目的：比较中国南方地区与西北地区慢性泪囊炎患者的菌群分布，明确细菌谱的地理差异性，对不同地区抗生素使用因地制宜提供依据。方法：本研究为回顾性横断面研究。纳入2022年3月—2024年4月在中国西北地区三甲医院眼科诊断为慢性泪囊炎，拟行泪囊鼻腔吻合术的患者，并选取同时期在中国南方地区诊断为慢性泪囊炎的患者，所有患者在行经鼻镜泪囊鼻腔吻合术时切开泪囊取泪囊分泌物。两组标本均行一般细菌及真菌培养，比较两组细菌培养阳性率和构成比。结果：南方地区和西北地区泪囊分泌物细菌培养阳性率分别为26.0%和50.7%，差异有统计学意义(P < 0.001)。南方地区细菌分布中革兰阳性球菌、革兰阴性杆菌的构成比分别为 45.9%、37.6%，西北地区两种菌构成比为 71.4%、19.0%，差异有统计学意义(分别为P = 0.007，P = 0.003)。两地区检出率最高的菌均为凝固酶阴性葡萄球菌，链球菌属占比在两地区间比较差异有统计学意义(P = 0.004)。结论：中国南方地区比西北地区泪囊分泌物培养阳性率低，慢性泪囊炎细菌谱均以革兰阳性菌为主，南方地区革兰阴性菌占比较西北地区更高，链球菌属检出率较西北地区明显更低。这可能是不同地理环境、不同气候、不同生活习惯等共同因素的结果。

Objective: To compare the bacterial distribution of patients with chronic dacryocystitis from southern China and northwest China and to elucidate the geographical differences in the bacterial spectrum. Methods: This retrospective cross-sectional study included patients diagnosed with chronic dacryocystitis at the ophthalmology departments of tertiary hospitals in southern and northwest China between March 2022 and April 2024. Endoscopic dacryocystorhinostomy was performed on all patients to collect lacrimal sac secretions. The specimens were cultured for bacteria and fungi, and the positive rates and composition ratios of bacterial culture were compared between the two groups. Results: The positive rates of bacterial cultures from lacrimal sac secretions were 26.0% in southern China and 50.7% in northwest China (P < 0.001). The proportions of Gram-positive cocci and Gram-negative bacilli were 45.9% and 37.6%, respectively, in southern China, compared to 71.4% and 19.0%, respectively, in northwest China (P = 0.007 and P = 0.003, respectively). Coagulase-negative staphylococci were the most frequently detected bacteria in both regions. However, the proportion of Streptococcus species was significantly higher in northwest China compared to southern China (P = 0.004). Conclusions: The positive rate of lacrimal sac secretion cultures was lower in southern China compared to northwest China. The bacterial spectrum of chronic dacryocystitis in both regions was predominantly composed of Gram-positive bacteria. However, the proportion of Gram-negative bacteria was higher in southern China, while the detection rate of Streptococcus species was significantly higher in northwest China. These differences may be attributed to variations in climate, geographical features, and lifestyle habits.

血泪是指因各种原因导致眼部流出血性泪液的症状，其病因和临床表现复杂多样，往往涉及多学科多专业。不同病因引起的血泪，无论是临床表现，还是诊治方法均差异很大。为了向临床医生提供可参考的血泪临床诊疗流程，中国医师协会眼科医师分会泪器病专业委员会及中国中西医结合学会眼科专业委员会泪器病学组组织有关专家以临床实践经验为基础，经过认真讨论建立本共识，对血泪的病因、临床特征及诊疗流程提出指导性意见。

Bloody tears refers to the symptoms of blooding tears flowing from the eye due to various reasons. Its etiology and clinical manifestations are complex and diverse, often involving multiple disciplines and specialties. In order to provide clinicians with a reference for the clinical diagnosis and treatment process of bloody tears, Lacrimal Diseases Professional Committee of Ophthalmologist Branch of Chinese Medical Doctor Association and Lacrimal Diseases Group of Ophthalmic Professional Committee of Chinese Association of Integrated Medicine organized relevant experts to establish this consensus based on clinical practice after serious discussion, and put forward guiding opinions on the etiology, clinical characteristics, and diagnosis and treatment process of bloody tears.

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: 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：探讨非超声乳化白内障手术两种不同的娩核方式对角膜内皮细胞数量和形态的影响，以及对术后视力恢复情况的影响。

方法：选择在本院手术治疗的40例白内障患者娩核方式分为直接娩出组和半娩出组，并根据 Emery－ little晶状体核硬度分级标准分为软核和硬核，手术方式为白内障非超声乳化手术，术后第3天用角膜内皮镜检查并记录角膜内皮细胞数量和形态。术后随访3个月，比较并观察4组患者术前和术后角膜内皮细胞丢失率、形态变化和视力恢复情况。

结果：术前和术后3个月角膜内皮细胞丢失率比较，硬核直接娩出组与另外三组比较差异有统计学意义(P＜0.01)，而软核直接娩出组、硬核半娩出组与软核半娩出组比较差异无统计学意义(P＞0.05)。术前和术后第二天视力比较硬核半娩出组和软核直接娩出组之间无统计学意义(P＝0.49)，软核半娩出组与这两组比较有统计学意义(P＝0.030)，硬核直接娩出组与这两组之间比较也有统计学意义(P＝0.14)，术后三个月视力比较4组之间均无统计学意义(P＝0.067)。术后 3 个月角膜内皮细胞形态变化不明显。

结论：白内障非超声乳化手术时，硬核直接娩核法对角膜内皮细胞损伤最大，软核半娩核法对角膜内皮损伤最小。若内皮细胞损伤较轻，对手术3个月后视力和角膜内皮细胞形态无明显影响。 

Purpose: To investigate the effect of non-phacoemulsification cataract operation in two different patterns of nucleus delivery on the quantity and morphology of corneal endothelial cells and postoperative visual acuity．

Methods: Forty patients diagnosed with cataract underwent cataract surgery and were assigned into the direct nuclear delivery and semi-nuclear delivery groups. Lens density was measured and divided into the hard and soft lenses according to Emery-little lens nucleus grading system. Non-phacoemulsification cataract operation was performed. At 3 d after surgery, the quantity and morphology of corneal endothelium were counted and observed under corneal endothelial microscope. During 3-month postoperative follow-up, the endothelial cell loss rate, morphological changes and visual acuity were compared among four groups．

Results: Corneal endothelial cell loss rate in the direct delivery of hard nucleus group significantly differed from those in the other three groups before and 3 months after operation (P＜0.01),  whereas no statistical significance was found among the direct delivery of soft nucleus,  semi-delivery of hard nucleus and semi-delivery soft nucleus groups (all P＞0.05).  Preoperative and postoperative 2-d visual acuity did not differ between the semi-delivery of hard nucleus and direct delivery of soft nucleus groups (P＝0.49)，significantly differed from those in the semi-delivery of soft nucleus (P＝0.03) and direct delivery of hard nucleus groups (P＝0.14). Visual acuity at postoperative four months did not differ among four groups (P＝0.067). 
Conclusion: During non-phacoemulsification cataract surgery, direct delivery of hard nucleus caused severe injury to corneal endothelium and semi-delivery of soft nucleus yielded mild corneal endothelial injury. Slight corneal endothelial injury exerted no apparent effect upon visual acuity and corneal endothelial morphology at three months after surgery．

Background: The effect of perioperative injection of Lucentis on intraoperative bleeding in patients with proliferative diabetic retinopathy (PDR) was systematically evaluated using a meta-analysis.

Methods: Reports of surgical eye treatment with and without perioperative intravitreal injection of Lucentis in Medline, the Cochrane Library, PubMed, the Chinese Biomedical Literature Database, and China Academic Journals Full-text Database were included in the study. A meta-analysis was performed on all included literature. A computerized search was performed in the above databases. In addition, relevant books, journals, and conference proceedings and their bibliographies were manually searched. Published literature was screened according to the inclusion and exclusion criteria. Data extraction was performed on included studies. RevMan5.2 software was used for the statistical analyses. Dichotomous variables are presented as odds ratios (ORs) and 95% confidence intervals (CIs). The major indicator was the occurrence of intraoperative retinal hemorrhaging during vitrectomy.

Results: A total of seven studies were included in the analysis. The treatment group included 159 eyes and control group included 149 eyes. The amount of intraoperative bleeding in the treatment group (perioperative Lucentis injection) was significantly lower than that in the control group (OR, 56.93; 95% CI: 21.81-148.57, P<0.01).

Conclusions: Intravitreal Lucentis injection before a vitrectomy significantly reduced intraoperative bleeding in PDR patients.

Background: The effect of perioperative injection of Lucentis on intraoperative bleeding in patients with proliferative diabetic retinopathy (PDR) was systematically evaluated using a meta-analysis.

Methods: Reports of surgical eye treatment with and without perioperative intravitreal injection of Lucentis in Medline, the Cochrane Library, PubMed, the Chinese Biomedical Literature Database, and China Academic Journals Full-text Database were included in the study. A meta-analysis was performed on all included literature. A computerized search was performed in the above databases. In addition, relevant books, journals, and conference proceedings and their bibliographies were manually searched. Published literature was screened according to the inclusion and exclusion criteria. Data extraction was performed on included studies. RevMan5.2 software was used for the statistical analyses. Dichotomous variables are presented as odds ratios (ORs) and 95% confidence intervals (CIs). The major indicator was the occurrence of intraoperative retinal hemorrhaging during vitrectomy.

Results: A total of seven studies were included in the analysis. The treatment group included 159 eyes and control group included 149 eyes. The amount of intraoperative bleeding in the treatment group (perioperative Lucentis injection) was significantly lower than that in the control group (OR, 56.93; 95% CI: 21.81-148.57, P<0.01).

Conclusions: Intravitreal Lucentis injection before a vitrectomy significantly reduced intraoperative bleeding in PDR patients.

Visual electrophysiology is widely used in clinical ophthalmology. It is also of significant value in the objective assessment of visual function in adult and pediatric cataract patients and for the diagnosis of and research on retinal and visual pathway diseases. This article systematically reviews visual electrophysiology techniques, their applications in the diagnosis and treatment of adult and pediatric cataracts, and factors influencing the application of visual electrophysiology during surgical treatment for cataracts.

Visual electrophysiology is widely used in clinical ophthalmology. It is also of significant value in the objective assessment of visual function in adult and pediatric cataract patients and for the diagnosis of and research on retinal and visual pathway diseases. This article systematically reviews visual electrophysiology techniques, their applications in the diagnosis and treatment of adult and pediatric cataracts, and factors influencing the application of visual electrophysiology during surgical treatment for cataracts.

The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal afl ibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor (anti-VEGF) for treating rubeosis iridis.

The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal afl ibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor (anti-VEGF) for treating rubeosis iridis.

Background: To report the outcomes of external drainage of subretinal fluid (SRF) in exudative retinal detachment secondary to central serous chorioretinopathy (CSCR).

Methods: Retrospective observational analysis of six eyes with exudative retinal detachment secondary to CSCR who underwent external drainage of SRF between 2004 and 2014 was performed. Collected data included demographics, steroid usage, surgical details, and visual acuity preoperatively and postoperative visual acuity and clinical examination data were collected.

Results: Six eyes of six subjects were included with mean age of 45 years (range, 32 to 61 years). All subjects were male. Mean duration of symptoms was 4.6 months (range, 3 to 8 months). The pre-operative bestcorrected visual acuity (BCVA) ranged from perception of light to 20/60. Four eyes were treated with conventional external drainage and two underwent Chandelier-assisted external drainage. Three cases had laser treatment before drainage and one case underwent photodynamic therapy (PDT) after drainage. The BCVA at last follow-up ranged from 20/2,000 (counting fingers at 2 feet) to 20/20. No recurrences were noted in any of the cases till the last follow-up. Mean duration of follow-up was 38 months.

Conclusions: Our study demonstrates successful management of exudative retinal detachment secondary to CSCR with external SRF drainage without any complications.

Background: To report the outcomes of external drainage of subretinal fluid (SRF) in exudative retinal detachment secondary to central serous chorioretinopathy (CSCR).

Methods: Retrospective observational analysis of six eyes with exudative retinal detachment secondary to CSCR who underwent external drainage of SRF between 2004 and 2014 was performed. Collected data included demographics, steroid usage, surgical details, and visual acuity preoperatively and postoperative visual acuity and clinical examination data were collected.

Results: Six eyes of six subjects were included with mean age of 45 years (range, 32 to 61 years). All subjects were male. Mean duration of symptoms was 4.6 months (range, 3 to 8 months). The pre-operative bestcorrected visual acuity (BCVA) ranged from perception of light to 20/60. Four eyes were treated with conventional external drainage and two underwent Chandelier-assisted external drainage. Three cases had laser treatment before drainage and one case underwent photodynamic therapy (PDT) after drainage. The BCVA at last follow-up ranged from 20/2,000 (counting fingers at 2 feet) to 20/20. No recurrences were noted in any of the cases till the last follow-up. Mean duration of follow-up was 38 months.

Conclusions: Our study demonstrates successful management of exudative retinal detachment secondary to CSCR with external SRF drainage without any complications.

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.