目的：研究基质金属蛋白酶-2（Matrix metalloproteinase-2, MMP-2）、基质金属蛋白酶-9（Matrix metalloproteinase-9, MMP-9）和血管内皮生长因子（Vascular endothelial growth factor, VEGF）在视网膜母细胞瘤（Retinoblastoma, RB）中的表达及其与 RB 分化程度和视神经浸润的关系，探讨它们在 RB 浸润、转移过程中的作用和临床意义。

方法：采用免疫组化方法检测 40 例 RB 中 MMP-2、MMP-9 和 VEGF 的表达。

结果：40 例 RB 中 MMP-2、MMP-9 和 VEGF 的阳性表达率分别为 52.5%、57.5% 和 72.5%。未分化型 RB 中 MMP-2、MMP-9 和 VEGF 的阳性表达均高于分化型（P < 0.05）；有视神经浸润的 RB 中 MMP-2、MMP-9 和 VEGF 的阳性水平均高于无视神经浸润的 RB（P < 0.05）。RB 中 MMP-2、MMP-9 和 VEGF 的表达呈正相关关系（P < 0.05）。

结论：RB 中 MMP-2、MMP-9 和 VEGF 高表达与 RB 的浸润和转移相关，且 MMP-2、MMP-9 表达与 VEGF 表达存在相关性。联合检测 MMP-2、MMP-9 和 VEGF 的表达可作为反映 RB 浸润、转移潜能的生物学指标，有助于筛选转移高危病例及评价患者预后。

Purpose: To study the expression of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) in retinoblastoma (RB) and its relationship with the differentiation and optic nerve infiltration of RB. And to investigate the role of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and VEGF in the infiltration and metastasis of RB and their clinical significance.

Methods: Immunohistochemical technique was used to detect the protein expression of MMP-2, MMP-9 and VEGF in 40 RB cases.

Results: The MMP-2, MMP-9 protein and VEGF protein expression were detected as positive in 52.5%, 57.5% and 72.5% of 40 RB cases respectively. The expression of MMP-2, MMP-9 and VEGF was significantly higher in the undifferentiated pattern than in the rosetted pattern (p < 0.05); and the expression of MMP-2, MMP-9 and VEGF was significantly higher in tumors with optic nerve invasion than in those without optic nerve invasion (p < 0.05). In RB, the expression of MMP-2, MMP-9 had a positive correlation with the expression of VEGF.

Conclusions: In RB, high expression of MMP-2, MMP-9 and VEGF is related to the invasion and metastasis of RB. The expression of MMP-2, MMP-9 is positively correlated with the expression of VEGF. The expression of MMP-2, MMP-9 and VEGF may act as a biological marker for the invasion and metastasis of RB. The method may help screen and identify the cases with high risk for metastasis and to predict the prognosis of patients. 

目的：观察不同程度早期糖尿病视网膜病变（diabetic retinopathy，DR）的多焦视网膜电图（multifocal electroretinograms，mf-ERG）一阶 kernel 反应（first order kernel，FOK）的变化特征，探讨糖尿病患者的视网膜组织形态学改变与功能学检查的关联，及早期DR视功能受损的敏感监测指标。方法：横断面研究，采用多焦视觉电生理检查系统测量分析16例无DR组、15 例轻度非增殖性DR（non-proliferative diabetic retinopathy，NPDR）组和 15 例中度非增殖性 DR（中度 NPDR 组），正常对照组 16 例 FOK 反应，选右眼测量，比较不同程度 DR 的 N1，P1 波潜伏期、振幅密度差异。结果：与正常组相比，无 DR 组、轻度 NPDR 组、中度 NPDR 组的N1，P1波潜伏期延长分别 1.42，1.35，2.75 ms和 0.98，1.01，2.71 ms（P < 0.001），N1，P1波振幅密度差异无统计学意义（P > 0.05）。随DR程度加重，N1，P1波潜伏期逐渐延长。无 DR 组虽尚未出现可见视网膜病变，但FOK 的 N1，P1 波潜伏期已出现异常。结论：糖尿病患者早期眼底尚未出现可见视网膜血管病变，mfERG 的 FOK 的 N1，P1 波潜伏期已出现异常。FOK 的 N1，P1 波的潜伏期的延长与 DR 的血管病变的严重程度呈正相关。FOK 的 N1，P1 波的潜伏期可能是较振幅密度更为敏感视网膜功能异常的观察指标。

Objective: To investigate the change of the first-order kernel (FOK) in multifocal electroretinogram (mf-ERG) in different severity grade of early diabetic retinopathy.

Methods: The FOK of mf-ERG were performed in 16 eyes with no diabetic retinopathy (non-DR group), 15 with mild non-proliferative diabetic retinopathy (mild NPDR group) and 15 with moderate NPDR; 15 age-matched healthy subjects were selected in the control group.

Results: Compared with the control group, N1 and P1 implicit times in the non-DR group, the mild NPDR group and the moderate NPDR group were delayed by 1.42, 1.35, 2.75 ms and 0.98, 1.01, 2.71 ms (all P < 0.001). N1 and P1 amplitudes did not significantly change (both P > 0.05).

Conclusion: Implicit times of N1 and P1 of mf-ERG delay before diabetic patients have no visible retinal vascular lesions. There is a significant correlation between retinopathy severity and the magnitude of the delays of N1 and P1 implicit times. Compared with the amplitude, implicit time of FOK yields high sensitivity in predicting the incidence of abnormal retinal function. Sensitivity to abnormal retinal function

目的：评价改良手法小切口白内障手术在尼日尔的临床疗效。方法：选取 2014 年10 月至 2016 年 10 月在受援尼日尔津德尔国家医院和尼日尔马拉迪中心医院的成熟期白内障患者800 例 (919 眼)，随机分为对照组 (457 眼)和治疗组 (462 眼)，治疗组采用改良小切口白内障手术；对照组采用传统以上穹隆为基底的结膜瓣的手术方式。分别记录两组一般情况、手术时间、散光度及手术相关并发症。于术前、术后1 d、术后3 d、术后1周、术后 2 周及术后 1 个月分别记录两组的裸眼视力情况及角膜散光度。结果：两组年龄、性别比例、核硬度分级及术前角膜散光比较差异无统计学意义 (P > 0.05)，两组患者术前裸眼视力比较差异无统计学意义 (P > 0.05)。与术前相比，两组术后裸眼视力治疗后均提高，散光度均有所降低 (P < 0.05)；治疗组术后 1，3 d时裸眼视力高于对照组 (P < 0.05)，且治疗组术后角膜散光度及手术相关并发症发生率更低 (P < 0 .05)。结论：改良手法小切口白内障手术，术后视力恢复早、手术安全性高、经济高效，是适合推广的术式。

Objective: To evaluate the efficacy of improved small incision cataract surgery in Niger. Methods: From October 1, 2014 to October 1, 2016, 800 cases (919 eyes) in the National Hospital of Niger Zinder were randomly divided into the experimental group (462 eyes) and the control group (457 eyes). The patients in the experimental group underwent the improved small incision cataract surgery. In the control group, those received conventional surgery with the dome-based conjunctival flap. The baseline data operation time and postoperative complications were recorded. The uncorrected visual acuity and corneal astigmatism value at postoperative 1 day, 3 days, 1 week, 2 weeks and 1 month were statistically compared between two groups. Results: There was no significant difference in age, sex ratio, corneal astigmatism value and nuclear hardness between two groups (all P>0.05). There was no significant difference in uncorrected visual acuity between the groups before operation (P>0.05). Compared with the preoperative value, the uncorrected visual acuity was significantly improved and the corneal astigmatism was considerably decreased after surgery (P<0.05). The uncorrected visual acuity in the experimental group was significantly higher than that in the control group at 1 and 3 days after the operation (P<0.05). In the experimental group, the corneal astigmatism value and the incidence of postoperative complications were significantly lower than those in the control group (both P<0.05). Conclusion: The improved small incision cataract surgery can accelerate the recovery of visual acuity, improve the clinical efficacy and ensure surgical safety.

目的：探讨推广新生儿眼病筛查以及婴儿期定期眼保健的必要性。方法：回顾分析 2014 年 1 月至 2016 年 12 月 20800 例惠州市妇幼保健计划生育服务中心门诊收集的婴儿眼保健资料。结果：共检出致盲性眼病 7 种 158 例，其中满 42 d 内检出 147 例，3 个月内检出 8 例，6 个月内检出 2 例，12 个月内检出 1 例。检出时已合并眼位、眼前节异常、影响视功能者 8 例。不同出生胎龄致盲性眼病检出率：≤ 34 周为 11.64％，34～37 周为 1.24％，≥ 37 周为 1.29％。相对于纸质宣传材料，开展家长学校讲课，利用 PPT 结合实际病例讲解，更有助于普及眼保健。相对于眼底检查，眼前节的方式更容易被接受、被推广。结论：致盲性眼病婴儿期发病在临床中并不少见，并且部分是可以早期筛查、早期治疗以避免视功能损害的。临床中需要大力普及眼保健知识，并可以在具备条件的医院，适当利用新生儿广域成像系统推广新生儿眼病普筛。

Objective: To discuss the necessity of screening for neonatal eye disease and regular eye care in infancy. Methods: A retrospective analysis of 20 800 infants in our hospital from January 2014 to December 2016 was conducted. From January 2014 to December 2016. Results: Seven types of blindness eye diseases were detected in 158 cases, including 147 cases at 42 days, 8 cases at 3 months, 2 cases at 6 months and 1 case at 12 months after birth. Eight cases were supervened with abnormal eye position, anterior segment abnormality and poor visual function. The detection rate of blindness-inducing diseases was 11.64% for infants aged ≤ 34 weeks, 1.24% for 34–37 weeks and 1.29% for ≥ 37 weeks. Compared with the paper propaganda materials, the introduction of parental school lectures and PPT combined with explanation of actual cases was more conducive to popularize eye care. Compared with fundus examination, anterior segment examination was more likely to be accepted and popularized. Conclusion: Eye disease inducing blindness in infancy are commonly encountered in clinical practice, which can be screened and treated early to avoid visual impairment. It is necessary to popularize the knowledge of eye care, and promote the screening of newborn eye disease in qualified hospitals.

目的：探讨两种经巩膜缝线固定法治疗人工晶状体（ intraocular lens，IOL）-囊袋复合物半脱位的方法及效果。方法：回顾性研究2014 年 6 月至 2017 年 12 月 IOL -囊袋复合物半脱位共计 31 例，36 眼。详细检查后分类处理。A 组为更换 IOL 组：对术中未植入囊袋张力环或术后发生脱位时间超过 1 年者，取出原 IOL 并重新行缝襻固定术。B 组为重新固定组：首次 IOL 植入术中植入了囊袋张力环且术后发生脱位时间不超过 1 年者，行囊袋张力环及 IOL 袢缝合固定。A 组 25 只眼，B 组 11 只眼。观察术中、术后并发症情况，术后 1 d 、 1 周、 3 个月的最佳矫正视力，并使用 Image-ProPlus v6.0 软件测量 IOL 偏心情况。结果：患者术后视力均较术前提高，术后 3 个月最佳矫正视力提高者 32 眼（91.7%），不变者 3 眼（8.3%）。术后 1 d ，两组术后视力分布差异有统计学意义；在术后 1 周、术后 3 个月，差异无统计学意义。两组术中未见视网膜脱离等严重并发症。A 组术后一过性眼压高 2 例，玻璃体积血 2 例，经保守治疗恢复。术前图像分析软件测量 IOL 偏心均大于 2 mm ，术后 3 个月 IOL 偏心小于 0.5 mm 者 4 眼（11.1%），偏心 0.5 ~ 1 mm 者 21 眼（58.3%），偏心 1 ~ 2 mm 者 11 眼（30.6%）。两组术后 3 个月 IOL 偏心差异无统计学意义。结论：根据 IOL 半脱位情况来选择不同的经巩膜缝线固定法较为安全有效。采用直接经睫状沟缝线固定复位 IOL 方法的患者术后视力恢复更快。

Objective: To investigate two methods and outcomes of transscleral sutured treatment of the intraocular lens (IOL)-capsular complex dislocation. Methods: A total of 31 cases (36 eyes) of IOL-capsular complex dislocation were studied retrospectively from June 2014 to December 2017. In group A, IOL replacement was performed. New IOL was sutured through the sulcus and the sclera after the original IOL was extracted when the capsular tension ring had not been implanted during the operation, or IOL dislocation happened at least 1 year postoperatively. In group B, IOL refixation was conducted. The original IOL was repositioned directly via transscleral suturing when the capsular tension ring was implanted, and the postoperative dislocation occurred less than 1 year after surgery. There were 25 eyes in group A and 11 eyes in group B. Intra- and post-operative complications were observed. Best corrected visual acuity (BCVA) was analyzed 1 d, 1 week, and 3 months after surgery. IOL decentration was measured using Image-ProPlus v6.0 software. Results: All patients had better visual acuity after the surgery. BCVA was improved in 32 eyes (91.7%), and remained unchanged in 3 eyes (8.3%) at postoperative 3 months. The difference of vision distribution between the two groups was statistically significant 1 d after surgery, and there was no statistical significance between two groups at postoperative 1 week and 3 months. No retinal detachment and other serious complications were observed. In group A, temporary increase in intraocular pressure was noted in 3 eyes and mild vitreous hemorrhage was observed in 2 eyes, which were effectively recovered after medical treatment. The imaging analysis revealed more than 2 mm IOL eccentricity was observed in all cases preoperatively. Postoperative IOL eccentricity were less than 0.5 mm in 4 eyes (11.1%), 0.5 - 1 mm in 21 eyes (58.3%), and 1-2 mm in 11 eyes (30.6%). There was no statistical significance in IOL eccentricity between two groups at 3 months after surgery.  Conclusion: It is safe and effective to choose different scleral suture fixation methods according to IOL-capsular bag dislocation. The visual acuity of patients is faster recovered after IOL fixation via ciliary sulcus suture compared with other approaches.

目的：评价药物治疗无效的开角型青光眼及部分复杂性青光眼行二氧化碳激光辅助下外层Schlemm管消融术(CO2 laser-assisted sclerectomy surgery，CLASS)的短期临床安全性及有效性。方法：收集2015年5月至2016年1月解放军总医院眼科行CLASS手术和小梁切除手术的青光眼患者各23例，共46例46只眼。观察术后1周、1个月和3个月眼压及并发症发生情况。结果：两组术后1周、1个月及3个月眼压较术前均明显下降(P=0.000)。术后1周、1个月及3个月时CLASS手术组眼压平均值均低于小梁切除术组，但无统计学差异(P>0.05)。CLASS手术组23例均无浅前房、脉络膜脱离等并发症出现。小梁切除手术组有4例在术后早期出现浅前房，其中1例出现脉络膜脱离，经治疗后均治愈。结论：CLASS手术在有效降低眼压的同时，能大幅降低患者术后出现浅前房等并发症的概率，但其远期降眼压效果及并发症发生情况有待进一步深入研究。

Objective: To evaluate the short-term of clinical safety and efficiency of CO2 laser-assisted sclerectomy surgery (CLASS) in patient with open-angle glaucoma and complicated glaucoma. Methods: Our study involved 46 eyes of 46 patients with glaucoma that underwent CLASS and trabeculectomy respectively by the same surgeon (Zhaohui Li) from May 2015 to January 2016 at the PLA General Hospital. Intraocular pressure and complications 1 week, 1 month and 3 months after operation was observed separately. Results: The intraocular pressure (IOP) 1 week, 1 month and 3 months after surgery decreased obviously (P=0.000). Compared to the trabeculectomy group 1 week, 1 month and 3 months after surgery, IOP of CLASS group was lower. But there was no statistically significant difference between these two groups (P>0.05). There was no complication occurred in CLASS group. Early postoperative complications occurred in trabeculectomy group included shallow anterior chamber and choroidal detachment, and they were all successfully resolved by pharmacotherapy. Conclusion: CLASS operation could reduce intraocular pressure effectively and decrease the incidence of complications, such as postoperative shallow anterior chamber in patients with glaucoma. However, its long-term effect and complications need to be further studied.

目的：探讨玻璃体手术治疗孔源性视网膜脱离后出现黄斑裂孔的临床表现并分析其原因。方法：回顾 7 例孔源性视网膜脱离患者行玻璃体手术后出现黄斑裂孔的病例资料和检查结果，对其视网膜脱离时裂孔的位置、性质进行归纳，分析术后黄斑部光学相干断层扫描（optical coherence tomography，OCT）特征，进一步推测黄斑裂孔形成的原因。结果：视网膜脱离玻璃体手术后的 OCT 图像提示黄斑区视网膜表面膜与黄斑裂孔形成密切相关。患者均行玻璃体切除联合内界膜剥离，术后黄斑裂孔解剖上闭合，5 例（71.4%）视力较术前提高，6 例（85.7%）术后视力 > 0.1。结论：玻璃体手术治疗视网膜脱离后出现的黄斑裂孔是罕见的并发症，推测视网膜表面膜是视网膜脱离玻璃体手术后黄斑裂孔形成的主要原因。

Objective: To study the clinical characteristics and pathogenesis of macular hole (MH) formation after vitrectomy for rhegmatogenous retinal detachment (RRD).Methods: We reviewed the medical records and optical coherence tomography (OCT) data of patients presenting with MH after RRD repair. Retinal breaks were described and foveal structure was examined by OCT, then the pathogenesis was postulated.Results: OCT images of the vitrectomized eyes showed macular hole with epiretinal membrane (ERM) over the inner layer, which was associated with macular formation. All patients underwent pars plana vitrectomy (PPV) combined with internal limiting membrane peeling and the macula was closed. Visual acuity was improved in 5 eyes (71.4%) and better than 0.1 in 6 eyes (85.7%).Conclusion: MH developing after vitrectomy for RRD is rare. Presence of ERM is considered as the main cause of MH formation after vitrectomy for RRD.