that interests in ophthalmology increased and more students expressed desires to be eye doctors. Most students were satisffed with the new method, while some suggested the process should be slower and the communication with their teacher needed to strengthen.

Conclusions: FC and PBL are complementary methodologies. Utilizing the mixed teaching meth of FC and PBL was successful in enhancing academic performance, student satisfactions and promoting active learning.

目的：探讨3种不同的滴眼液在麻醉小鼠晶状体浑浊中的保护作用。方法：将20只6周龄C57BL/6j小鼠分为4组，A组为自然暴露组(对照组)，B组为滴用透明质酸钠组，C组为滴用甲基纤维素滴眼液组，D组为滴用生理盐水组。分别于麻醉后10，20，30，45和60 min观察小鼠晶状体浑浊情况。结果：与A组相比，3种滴眼液均不同程度地延长小鼠晶状体浑浊的时间；30 min时，4组小鼠浑浊 发生率分别为90%，50%，50%和10%，并延缓晶状体浑浊的进展；60 min时，4组小鼠3级浑浊的发生率为30%，10%，10%和0，其中生理盐水的作用效果最优，可以明显延迟晶状体变浑浊的时间。结论：麻醉小鼠的晶状体浑浊程度可以被相关滴眼液延缓，适用于短时间的眼科检查和处理，又因其经济易得，可广泛应用于小鼠活体的眼科检查中。

Objective: To study the effect of saline, carboxymethylcellulose sodium eye drops and sodium hyaluronate gel to stop the development of cataract in anesthetized mice. Methods: Twenty C57BL/6j mice, aged 6 weeks, were divided into four groups, group A was naturally exposed to air, group B was treated with sodium hyaluronate gel, group C was treated with carboxymethylcellulose sodium eye drops and group D was treated with saline. The lens opacity was observed at 10, 20, 30, 45 and 60 min after the start of the experiment. Results: Compared with group A, the eye drops delayed the development of lens opacity in varying degrees. At 30 min, the incidence rate of cataract in group A, B, C and D was 90%, 50%, 50% and 10%, respectively. At 60 min, the incidence rate of grade 3 cataract in group A, B, C and D was 30%, 10%, 10% and 0 respectively, saline did the best, which can significantly slow the process. Conclusion: Cataract development can be slowed by the protective eye drops. This finding is relevant for those experimental settings in which clear ocular media are required.