Abstract:AIM: To explore whether adaptive immunity is involved in initiation of fungal keratitis(FK).

METHODS: Balb/c mice and severe combined T/B-null immunodeficiency(SCID)mice on same background were subjected to keratitis induction via intrastromal injection of 1×10⁵ Candida albican or Aspergillus fumigatus spores. The disease was monitored using slit-lamp and scored according to area and density of opacity and surface irregularity of the affected corneas. At desired time points, murine eyes were enucleated for histological examination by hematoxylin-eosin and Periodic acid Schiff staining. The number of live-fungi in corneal tissue was detected with colony forming assay, and the levels of IL17, IFNγ and IL10 in plasma and corneal tissue homogenate were evaluated by ELISA.

RESULTS: Both Balb/c mice and SCID mice developed typical keratitis when subjected to FK induction. Gross clinical presentation and disease scoring, as well as histology and pathogen load assay showed no significant difference between Balb/c mice and SCID mice with either pathogen. With the cytokine levels in either plasma or cornea, neither IL17 nor IFNγ showed significant difference between these two mouse strains, but IL10 was undetectable in any SCID mice though it could be detected in Balb/c mice, especially at early time points after FK induction.

CONCLUSION: The presence or absence of adaptive immunity compartment, at least in the studied Balb/c and SCID mice pairing, does not alter the course of primary FK, supporting the hypothesis that innate immunity component is more relevant with the pathogenesis of FK.

Abstract:AIM: To evaluate the clinical outcomes of tissue-engineered epithelium transplantation on decreasing corneal neovascularization in patients with limbal stem cell deficiencies caused by alkali burns.

METHODS: A non-randomized, retrospective observational case series included 23 eyes of 19 cases with severe corneal alkali burns from 2006 to 2011 in our hospital. All of these eyes had complete limbal stem cell deficiencies. Ten cases(13 eyes)were performed with tissue-engineered epithelium transplantation, and 9 cases(10 eyes)were performed with amnion membrane transplantation. Vascularization was observed in all cases by slit-lamp microscope before and after surgery. A neovascularization scoring system was used to evaluate each eye at the 21^th and 60^th after surgery.

RESULTS: At the 21^th day and 60^th day after tissue-engineered epithelium transplantation or amniotic membrane transplantation was performed, corneal neovascularization decreased significantly(P<0.05). And averaged scores of corneal neovascularization were significantly lower in tissue-engineered epithelium transplantation group at the 21^th day and 60^th day after surgery than those of amniotic membrane transplantation group(P<0.05).

CONCLUSION: Tissue-engineered epithelium transplantation is more effective in inhibitting the growth of corneal neovascularization in patients with limbal stem cell deficiencies caused by alkali burn than amnion membrane transplantation.

Abstract:AIM: To observe the effect of Traditional Chinese Medicine(TCM)of Bushenhuoxue on primary visual cortex(PVC)'s Nissl bodies damage in rat model of chronic elevated intraocular pressure(EIOP), and explore the mechanism of it initially.

METHODS: The rat model of chronic EIOP was established by unilaterally cauterizing 3 episcleral vessels, then 30 rats were divided into 3 groups randomly: control group, model group, and treatment group. After given drugs or normal saline for 8 weeks, the rats were put to death. The effect of intraocular pressure(IOP), content of Nissl bodies and ultrastructure of neuron cell in the PVC was observed.

RESULTS: Unilaterally cauterizing episcleral vessels increased IOP of the rat modle obviously, there was significant difference compared with preoperative(P<0.01). Semi-quantitative pathological analysis showed that Nissl body of total area in the model group was(34941±8482.1)S/μm²,mean optical density was(152.8±27.97), integrated optical density was(11993±3084.8), compared with the control group, total area was(55742±6348.1)S/μm²,mean optical density was(304.04±100.1),integrated optical density was(18219±3548.9), there were statistically differences(all P<0.05). There were statistically difference in Nissl body of total area, mean optical density and integrated optical density between model group and treatment group, total area was(46406±5989.3)S/μm²,mean optical density was(251.05±77.41),integrated optical density was(16899±4040.6, all P<0.05).

CONCLUSION: TCM of Bushenhuoxue can repair PVC's damage in the rat model of chronic EIOP by enhancing expression of Nissl body, improving ultrastructure of neuron cell.

Abstract:AIM: To evaluate toric intraocular lens(IOL)implantation as a treatment of regular corneal astigmatism during phacoemulsification.

METHODS: Forty-seven eyes in 41 patients with cataract and corneal astigmatism had toric IOL(22 eyes)or spherical IOL(25 eyes)implantation during phacoemulsification. Outcome measures were uncorrected distance visual acuity(UDVA), best-corrected distance visual acuity(BCDVA), postoperative refractive cylinder, toric IOL axis rotational stability and complications.

RESULTS: Six months postoperatively, the mean UDVA was(0.73±0.37)in toric IOL group and(0.47±0.18)in spherical IOL group; the UDVA was better than 0.50 of 81.8% and 32.0% in two groups, respectively. The residual astigmatism was(0.53±0.40)D in toric IOL group and(2.13±0.76)D in spherical IOL group. The mean toric IOL misalignment was(4.22±1.46)degrees.

CONCLUSION: Implantation of toric IOL during cataract surgery is effective, predictable and safe in correcting corneal astigmatism.

Abstract:AIM: To observe the influence of recombinant human erythropoietin(rhEPO)on cultured retinal ganglion cells(RGCs)survival and axonal regeneration of rats, detect the expression of growth associated protein 43(GAP-43), and to investigate the possible effective mechanism.

METHODS:RGCs were cultured in DMEM(control group)or DMEM containing rhEPO(rhEPO group)for 72 hours. Cell morphology and axonal growth were observed under phase-contrast microscope. The length of the longest processes of RGCS were measured and compared between two groups. The GAP-43 expression was detected by Western blot and the gray value scales of GAP-43 were measured by imaging analysis system. All results were compared using t test.

RESULTS:The RGCs were observed to extend processes under microscope after culturing for 72 hours. The cells in rhEPO group were bigger and the processes were longer compared to the control group(P<0.05). The expression of GAP-43 in vitro was detected by Western blot. The expression of GAP-43 in rhEPO group was higher than that in control group(P<0.05).

CONCLUSION: rhEPO can promote the axonal growth of cultured RGCs in vitro. rhEPO can also increase the expression of GAP-43 in cultured RGCs, which may result in the promotion of rhEPO on the axonal growth of RGCs.

Abstract:AIM: To study the effects of different density of Rhizoma Zedoariae on the multiplication and apoptosis of human retinal capillary endothelial cells(HRCECs)and vascular endothelial multiplication factor(VECF)in high glucose environment.

METHODS: Fresh eyeballs HRCECs extracted just after cornea transplanting operation were cultivated in vitro. The third or fourth generation healthy cells for this experiment were obtained, and divided into three groups: low glucose, high glucose, high glucose plus different density of Rhizoma Zedoariae group(60, 80, 100, and 120μg/mL). MTT was employed to detect the multiplication of HRCECs, and the HRCECs VEGF through immune cells was observed.

RESULTS: MTT comparison: there was no obvious difference between high glucose and low glucose groups(P>0.05), while there was significant difference between high glucose+ and high glucose groups(P<0.05), and different density of glucose showed big difference. Immune cells: high glucose group had obvious affection compared with low glucose group, and there was significant difference between high glucose+ group and high glucose group in their affection on VEGF(P<0.05), as well as in different density among high glucose group.

CONCLUSION: Rhizoma Zedoariae can restrain the multiplication of HRCECs and VEGF in high glucose environment.

Abstract:AIM:To build up the model of experimental choroidal neovascularization(CNV), for preparing the further pharmacodynamics experiment.

METHODS:The method of subretinal injection of Matrigel on grey rabbits was used to build up the model of experimental CNV. Fundus examination, FFA, choroidal flat mount and pathological changes were measured to choose the best dose and injecting technique of Matrigel.

RESULTS: In the FFA examination, the fluorescence leakage was happened in Matrigel 40μL and 20μL groups at 7 day, which was enhanced at 14 day and 28 day; the fluorescence leakage was happened in Matrigel 10μL group at 14 day and 28 day,which was never found in Matrigel 5μL group. In the fundus examination, most of retinas were attached back at 7 day; a few of those were detached. A few of retina had proliferative detachment in Matrigel 40μL group. Cataract and vitreous muddy were found in Matrigel 40μL group. In the tissue pathological examination, small vessels and/or immature fibrous tissues were found in Matrigel 40μL and 20μL groups. The retinal injure was most severely in Matrigel 40μL group.

CONCLUSION: The method of subretinal injection of Matrigel could create CNV successfully, 20μL is the best dose.

Abstract:AIM:To observe the influence of free iron, synthetic or biological iron chelating agent on the formation of pseudomonas aeruginosa biofilm on the contact lenses.

METHODS:Different concentration of free iron, different concentration and variety classes of synthesis iron and biological iron chelating agent were added into pseudomonas aeruginosa biofilm, and then the clump count on the biofilm was detected.

RESULTS:Low concentration of free iron increased the adhesive capacity of the bacterial, with 10μmol/L of iron had the most obvious effect. 0.1μmol/L of EDTA and lactoferrin significantly inhibited the bacterial count of pseudomonas aeruginosa biofilm.

CONCLUSION: Low concentration of free iron can promote the bacterial count of pseudomonas aeruginosa biofilm on the contact lens, the lack iron circumstance which formed by finite concentration lactoferrin and EDTA can prevent the formation of the biofilm.

Abstract:AIM: To observe the expression of proliferating cell nuclear antigen(PCNA)in SD rats corneal limbus following alkali burns by amniotic membrane transplantation, and to explore the effect of limbal stem cells in alkali burned rats.

METHODS: Forty healthy SD rats forty eyes were randomly divided into experimental and control groups, with 20 animals in each group. After the preparation of corneal alkali burn models, cornea of rats in the experimental groups was given amniotic membrane transplantation, and control groups received no treatment. Five rats of each group were killed at weeks 1, 2, 3, 4 after operation. The expression of PCNA in limbal stem cells was detected with immunohistochemistry and computer image analysis system at different time points.

RESULTS: The expression of PCNA in experimental groups was higher than the control groups and there was significant difference(P<0.05). The expression of PCNA gradually decreased as time of alkali burn passed by.

CONCLUSION: Amniotic membrane transplantation can enhanced limbal stem cells proliferation in rats with corneal alkali burn and accelerate the healing of corneal epithelium.

Abstract:AIM: To determine the association between cigarettes smoking, body mass index(BMI)and the risk of age-related cataract(ARC)in middle-aged and elderly men in northeast China.

METHODS: A hospital-based case control study was conducted. Cases(n=362)were men who had surgically treated ARC, 45-85 years old; controls frequency-matched(n=362)were men who had been admitted to the same hospital as cases for many different diseases not related with eye diseases. Cases and controls were matched with 1:1. The cases and controls were interviewed during their hospital stay, using a structured interviewer-administrated questionnaire that included information on sociodemographic characteristics, socioeconomic, lifestyle habits(tobacco smoking and alcohol consumption, etc.), anthropometric measures, personal medical history, and family history of ARC in first-degree relatives, and simultaneously body mass index(BMI)was calculated. The odds ratios(OR)and 95% confidence intervals(CI)of ARC were estimated using multiple logistic regression models.

RESULTS: After adjusting for age and multiple potential confounders, higher BMI was associated with an increased risk of ARC. Cigarette smoking, years smoked or moderate cigarette smoking(1-29 cigarettes/day)had no relation with the risk of ARC(P>0.05), although patients smoked ≥30 cigarettes per day had an elevated risk of ARC as compared with the non-smokers(OR=1.55, 95% CI; 1.16-2.85, P=0.026). Higher BMI was associated with an increased risk of ARC. Both overweight and obesity was associated with an obviously increased risk for surgically ARC(OR =1.55, 95% CI: 1.02-1.98, P=0.015 and OR=1.71, 95% CI: 1.32-2.39, P=0.013 respectively)compared to normal BMI. Then participants were grouped into quartiles of BMI(Q1 to Q4), compared to controls in the lowest quartile, the OR for cases in the highest quartile of BMI was 1.54(OR=1.54, 95% CI: 1.08-2.46, P=0.022). The results of univariate analysis showed cigarette smoking was not associated with ARC formation for men with lower or normal BMI(P >0.05).Compared to the non-smokers, for men of overweight or obesity, cigarette smoking was associated with a significantly increased risk for surgically ARC(OR=2.00, 95% CI: 1.49-6.65, P=0.003 and OR=1.66, 95% CI: 1.63-13.21, P=0.002 respectively). Similarly, smokers in the highest quartile of BMI had approximately 1.5 times the risk of ARC as non-smokers in the lowest quartile(OR=1.46, 95% CI: 1.06-5.29, P <0.001). Followed multivariate models revealed that the association had never changed.

CONCLUSION: Current cigarette smoking was positively related to ARC only among those who smoked 30 or more cigarettes/day. For men who were both overweight and obesity, cigarette smoking was associated with a significantly increased risk for ARC.

Abstract:AIM: To observe visual acuity, refractive outcomes and rotational stability after phacoemulsification combined Acrysof Toric intraocular lens(IOL)implantation for treating cataract and preexisting astigmatism.

METHODS: Totally 59 patients(83 eyes)with ≥0.75 diopter(D)of preexisting corneal astigmatism were divided into 2 groups: one group 39 patients(53 eyes)with Toric IOL implantation and the other group 20 patients(30 eyes)with non-Toric IOL. All patients were operated with phacoemulsification and IOL implantation. We examined uncorrected visual acuity(UCVA), refractive outcomes, IOL axis shift, contrast sensitivity and wavefront aberration of Toric IOL group at 1 week, 1 month, 3 months after surgery. And we contrasted UCVA, refractive outcomes, contrast sensitivity and wavefront aberration of Toric IOL group with non-Toric IOL group at 3 months postoperatively.

RESULTS:(1)Visual acuity: The rate of achieving ≥1.0 in Toric IOL group was larger than non-Toric IOL group postoperatively.(2)Corneal astigmatism: The mean corneal astigmatism before surgery was similar with the one postoperatively in Toric IOL group.(3)Toric IOL stability: At 3 months postoperatively, the axis of IOL shift to 1-4 degree was in 22% of the eyes.(4)Contrast sensitivity(CS): The CS with different spatial frequency of all of eyes was raised significantly in Toric IOL group, and was higher than the CS of non-Toric IOL group.(5)Wavefront aberration: The mean C12, C7, C8, RMSh of post-operation were significantly lower than those of pre-operation in Toric IOL group, and C7,C8, RMSh were both lower than non-Toric IOL group.C12 of Toric IOL group were similar with non-Toric IOL group.

CONCLUSION: Toric IOL implantation showed good visual and refractive outcomes for correcting regular corneal astigmatism.

Abstract:AIM:To evaluate the clinical efficacy of different shape scleral flaps in trabeculectomy for glaucoma.

METHODS: Totally 115 glaucoma patients 122 eyes were randomly divided into 2 groups: the treatment group of 55 patients(60 eyes), the scleral flap surgery using the L-shaped, single-needle suture method, the control group of 60 patients(62 eyes), intraoperative scleral flap using rectangular shape with two-needle suture. Postoperative intraocular pressures(IOP), anterior chamber depth, filtering bleb shape were followed up for 6 months to 36 months.

RESULTS: The postoperative IOP: until postoperative 1 month, the difference between the treatment group and the control group was statistically significant(P<0.05). In the 3rd month and 6th month post-operation, the difference between two groups was not statistically significant(P>0.05); postoperative anterior chamber depth: until postoperative 2 weeks, the formation of anterior chamber of the control group was better than the treatment group, yet the difference was not statistically significant(P>0.05); postoperative bleb situation: In 6th month postoperatively, the formation of filtering bleb in treatment group was significantly better than the control group(P<0.01).

CONCLUSION: L-shaped scleral flap using single-needle stitching, although there may be a temporary shallow anterior chamber, has a obvious advantage over the traditional two-needle suture method in IOP control and filtering bleb formation.

Abstract:AIM: To evaluate the clinical effect of toric intraocular lens(IOL)implantation as a treatment of special corneal astigmatism during phacoemulsification.

METHODS: Ten patients 12 eyes with cataract and corneal astigmatism had toric IOL implantation during phacoemulsification. 4 eyes had pterygium surgery before, 3 eyes got corneal scar after wound, 5 eyes had corneal nebula or macula. Outcome measurements were uncorrected distance visual acuity(UDVA), best-corrected distance visual acuity(BCDVA), postoperative refractive cylinder, toric IOL axis rotational stability and complications in 6 months following-up.

RESULTS: Six months postoperatively, mean UDVA was 0.62±0.31, mean BCDVA was 0.70±0.35. UDVA was better than 0.8 in 2 eyes(17%)and better than 0.5 in 9 eyes(75%). Residual refractive cylinder postoperatively was 0.51±0.36D. Corneal astigmatism did not change significantly. Residual astigmatism was significantly lower than preoperative. The mean IOL misalignment was 3.80±1.46 degrees, less than 5 degrees in 11 eyes(92%). Only 1 eye got rotation in 6 degrees.

CONCLUSION: Implantation of the toric IOL during cataract surgery is effective, predictable and safe in correcting some special cases with corneal astigmatism.

Abstract:AIM: To observe clinical results of multifocal intraocular lens(MIOL)and matching astigmatic intraocular lens(IOL)for cataract patients with corneal astigmatism.

METHODS:Twenty patients(40 eyes)were included into the observation group. One eye with corneal astigmatism 1.50-2.50D(2.15±0.87D)was implanted astigmatic IOL(Acrysof Toric, Alcon); another eye with corneal astigmatism less than 1.50D(0.78±0.26D)was implanted MIOL. In the control group, 20 patients(40 eyes)with corneal astigmatism less than 1.00D(0.62±0.34D)were implanted MIOL in both eyes. 3 months after surgery, uncorrected distant vision and near vision with one eye and both eyes were observed in two groups.

RESULTS: In the observation group, uncorrected distant vision and near vision were 0.81±0.32 and 0.58±0.27 with Toric IOL, 0.76±0.28 and 0.67±0.24 with MIOL. There were no statistical differences(t=0.797,P>0.05; t=1.243,P>0.05). Uncorrected distant vision and near vision with both eyes were 0.90±0.33 and 0.79±0.22 in the observation group, 0.92±0.25 and 0.85±0.28 in the control group, there were no statistical differences(t=0.601, P>0.05; t=0.875, P>0.05).

CONCLUSION: MIOL and matching astigmatic IOL are good choice to increase vision without glasses for cataract patients with corneal astigmatism.

Abstract:AIM:To discuss the change of stereopsis and pattern visual evoked potential(P-VEP)in amblyopia before and after the treatment.

METHODS: According to the type of amblyopia, forty-one patients(68 eyes)were divided into strabismic group(7 eyes of 4 patients), anisometropic group(11 eyes of 11 patients)and ametropic group(50 eyes of 26 patients). Uncorrected visual acuity, best-corrected visual acuity, P-VEP, simultaneous perception, range of fusion and stereoacuity were examined before and after the treatment, which including laser therapy, CAM training, red light flashing, stereoacurity training and IF-pulse treatment of computer.

RESULTS: Before the treatment, the abnormal rate of simultaneous perception and range of fusion were both 51.2%, while stereoacuity was 80.5%, which means stereoacuity was damaged most commonly in amblyopia. Visual acuity was improved after the treatment: cure rate was 63%; progress rate was 31%; total efficiency rate was 94%.There was a statistical difference between ametropic group and strabismic or anisometropic group in term of efficiency rate. Stereopsis was significantly promoted(P<0.01)and the P100 latency was significantly shortened(P<0.05).

CONCLUSION: After the treatment of amblyopia, visual acuity and stereopsis were both promoted and the P100 latency was shortened.

Abstract:Microincision phacoemulsification is a promising surgical technique due to the substantial features of security, high-efficiency, minimally invasive and less surgically induced astigmatism, etc. Microincision phacoemulsification has obtained the good curative effect; however, there are still questions and disputes, including further improvements in surgical techniques and instruments, etc. Degree of vision correction after cataract surgery is influenced by many factors. This article reviews the security, clinical application and existing problems of the new operative method.

Abstract:Filtering surgery which has a good control of intraocular pressure(IOP)and less postoperative complications is the main treatment for patients with uncontrolled glaucoma. The good postoperative IOP depends on the long-term maintenance of functional filtering blebs. It is very important for clinicians to evaluate the morphology and the function of the filtering bleb. This paper reviews recent development in the glaucoma filtering blebs.

Abstract:Diabetic retinopathy(DR)is one of the most serious and common microvascular complications of diabetes, it is a major cause of blindness all over the world. The pathogenesis of DR is very complex and are still being elucidated at present. The classic theory includes abnormal metabolism of polyol, increased advanced glycation end products, activation of protein kinase C, oxidative stress, etc. Recently, with the rapid development of molecular biology, the research of molecular basis has become the focus and hot topic. Cytokines have been shown to involve in the progress of DR such as VEGF, IGF-1, bFGF, etc. A variety of cytokines can induce intraocular angiogenesis through complex signal transduction system, break down blood retinal barrier, and finally result in the development of DR. This article reviews the relationship between cytokine and the progress of DR.

Abstract:Retinal angiomatous proliferation(RAP)is the other pathological pattern of wet age-related macular degeneration(AMD), which is originated from deep retinal focal intraretinal hemorrhage, pigment epithelial detachment and retinal-choroidal anastomosis(RCA). It can impair visual acuity severely. The pathogenesis, clinical stages, diagnosis features, treatment and prognosis were reviewed in this article.

Abstract:The purpose of this review is to outline the status and progress of dominant eye measurement, and to introduce research progress of dominant eye application. These researches mainly include dominant eye and ametropia, dominant eye and strabismus, dominant eye and amblyopia, dominant eye and refractive surgery, dominant eye and handness, dominant eye and sports vision.

Abstract:AIM: To evaluate the safety and long-term efficacy of intravitreal bevacizumab injection(IVB)as therapy for chronic central serous chorioretinopathy(CSC).

METHODS: Six patients(6 eyes)with CSC were treated with an intravitreal injection of bevacizumab(1.25mg/0.05mL). 5 patients received second intravitreal injection of bevacizumab 3 months after the first injection. Patients had follow-up on 1, 3, 6, 12, 24 months after the injections. Outcome measures included pre and post-treatment changes in best-corrected visual acuity, intraocular pressure(IOP), subretinal fluid(SRF)measurement with optical coherence tomography(OCT), changes in fluorescein angiography(FA).

RESULTS: After the first injection, 1 patient showed resolution of SRF completely, while his visual acuity showed no change; 1 patient whose visual acuity improved and SRF resolved completely on 1 month recurred; 3 patients showed no obvious changes in the SRF and in visual acuity; 1 patient showed decreased thickness of SRF while his visual acuity were stable. After the second injection, 1 patient showed resolution of SRF completely with improved his visual acuity; 2 patients showed resolution of SRF completely, while his visual acuity showed no change; the others showed no obvious change. The changes of SRF and visual acuity seemed to have no direct relation. The visual acuity showed no significant difference before and 12,24 months after the first injections. Pre and post-treatment the IOP of the 6 patients all belong to normal range. No cases of endophthalmitis were reported.

CONCLUSION:IVB have some effect in chronic CSC cases in improving subretinal fluid resolution. But IVB have no long-term effect on improving visual acuity.

Abstract:AIM:To observe the effect of protein-free calf blood extract eye gel and recombinant bovine basic fibroblast growth factor(bFGF)eye drops on cornea epithelial healing after epipolis laser in situ keratomileusis(Epi-LASIK), and to evaluate the efficacy and safety.

METHODS:One hundred and twenty cases 240 eyes performing Epi-LASIK were randomized into experimental and control group. Sixty cases(120 eyes)were treated as control group with bFGF eye drops for 7 days, four times a day conventionally. Sixty cases(120 eyes )were treated as experimental group with protein-free calf blood extract eye gel for 7 days, four times a day. All the patients of two groups started postmedicating just after the first check on the first day after Epi-LASIK. The postoperative symptoms and signs, time of corneal epithelial recovery, visual acuity, spherical equivalent and corneal subepithelial opacity(haze)were examined at special time in patients of two groups within 6 months.

RESULTS: There was no significant difference in grades of postoperative symptom and sign between experimental and control group before postmedicating on the first day after Epi-LASIK(t=1.2912,P>0.05). There was no significant difference in effective rate between two groups(P>0.05). The experimental group got a more significant decline of grades of postoperative symptom and sign than control group on the 3^rd day postoperatively(t=2.2366, P<0.05), which gave evidence of protein-free calf blood extract eye gel has faster onset of action than bFGF eye drops. There was no significant difference in time of corneal epithelial recovery between two groups(t=1.4586, P>0.05). There was no significant difference in the long-term results of visual acuity, spherical equivalent and haze between two groups(P>0.05). There was no adverse drug effect during treatment.

CONCLUSION: Short-term application of protein-free calf blood extract eye gel after Epi-LASIK has distinct stimulative effect on the healing of corneal epithelium, which can significantly improve the postoperative irritative symptoms. Its effect is faster than conventional treatment. Protein-free calf blood extract eye gel with good safety, can be used alone or in combination, and has better application prospect.

Abstract:AIM:To observe the clinical curative effect of povidone iodine combined with carbolic acid in the treatment of fungal corneal ulcer.

METHODS: A total of 110 eyes clinically diagnosed with fungous cornea ulcer were divided to two groups at random, each with 55 eyes. The observation group was firstly treated with povidone iodine eye drops, carbol cauterize corneal ulcer and then, Fluconazole eye ointment and recombinant bovine basic fibroblast growth factor gel enveloping eyes. The control group was firstly treated with iodine tincture cauterize corneal ulcer and then used Fluconazole eye ointment and recombinant bovine basic fibroblast growth factor gel enveloping eyes. The clinical feasibility of iodine tincture and povidone iodine combined with carbolic acid in the treatment of fungal corneal ulcer was observed and comparatively studied.

RESULTS: Fifty-five eyes in the observation group used povidone iodine combined with carbolic acid cauterize corneal ulcer wound surface, all ulcer healed up, and the course of disease was shortened, the effect was better than the control group(P<0.05).

CONCLUSION:Povidone iodine combined with carbolic cauterize in the treatment of fungal corneal ulcer can enhance the curative rate obviously. It is an effective and safe therapeutic method.

Abstract:AIM: To observe clinical results of pupil adhesion in operation on complicated cataract with uveitis by use of pupil flange ring excision method.

METHODS: Fifty patients 50 eyes with pupil adhesion due to complicated cataract with uveitis were selected and divided into observation group and control group, with 25 eyes in each group. Patients of two groups received phacoemulsification intraocular lens(IOL), in the observation group pupil flange ring excision method was adopted to treat pupil adhesion or seclusion, while in the control group blunt separation was used.

RESULTS: Patients' visual acuity of two groups both enhanced three months after operation. In observation group, there were 5 eyes with visual acuity less than 0.3(20%), 7 eyes between 0.3-0.6(28%), and 13 eyes greater than 0.6(52%). In control group, 6 eyes less than 0.3(24%), 8 eyes between 0.3-0.6(32%), and 11 eyes greater than 0.6(44%), the difference between the two groups was not statistically significant(P>0.05). However, there were 22 eyes(88%)with circular pupil and light reflex in observation group, while in control group it was 7 eyes(28%), the difference showed statistical significance. Of all patients, no apparent intraoperative and postoperative complications were recorded.

CONCLUSION: In the operation on complicated cataract with uveitis, application of pupil flange ring excision can effectively resolve the ‘small pupil' problem, ensure safe execution of phacoemulsification, achieve satisfactory postoperative vision and bring about sound pupil formation.

Abstract:AIM: To probe the reason of complications of phacoemulsification and intraocular lens implantation in primary hospital.

METHODS: Totally 200 clinical cases(250 eyes)from February in 2011 to February in 2012 were involved. The complications of the phacoemulsification and intraocular lens implantation were observed.

RESULTS: There were 6 eyes(2.4%)with rupture of posterior capsule, 15 eyes(6%)with rupture of anterior capsule, 3 eyes(1.2%)with dehiscence of the zonule, 5 eyes(2%)with iris injure, 5 eyes(2%)with incision injury.

CONCLUSION:Phacoemulsification and intraocular lens implantation is safe. But since the surgeons in primary hospital are not familiar with this operation, some complications have happened.

Abstract:AIM: To compare visual function in patients with bilateral diffractive multifocal intraocular lenses(IOLs)and patients with monovision.

METHODS:This study comprised consecutive bilateral cataract patients 45 cases(90 eyes)between March 2011 and January 2012. All cases were divided into two groups: multifocal IOL group(23 patients)with implantation of AcrySof ReSTOR +3D(SN6AD1)multifocal IOLs, monovision group(22 patients)with implantation of AcrySof IQ(SN60WF)IOLs. Parameters analyzed 3 months postoperatively included binocular uncorrected distance, intermediate, and near visual acuities, stereo vision, photopic, mesopic contrast sensitivity function without glare; spectacle independence and subjective visual symptoms. The independent-samples t test was used to compare the measured data which met normal distribution. The Chi-square test was applied to compare categorical variables.

RESULTS: There were no significant differences between groups in bilateral uncorrected distance vision(t=2.001, P=0.052), intermediate(t=1.304, P=0.199)and near vision(t=1.642, P=0.108). Percentage of patients wearing spectacle for distance vision were less than 4% in all groups. On the questionnaire, patients in multifocal IOL group complained with double vision, trouble in night vision and halo.

CONCLUSION: Pseudophakic monovision and multifocal IOL achieved distance vision, intermediate vision and near vision.

Abstract:AIM: To explore a simple method to prevent posterior capsular opacification(PCO)after phacoemulsification in youth.

METHODS:Phacoemulsification combined with intraocular lens(IOL)implantation was performed 1 months earlier than Nd:YAG laser posterior capsulotomy.

RESULTS: In the observation group of 21 eyes, there was no PCO in 18 eyes after 3 years. In the control group of 20, PCO occurred in 12 eyes after 3 years. In comparison to the control group and observation group after 3 years, Z=-3.04, P=0.002, the difference between the two groups was statistically significant.

CONCLUSION:Nd:YAG laser posterior capsulotomy can effectively prevent PCO after phacoemulsification in youth.

Abstract:AIM: To analyze the feasibility of intraocular lens(IOL)implantation without a successful continuous circular capsulorhexis in phacoemulsification surgery, and to discuss the key points of each step, as well as the complications.

METHODS: IOL implantations after the failure of continuous circular capsulorhexis in 56 eyes were analyzed.

RESULTS:Phacoemulsification and IOL implantation were performed in all 56 eyes of the group, with intraoperative posterior capsular rupture in 4 eyes and IOL implantation in all eyes.

CONCLUSION: Timely remediation of the torn capsule membrane with serious analysis and cautious treatment of the following operation steps can still make phacoemulsification surgery finished smoothly.

Abstract:AIM:To evaluate the clinical effect of the Acrysof ReSTOR multifocal intraocular lens(IOL)by comparison of pseudoaccommodation and visual quality between Acrysof ReSTOR multifocal IOL and Acrysof SN60AT monofocal lens implantation at 3 years follow-up.

METHODS: A total of 68 patients 80 eyes with age-related cataract underwent phacoemulsification and IOL implantation were divided into two groups. One group of 32 patients 40 eyes received Acrysof ReSTOR multifocal IOL(group A), the other 36 patients 40 eyes received Acrysof SN60AT monofocal lens(group B). Pseudoaccommodation, the postoperative uncorrected distance and near visual acuity, the best-corrected distance and near visual acuity, distance-corrected near visual acuity and contrast sensitivity were statistically analyzed. Also, visual quality and satisfactory after the operation were evaluated by questionnaires.

RESULTS: All patients had similar uncorrected distance visual acuity, best-corrected distance and near visual acuity postoperatively(P>0.05). The multifocal eyes was better than the monofocal eyes in uncorrected near visual acuity, distance-corrected near visual acuity, pseudoaccommodation and independence on spectacles(P<0.01), and nearly all subjects were satisfied with the results of their surgery.

CONCLUSION: The Acrysof ReSTOR multifocal IOL implantation can provide a high level of uncorrected and corrected distance vision, improve uncorrected and distance-corrected near vision and reduce spectacle dependency with a high level of patients' satisfaction.

Abstract:AIM: To make assessment of clinical operation effect of implanting Acrysof IQReSTORE+3D aspheric diffraction-type multifocal intraocular lens(IOL).

METHODS: Forty-four patients of senile cataract(55 eyes)were selected to perform phacoemulsification, and monofocal or multifocal IOL was implanted according to the willingness of the patients. For multifocal IOL group(“MIOL”), Acrysof IQReSTORE+3D were implanted for 21 patients 27 eyes in total; for monofocal IOL group(“MoIOL”), Abbott Sensar were implanted for 23 patients 28 eyes in total. All patients suffered no other oculopathy which may affect postoperative visual acuity. Three months after operation, observation was made on two groups of patients with respect to uncorrected distance visual acuity, uncorrected near visual acuity, best-corrected distance visual acuity, best-corrected near visual acuity, intraocular spectacles abandon rate, visual symptom, self assessment of comforts and satisfaction by patients.

RESULTS: In terms of uncorrected near visual acuity, spectacles abandon rate, visual symptom, self assessment of comforts and satisfaction by patients, MIOL group made a better assessment than MoIOL group. No evident difference related to intraocular variation between MIOL and MoIOL was discovered.

CONCLUSION: Comparing with implant of traditional monofocal IOL, performing phacoemulsification with implant of aspheric diffraction-type multifocal IOL could help patients achieve satisfactory distant, medium and near vision. With better vision quality, patients have higher satisfactory rate of operational effect. The postoperative results were even more obvious with patients who have received operation for two eyes.

Abstract:AIM: To evaluate the clinical effect and the rotational stability of AcrySof Toric intraocular lens(IOL).

METHODS:Eighty-six eyes of 72 subjects were enrolled from No.474 Hospital of Chinese PLA, Center of Ophthalmology of Chinese PLA. The preoperative corneal astigmatism was more than 1.00 diopter(D)for all eyes.All patients underwent similar phacoemulsification combined with Toric IOLs implantation.The uncorrected visual acuity(UCVA), best-corrected visual acuity(BCVA), preoperative corneal astigmatism, anticipated residual astigmatism, postoperative residual astigmatism and Toric lens axis were detected and measured. The postoperative IOL position was assessed at 1 day, 1 week, 1 month and 3 months using a specially designed angle measuring eyepiece under the slit-lamp.

RESULTS: Three months following surgery, 92% of eyes showed 0.5 or better in UCVA.78% of eyes was 0.8 or better in UCVA and 95% of eyes achieved 0.8 or better in BCVA. The mean preoperative corneal astigmatism was 2.25±0.43D and the postoperative refractive cylinder was 0.42±0.32D, indicating a significant decrease in refractive cylinder after surgery(t=2.880, P<0.01). And there was no statistical significance(t=1.752, P>0.05)with anticipated residual cylinder 0.45±0.39D. The mean rotation of Toric IOLs was 3.15±1.05 degrees after operation 1 week, 3.3±1.5 degrees after 1 month, and 3.55±1.75 degrees after 3 months, there was no significant difference among three groups(F=2.26, P>0.05), and the mean rotation was within 5 degrees in 95.3% of eyes, 100% of eyes rotated less than 10 degrees.

CONCLUSION: The Toric IOL showed good rotational stability and predictability in the correction of corneal astigmatism. Implantation of AcrySof Toric IOL is an effective option for the correcting of preexisting corneal astigmatism in cataract surgery.

Abstract:AIM: To compare the efficacy of two different treatment methods for neovascular glaucoma(NVG).

METHODS: According to the different surgical treatments, divide 32 NVG patients(32 eyes)into two groups: Group A 14 patients(14 eyes)were treated with Ahmed glaucoma valve implantation and panretinal photocoagulation(PRP); Group B 18 patients(18 eyes)with trabeculectomy and amnion transplantation and panretinal photocoagulation(PRP).

RESULTS: The mean intraocular pressure(IOP)in patients discharged after six months: Group A, was 12.15±5.47mmHg, surgical success rate was 85.7%; Group B, was 14.32±4.75mmHg, surgical success rate was 83.3%.

CONCLUSION: The two methods can both reduce IOP on different levels. There is no obvious difference between their surgical success rates. But for NVG patients, it is more economic to be treated with trabeculectomy and amnion transplantation and panretinal photocoagulation(PRP).

Abstract:AIM: To observe the treatment method and efficacy to the earlier dysfunctional filtering blebs of refractory glaucoma, and investigate safer and more effective treatment method.

METHODS: Twenty eyes of 20 patients with refractory glaucoma were included in this study between January 2006 and January 2012, every eye had the failing filtering bleb(or failing tendency)after suffering trabeculectomy. The treatment methods included eyeball massage or after breaking suture of sclera, and bled needling with a blunt needle or 5-fluorouracil(5-FU)subconjunctival injection. All patients underwent the treatment of failing filtering blebs 3-8 days after trabeculectomy with mitomycin-C. All the patients were followed up for 6 months.

RESULTS: After massage and revision with bled needling and 5-FU subconjunctival injection, the failing filtering blebs turned to be functional blebs in 18 eyes(90%). The average intraocular pressures(IOPs)were 24.61±5.4mmHg(1mmHg=0.133KPa)before treatment and 15.20±4.8mmHg 6 months after treatment. There was significant difference in IOP between pre- and post treatment eyes(P<0.001). No any severe complications were found during and after surgery.

CONCLUSION: Refractory glaucoma was more complicated, and the failing filtering bleb(or failing tendency)was more readily available after suffering trabeculectomy. Eyeball massage or after breaking suture of sclera, and bled needling with a blunt needle or 5-FU subconjunctival injection are a safer and more effective method to treat early dysfunctional filtering bleb after glaucoma trabeculectomy, and it can improve the success rate of surgery.

Abstract:AIM:To investigate the clinical efficacy of Ahmed glaucoma valve implantation with mitomycin C(MMC)combined with retinal photocoagulation for treatment of neovascular glaucoma(NVG).

METHODS:The medical records of 41 cases 41 eyes of NVG who underwent Ahmed glaucoma valve implantation with MMC combined with retinal photocoagulation were retrospectively analyzed, including intraocular pressure(IOP), visual acuity, the operative success rate and surgery complications.

RESULTS:The average IOP postoperatively all had statistical difference compared with preoperative IOP(all P<0.05). The operative successful rate was 93%, in which 36 eyes(88%)with complete success, 2 eyes(5%)with success at certain condition and 3 eyes(7%)with failure. The difference of visual acuity was not significant(P>0.05). The complication after the operation included early hypotony in 4 eyes(10%), postoperative shallow anterior chamber in 1 eye(2%), hyphema in 3 eyes(7%)and tube occlusion in 1 eye(2%).

CONCLUSION:Ahmed glaucoma valve implantation with MMC combined with retinal photocoagulation is a safe and effective therapy to decrease the IOP of NVG.

Abstract:AIM: To observe the photoreceptor integrity by spectral-domain optical coherence tomography(SD-OCT)in diabetic macular edema(DME)with or without serous retinal detachment(SRD), and assess their association with visual acuity.

METHODS: In this prospective study, consecutive patients were observed by SD-OCT with central subfield mean thickness(CSMT)≥300μm and without definite macular traction or compact hard exudates in central 500μm. They were divided into two groups: with or without SRD. The integrity of photoreceptor was observed in the central 500μm. The integrity of external limiting membrane(ELM)in all eyes and the integrity of inner and outer segments(IS/OS)in eyes without SRD was classified as existent or completely absent. In SRD eyes, the integrity of IS/OS was classified into another two grades: preserved or atrophic. BCVA between different integrity of IS/OS or ELM were compared.

RESULTS: In all the 56 eyes of 41 patients, there were 32 eyes detected without SRD and 24 eyes with SRD. In eyes without SRD, BCVA was significantly poorer in eyes with completely absent IS/OS or ELM than those with existent IS/OS or ELM(t=-7.938, P=0.000; t= -7.347, P=0.000). In eyes with SRD, BCVA was also significantly poorer in eyes with atrophic IS/OS than those with preserved IS/OS(t=-4.354, P=0.000), but there was no significant difference in BCVA between eyes with or without completely absent ELM(t=-0.895, P=0.381).

CONCLUSION: In patients of diabetic macular edema, the integrity of subfoveal IS/OS was closely related to BCVA. But the associations between the integrity of ELM and BCVA might not consistent in eyes with or without SRD.

Abstract:AIM: To observe clinical efficacy of argon laser photocoagulation or panretinal photocoagulation(PRP)therapy on plateau diabetic retinopathy(DR), retinal vein occlusion(RVO), and to evaluate security and effectiveness of argon laser treatment of fundus diseases.

METHODS: Totally 122 cases(227 eyes)of DR were selected, including 51 cases(90 eyes)of preproliferative diabetic retinopathy(PPDR), 71 cases(137 eyes)of proliferative diabetic retinopathy(PDR), 120 cases(124 eyes)of RVO, 27 cases(27 eyes)of central vein occlusion(CRVO), 93 cases(97 eyes)of branch retinal vein occlusion(BRVO). They were performed argon laser photocoagulation treatment. The fundus examination, visual acuity and fundus fluorescein angiography(FFA)examination of each patient were taken in the end after the last treatment 1 month, 3 months and 6 months postoperatively.

RESULTS: After the retinal photocoagulation on DR patients, operation were effective in 81 eyes(90.0%), ineffective in 9 eyes(10.0%)in PPDR cases; effective in 98 eyes(71.5%), ineffective in 39 eyes(28.5%)in PDR cases, and the total effective rate was 78.9%. After the retinal photocoagulation on RVO patients, operation was effective in 90 eyes(92.8%)in BRVO cases; effective in 22 eyes(81.5%)in CRVO cases. The total effective rate of argon laser(532nm)treatment on retinal vascular disease was 82.9%.

CONCLUSION: Fundus argon laser photocoagulation(532nm)for the vascular fundus diseases in highland area is a safe and effective method in the treatment of DR. The effective rate of laser therapy on PPDR was higher than the proliferative phase, timing of treatment selection can effectively prevent the progression of DR to prevent blindness in serious consequences; timing retinal laser photocoagulation therapeutic intervention on RVO can accelerate hemorrhage and absorption of edema, prevent forming neovascularization and reduce complications.

Abstract:AIM:To evaluate the efficacy of photodynamic therapy(PDT)after 1/2 dose verteporfin injection in treating central serous chorioretinopathy(CSC).

METHODS:Thirty-six eyes of 36 patients diagnosed with CSC received one single session of PDT using 1/2 dose(3mg/m²)verteporfin. Best-corrected visual acuity(BCVA)and OCT were measured before, 1 week, 4, 12 and 24 weeks after PDT treatment with 1/2 dose. OCT, FFA and ICG examination were performed before, 4 and 24 weeks after PDT treatment with 1/2 dose.

RESULTS:Twenty-seven of 36 eyes(75%)had complete resolution of subretinal fluid(SRF)1 week after 1/2 dose PDT treatment. SRF was partly absorbed in 9 of 36 eyes(25%). After 4 weeks, SRF in 36 eyes was completely absorbed, fluorescein leakage of 36 eyes disappeared in FFA and the tortuous choroidal vessels appeared normal in ICG; Twelve to twenty-four weeks after PDT treatment, there was no recurrence of CSC in 36 eyes. The mean BCVA was improved from 0.52 to 0.80 four weeks after PDT treatment.

CONCLUSION:PDT with 1/2 dose verteporfin injection is effective and safe in treating CSC in short time follow-up. It can shorten the coursing of CSC and protect the macular visual function.

Abstract:AIM: To investigate the clinical application of 23-gauge vitrectomy system in the treatment of vitreoretinopathy disease and evaluate its efficacy and safety.

METHODS: A retrospective study of 26 cases(26 eyes)who received 23-gauge vitrectomy from February 2012 to September 2012 was retrospectively studied. The diseases included vitreous hemorrhage(6 cases), rhegmatogenous retinal detachment(14 cases), proliferative diabetic retinopathy(5 cases)and macular epiretinal membrane(1 case). The main observation was the surgical effects and complications. The follow-up time was from 1 month to 6 months.

RESULTS: All cases were successfully completed without significant complications. The best-corrected visual acuity was improved in different degrees.

CONCLUSION: The 23-gauge vitrectomy system with better curative effect, faster postoperative recovery and few complications is an effective and safe surgical technique for all vitreoretinopathy diseases.

Abstract:AIM: To evaluate aqueous humor level of vascular endothelial growth factor(VEGF)in proliferative diabetic retinopathy(PDR)patients before and after vitrectomy.

METHODS: Aqueous humor samples were collected from 30 PDR patients before and after vitrectomy. Thirty cases of cataract patients without diabetes mellitus were chosen as a normal control group. Aqueous humor concentrations of VEGF were determined by enzyme-linked immunosorbent assays(ELISA).

RESULTS: Aqueous humor concentrations of VEGF were significantly greater in PDR patients than in control(P<0.05). VEGF concentrations decreased significantly in postoperative samples than that in preoperative samples(P<0.05).

CONCLUSION: VEGF actively takes part in the occurrence and development of PDR, and has a close relationship with neovascularization in the late stage of PDR.

Abstract:AIM:To observe the advantages and disadvantages of different surgeries for the treatment of ptosis to provide theory and basis for clinical choice of reasonable operation method.

METHODS:A retrospective analysis of 225 cases 298 eyes performed ptosis operation in our hospital from January 2008-December 2011. According to the different operation modes patients were divided into two groups: borrow frontalis muscle power operation, as well as the levator palpebrae superioris complex operation. Patients were performed 3-6 months' follow-up observation, evaluation and analysis. The effects of two groups were compared.

RESULTS: All of the patients divided into two groups, borrowed from the frontal muscle power operation in 38 cases 44 eyes,2 eyes overcorrection, 1 case of recurrence, the cure rate was 93.2%; levator palpebrae superioris complex operation in 187 cases 254 eyes,6 eyes and 2 eyes overcorrection, undercorrection, the cure rate was 97.6%, significantly higher than the amount of muscle strength in use operation group 2 cases 2 eyes with ptosis after operation of short-term undercorrection, reopened incision and upregulated the levator palpebrae superioris muscle fixed position; 1 case 1 eye recurred after half year, the re-operation found suture exfoliated then repaired; 4 cases 6 eyes of overcorrection released upper eyelid muscle to adjust the margin position. All surgeries have improved the blepharoptosis symptoms and reached the appearance change.

CONCLUSION:Congenital ptosis in principle should be treated early, earlier operation can prevent children from amblyopia and mental disorders. Acquired ptosis due to a variety of causes, which should be treated according to the different causes first, then in stable condition 3-6 months after choose different operation methods. Correction of ptosis based on the severity, select the appropriate operation, improve the curative effect to reduce complications.

Abstract:AIM: To evaluate the accuracy of HAR-800 hand-held autorefractor on preschool children.

METHODS:Totally 173 preschool children were included in this study. They were performed HAR-800 hand-held autorefractor examination before using atropine ointments for cycloplegic refraction. The results from HAR-800 refractor were set as experimental group, and the cycloplegic refraction were controlled group. The refractions between the two groups were compared and analyzed.

RESULTS: The sphere was 1.59±0.61D in the experimental group, while 3.15±0.72D in the controlled group. The difference was significant(t=-82.89, P<0.001), however, there was a significant correlation(r=0.87, P<0.001, Pearsons correlation analysis). The cylinder difference was also significant(t=-6.97,P<0.001)and a significant correlation also existed between the two groups(r=0.76,P<0.001, Pearsons correlation analysis).

CONCLUSION: The HAR-800 hand-held autorefractor can not replace cyclopegic refraction using atropine, but the results can reflect the preschool children refraction.

Abstract:AIM:To evaluate the effect of comprehensive treatment for children and teenagers with anisometropia amblyopia.

METHODS: Forty-five children and teenagers with anisometropia amblyopia, aged 8-15 years old, selected from our hospital between January 2007 and October 2010, were divided into two groups. Group A(22 patients)wore rigid gas permeable(RGP)lenses and group B wore eyeglass frames. Both groups received same amblyopia therapy with a patch, red light flashing, synoptophore disinhibition, and using of oral levodopa and depending on binocular vision and stereopsis comprehensive treatment method to carry on the treatment. Follow-up for 30 months observed in patients with visual acuity and stereopsis of near and far.

RESULTS: Comprehensive treatment of amblyopia after 30 months, two cases of corrected visual acuity were improved, Recovery rates were different for groups A and B:40.9%(9/22)and 17.4%(4/21), the curative effect of group A was significantly higher in B group, two groups had statistical significance(χ²=6.932, P<0.05). The rank sum test, group A of far and near stereopsis was clearly higher than group B(P<0.05).

CONCLUSION:Older children and teenagers with anisometropic amblyopia should take active treatment of amblyopia. For anisometropic amblyopia, patients should be recommended to wear RGP lens, which can improve the clinical cure rate,and maximize the possible recovery of binocular vision.

Abstract:AIM: To evaluate the clinical outcome of correction of corneal astigmatism and rotational stability of implantation of the AcrySof Toric intraocular lens(IOL)in cataract surgery.

METHODS: Twenty-eight patients(thirty-two eyes)with more than 1.0 diopter(D)of preexisting astigmatism underwent similar phacoemulsification combined with AcrySof toric IOL implantation. The uncorrected visual acuity(UCVA), best-corrected visual acuity(BCVA), preoperative corneal astigmatism, anticipated residual astigmatism, postoperative residual astigmatism and toric lens axis were detected and compared.

RESULTS: At 1 year following surgery, 85% of eyes showed the 0.5 or better in UCVA; 86% of eyes was 0.8 or better in BCVA and 92% of eyes achieved 0.6 or better in BCVA. The mean preoperative corneal astigmatism was(2.20 ±0.65)D and the postoperative residual astigmatism was(0.54±0.13)D, indicating a significant decrease in refractive cylinder after surgery(t=10.134, P<0.01). Preoperative predictive astigmatism(0.52±0.14)D and postoperative residual astigmatism(0.54±0.13)D showed no significant difference(t=0.364, P>0.05). After postoperative 6 month, the mean rotation of toric IOLs was 3.4°±2.2°, and after postoperative 1 year it was 3.82°±1.27°.

CONCLUSION:AcrySof Toric IOL implantation is a viable and highly predictable method of correcting the corneal astigmatism, with no injury of the cornea. Careful selection of the patient, accurate keratometry and precise alignment of the cylindrical axes are some of the factors to be considered for a superior outcome.

Abstract:AIM: To assess the clinical outcome of the implantation of phakic posterior chamber Toric intraocular lens(TICL)for high myopia with astigmatism.

METHODS: Totally 50 eyes of 30 patients with high myopia and astigmatism were treated with TICL implantation from October 2009 to November 2011. The preoperative mean spherical equivalent was -10.75±2.65D, the mean cylindrical equivalent was -2.85±0.75D. All of the patients were followed up for 3 months to 2 years. Uncorrected and best-corrected visual acuity, refraction, intraocular pressure and endothelial cell morphometry, as well as the complications were observed.

RESULTS: The range of uncorrected visual acuity after operation was 0.5-1.2, mean 0.75±0.34. The range of preoperative best-corrected visual acuity was 0.3-1.0, mean 0.58±0.35. The mean best-corrected visual acuity after operation was 0.78±0.35. The uncorrected visual acuity after operation of 20 eyes was same and of 30 eyes was better than the preoperative best-corrected visual acuity. The mean spherical equivalent after operation was -0.52±0.35D, the mean cylindrical equivalent was 0.52±0.25D. Corneal endothelium counting before and after the operation had no significant difference. No serious complication was detected during the follow-up.

CONCLUSION: The implantation of phakic posterior chamber TICL for high myopia with astigmatism is safe and effective. It is a suitable treatment method for high myopia.

Abstract:AIM: To analyze the reasons of corneal descemet membrane detachment during phacoemulsification cataract operation, discuss the treatment and prevent methods.

METHODS: Retrospective data analysis was conducted in 954 cases underwent phacoemulsification cataract surgery at eye hospital of Taizhou from January 2010 to June 2012, and 87 cases were found with corneal descemet membrane detachment during the operation.

RESULTS: All the 87 eyes of corneal descemet membrane detachment were treated with gas injection to anterior chamber, and had obvious curative effects.

CONCLUSION: Early detection in operation, proper and prompt treatment are the key factors for prevention of postoperative complication and gaining good vision recovery.

Abstract:AIM: To study the clinical therapy effect for fungal keratitis with local shallow ‘slope type flap appearance' lamellar corneal excision.

METHODS: Fifty-three eyes diagnosed with fungal keratitis were treated with the local shallow ‘slope type flap appearance' lamellar corneal excision.

RESULTS: In 53 patients 53 eyes, 48 eyes corneal epithelial were basically healed in 3 to 10 days after operation. It cost an average of 6.6±3.4 days for repairing corneal epithelial, and the time for anterior chamber inflammation and artial flash was 20.2 ±15.1 days, visual recovered≥0.05. The pre-operative visual acuity compared with post-operative visual acuity, it showed significant differences(t=10.40, P<0.01).

CONCLUSION: It is an effective method of local shallow ‘slope type flap appearance' lamellar corneal excision treatment for fungal keratitis.

Abstract:AIM: To evaluate the clinical effects of deep lamellar keratoplasty(DLKP)for keratopathy.

METHODS: There are 5 cases 6 eyes with mooren's ulcer, margin corneal degeneration, herpes simplex keratitis or corneal dermoid tumor. DLKP with or without scleral ring transplantation were taken in these patients, and a retrospective study was made. All patients were followed up for 18 months. The postoperative complications, postoperative vision, the transparency of tissue lens were observed.

RESULTS: Their visual acuities were HM/10cm -0.06 preoperatively. In the follow-up, the best-corrected visual acuities of 5 eyes improved obviously, ranging in 0.2-0.5. One eye had moderate turbidity, its visual acuities(0.05)slightly improved.

CONCLUSION: DLKP is effective and safe for keratopathy, and easy be performed in primary hospital.

Abstract:AIM: To evaluate the outcome of middle incision cataract extraction for aged patients during Vision Action in Honghe, Yunnan Province.

METHODS: Totally 79 eyes from 67 cases(age≥80 years old)of age-related cataract during Vision Action were involved in this study, for whom middle incision cataract extraction combined with intraocular lens implantation was performed. Visual acuity, intraocular pressure, complications and clinical signs were followed up for 1 month and analyzed.

RESULTS: Postoperatively, 42 eyes(53.2%), 63 eyes(79.7%), and 69 eyes(87.3%)got visual acuity better than 0.3 on 1 day, 1 week, and 1 month post operation respectively. And no significant change was found for intraocular pressure between pre- and post operation. Posterior capsule rupture occurred in 4 eyes during surgeries, and iridodialysis in 1 eye. And corneal edema and anterior chamber flare almost disappeared in about 1 week post operation.

CONCLUSION: Middle incision cataract extraction is safe and effective for aged cataract patients during Vision Action, and could be master in short term.

Abstract:AIM: To discuss the therapeutic results of phacoemulsification for cataract in the treatment of cataract patients.

METHODS:Totally 48 cases of the cataract patients who were admitted to our hospital between March of 2010 and December of 2011 were chosen as treatment group to be treated with phacoemulsification. Another 48 cataract patients in our hospital during the same period were chosen as control group to be treated with traditional phacoemulsification.

RESULTS: The total efficiency of the treatment group was obviously higher than that of the control group, and the difference was statistically significant(P<0.05).

CONCLUSION: The therapeutic results of phaco-emulsification for cataract have significant effect and are worthy of promotion.

Abstract:AIM: To compare the clinical results of cataract extraction with small incision non-phacoemulsification and phacoemulsification for cataract.

METHODS: Patients were divided into two groups randomly, with 172 eyes of 166 cases in group A and 180 eyes of 175 cases group B, topical anesthesia cataract extraction with small incision non-phacoemulsification or phacoemulsification combined with intraocular lens implantation was performed in the two groups, respectively.

RESULTS: There was no significant difference in postoperative visual acuity and corneal astigmatism between the two groups(P>0.05), and no significant difference in the postoperative complication rate between the two groups(P>0.05).

CONCLUSION: Cataract extraction with small incision is a feasible, effective and recommendable approach for cataract surgery.

Abstract:AIM: To evaluate the clinical effects of phacoemulsification combined the foldable intraocular lens implantation on patients with myopia and cataract.

METHODS:This study evaluated 62 eyes of 41 patients with myopia and cataract who received phacoemulsification combined the foldable intraocular lens implantation, and the intraoperative and postoperative complications, postoperative visual acuity were observed. The follow-up time was from 1 month to 6 months, average 3 months.

RESULTS: Posterior capsule rupture postoperatively occurred in 3 eyes and no other intraoperative complications. The first day after surgery, the uncorrected visual acuity of <0.1 were in 7 eyes(11%), 0.1≤visual acuity<0.5 in 42 eyes(68%), visual acuity≥0.5 in 13 eyes(21%); follow-up 3 months, the uncorrected visual acuity <0.1 were in 4 eyes(6%), 0.1≤ visual acuity<0.5 in 40 eyes(65%), visual acuity≥0.5 in 18 eyes(29%). The best-corrected visual acuity <0.1 were in 2 eyes(3%), 0.1≤visual acuity<0.5 in 36 eyes(58%), visual acuity≥0.5 in 24 eyes(39%), in the follow-up posterior lens capsule opacity was in 3 eyes(5%), without retinal detachment, choroidal detachment and macular edema.

CONCLUSION: It is safe and effective for high myopia with cataract to implant a foldable intraocular lens after phacoemulsification.

Abstract:AIM: To compare the clinical effects of two modes of conjunctival flap in trabeculectomy.

METHODS: In a randomized controlled clinical trial, 148 eyes 132 patients were divided randomly into two groups, the base in limbus of cornea conjunctival flap(group A)was 64 cases(72 eyes)and base in fornex(group B)was 68 cases(76 eyes). The follow-up time was 6-12 months to observe intraocular pressure, filtering bubble, anterior chamber depth and intraoperative and postoperative complications.

RESULTS: No statistically significant difference of the two modes of conjunctival flap on the postoperative success rate and postoperative IOP. The fornix base conjunctival flap(group B)can get a better bleb. Limbal base conjunctival flap(group A)showed more complications, such as late bleb leakage, hypotony.

CONCLUSION: The basement by the fornix conjunctival flap(group B)is better than the limbal base conjunctival flap(group A).

Abstract:AIM: To explore the safety and effectiveness of double frequency 532 laser peripheral iridoplasty(LPI)in treatment of acute attack of primary angle-closure glaucoma(PACG)which isn't suitable for drugs.

METHODS: Thirteen consecutive patients with acute PACG were recruited into the study. Each patient received oxybuprocaine(4g/L), and double frequency 532 LPI immediately. The intraocular pressures(IOP)of 15 minutes, 30 minutes and 60 minutes after double frequency 532 LPI were documented.

RESULTS: The mean IOP of this group of patients was reduced from 60.6 ±8.8mmHg(1kPa=7.5mmHg), before double frequency 532 LPI to 37.4 ±7.3mmHg in 15 minutes, 26.2±6.6mmHg in 30 minutes, and 17.1±5.3mmHg in 60 minutes after LPI. The cornea edema patients cleared up, no serious complications.

CONCLUSION: Double frequency 532 LPI in the treatment of PACG is safe, effective, and can be used for treatment of first choice.

Abstract:AIM: To investigate the safety and efficacy of trabeculectomy in glaucoma and ocular hypertension status.

METHODS:For 25 glaucoma patients 26 eyes whose intraocular pressure was still abnormal after full antihypertensive treatment, the anterior chamber puncture was performed to release aqueous, then the patients underwent the trabeculectomy, the efficacy and complications were observed.

RESULTS: All operations were successfully completed,without choroidal hemorrhage, vitreous loss or other serious complications, postoperative intraocular pressure was ≤21mmHg, and postoperative visual acuity improved in 25 eyes, the total efficiency was 96.2%.

CONCLUSION:Treatment of glaucoma with trabeculectomy is safe, simple, and reliable. And for the glaucoma with uncontrolled persistent ocular hypertension, release of aqueous and then trabeculectomy is still the most effective, ideal technique.

Abstract:AIM: To investigate the curative effect of Nd:YAG 532nm laser combined with compound anisodine in treatment of branch retinal vein occlusion(BRVO).

METHODS: Totally 130 cases 130 eyes of BRVO were randomly divided into control group and treatment group. The control group was treated by 532nm laser retinal laser photocoagulation, treatment group was treated by 532nm laser retinal photocoagulation combined with compound anisodine with local blocking. Observation of 3 months after treatment in two groups of patients with visual function and the changes of fundus fluorescein angiography(FFA)examination of retinal circulation.

RESULTS: Combined compound anisodine treatment group compared with simple laser treatment control group, the difference was statistically significant in improved visual acuity(P=0.02<0.05). Direct ophthalmoscopy and FFA examination revealed that the retinal hemorrhage absorption, the degree of macular edema reduction, capillary nonperfusion area disappearance, and no new blood vessel formation in the treatment group were better than those in control group.

CONCLUSION: Double frequency Nd:YAG 532nm laser combined with compound anisodine in treatment of BRVO after 3 months, the visual function and FFA was significantly better than that of 532nm laser treatment.

Abstract:AIM: To discuss the therapeutic effect of autologous serum subconjunctival injection in treatment of allergic conjunctivitis.

METHODS: Sixty-four cases of allergic conjunctivitis were divided into treatment group(32 cases)and control group(32 cases), two groups had no significant difference in age, sex, clinical situation and causation of disease(P >0.05). Autologous serum subconjunctival injection was used in the treatment group, one time a week, four times in one course of treatment. Olopatadine was used in control group, two times a day.

RESULTS: After four weeks treatment, the cure rate in treatment group and control group was 84.4% and 90.6%, respectively.The difference between the two groups was not statistically significant(χ²=0.571, P>0.25).

CONCLUSION: Treating allergic conjunctivitis with autologous serum subconjunctival injection has the same therapeutic effect as olopatadine.

Abstract:AIM: To investigate the sonographic characteristics of vitreous hemorrhage in order to be helpful in the clinical diagnosis and treatment.

METHODS:Clinical data of 62 cases with vitreous hemorrhage caused by various reasons were retrospective analyzed.

RESULTS: The patients with vitreous hemorrhage caused by injury were 11 cases, accounting for 18%(11/62). High myopia, hypertension, diabetes and other causes of retinal lesions resulting in vitreous hemorrhage were 51 cases, accounting for 82%(51/62).

CONCLUSION: The image is clear by using ultrasound diagnosis of vitreous hemorrhage, which plays a supporting role to clinical treatment options and prognosis monitoring, at the same time it can observe the changes of vitreous hemorrhage before and after treatment to provide clinical practical value.

Abstract:AIM: To study the clinical characteristic of early secondary orbital implant insertion of hydroxyapatite in the anophthalmic patients after ophthalmectomy.

METHODS: Sixteen anophthalmic patients(16 eyes)after ophthalmectomy received early secondary orbital implant insertion of hydroxyapatite. The cause, time, future, effect and complications of the operation were analyzed retrospectively. Patients were follow-up for 10(ranged 6 to 13)months.

RESULTS: Severe ocular trauma combining contaminative tissue or sporadic foreign bodies of fossa orbitalis, severe endophthalmitis, ocular tumor, transferring from other hospital were the main causes of the operation of early secondary orbital implant insertion of hydroxyapatite. Sixteen patients received this operation successfully at the 12(ranged 7 to 15)day. All patients had a good cosmetic result and prosthetic motility. There were no complications of implant infection, exposure or extrusion, ptosis in all patients except for bulbar conjunctiva and conjunctival cyst in one patient respectively.

CONCLUSION: Procedure and effectiveness of early secondary orbital implant insertion of hydroxyapatite is similar to one - stage operation. It is safe and effective under the condition of selecting patient reasonably and perfect operation skill.

Abstract:AIM: To investigate the etiology characteristics of orbital disease in children.

METHODS: Totally 81 cases, 83 orbits with orbital disease were reviewed retrospectively. First, the prevalence situation was statistically classified. Then, the prevalence situation of orbital disease and new characteristics was analyzed.

RESULTS: Injuries of the orbit were found in 15 of 83 orbits(18%), space-occupying lesions were 56 orbits(67%),the others were 12 orbits(14%). In the space-occupying lesions, there were 3 orbits with inflammation(4%), 14 orbits with cyst(17%), 19 orbits with primary tumor(23%), 19 orbits with secondary tumor(23%), 1 orbit with the others(1%). 47 orbits were benign lesion(57%), 21 orbits were malignancy lesion(25%), 15 orbits were injuries of the orbit(18%).

CONCLUSION: The benign lesions are predominant in children patients with orbital disease, injuries of the orbit were worth to attention in clinic.

Abstract:AIM: To observe and evaluate the clinical effect of pterygium extended excision with corneal limbal stem cells autograft transplantation.

METHODS: Fifty-nine patients(60 eyes)with pterygium were randomly divided into 2 groups: group A accepted simple pterygium excision in 27 patients(27 eyes); group B accepted pterygium extended excision with corneal limbal stem cells autograft transplantation in 32 patients(33 eyes), then the recurrence rate, epithelial healing time of postoperative wound on cornea, and tear function were compared.

RESULTS: All the patients were followed up for 15-25(18±3.6)months, 8 eyes(30%)recurred in group A and 2 eyes(6%)in group B, the average epithelial healing time of postoperative wound of group B was shorter than that of group A, the tear film break-up time prolonged, there were statistical significant differences between two groups.

CONCLUSION: It is effective and safe that pterygium extended excision with corneal limbal stem cells autograft transplantation. It has low recurrence, causes less discomfort, take less time and helps wound surface to heal quickly.

Abstract:AIM: To investigate the performance of visual acuity and refractive after the two different surgical methods for treatment of primary pterygium.

METHODS: A total of 120 cases 120 eyes underwent pterygium surgery were divided into 2 groups randomly, group A(pterygium excision with limbal stem cell transplantation)and group B(pterygium excision with amniotic membrane transplantation). The incision condition of the wound margin of conjunctiva and corneal were observed everyday by slit lamp microscope on the first week after pterygium surgery, and the growth of transplantation, with or without infection and corneal epithelium repair and corneal growth of new blood vessels also were observed everyday by slit lamp microscope on the first week after pterygium surgery. Naked visual acuity, corneal curvature and corneal astigmatism were measured and compared in preoperative 2 weeks, postoperative 3 weeks.

RESULTS: In group A and B, the results of naked visual acuity, corneal curvature and corneal astigmatism in postoperative 3 weeks were different to that of preoperative with statistical significance(P<0.05). While the changes in postoperative 3 weeks had no statistical significance difference between two groups(P >0.05).

CONCLUSION: The surgery for pterygium can change the corneal refraction. Both pterygium excision with limbal stem cell transplantation and pterygium excision with amniotic membrane transplantation can decrease astigmatism degree and improve visual acuity. We should choose the operation method according to the patient's condition.

Abstract:AIM: To observe the effect and clinical significance of alcohol soaked peeling during the pterygium surgery.

METHODS: Totally 48 eyes of primary pterygium, a special metal ring was placed on the head of pterygium under local anesthesia, which filled with 200ml/L alcohol in metal ring, 40-60 seconds later, adequate flushing with saline, then peeled and cleaned up the degenerative organization of pterygium using a special curette, transplanted an autologous conjunctival flap with corneal limbus.

RESULTS: Follow-up one week to one year, postoperatively 48 eyes had good operative effect, smooth and clean in operation location, complete tissue construction, little scar and less astigmatism than preoperative.

CONCLUSION: The peeling operation of pterygium aided alcohol soak is a safe, effective method.

Abstract:AIM: To retrospectively analyze the epidemiological characteristics and modern ophthalmic microscopic technology of 137 cases(138 eyes)with ocular trauma to observe the result of ocular trauma prognosis vision.

METHODS:Clinical data of 137 cases(138 eyes)with ocular trauma in our hospital were reviewed; injured causes, time, place and time of get hurt by species, kind, and complications of injury classification and operation method, eyesight before and after treatment were recorded. Vision < 0.1 as the poor standards of prognosis was compared with visual acuity ≥0.1 group. The difference in vision between before and after treatment was analyzed.

RESULTS:The gender ratio of 137 cases of ocular trauma was 6.61:1, with 19-49 years old for young adults, with an average age of 33.28 years. The first cause of injury was metal implements, the second was wood. 90 cases(90 eyes)underwent second stage surgical treatment, accounting for 65.2%. There were 34 cases(34 eyes)accepted the vitrectomy, the best-corrected visual acuity(BCVA)≥0.5 in 31 cases(31 eyes)6 months after surgery, accounting for 22.5%, BCVA≥ 0.1 in 77 cases(77 eyes), accounting for 55.8%. Constituent ratio of visual acuity before and after treatment had statistically significant difference. The visual acuity were markedly improved after treatment(the Chi-square=137.40, P=0.000). 1 case of explosion hurt patient's 1 eye performed eye excision.

CONCLUSION: Ocular trauma in undeveloped areas accords with international ocular trauma in epidemiological characteristics, and has its own characteristics. Positive first phase treatment and second phase vitrectomy can effectively improve the postoperative BCVA, reduce the complications and improve the quality of life for ocular trauma patients after injury.

Abstract:AIM:To observe the effect of dacryocystorhinostomy for chronic dacryocystitis under nose endoscope.

METHODS:Clinical materials of 15 cases 17 eyes with chronic dacryocystitis after dacryocystorhinostomy under nose endoscope were reviewed.

RESULTS:Of all patients, 13 cases 15 eyes were cured and 2 cases 2 eyes were improved. The total treatment effectiveness was 100%.

CONCLUSION:Dacryocystorhinostomy under nose endoscope is an effective and reliable treatment method for chronic dacryocystitis.

Abstract:AIM: To compare the accuracy of different refraction measurements after laser in stiu keratomileusis(LASIK)for myopia and astigmatism.

METHODS: Totally 48 cases 96 eyes with myopia were measured before and one month after LASIK, with auto refractor(TOPCOON)objectively, girdle-shaped scissors-shadow scope and subjectively trial lens. The data obtained were statistically analyzed.

RESULTS: Both spherical power and astigmatism results of three measurements had no statistical difference preoperatively(F=4.32, P=0.69; F=0.57, P=0.57). Postoperatively, refraction test with girdle-shaped scissors-shadow scope and trial lens had no statistical difference(P=0.68; P=0.15). But refraction with auto refractor had statistical difference with the tests with the first two methods(P=0.00).

CONCLUSION: Preoperatively, the objective refraction with an auto refractor is approximate to the retinoscopy optometry and the subjective refraction. The postoperative objective refraction with an auto refractor is less accurate than that preoperatively. It is not sufficient to determine the accurate value of the ametropia. Cycloplegic dioptoscopy can get a relative accurate diopter values after LASIK.

Abstract:AIM: To investigate the application of pranoprofen eyedrops in laser epithelial keratomileusis(LASEK).

METHODS:Totally 112 eyes of 56 patients who have undergone LASEK in our hospital from May 2011 to August 2011 were divided into experimental group(use of pranoprofen)and control group. Corneal irritation and healing of epithelium between these two groups were compared and observed.

RESULTS: Corneal irritation in the study group was much better than that of the control group on 1-day and 3-day after operation. However, there was no obvious difference in the healing of the epithelium.

CONCLUSION:Pranoprofen eyedrops can significantly alleviate corneal irritation after LASEK, and will not affect the healing of epithelium, nor increase the ratio of secondary ocular hypertension.

Abstract:AIM: To observe the changes of electrocardiogram(ECG), respiration, oxygen saturation and blood pressure in local anesthesia care cases in adult horizontal strabismus operation.

METHODS: Seventeen adult patients with clinical diagnosis of horizontal strabismus were enrolled to our study, including 19 eyes and 36 extraocular muscles. There were 10 males, 7 females, aged from 18- 71, with an average age of 32.65; 14 exotropia cases(8 males, 6 females), 3 esotropia cases(2 males, 1 female). All of the patients had the examination of best-corrected visual acuity(BCVA), slit-lamp microscope, indirect ophthal-moscopy, fluorescein and synoptophore. A professional anesthesiologist conducted the whole closely monitoring by using monitor during the operation. The changes of ECG, respiration, oxygen saturation and blood pressure between preoperative and intraoperative were comparatively analyzed with local anesthesia monitoring, the differences of medial and lateral rectus, different gender and different age group were compared.

RESULTS: There were 36 extraocular muscles pulled of the 17 cases adult horizontal strabismus in local anesthesia care, the incidence of oculocardiac reflex was 86.1%; pulling medial and lateral rectus, the positive rates of oculocardiac reflex were respectively 100% and 72.2%. Oculocardiac reflex had no statistical differences in different gender. The positive rates of oculocardiac reflex were significantly higher in 18-30 years than that of 31-71 years. Intraoperative respiratory frequency increased with oculocardiac reflex synchronization, but unrelated with pulling the rectus, gender and different age groups. No significant changes in oxygen saturation. Blood pressure appeared a transient increase at the beginning of the operation, a transient decrease when first pulling the rectus, there was no obvious difference in gender and age.

CONCLUSION: In local anesthesia care of adult horizontal strabismus operation, the oculocardiac reflex had a high incidence, pulling medial rectus occurred 100%; respiratory increased with oculocardiac reflex synchronization; blood pressure increased at the beginning, while decreased with pulling the rectus.

Abstract:AIM: To investigate the relationship between the extent, type, age and efficacy of amblyopia, and to provide reference for the clinical treatment.

METHODS: Totally 186 patients(272 eyes)with refractive errors in children with amblyopia were randomly divided into three groups: hypermetropic, myopic and astigmatic amblyopia. And degree of amblyopia and therapeutic effect of age were compared. Treatment included wearing the appropriate glasses, cover the eye, or alternately covered with fine eyesight job training and amblyopia treatment instrument applications.

RESULTS:The basic cure rate in patients with hyperopic amblyopia was the highest(78.5%), myopic amblyopia(64.6%), astigmatism amblyopia(52.6%), there was significant difference(P<0.05). The treatment effect of hyperopic amblyopia, mild amblyopia, and age of onset of amblyopia was good(P<0.05).

CONCLUSION: The results of treatment are associated with types of refractive error. These data show that therapeutic effect is correlated with refractive status, degree of amblyopia and age.