前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段增大疾病，表现为大角膜(直径≥ 12.5 mm)、前房极深、角膜厚度正常或轻中度变薄和睫状环扩大等。并发性白内障以及晶状体脱位是导致AM视力下降的主要原因。然而，解剖结构的异常使AM白内障手术具有很大的挑战性。文章报道了一例AM合并白内障的48岁男性患者，成功为其行手法小切口白内障摘除联合人工晶状体(intraocular lens, IOL)一期植入术，患者术后视力恢复良好，IOL位置居中，未出现较大的屈光误差。对该典型AM病例的临床特点以及手术难点的回顾总结，有助于加深广大眼科临床工作者对该疾病的认识。
Anterior megalophthalmos is a rare congenital enlargement of the anterior segment, characterized by bilateral nonprogressive megalocornea (diameter ≥12.5 mm), extremely deep anterior chamber, normal or moderate thinning of the cornea, and elongation of the ciliary ring. Cataract and lens dislocation are the main causes of decreased vision in patients with AM. However, cataract surgery on patients with AM are challenging due to the anatomical abnormalities. This case reports a 48-year-old male patient diagnosed with AM and cataract, who successfully underwent a manual small incision cataract extraction combined with intraocular lens implantation. Finally, our patient showed a good visual outcome with a well centered IOL and without obvious refractive error. In this typical AM case, we reviewed and summarized the clinical characteristics and the challenges of surgical treatment so that other ophthalmologists can learn about this disease.
后视路病变是视交叉以后的视觉通路其本身或毗邻结构发生病变，引起视觉功能改变的一类疾病。神经眼科医生比较熟悉枕叶病变引起的对称性同侧偏盲，但枕极(纹状皮质的最后部分)的病变产生中心性对称性同向盲点，此类视野改变容易被忽略或误诊。该文报道一例老年男性患者，因双眼视觉清晰度下降、视物变形就诊。眼科检查：最佳矫正视力：右眼0.8，左眼1.0，FM-100检查提示重度色觉异常，颅脑磁共振成像(magnetic resonance imaging,MRI)提示双侧枕叶脑梗死(右侧枕极部，左侧纹状皮质前部)，24-2 Humphrey视野检查可见双眼同向暗点趋势(不典型)，10-2 Humphrey视野检查可见双眼中心视野同向偏盲(暗点)，故而确诊。后视路病变可引起多种特征性的视野改变，可伴有高级视功能异常及其他神经系统症状和体征，是神经眼科的重要组成部分。该例枕极脑梗死病变产生对称性同向性盲点伴色觉改变患者的诊治过程，提示需关注后视路病变视野改变的多样性及其他视觉功能异常，提高早期诊断率，改善患者预后。
The disease of the posterior visual pathway is a kind of lesion in which the visual pathway itselfor its adjacent structure changes after optic chiasma causes pathological changes, resulting in changes in visual function. Neuro-ophthalmologists are familiar with symmetrical ipsilateral hemianopia caused by occipital lobe lesions, but occipital tip (the last part of the striatal cortex) lesions produce central symmetrical homonymous scotomas, which can easily be overlooked or misdiagnosed. This article reported a case of an olderly male patient treated with decreased binocular visual clarity and distortion. Ophthalmology examination: best corrected visual acuity: 0.8 in the right eye, 1.0 in the left eye; FM-100 examination indicated severe dyschromatopsia; cranial magnetic resonance imaging: infarction of bilateral occipital lobe (right portion of the occipital tip and left anterior portion of striate cortex); 24-2 Humphrey field examination showed a tendency of homonymous scotoma in bilateral eyes (atypical); 10-2 Humphrey field examination showed homonymous hemianopia (scotoma) in the central visual field. These results confirm a diagnosis of the disease of the posterior visual pathway. As an important part of neuro-ophthalmology, the posterior visual pathway can cause various characteristic visual field defects, which can be accompanied by advanced visual dysfunction and other neurological symptoms and signs. The diagnosis and treatment process of this case of occipital tip cerebral infarction with symmetrical homonymous blind spot accompanied by color vision changes suggests that attention should be paid to the diversity of visual field changes and other visual functional abnormalities in the posterior visual pathway lesions, so as to improve the early diagnosis rate and prognosis of the patient s.
临床上囊袋张力环(capsular tension ring,CTR)与睫状体接触导致的反复持续性高眼压较为少见，本文报告一例改良型CTR植入术后反复持续性高眼压的病例，行“巩膜悬吊线松解术”后高眼压状态有效缓解，考虑可能与巩膜固定缝线过紧，造成改良型CTR局部与睫状体相接触，刺激睫状体分泌过量房水有关。
Recurrent intraocular hypertension caused by contact between capsular tension ring (CTR) and ciliary body is rare clinically. We report a case of recurrent intraocular hy pertension after modified CTR implantation. The IOP returned to normal levels when released the scleral suture. We speculated that the ciliary process irritated by MCTR might increase aqueous humor secretion because of a tight scleral suture.
该文报道一例激光原位角膜磨镶(laser-assisted in situ keratectomy,LASIK)术后行白内障超声乳化摘除联合多焦点散光矫正型人工晶状体植入术的病例。该患者为42岁女性患者，20年前外院行双眼LASIK手术，现因右眼视物模糊1年就诊。术前IOLMaster检查患者右眼眼轴长度29.66 mm，前房深度3.18 mm，晶状体厚度4.75 mm，白到白距离11.6 mm，前表面及全角膜散光分别为1.01 D@67 °及0.91 D@56 °。Pentacam角膜地形图15 °范围模拟角膜屈光力得到的角膜散光为1.2 D@58.1 °，为规则领结型。患者眼底检查未见明显异常，因其脱镜意愿强烈，植入双焦点散光矫正型IOL(德国Zeiss公司AT LISA toric 909M)。根据Barrett True-K Toric公式测量的后表面散光计算结果进行手术规划，选择+17 D球镜1.5 D柱镜Zeiss 909M IOL，植入轴位55 °。术后1个月患者裸眼远视力0.8，35 cm裸眼近视力1.0，最佳矫正远视力–0.25 DS/–0.5 DC×120 °至1.0，患者满意。提示经过详细的术前评估及规划，并与患者充分沟通，多焦点散光矫正型人工晶状体可以在部分适合的LASIK术后患者中取得良好效果。
It is reported a case of cataract phacoemulsification combined with toric multifocal intraocular lens (IOL) implantation after LASIK surgery in this article. A 42 year-old female patient who underwent bilateral LASIK surgery in other hospital 20 years ago. She visited our hospital due to blurred vision in her right eye for one year. The preoperative IOL Master examination results showed an axial length of 29.66 mm, anterior chamber depth of 3.18 mm, lens thickness of 4.75 mm, white to white distance of 11.6 mm, and anterior surface and total corneal astigmatism of 1.01 D @ 67 ° and 0.91 D @ 56 °, respectively in right eye. The corneal astigmatism measured by Pentacam using 15°range simulated keratometry is 1.2 D@ 58.1 °, which is a regular bow tie shape.No obvious abnormalities was found in the patient's fundus examination. Due to her strong desire to get rid of the glassesa toric bifocal IOL (AT LISA Toric 909M, Zeiss, Germany) was implanted.Based onthe IOL power calculation results of Barrett True-K Toric formula with measured posterior corneal astigmatism, an IOL with Sph 17.0 D/Cyl1.5 D/A 55°was chosen. One month after surgery, the patient's uncorrected distance visual acuity was 20/25, 35 cm uncorrected near visual acuity was 20/20, and the best corrected distance visual acuity was 20/20 with a prescription of –0.25 DS/–0.5 DC × 120 °. The patient was satisfied with the outcome. After detailed preoperative evaluation and design, and sufficient communication with patients, toric multifocal IOL implantation can achieve good results in some apropriated for the patients after LASIK surgery.
球形晶状体是一种罕见的先天性晶状体悬韧带疾病，表现为晶状体前后径增加，赤道半径减小，类似球形。临床特点包括浅前房、晶状体源性高度近视、晶状体脱位及继发青光眼等。治疗上早期可以通过验光配镜提高视力，当继发晶状体脱位及青光眼时需尽早进行手术治疗。本例报道一例72岁男性患者，因右眼视力下降2年入院。既往近视，近视逐渐加深，近2年患者双眼配镜-10D，视力无明显改善。就诊后考虑球形晶状体所致晶状体不全脱位合并白内障，入院后行囊袋拉钩固定下白内障超声乳化+人工晶状体悬吊+前段玻璃体切除术。患者术后1个月后复诊，发现黄斑水肿，予以复方平地木颗粒口服，溴芬酸钠滴眼液滴眼。2周后复诊视力及黄斑水肿明显好转。
Microspherophakia (MSP) is a rare congenital zonular dysplasia characterized by increased anteroposterior lens thickness and reduced equatorial diameter, resembling a spherical shape. The related ocular manifestations of MSP include shallow anterior chamber, lens derived high myopia, ectopia lentis and secondary glaucoma. In the early stage of MSP, vision acuity may be improved by glasses. Cataract surgery is necessary once secondary lens dislocation and glaucoma occur. A 72-year-old male hospitalized patient was reported who complained increased blurred vision of his right eye for 2 years. In the past 2 years, the power of his binocular glasses was increased to -10 diopters without significant improvement in visual acuity. Lens dislocation and phakic insufficiency caused by MSP was diagnosed after he attending clinics at the Eye and ENT Hospital of Fudan University, Shanghai, China. Phacoemulsification with scleral sutured intraocular lens (IOL) implantation surgery and anterior vitrectomy were performed. One month after operation, macular edema was found at first follow-up. Compound pingdingmu granule was taken orally and Bromfenac sodium eye drops were applied three times a day. Two weeks later, visual acuity of his right eye was improved significantly and macular edema was eliminated dramatically.
Terson综合征又称蛛网膜下腔出血合并玻璃体积血综合征，是一种较为罕见的眼科疾病。患者多因颅内出血而存在意识障碍、沟通困难，极易漏诊，错过最佳治疗时机。该文报道了一例30岁男性患者，因弥漫蛛网膜下腔出血，突发昏迷，于发病1个月后出现双眼视物模糊，最终确诊为双眼Terson综合征，并行双眼玻璃体切割术及右眼视网膜前膜剥膜术治疗。术后54 d，患者左眼视力由指数/5 cm恢复至矫正视力0.3。术后19 d，患者右眼视力由手动/20 cm恢复至矫正视力0.12。
Terson syndrome, also known as subarachnoid hemorrhage combined with vitreous hemorrhage syndrome, is a relatively rare ophthalmic condition. Patients mostly have impaired consciousness and communication difficulties due to intracranial hemorrhage, which makes it very easy to miss the diagnosis and the best time for treatment. This article reports the basic case of a 30-year-old male patient with sudden coma due to diffuse subarachnoid hemorrhage. And he had blurred vision in both eyes 1 month later, which was finally diagnosed as binocular terson syndrome. He was treated with vitrectomy in the left eye and vitrectomy + anterior retinal detachment surgery in the right eye. The visual acuity of patient was restored from finger count/5cm to corrected visual acuity of 0.3 in the left eye when 54 days after surgery and from manual/20 cm to corrected visual acuity of 0.12 in the right eye when 19 days postoperative.
渐进性视功能障碍多见于屈光不正、原发性开角型青光眼、白内障、视神经视网膜遗传代谢性疾病等，少见于眶内和颅内占位性疾病。颅内蛛网膜囊肿通常是无症状的先天性良性病变，少数出现视功能障碍。 视神经管骨壁缺如见于后组筛窦和蝶窦气化良好的正常人。该文报告 1例59岁男性患者，因左眼视野缺损伴视物模糊1年余就诊，确诊左侧颞极蛛网膜囊肿合并视神经管骨壁缺如。笔者通过收集该患者的病史、影像学资料和视功能检查结果，分析其出现视功能障碍的机制。
Progressive visual impairment is more common in ametropia, primary open-angle glaucoma, cataract, hereditary and metabolic diseases of optic nerve and retina, and less common in orbital and intracranial masses. Intracranial arachnoid cysts are usually asymptomatic benign congenital lesions with a small number of visual impairments. The absence of the bone wall of the optic canal was seen in normal subjects with good gasification of the posterior ethmoid sinus and sphenoid sinus. In this case report we describe a 59-year-old man with a left temporal arachnoid cyst and a defect of the bone wall of the optic canal complained of left visual field defect and blurred vision for more than one year. The mechanism of visual dysfunction was analyzed by collecting the patient’s medical history, imaging data and the results of visual function examination.
内源性真菌性眼内炎(endogenous fungal endophtalmitis, EFE)是最具破坏性的眼部感染之一，在临床上较少见。如诊断和治疗不及时，可严重损害患者视力，甚至需摘除眼球。由于EFE发病隐匿，病程较长，病原学涂片和培养阳性率较低，早期临床症状与葡萄膜炎相似，极易被误诊和漏诊，延误治疗时机。EFE最常见的感染灶来源为肝脏、肺、尿路、脑膜炎、胃肠道、心内膜以及骨髓。文章报道了一例腰椎感染致双眼内源性念珠菌性眼内炎的男性患者，66岁，因“右眼视力下降1周”首诊于眼科，专科检查见右眼玻璃体炎性混浊，初诊为右眼葡萄膜炎，予抗炎等治疗症状无好转，右眼视力持续下降，右眼前房穿刺抽液送检提示：热带念珠菌感染，之后左眼视力也逐渐下降，加之患者近期于骨科住院，术中腰椎间盘退变的纤维软骨组织DNA-病原微生物宏基因组检测结果示热带念珠菌，考虑双眼EFE，予全身及局部使用抗真菌药物联合双眼玻璃体切割手术，治疗后患者视力恢复良好，随访1年无复发。该病例及相关文献回顾，有助于加深临床医生对此类疾病的认识，为今后临床诊疗提供一定思路，也起到一定警示作用。
Fungal endophthalmitis is one of the most destructive eye infections and is relatively rare in clinical practice.If not diagnosed and treated promptly, it can severely damage vision and even lead to enucleation.Due to its insidious onset, long course, low positive rates in smears and cultures, and early clinical symptoms similar to uveitis, it is prone to misdiagnosis and missed diagnosis, leading to delayed treatment. A review of the literature indicates that the most common sources of EFE infection are the liver, lung, urinary tract, meningitis, gastrointestinal tract, endocarditis and osteomyelitis.In this paper, we report a case of lumbar spine infection causing bilateral candidal endophthalmitis in a 66-year-old male patient.He initially presented to the ophthalmology department of our hospital with a one-week history of decreased vision in the right eye, specialized examination revealed inflammatory opacity in the vitreous of the right eye, initially diagnosed as uveitis and treated with anti-inflammatory therapy without improvement.As the vision in the right eye continued to decline, aqueous humor aspiration from the anterior chamber of the right eye indicated infection with tropical Candida.Subsequently, the vision in the left eye also gradually decreased.Considering the recent hospitalization in the orthopedic department for lumbar disc degeneration, metagenomics analysis of fibrous cartilage tissue DNA during surgery detected tropical Candida, suggesting bilateral endogenous fungal endophthalmitis,The patient was treated with systemic and local antifungal medications in combination with bilateral vitrectomy surgery.After treatment, the vision recovered well, and there was no recurrence during a one-year follow-up.The objective of this thesis is to deepen the understanding of clinicians on this type of disease by reporting this case and reviewing relevant literature, providing some insights for future clinical diagnosis and treatment, and serving as a warning.
准分子激光原位角膜磨镶术(laser-assisted in situ keratomileusis,LASIK)是矫正屈光不正的重要角膜屈光手术方式之一。经过准分子激光切削的角膜，生物测量数据发生改变。对于此类患者，通过常规测量获得的参数数据以及使用常规计算公式确定的IOL屈光度将变得不再准确，由此将会导致术后较大的屈光误差，进而影响患者的视觉质量。本文报道一例46岁的男性白内障患者。该患者既往双眼屈光不正，曾接受过LASIK手术治疗。白内障术前角膜地形图检查发现该患者双眼存在角膜偏心切削，这为IOL屈光度的确定带来困难。手术医生通过角膜地形图判断角膜切削的居中性，在特定区域内选择角膜曲率K值，并采用Barrett True K公式计算出IOL屈光度。白内障术后患眼屈光误差相对较小，视力提高，视觉质量改善。
Laser-assisted in situ keratomileusis (LASIK) is a crucial corneal refractive surgery for correcting refractive errors. The cornea, after undergoing excimer laser ablation, undergoes changes in biometric measurements. For such patients, conventional measurements and IOL power calculations based on standard formulas may no longer be accurate, leading to significant postoperative refractive errors and subsequently impacting the patient's visual quality. This article presents a case of a 46-year-old male cataract patient who had a history of refractive errors in both eyes and had previously undergone LASIK surgery. Preoperative corneal topography revealed corneal eccentric ablation in both eyes, posing challenges in determining IOL power. The surgeon assessed the centration of corneal ablation using corneal topography, selected the keratometry value (K value) within specific corneal regions, and calculated the IOL power using the Barrett True K formula. Postoperatively, the cataract patient experienced relatively minor refractive errors, leading to improved vision and enhanced visual quality.
报告一例视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)合并人体免疫缺陷病毒(human immunodeficiency virus,HIV)感染/获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)，并通过文献复习，总结其发病机制、临床特征、治疗及预后。检索文献包括7篇英文文献(8个病例)，1篇中文文献，共报道9例NMOSD合并HIV感染/AIDS病例，结合本文报道的1例共10例，其中5例为女性，5例为男性，3例HIV感染/AIDS为新发，其他病例的HIV感染/AIDS发病均早于NMOSD。临床表现上，7例均为视神经炎和脊髓炎同时或相继发生，2例表现为单相病程或复发性脊髓炎，1例仅表现为双眼相继发生的视神经炎，10例患者头或脊髓MRI均有典型的视神经或脊髓异常信号，伴或不伴强化。2例患者未进行水通道蛋白4(aquaporin protein-4,AQP4)抗体IgG检测，其余8例中5例AQP4抗体阳性、3例阴性。针对AIDS的治疗，10例患者中，8例接受了高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)。针对NMOSD的治疗，10例患者中，急性期有8例患者接受糖皮质激素冲击治疗、3例患者接受血浆置换、2例接受丙种球蛋白治疗，序贯治疗期有6例患者接受免疫抑制剂治疗，其中1例因高胆红素血症停药。发生视神经炎的7例中，2例患者经治疗仍失明、5例视力部分恢复，发生脊髓炎的8例中，5例患者遗留截瘫或轻瘫、3例肌力部分恢复。1例因严重并发症去世。NMOSD合并HIV感染/AIDS临床较罕见，预后差，往往遗留严重的视力障碍及瘫痪等，临床治疗较为棘手，糖皮质激素和免疫抑制剂并非使用禁忌证，但制定治疗决策前需要充分考虑风险与获益的平衡。
A case of neuromyelitis optica spectrum disorders(NMOSD) complicated with human immunodeficiency virus(HIV) infection/acquired immunodeficiency syndrome(AIDS) was reported, and the pathogenesis, clinical characteristics, treatment and prognosis were summarized through the literature review. The retrieved literatures included seven English literatures (eight cases) and one Chinese literature, in which a total of nine cases of NMOSD co-infected with HIV infection/AIDS were reported. Combined with the case reported in this paper, the total number of cases was ten, among which five cases were female and five cases were male, three cases of HIV infection/AIDS were newly developed, and the other cases had earlier onset of HIV infection/AIDS than NMOSD. In terms of clinical manifestations, seven cases all had simultaneous or sequential optic nerve and myelitis, two patients presented with a uniphasic course or recurrent myelitis, and one case presented only with bilateral optic neuritis occurring sequentially in both eyes. All ten patients had typical abnormal signals of the optic nerve or spinal cord with or without enhancement on cranial or spinal MRI. Two patients did not undergo AQP4 antibody IgG testing , and of the remaining seven cases, five were positive for AQP4 antibodies and three were negative. For AIDS treatment, eight of the ten patients received highly active antiretroviral therapy(HAART). For NMOSD treatment, among the ten patients, eight patients received intravenous methylprednisolone,three patients received plasmapheresis, and two patients received intravenous immunoglobulin in the acute phase. Six patients received immunosuppressive therapy during the sequential treatment period, and one of them was discontinued due to hyperbilirubinemia. Of the seven cases with optic neuritis, two patients remained blind after treatment and five had partial recovery of vision. Of the eight cases with myelitis, five patients were left with paraplegia or mild paralysis, and three had partial recovery of muscle strength. One case died due to serious complications.NMOSD combined with HIV infection/AIDS is rare in clinic and has a poor prognosis. Patients are often left with severe visual impairment and paralysis. Clinical treatment is quite difficult, hormones and immunosuppressive agents are not considered as contraindications. Treatment decisions need to be made with fully considered about the balance of risks and benefits.
