Endothelial keratoplasty(EK)has the advantage of minor surgical injury and fast visual recovery and herein has become the optimal surgical choice for endothelial disorders.It has unique complications closely related to surgical maneuver,skill of operation and proper intervention.The most common complication is graft dislocation,especially in eyes with defect lens-iris diaphragm.The damage of endothelium cells is another characteristic of this surgery.In severe cases,it may lead to primary graft failure.The rejection rate of this surgery is lower than that of penetrating keratoplasty.And its manifestation for rejection is different from other types of keratoplaty.So EK is a new type of surgery and it is necessary to acknowledge and understand its surgical features.

Descemet's stripping automated endothelium keratoplasty(DSAEK) has gained popularity in the surgical treatment of endothelial disorder as an alternative to penetrating keratoplasty.Selective transplantation of endothelial layer avoids the potential complications. Instead,there is structural integrity for the recipient,minimal change in refraction,and faster recovery of vision.The procedure is that:A 5 mm scleral tunnel incision was made,a special hook was used to score the descemetorhexis and strip off the recipient Descemet's membrane and endothelium,and the donor butten with part posterior stroma,Descemet membrane and endothelium was insert to anterior chamber.Filtered air then was injected to force the apposition of the posterior donor stroma to the recipient stromal bed. The surgery no suture and avoid the astigmatism post-operation.The key procedures and experiences during and post operation are that:We often meet some problem in insertion and unfold of donor button because of shallow anterior chamber in Asia.The important measure is that to reduce intraocular pressure,to avoid the anterior removal of lens-iris diaphragm and provide larger place of anterior chamber.Dislocation of donor graft is common complication,it often induce surgery failure in DSAEK.The prevent measure is that:To decrease the amount of viscoelastic and remove completely viscoelastic before insertion of donor graft.To remove the interface liquid between recipient bed and donor graft,to increase both adherence.The integrity of lens-iris diaphragm is a very important factor to maintain the stable air bubble in anterior chamber,otherwise the air bubble easily enter into vitreous cavity to loss the support the donor graft.So the indication should be caution to choice in beginning stage.

Viral cornea endotheliitis is not uncommon,but misdiagnosis and missed diagnosis are often seen in clinic,and leading to serious results due to lack of knowledge.Cornea endotheliitis is mainly caused by simplex virus(HSV) or varicella zoster virus(VZV) infection.It can be classified clinically into three forms:linear,disciform,and diffuse.The main manifestation is corneal edema associated with mutton-fat keratic precipitates.When an elevated IOP is accompanied as a result of combined trabecular meshwork inflammation,corneal endotheliitis can be misdiagnosed of glaucomatocyclitis.The two key points of treatment are anti-virus and antiinflammation.It is important to apply antiviral agents and cortical steroids appropriately.The administration route can be systematic and local.For most patients,local medication is the main route,but for those with recurrent lesion and severe inflammation,systemic application should be considered.The concentration and frequency of cortical steroids should be decided based on patient's condition individually.However,the principle is to apply cortical steroids of high bioavailability based on sufficient antiviral agent systematically and locally.It is very important to control inflammation rapidly,taper steroids gradually,and cease them slowly.

Meibomian gland dysfunction (MGD)is a common ocular surface disease in clinic and characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion.Meibomian gland obstruction may decrease superficial lipid element of the tear film,resulting in evaporative dry eye.Inflammation of lid margin and meibomian gland may result in conjunctival and corneal disease.Diagnosis of MGD depends on symptom and sign.Symptom of MGD is similar to dry eye,so MGD is nonspecific in diagnosis.Signs of MGD include the changes in morphology of lid margin,quantification of meibum expressibility/quality and dropout of meibomian gland.The managing regimes for MGD are warm,clean compresses and lid massage to increase secretion of meibomian,meanwhile,anti-infection and anti-inflammation and artificial lubricants also are available.Antiinflammation is essential for moderate to severe cases,and the treating medicines include steroid,nonsteroidal antiinflammatory drugs (NSAIDs)and immunosuppressive agents.Evaluation of meibomian gland function is very important when ophthalmologist check ocular surface with slit-lamp,especially for the patients going to perform refractive and intro-operation,so that avoid severe ocular surface complications and evade medical risks.

AIM:To explore the histopathological classification and incidence of orbital space-occupying lesions in children in order to provide references for the diagnosis of orbital space-occupying lesions in children.
METHODS:A total of 290 paediatric patients with orbital space - occupying lesions diagnosed by pathological examinations at the Second Hospital of Tianjin Medical University from January 1998 to December 2012 were retrospectively reviewed.
RESULTS:In 290 paediatric patients with orbital space-occupying lesions, venous hemangioma was the most common (58 cases,20. 0%), the other commons were as follows: hemangio lymphangioma, dermid cyst, neurofibroma, optic nerve glioma, rhabdomyo sarcoma and so on. Capillary hemangioma, venous hemangioma, optic nerve glioma had the predominant age incidence. On the other hand, optic nerve glioma, venous hemangioma, rhabdomyosarcoma had the predominant sex incidence.
CONCLUSION: The majority of paediatric patients with orbital space - occupying lesions are congenital and embryonic lesions, the most common of which is venous hemangioma. Some lesions had the predominant age and sex incidence.

Background Descemet stripping automated endothelial keratoplasty (DSAEK) is the main treatment for corneal endothelial dysfunction.But the visual outcome after operation varies depending on the difference of corneal diseases.Objective This study was to evaluate and compare the visual outcomes following DSAEK in different keratopathy.Methods The clinical data of 72 eyes of 67 patients with endothelial dysfunction underwent DSAEK from December 2007 to December 2009 at Peking University Third Hospital were retrospectively analyzed.The patients were divided into Fuchs endothelial dystrophy (FED) group (22 eyes of 19 cases),cataract surgeryinduced bullous keratopathy group (37 eyes of 36 eases) and other endothelial keratopathy group (12 eyes of 12 cases).The distribution of visual acuity and LogMAR acuities were compared and evaluation among the 3 groups before operation and 1 day,3,7,30,90 and 180 days after operation.Results Preoperatively,the vision was lower than 0.1 in 71.83％ patients,and all the patients had the visual acuity less than 0.3.No significant difference was found in the preoperative acuity among the FED group,cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group(x2 =3.427,P＞0.05).The visual acuity was ≥ 0.4 in 40 eyes (56.34％) and ≥ 0.1 in 65 eyes (91.55％),and the percentage of vision ≥0.8 was 22.73％ in the FED group,10.81％ in the cataract surgery-induced bullous keratopathy group and 8.33％ in the other endothelial keratopathy group,and no significant difference was found in the percentage of eyes in different visual acuities 180 days after operation (x2 =0.330,P＞ 0.05).In the 3 groups,LogMAR values were gradually decreased with the lapse of the time,showing a significant difference (Ftime =88.000,P ＜ 0.01).In the seventh day after operation,LogMAR value was 1.29 ± 0.57 in the cataract surgery-induced bullous keratopathy group,which was significantly higher than that of the FED group (0.82± 0.43) or other endothelial keratopathy group (0.91 ±0.39) (both at P＜0.05).Ninety days after operation,LogMAR value was 0.40 ±0.28 in the FED group and was significantly declined in comparison with the cataract surgeryinduced bullous keratopathy group (0.64±0.44) and other endothelial keratopathy group (0.73±0.54) (both at P＜0.05).However,no significant differences was seen in the LogMAR values among the three groups 180 days after operation (all at P＞0.05).The vision was stable 3 months after operation in the FED group,however,the vision was still changed over 3 months in the cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group.Conclusions DSAEK is available for corneal endothelial diseases.Visual acuity improves more rapid in FED patients than other keratopathies.

It is found that Virtual experiment(VE)can not only improve the experimental condition,enrich the experimental content,but also help to foster the innovation ability of the students. To bring the teaching contribution of VE into full play,it is important to note that VE should be combined with actual experiment and be introduced step by step. Meanwhile,the teach-ing staff should also acquire more learning and further technical skills.

Objectives To observe the effect of flurbiprofen as preemptive analgesic and it's relative adverse reactions in pa-tients undergoing selective craniotomy .Methods Sixty patients undergoing selective craniotomy were divided into two groups randomly by age,sex,location of craniotomy:observation group (Group-flurbiprofen) and control group (Group-saline).Monitored sonoclot signal and estimate bleeding amount during the operation .Evaluated the quality of emergence after operation .Recorded the VAS pain scores 2 hours,6 hours,12 hours and 24 hours after operation ,and the occurrence of adverse reactions as nausea , vomiting and respiratory de-pression.Results The concentration of prostaglandin E2(PGE2) in the serum of the observation group was lower than that of control group( P <0.05).There were no significant differences in ACT (activated coagulation time) and CR (clot rate) of the two groups( P>0.05),but the PF (platelet function) of observation group was lower than that of control group ( P <0.05).There were no signifi-cant differences in awakening time and extubation time of the two groups ( P >0.05).The 2 hours'pain scores of the two groups was of no significant difference( P >0.05),but the pain scores of observation group were lower than that of control group in 6 hours,12 hours and 24 hours after operation( P <0.05).The occurrence of nausea , vomoting and respiratory depression had no significant differences ( P >0.05) .Conclusions Flurbiprofen as preemptive analgesic can reduce the postoperative pain in patients undergoing cranioto -my,without increasing the occurrence of nausea , vomit and respiratory depression .It can effect the platelet function ,but could not in-crease the amount of bleeding .

Early diagnosis and timely treatment of hepatic steatosis is very important for controlling the development and improving the prog-nosis of disease.This paper introduces the controlled attenuation parameter (CAP),a novel non -invasive method to quantitatively assess hepatic steatosis.This paper briefly describes the advantages of CAP compared with other methods for detecting hepatic steatosis:CAP is simple,fast,repeatable,and generally accepted by patients.CAP is of great value for early detection of fatty liver.Moreover,this paper re-views the optimal cut -off values of CAP for detection of fatty liver in different studies.CAP can be used to dynamically monitor the progres-sion and regression of fatty liver as a guide to clinical treatment.

Objective To explore the effects of cannabinoid receptor agonist WIN55,212-2 preconditioning on spinal cord ischemia reperfusion injury in rats.Methods A total of 32 male Sprague-Dawley rats was randomly divided into four groups (n =8):sham group,control group,dimethyl sulfoxide(DMSO) group which was given intraperitoneally DMSO 0.3 ml 30 min before ischemia reperfusion,and WIN group which was given intraperitoneally WIN55,212-2 1 mg/kg 30 min before ischemia reperfusion.Each rat was neurologically assessed at 24 h and 48 h after reperfusion by Tarlov scale,and the number of normal motor neurons at anterior horn of the spinal cord was recorded.Res uits The Tarlov scale of WIN group was significantly higher than that control and DMSO groups (P ＜ 0.05).There were more normal motor neurons at anterior horn of the spinal cord in WIN group than those in control and DMSO groups (P ＜ 0.05).Conclusions Cannabinoid receptor agonist WIN55,212-2 preconditioning might attenuate spinal cord ischemia reperfusion injury.