Abstract:AIM: To investigate the expression and relationship of S-phase kinase-associated protein 2(Skp2)and p27 in mucosa-associated lymphoid tissue(MALT)lymphoma of ocular adnexal.

METHODS:The expression of Skp2, p27 were detected on resected specimens from patients suffering from MALT lymphoma and lymphadenosis of ocular adnexal in Ophthalmology Department, Affiliated Hospital of Medical College Qingdao University from 1995 to 2011 by immunohistochemical analysis.

RESULTS: The expression of Skp2 in MALT lymphoma was higher than that in lymphadenosis(P<0.05). The expression of p27 in MALT lymphoma was lower than that in lymphadenosis(P<0.05). The expression of Skp2 and p27 do not related with the Ann Arbor clinical stage. There was a negative correlation between p27 and Skp2 in MALT lymphoma(r=-0.129,χ²=15.39, P<0.05).

CONCLUSION: Comprehensive analysis of the expression of p27 and Skp2 protein may have certain guiding significance on the prognosis evaluation of the disease. The expression of two substances may correlate with each other.

Abstract:AIM: To define the fundus autofluorescence(FAF)patterns in acute and chronic idiopathic central serous chorioretinopathy(ICSCR)and correlate them with fundus fluorescein angiography(FFA)findings.

METHODS: This is an observational case study in which we retrospectively reviewed the clinical data and FFA and FAF images of ICSCR patients and compared the findings.

RESULTS: The study included 25 eyes of 17 patients. We detected acute ICSCR in 5 eyes, and chronic disease or recurrence in chronic disease in 20 eyes. FAF images in acute cases showed a sharply delineated hypoautofluorescent spot in exactly the same location as the pinpoint leak detected on fluorescein angiography. In FFA images of chronic ICSCR diffuse areas of RPE atrophy are visualized as transmission fluorescence. FAF images demonstrate hypo-autofluorescence that corresponds in shape and location to the areas showing the most intense transmission fluorescence on FFA, whereas areas with less transmission fluorescence on FFA correspond to hyper-autofluorescence on FAF. The hypo-autofluorescent spot pointing to the site of RPE leakage cannot be localized as precisely as in acute cases.

CONCLUSION: FAF imaging in ICSCR is capable of depicting FAF patterns that are characteristic of various stages of the disease. It is a risk-free and reproducible alternative to fluorescein angiography in ICSCR.

Abstract:AIM: To evaluate the clinical characteristics of patients with bilateral nonarteritic ischemic optic neuropathy(NAION)and the prognosis of NAION's impact factors.

METHODS: NAION patients with both eyes onset from 2006 were included in this study, their clinical characteristics, treatment methods, the demographic index, medical history, visual acuity, visual field and other clinical data of NAION, including the impact factors of the prognosis, were obtained statistically.

RESULTS: A total of 61 patients(122 eyes)have been diagnosed with NAION bilaterally, including 39 males and 22 females, with an average age of 58.0±11.0 years old, and the duration of the first onset was 12.5mo(IQR 4.75-26.5). The median of the best log MAR corrected visual acuity of the 122 eyes at initial visit were 0.7 logMAR(IQR 0.2-1.3), optic disc edema was seen in 38 eyes while optic disc saw in 76 eyes were pale or white. The most common types of visual field defects were inferior altitudinal visual field defect(38 eyes), supero-nasal defect(21 eyes), infero-nasal defect(16 eyes), superior altitudinal visual field defect(13 eyes), and tubular visual field defect(12 eyes). Among all the patients, there were 31 accompanied with hypertension, hyperlipidemia, diabetes, or a history of other cardiovascular and cerebrovascular diseases. After an median of 12mo(IQR 6-23.5)of follow-up observation, the visual acuity has been increased from 0.7 logMAR(IQR 0.2-1.3)to 0.4 logMAR(IQR 0.175-1.1), in which 45 eyes(36.9%)increased 2 lines or more. Best corrected visual acuity(BCVA)had no significant differences(Z=-0.521, -1.600, P>0.05)between the male and female patients at initial visit and during follow-up. BCVA of patients accompanied with cardiovascular or cerebrovascular disease had no significant differences(Z=-1.103, P>0.05)from those without cardiovascular or cerebrovascular disease before the treatment, while there were significant differences(Z=-2.090,P<0.05)between the two type of patients at their last follow-up visit. The visual acuity of the earlier onset cases and the later onset cases were both significantly higher(P=0.003, 0.019)than that at last visit, while BCVA of earlier onset cases improved more than later onset cases(median with 0.2 and 0.1 logMAR respectively, P=0.195)though there was no significant differences.

CONCLUSION: After summarizing the demographic index, incidence, medical history, visual acuity, and visual field characteristics of the bilateral NAION patients, we found that patients who were accompanied with cardiovascular or cerebrovascular disease and the later onset eyes might had a poor prognosis than the others, though there were further evidence needed to support this finding.

Abstract:AIM: To verify the advantages of an improved protocol for pterygium surgery(small incision removal)over a conventional protocol of this surgery.

METHODS: Totally 40 primary pterygium cases were divided into two groups(n=20 each)according to the protocols: small incision removal versus conventional removal. In our small incision removal, group 1, the pterygium body was cut open with a small incision firstly, through which the conjunctiva was separated from the underlying degenerated Tenon's layer; while in the conventional protocol, group 2, the whole head of pterygium was taken down before the separation. Then the head of pterygium was torn down in our protocol using a forceps instead of cutting it down with a blade, which was facilitated by a special corneal epithelial flap formation method. Surgery time, pain score and corneal wound healing were measured to provide objective comparison of outcome between the two protocols.

RESULTS: In the group using small incision removal, the average surgery time was 7.72min(or 48.9%)shorter than that of the control group using conventional protocol(P<0.001). The pain score was lower and the corneal wound was healed better in day 1 and 2 after the surgery in the small incision group(P<0.001). In addition, the surgery can be done by one surgeon using the small incision protocol, while the surgery using the conventional protocol requires two persons.

CONCLUSION: The small incision pterygium removal protocol was easier to perform and resulted in a better outcome than the conventional protocol.

Abstract:AIM: To establish dry eye model of rats induced by botulinum toxin B(BTX-B)and provide the basis for the pathogenesis and experimental treatment of dry eye caused by inflammation.

METHODS: Thirty-six healthy female SD rats were selected and divided into four groups randomly, and the experimental group included three groups, which were individually injected 0.1mL 1.25, 5, and 10mU BTX-B solution on the right lacrimal gland; the control group was injected 0.1mL normal saline on the right lacrimal gland, then received Schirmer Ⅰ test(SⅠt)and examination of corneal fluorescein(FL)staining respectively at the 3, 7, 14 and 28d. The other 32 rats were selected and divided into two groups randomly, the rats in the experimental group were injected 0.1mL 1.25mU BTX-B solution on the right lacrimal gland and then five rats were randomly chosen to be removed lacrimal gland tissue respectively at the 3, 7, 14, 21, 42d. The Lacritin protein was detected in the qualitative and quantitative way by immunofluorescence and Western-blot, and the histopathological test was received by routine HE staining.

RESULTS: The three groups in the experimental group during the preparation of the model appeared that tear secretions decreased and corneal epithelium got damaged at 3d, but there was no significant difference for each other of two changes(P>0.05). The change was reached the peak at 7d and improved at 14d. The tear secretions returned to normal level at 28d, but the damage of corneal epithelium was still existed. The expression of Lacritin protein was only observed in acinar cells of both experimental group and control group, and the content of Lacritin protein in the experimental group decreased significantly. The decreasing situation appeared at 3d, reached the peak at 7d, improved at 14d, began to recover at 28d, and returned to the normal level at 42d.

CONCLUSION: Dry eye model of SD rats can be successfully established by lacrimal gland injection of 1.25mU BTX-B solution, with symptoms of dry eyes such as tear secretions reducing and corneal epithelial injury, which can provide experimental basis and foundation for the research on the pathogenesis and experimental treatment of dry eye. Lacritin protein only expresses in acinar cells of lacrimal gland, and the content of Lacritin protein has a synchronous change with tear secretions and degree of dry eye, which provides a new basis for perfecting the standards on evaluating the degree of dry eye.

Abstract:AIM:To investigate effects of arsenic trioxide(As₂O₃)on the proliferation and apoptosis of on adenoid cystic carcinoma-2(ACC-2)cells and detect the expression of MDM2 gene from gene and protein level and to explore detailed mechanism of As₂O₃ inducing ACC-2 cells apoptosis.

METHODS: ACC-2 cells were cultured in vitro and divided into the experiment group and control group. Different concentrations of As₂O₃(2, 4, 6, 8μmol/L)were applied to cells in logarithmic growth phase at different time as experiment group, the control group was given the same amount of cell culture fluid, after added As₂O₃, the cells were cultured at different times, respectively. The effect of different As₂O₃ concentrations at each point time on inhibition and metamorphoses of ACC-2 cells was observed under inverted phase contrast microscope. Expression changes of MDM2 mRNA(24, 48h)and protein(24, 48, 72h)were determined by reverse transcription polymerase chain reaction(RT-PCR)and immunohistochemistry test(IHCT)respectively.

RESULTS: Cells shrinkage, nuclear chromatin condensation, apoptotic cells increased and the number of viable cells significantly reduced after being cultured with different concentrations of As₂O₃. The results of RT-PCR and IHCT were showed consistent the expression of MDM2 in experiment group decreased gradually with the increase of As₂O₃ concentrations and extension of action time, which was significantly different to that in the control group(P<0.05). Campared with each other, it was statistically significant between the different concentration and time of two groups(P<0.05). MDM2 expression was negatively correlated with concentration and time(r<-0.7, P<0.05), that was, it presented in dose- and time-dependent manner.

CONCLUSION: As₂O₃ has the inhibitory and apoptosis-inducing effect on ACC-2 cells, and it can downregulate the expression of MDM2 mRNA and protein in ACC-2 cell line. This may be the mechanism of As₂O₃ induced ACC-2 cells apoptosis.

Abstract:AIM: To identify the oxidative stress related miRNA in retinal pigment epithelium(RPE)by miRNA expression profile chip and provide a new idea for comprehensive and deep research on the molecular mechanisms of age-related macular degeneration(AMD).

METHODS: Human RPE cell line D407 was treated by 100, 200, 400μmol/L H₂O₂ for 24h and harvested to isolate total RNA by Trizol reagent. The expression difference of D407 cell miRNA after processing of different concentrations was generated by Exiqon miRCURY LNA^TM microRNA expression profile chip and the changes after processing of different concentrations were conducted by Hierarchical Clustering analysis. The results of chips were verified through Stem loop realtime PCR, and the target genes of identified miRNAs were predicted by bioinformatics software.

RESULTS: Among the 1 425 known miRNAs listed on microarray, 367 miRNAs showed differential expression after H₂O₂ treatment. The Treeview Clustering showed that 17 miRNAs, including miR-31, were downregulated along with the increase of H₂O₂ concentration. Meanwhile, 7 miRNAs, including miR206, were upregulated. The results of qRT-PCR further validated the better results of microarray.

CONCLUSION:The miRNA expression of human RPE is dramatically changed after H₂O₂ treatment. miRNA adjusts the molecules level of micrornas transcription and it is involved in cell oxidative stress reaction, and miRNA may play a pivotal role in the pathogenesis and development of AMD.

Abstract:AIM:To compare the concentration of Bevacizumab in serum and vitreous after bevacizumab administered by retrobulbar Tenon capsule perfusion and intravitreal injection in eyeballs of rabbits and observe the fluorescence of retinal, and to investigate the intraocular permeability of bevacizumab after retrobulbar Tenon capsule perfusion feasibility of extraocular administration route.

METHODS: Twenty healthy adult New Zealand rabbits were used in the study. The rabbits were randomly divided into two groups, group A received single administration of 1.25mg bevacizumab(1.25mg/0.05mL)by intravitreal injection, group B received single administration of 5mg bevacizumab(5mg/0.2mL)by retrobulbar Tenon capsule perfusion. Bevacizumab concentrations in serum and vitreous were determined by double antibody sandwich Elisa at 1 and 3d after administration. The changes of bevacizumab concentrations in serum and vitreous of two groups were compared, and the fluorescence of retinal was observed by laser confocal microscope.

RESULTS: One day after administration, intravitreal concentrations of bevacizumab in vitreous of group A and B were 254.40±13.65 and 1.60±0.32μg/mL respectively. Concentrations of bevacizumab in serum of group A and B were 0.55±0.15 and 0.63±0.05μg/mL respectively. The changes of bevacizumab concentrations in serum between two groups did not vary significantly(t=1.168, P=0.277). At 3d after administration, concentrations of bevacizumab in vitre-ous of group A and B were 236.80±8.70 and 1.40±0.23μg/mL respectively. Concentrations of bevacizumab in serum of group A and B were 0.66±0.17μg/mL and 0.64±0.14μg/mL respectively. The changes of bevacizumab concentrations in serum between two groups did not vary significantly(t=0.207, P=0.841). For two administration routes, the fluorescence distribution of retina layers could be clearly detected.

CONCLUSION: At 1 and 3d after intravitreal injection, intravitreal concentrations of bevacizumab of group A is much higher than that of group B. Intravitreal injection of bevacizumab is the more effective route of administration for intraocular tissue. But retrobulbar Tenon capsule perfusion can also achieve the minimum concentration which can completely blocks VEGF activity(>500ng/mL), and can remain for at least three days. Both intravitreal injection and retrobulbar Tenon capsule perfusion of bevacizumab results in high serum concentration, and the change of bevacizumab concentration in serum between two groups does not vary significantly. In both administration routes, the fluorescence distribution of retina layers can be clearly detected, and both two dosing ways can work on each layer of retina.

Abstract:AIM: To explore the clinical effect of phacoemulsification combined with Ex-PRESS implantation in the treatment of primary open angle glaucoma with cataract.

METHODS: The 51 patients(63 eyes)with primary open angle glaucoma with cataract were divided into 2 groups according to a prospective research programme. Twenty-five cases(32 eyes)were treated by phacoemulsification combined with trabeculectomy in the contol group, and 26 cases(31 eyes)were treated by phacoemulsification combined with Ex-PRESS implantation in the observation group. The clinical effect, level of vision improvement, and result of controlling intraocular pressure were compared, at the same time, the follow-up of 3～6mo was completed to observe the occurrence of complications.

RESULTS: The treatment method and detecting time were both showed the influence on the intraocular pressure of patients(P<0.01), and there was no interactional effect between two factors(P>0.05). At 3mo after treatment, there was no significant difference for best corrected visual acuity(BCVA)between groups(P>0.05), but the clinical efficacy of the observation group was better than that of the control group. The complication rate of the observation group was lower than that of the control group, and there was significant difference between two groups(P<0.05).

CONCLUSION: Phacoemulsification combined with Ex-PRESS implantation has high curative effect and security in the treatment of primary open angle glaucoma with cataract.

Abstract:AIM: To observe the therapeutic effects of phacoemulsification combined with intravitreal injection of triamcinolone(IVTA)in treating cataract with diabetic macular edema.

METHODS: Forty-four patients(52 eyes)with cataract and diabetic macular edema were randomly divided into two groups: the control group and the IVTA group. Twenty-six eyes in the control group underwent phacoemulsification and intraocular lens implantation. Additionally, 26 eyes in the IVTA group were treated with IVTA at completion of the surgery. Results of best corrected visual acuity(BCVA), optical coherence tomography(OCT)and ophthalmological examination were analyzed. Before and after the treatment, differences of Logarithm of the minimum angle of resolution(LogMAR BCVA)in groups were compared, as well as the central macular thickness(CMT). Correlations between LogMAR BCVA and other factors were analyzed by Pearson correlation analysis. Six months after the operation, multivariate liner regression analysis was taken to evaluate the correlations between LogMAR BCVA and affecting factors.

RESULTS:LogMAR BCVA in both groups were improved significantly at 3 time points(1, 3 and 6mo respectively)after the surgery(F=3.351,4.588, P=0.022,0.005). No significant difference in LogMAR BCVA between groups were found(P>0.05). One month or 3mo after the surgery(but not 6mo), the IVTA group showed thinner CMT than the control group(t=3.402,2.083, P=0.001, 0.042). Six months after the operation, the mean LogMAR BCVA negatively correlated with the ELM state of the patients(r=-0.611, P=0.006). Results of multivariate liner regression analysis showed that the visual recovery in 6mo after the surgery was affected by the external limiting membrane status(B=0.333,P=0.030)and the duration of diabetes(B=-0.307, P=0.005).

CONCLUSION: Phacoemulsification combined with IVTA is effective in treating patients with cataract and diabetic macular edema by reducing edema and improving their visual acuity. But IVTA is more effective in reducing edema than improving LogMAR BCVA.

Abstract:AIM: To analyze the differences of postoperative visual quality among LASIK guided by wavefront aberration, aspheric cutting and conventional cutting.

METHODS: From our hospital between January 2007 and December 2009, the independent line during LASIK surgery in 90 patients(180 eyes)with myopia as the research subjects. According to the different way of cutting and the voluntary principle of nonrandom selection, the patients were divided into three groups: aspheric cutting group, wavefront guided cutting group and conventional cutting group. Each group included low myopia(diopter: ≤-3.00D), moderate myopia(diopter: -3.25～-6.00D), high myopia(diopter: -6.25～-9.00D)and 10 cases(20 eyes). Postoperative uncorrected visual acuity, corneal Q value, higher-order aberrations(RMS value)and visual quality parameters, such as patients with visual satisfaction were compared and analyzed among three groups.

RESULTS: Postoperative uncorrected visual acuity was 1.0 or more after surgery with three different laser cutting modes, without significant difference between groups(P=0.26). Postoperative corneal Q value increased, it was smaller in aspheric cutting group than other two groups, with a statistically significant difference(P<0.05). The high-order aberration RMS values of three groups was increased compared with preoperative, it was significantly smaller in aspheric cutting group and wavefront guided cutting group than that in conventional cutting group(P<0.05). There was no significant difference between aspheric cutting group and wavefront guided cutting group(P>0.05). All patients were satisfied after surgery, it was was obviously higher in aspheric cutting group than other two groups, with no statistical significance(P=0.57)

CONCLUSION:Conventional, aspheric and wavefront guided cutting in LASIK for the treatment of myopia are able to obtain a better visual quality and clinical application, while the effect of aspheric cutting is better.

Abstract:AIM: To evaluate the long-term outcomes of free-flap laser subepithelial keratomileusis(LASEK)for treatment of high myopia.

METHODS: Two hundred and nine patients(277 eyes)with high myopia were treated with free-flap LASEK in our hospital, each patient was followed up for 5a. Patients were divided into two groups including groupⅠwith high myopia(<-9.00D, 145 eyes of 115 cases)and groupⅡ(≥-9.00D, 132 eyes of 94 cases). All patients were evaluated at 1, 5d, 1wk, 1, 3, 6mo, 1, 2 and 5a after surgery. The postoperative irritation, uncorrected and corrected visual acuity, refractive status, corneal complications, intraocular pressure were observed and analyzed.

RESULTS: On the fifth day after surgery, all epithelial flaps were nearly transparent and 96.3% patients had postoperative irritation symptom such as wear eye pain, photophobia, tearing, foreign body sensation but all could tolerate. Five years after operation, 131 eyes(90.3%)had uncorrected visual acuity(UCVA)of ≥1.0, 145 eyes(100%)≥0. 8 in group Ⅰ; 104 eyes(78. 8%)had UCVA of ≥1.0, 119 eyes(90.2%)≥0. 8, 129 eyes(97.7%)≥0. 6 and 3 eyes(2. 3%)<0.6 in group Ⅱ. The diopter tended to be stable in both groups after 6mo and there was no statistically significant difference after 6mo and 5a(P>0. 05), but there was statistical significance difference between each time point of postoperative and preoperative(P<0.01). The two groups had refraction regression, but had no serious intraoperative and postoperative complications, the main complications included haze, refractive regression and high intraocular pressure.

CONCLUSION: Free-flap LASEK is one of methods to treat eyes with high myopia safely and effectively, but should be cautious for super-high myopia.

Abstract:Fungal keratitis(FK)is an infectious corneal disease caused by pathogenic fungi and has an extremely high rate of blindness. With the development of modern medicine, drugs or surgery treament rate had more obvious enhancement than before for fungal infection in patients at early stage or with drug sensitivity. However, difficulty of being controlled through drugs, resulting the delayed healing of ulcer, deterioration of disease progression are still one of the main clinical causes of corneal blindness at present for fungal infection in patients at advanced stage and without drug sensitivity. In this paper, we reviewed about the drugs and surgical treatment progress of FK according to the studies in the past 5a at home and abroad.

Abstract:In recent years, with the rapid development of stem cells science, mesenchymal stem cells(MSCs)have become a research hotspot. Bone marrow mesenchymal stem cells(BMSCs)are MSCs that derived from bone marrow with some advantages, such as the potential of multi-directional differentiation, low immunogenicity, promoting damage repair and stable performance. The study by many scholars found that BMSCs are promising special cells in the field of medicine, and BMSCs have been widely used in almost every system in treatment of disease. For treatment of corneal disease, ophthalmology scholars found that BMSCs have already become a kind of seed cells with clinical and science value. BMSCs brought promising to the patients who have complex corneal disease. In this paper, we introduce the function of BMSCs on the treatment of corneal injury and corneal allograft rejection.

Abstract:Human autoimmune uveitis is a group of common ocular inflammatory diseases caused by autoimmune disorder. It is considered an inflammatory response dominated by CD4⁺ T cells at present. It is well known that CD4⁺ T cells are divided into four subsets including Th1, Th2, Th17 and Treg cells(CD4⁺CD25⁺Foxp3⁺ regulatory T cells). Previous studys have focused on Th1 and Th2 cells. Recent studys indicate that Th17 cells are the main factor of induction of uveitis while Treg cells are the main factor of negative regulation of uveitis. And they both play important roles in the onset and progression of uveitis. We give a review of current research in the relationship between Th17/Treg cells with autoimmune uveitis.

Abstract:In recent years, with the phacoemulsification equipment constantly updating and improving of surgical techniques, micro-incision cataract surgery with its small surgical trauma, small surgically induced astigmatism after surgery, and fast early postoperative recovery of visual function and other advantages, it has gradually and widely used in clinical practice. While ultrathin intraocular lens that fits micro-incision implantation is constantly developing and improving, the quality of cataract surgery has been greatly improved. This review focuses on the advancement of ultrathin intraocular lens researches in recent years.

Abstract:AIM:To evaluate the comparative effectiveness between phacoemulsification cataract extraction combined with either goniosynechialysis or trabeculectomy for the treatment of primary angle-closure glaucoma with cataract.

METHODS: We searched literatures about randomized controlled trial(RCT)in phacoemulsification cataract extraction combined with goniosynechialysis compare with phacoemulsification cataract extraction combined with trabeculectomy for treatment of primary angle-closure glaucoma, in database of PubMed, Science Direct, CNKI, CqVip and Wanf, collected from January 2000 to February 2015, published or embodied. Clinical evaluation included amplitude of intraocular pressure(IOP)variation, vision improvement, anterior chamber depth change, angle open degree, success rate and postoperative complications. Revman5.0 Meta analysis software was used.

RESULTS: According to the literature and exclusion criteria, finally 5 references were included in the Meta analysis, with a total of 492 patients. Meta analysis results showed that reduction of IOP in phacoemulsification cataract extraction combined with trabeculectomy was larger \; with goniosynechialysis, angle open degree was better, as well as the anterior chamber depth \; in vision improvement and success rate, there was no significant difference \〖OR 0.39, 95% CI(0.12～1.30)\〗; with trabeculectomy, there existed more complications.

CONCLUSION: Phacoemulsification cataract extraction combined with either goniosynechialysis or trabeculectomy can effectively control intraocular pressure and improve visual acuity. With goniosynechialysis, because of its fewer complications, it has the potential to be one of the main treatments in treating primary angle-closure glaucoma with cataract.

Abstract:Retinal angiomatous proliferation(RAP)is a special type of wet age-related macular degeneration(AMD)and is classified into stages Ⅰ～Ⅲ by clinical manifestations, the form of neovascularization at the end stage. Differed with several types of neovascular AMD, the neovascularizations in RAP are believed to originate from the inner retinal capillary network. At present, it is controversial that RAP and wet AMD are different subtypes of the same disease or two independent diseases. Clinical differential diagnosis of the two diseases are important because of their different nature history, prognosis and treatments. In recent years, the identification of RAP and wet AMD has made significant progress with new technology application, such as the indocyanine green angiography(ICGA)and optical coherence tomography(OCT). In this paper, the clinical manifestations, natural history, treatments and prognosis of the two diseases were reviewed.

Abstract:Central serous chorioretinopathy(CSCR)has become a common retinal disease in our country. In recent years, the utilisation of optical coherence tomography(OCT)has played a significant role in the study of subretinal fluid(SRF)and analyzing retinal structure changes. At the same time, the enhanced depth imaging optical coherence tomography(EDI-OCT)has vividly demonstrated the changes of choroidal morphologic of CSCR. In addition, multifocal electroretinography(mf-ERG)has revealed retinal dysfunction of CSCR. And the combination of OCT and mf-ERG has improved the understanding in the relationships between the functional and structural abnormalities in eyes with CSCR. The wide application of numerous new technologies has provided clues and basis for the diagnosis and treatment as well as prognosis assessment and following-up of CSCR.

Abstract:It is very important for ophthalmic clinical diagnosis and research to obtain anterior segment information by non-invasive means. With the progress of science and technology, the application of optical coherence tomography(OCT)on clinical practice and scientific research of ophthalmology has been widely accepted. It not only can achieve precise imaging of an organization structure, but also can do some quantitative analysis for the assessment of clinical treatment and follow-up as an irreplaceable information.

Abstract:AIM: To explore the difference in corneal diameter between genders, right and left eyes, and the correlation between spherical equivalent(SE)by measuring the corneal diameter of myopia operation patients,.

METHODS: Corneal horizontal diameters \〖white-to-white(WTW)distance\〗 were measured with IOL Master of German Zeiss company in 126 myopia cases(252 eyes)undergone excimer laser operation, male 48 cases(96 eyes)and female 78 cases(156 eyes), aged between 18～45 years(average age 24.23±5.35 years), from March 2013 to August 2013 in our myopia outpatient. Subjective refraction was adopted by NIDEK RT-2100 comprehensive refractometer for each eye, and converted into the SE. Eyes were divided into three groups according to the SE as follows: group 1(low myopia group, -3.00DRESULTS: The average corneal diameter was 11.52±0.41mm. The average corneal diameter was 11.60±0.35mm in males compared with 11.43±0.36mm in females, the differences in gender were significant in the t-test for independent samples(t=0.021, P=0.009). The average corneal diameter was 11.53±0.40mm in right eyes and 11.51±0.42mm in left eyes, there were no significant differences between right and left eyes in the t-test for paired samples(t=-0.115, P=0.912). Corneal diameters classified with SE were 11.59±0.39mm, 11.48±0.40mm and 11.45±0.41mm respectively for low, moderate and high myopia. The corneal diameter was negatively correlated with the SE(R²=0.001, P=0.001). Differences among three groups proved to be significant in the ANOVA(F=4.487, P=0.004).

CONCLUSION: The corneal diameter in myopia operation patients is significantly greater in males than that in females, but no significant differences between the right and left eyes. The corneal diameter is negatively correlated with the SE. The higher the degree of myopia, the shorter the corneal diameter.

Abstract:AIM:To observe and compare the changes of corneal endothelial cells with after phacoemulsification and small incision non- phacoemulsification in elderly hard nuclear cataract.

METHODS:In this retrospective analysis, the patients received small incision non-phacoemulsification cataract extraction combined with intraocular lens implantation were as group A, 36 cases(40 eyes)and those underwent ultrasonic phacoemulsification combined with intraocular lens implantation were for group B, 38 cases(46 eyes). Operation time, preoperative, postoperative 1and 6mo, uncorrected visual acuity, corneal endothelial changes were compared.

RESULTS: The operation time of the two groups had no significant difference. UCVA of postoperative 1mo was ≥ 0.5 after surgery, the difference between the two groups had statistical significance(χ²=5.174, P=0.023). One month and 6mo after operation, the corneal endothelial cell counts of two groups were compared, with statistical significance(t=2.565, P=0.038; t=2.774, P=0.041)and the difference of corneal endothelial cell loss rate between two groups had statistical significance(P<0.05). The difference of AVC between two groups at postoperative 1 and 3mo had statistical significance(t=2.225, P=0.045; t=2.153, P=0.039). The coefficient variation of two groups had statistically significant difference(P<0.05).

CONCLUSION: Small incision non-phacoemulsification operation is a more safe and effective surgery method for treating elderly hardcore cataract patients.

Abstract:AIM: To evaluate the effect of cataract surgery on quality of life(QOL)for the patients with high myopia complicated with cataract.

METHODS: Forty-six patients with high myopia complicated with cataract undergone cataract surgery were selected among the patients following Vision Recovery Project in Zizhou County, Shaanxi Province. Visual acuity of the patients was inspected. At the same time, the functional indexes changes of all abilities, visual function and QOL questionaire were analyzed.

RESULTS: Fourty-four patients(96%)were undergone the cataract surgery on their first eye, 2 patients(4%)on their second eye among the all 46 participants. Visual acuity after surgery was higher than before in all patients. The measurement of postoperative visual function and QOL including that of patients with visual function deterioration was higher than that of preoperative records. Functional indexes before and after operation had significant changes.

CONCLUSION: Cataract surgery with safe and excellent effects can improve QOL of the patients with high myopia complicated with cataract. It is an important method of rehabilitation in addition to basic rehabilitation and visual rehabilitation in this kind of patients.

Abstract:AIM:To compare the levels of IL-2 and IL-6 between primary acute angle-closure glaucoma and normal controls at perioperative. To discuss the correlations between cytokine levels and optic nerve damage of primary acute angle-closure glaucoma.

METHODS: Hospitalized patients with primary acute angle-closure glaucoma in the Department of Ophthalmology of Yongchuan Hospital of Chongqing Medical University from May, 2013 to October, 2014 were collected as the case group(Group A), Group A was divided into three subgroups of minor, medium and severe(a, b and c)according to the degree of optic nerve injury. The patients with cataract hospitalized within the same period were selected as the control group(Group B). The concentrations of IL-2 and IL-6 in the peripheral blood of research objects were determined with the double-antibody sandwich enzyme-linked immunosorbent assay(ELISA). The differences in the mass concentration of cytokines between the two groups of A and B and the three subgroups of a, b and c were compared, and the correlation between the level of cytokines in the bodies of patients with primary acute angle-closure glaucoma and the degree of optic nerve injury was analyzed.

RESULTS: Concentrations of IL-2 and IL-6 in experimental group were significantly lower than those in the control group(P<0.05). Concentrations of IL-2 and IL-6 in glaucoma patients severe injury of optic nerve were significantly lower than those in mild injury of optic nerve( P<0.05). To discuss the correlations between cytokine levels and optic nerve damage in subgroups a, b, and c, mult-variable linear return analysis was used, the difference on IL-2 level had statistical significance(P<0.05).

CONCLUSION: In primary acute angle-closure glaucoma patient, levels of IL-2 and IL- 6 are lower than the normal. IL-2 may be associated with glaucomatous optic neuropathy.

Abstract:AIM: To discuss the operation manner and efficacy of traumatic angle recession glaucoma.

METHODS:The clinical data of 80 patients(80 eyes)who was treated traumatic angle recession glaucoma by three different operation manners between January 2008 and December 2013 retrospectively. Of them, 66 eyes of 66 patients whose onset time after injury was 1mo～2a, preoperative IOP was 25～<30mmHg, angle recession range ≤180°, optic C/D≥0.6 received trabeculectomy; 11 eyes of 11 patients whose onset time after injury was >2～10a, preoperative IOP was 30～39mmHg, angle recession range >180°, the disc C/D =0.6～<0.8 underwent compound trabeculectomy; 3 eyes of 3 patients whose onset time after injury was >10a, preoperative IOP 39～50mmHg, angle recession range >180°, the disc C/D =0.8～1.0 selected Ahmed glaucoma valve implantation.

RESULTS: IOP of all patients in three groups decreased to the normal range after operation(t=62.16, P<0.01; t=20.39, P<0.01; t=6.78, P<0.01), without glaucoma symptoms and progressive visual field narrowing. Visual acuity in trabeculectomy and compound trabeculectomy groups increased slightly than that of preoperative, but it did no change significantly in Ahmed glaucoma valve implantation group. Sixty-five cases(98%)had effective filtering bleb in trabeculectomy group, 9 cases(82%)in compound trabeculectomy group and 3 cases in Ahmed glaucoma valve implantation group formed effectively bleb.

CONCLUSION: For those patients with ineffective drug treatment, we can choose a different surgical approach, according to onset time, angle recession range and IOP, to effectively reduce IOP, improve visual acuity, and avoid further damage to visual function.

Abstract:AIM: To observe the efficacy of phacoemulsification with intraocular lens(IOL)implantation combined with goniosynechialysis in treating acute primary angle-closure glaucoma with cataract.

METHODS: Fifty-two eyes of 40 patients(52 eyes)from October 2009 to June 2014 in our department with acute primary angle-closure glaucoma combined with cataract were included in this study. All patients were undergone phacoemulsification with IOL implantation combined with goniosynechialysis through clear corneal incision at the temporal side and were followed up for 6mo.

RESULTS: Best corrected visual acuity was improved after surgery(P<0.01). The mean intraocular pressure(IOP)at 6mo after surgery was 15.76±2.09mmHg, significantly lower than preoperative IOP(P<0.01). Postoperative chamber angles were all wider than those after the surgery, and the closed quadrant of chamber angle adhesion opened in different degree. Preoperative anterior chamber depth was 1.97±0.29mm, postoperative anterior chamber depth increased to 2.83±0.35mm, and there was significant difference for the change(P<0.05). Malignant glaucoma and posterior capsule rupture was not observed during the follow-up. All IOL of operation eyes were in lens capsular bag, and the situation of deviation and clamping did not appear.

CONCLUSION: Phacoemulsification with IOL implantation combined with goniosynechialysis is a safe and effective treatment for acute primary angle-closure glaucoma combined with cataract in decreasing IOP and improving visual acuity.

Abstract:AIM: To investigate the relationship of the change of peripapillary atrophy β zone and progress of optic disc damage in primary open angle glaucoma(POAG).

METHODS: In this retrospective study, 66 eyes of 44 POAG subjects were selceted and made the morphology evaluation of the color fundus photographs(30°)which were taken in baseline and five-year visit. The change of peripapillary atrophy β zone(β zone)and the progress of optic disc damage was detected. The disc rim/disc area ratio, β zone/disc area ratio and vertical cup/disc ratio both baseline was calculated by computer software.

RESULTS:Forty-eighty eyes had β zone in 66 POAG subjects in baseline, β zone of 20 eyes(42%)was expanded, there was no significant difference on age, refractive error, gender, vertical cup/disc ratio, rim/disc area ratio, β zone/disc area ratio of baseline between β zone-developed group and β zone-undeveloped group. After excluded the eyes' refractive error >-3.00D, β zone of 15 eyes(60%)had developed in 25 progressed glaucoma eyes and 4 eyes(21%)had undeveloped in 19 unprogressed glaucoma eyes. There was significantly different(χ²=6.67, P=0.011).

CONCLUSION: The prevalence of β zone development in progressed group is larger than unprogressed group in POAG. To monitor the change of β zone may have some effects in predicting the progress of POAG.

Abstract:AIM: To identify relationship between the expression of vascular endothelial growth factor(VEGF)of uveal melanoma patients whether with uveal melanoma metastasis and prognosis.

METHODS: The peripheral blood VEGF of uveal melanoma patients and patients in normal control group were detected by enzyme-linked immunosorbent assay(ELISA). The mRNA and protein expression level of VEGF in uveal melanoma tissues were analyzed through reverse transcription-polymerase chain reaction(RT-PCR)and Western-blot. Uveal melanoma patients were followed up, and the relationship of baseline serum VEGF and postoperative metastasis was analyzed by Kaplan-Meier method.

RESULTS: The expression level of peripheral blood VEGF was significantly increased in uveal melanoma patients than that in healthy people. The mRNA and protein expression level of VEGF in the uveal melanoma patients with metastasis when seeing a doctor were higher than patients without metastasis. In the process of follow-up, the uveal melanoma patients(serum VEGF ≥700pg/mL)had higher risk for tumor metastasis.

CONCLUSION: The expression level of VEGF of uveal melanoma patients is closely related to uveal melanoma metastasis.

Abstract:AIM:To observe the clinical efficacy after Ranibizumab intravitreal injection in the treatment of recurrent diabetic macular edema.

METHODS: The study was a retrospective analysis of 30 cases of recurrent diabetic macular edema(39 eyes), including 18 males(23 eyes)and 12 females(16 eyes), aged 54.20±11.50 years. The patients, who were diagnosed to be with recurrent diabetic macular edema, were further treated with intravitreal injection of 0.05mL(0.5mg)ranibizumab. All the treated patients performed best corrected visual acuity, intraocular pressure, slit lamp microscope examination, fundus pre-set lens, fundus fluorescein angiography, and optical coherence tomography(OCT)examinations. The best corrected visual acuity, intraocular pressure and macular central retinal thickness(CRT)were recorded before and after the surgery. The results obtained from the last follow-up visit were used as the index for the evaluation of curative effects.

RESULTS: The follow-up periods ranged 6～12mo with the mean±standard deviation of 8.69±2.26mo. The injection numbers for each eye ranged 1～4 times with the mean±standard deviation of 1.82 ±0.82 times. The visual acuity before the treatment was 0.14±0.09, while significantly increased to 0.33±0.21 after the treatment(t=8.11, P<0.01). The macular OCT examination showed that macular edema was significantly alleviated after the treatment. The CRT was 495.74±147.84μm before the treatment, while significantly decreased to 219.33 ± 62.17μm after the treatment(t=10.68, P<0.01). Further specifically, CRT in 2 patients decreased without improvement of vision after the treatment, and no case of vision decrease after the treatment was observed.

CONCLUSION: Ranibizumab intravitreal injection is effective and safe in the treatment of recurrent diabetic macular edema.

Abstract:AIM: To observe the clinical curative effect of conbercept intravitreal injection for the treatment of wet age-related macular degeneration.

METHODS: Sixty patients with wet age related macular degeneration were randomly divided into treatment group 30 cases and control group 30 cases according to the random number table. The treatment group was injected with Conbercept 0.05mL, the control group was injected with triamcinolone acetonide 0.1mL. The best corrected visual acuity(BCVA)was performed before and after 1d, 1 and 3mo after treatment, and the thickness of macular was detected by optical coherence tomography(OCT). The complications of patients were observed after 1d, 1 and 3mo,including inflammatory reaction, corneal edema, anterior chamber, high intraocular pressure, etc.

RESULTS:In treatment group 1d, 1 and 3mo after treatment, eyesight was improved significantly better than the control group(P<0.05), macular center concave retinal thickness was significantly lower than the control group(P<0.05). Treatment group and control group 1d, 1 and 3mo after treatment did not appear serious eye complications.

CONCLUSION: Intravitreal injection of Conbercept in the treatment of wet age-related macular degeneration can improve the curative effect.

Abstract:AIM: To observe the efficacy of first Ranibizumab intravitreal injection on macular edema caused by retinal vein occlusion(RVO).

METHODS: Thirty-nine eyes of 39 patients with macular edema due to RVO were treated in our hospital during June 2014 to December 2014. Patients received intravitreal injection of 0.05mL ranibizumab. Best corrected visual acuity(BCVA), central macular thickness(CMT)and cube average thickness(CAT)were analyzed at 2d, 2, and 4wk after injection, respectively.

RESULTS: The baseline BCVA(LogMAR), CMT and CAT were 0.82±0. 45, 541±136μm and 382±107μm before treatment. After first ranibizumab intravitreal injection, mean BVCA significantly improved at 2d(0. 56±0.35,P<0.01), 2wk(0.48±0.39,P<0.01), 4wk(0.51±0.44, P<0.01), compared to baseline BCVA. Mean CMT also decreased at 2d(372±86μm, P<0.01), 2wk(281±74μm, P<0.01), 4wk(286±97μm, P<0.01), mean CAT also decreased at 2d(331±46μm, P<0.01), 2wk(312±54μm, P<0.01), 4wk(319±68μm, P<0.01), compared to baseline BCVA.

CONCLUSION: First intravitreal injection of ranibizumab can improve macular edema caused by RVO in short-term, but long-term effects is needed further observed.

Abstract:AIM: To evaluate the preservation of anterior capsule used in vitrectomy combined with extra retinal photocoagulation for proliferative diabetic retinopathy(PDR)stage Ⅵ with cataract.

METHODS: Retrospective analysis of 38 patients(45 eyes)with PDR stage Ⅵ with cataract in our hospital from January 2010 to June 2013, preoperative visual acuity were LP to 0.1, underwent vitrectomy reserved anterior capsule and intraoperative extra retinal photocoagulation(E-PRP)with silicone oil tamponade in all eyes. Patients were followed up for 12～26mo to observe the intraocular pressure, visual acuity, anterior and posterior segment conditions.

RESULTS: Postoperatively 32 eyes(71%)improved in visual acuity and 13 eyes(29%)didn't improve, 23 eyes with BCVA ≥0.05 there was a significant difference(χ²=16.80, P<0.01)compared with preoperative. Anatomic retinal attachment was achieved in 39 eyes(87%). There were 2 eyes(4%)of silicone oil dependence and 7 eyes(16%)with epiretinal proliferative membrane. One eye(2%)was found iris neovascularization(INV)and progressed to neovascular glaucoma, 4 INV eyes gradually subsided, but there was no significant difference compared with the preoperative(χ²=1.61, P=0.21). The postoperative complication incidence of transient intraocular pressure rise, corneal edema, anterior chamber fibrin exudation, posterior synechia and anterior capsule opacification was 24%(11 eyes), 18%(8 eyes), 13%(6 eyes), 4%(2 eyes)and 29%(13 eyes).

CONCLUSION: The preservation of anterior capsule invitrectomy combined with E-PRP is safe and effective for patients with PDR stage VI with cataract. It can improve postoperative visual acuity and reattach retina effectively, and may also reduce the incidence of iris neovascularization.

Abstract:AIM: To observethe changes of visual evoked potential(VEP)of optic nerve contusion treated with mouse nerve growth factor and estimate the efficacy of mouse nerve growth factor.

METHODS: Thirty-four cases(34 eyes)of optic nerve contusion enrolled from October 2013 to February 2015 were selected and randomly divided into two groups. The treatment group 22 patients(22 eyes)was given the mouse nerve growth factor 30μg, with 2.0mL dissolved in water for injection, intramuscular injection once daily, with an average treatment of 42d, while for the hormones and vitamins medication treatment. For the control group 12 cases(12 eyes), mouse nerve growth factor was not used, other drugs were the same as the treatment group. All patients were accepted a review of vision and VEP at 21, 42d after the treatment.

RESULTS: After 42d treatment, the difference of best corrected visual acuity showed statistical significance(P<0.05)and VEP P100 latent period was 104.59±7.54ms, amplitude was 5.12±1.48μV in treatment group. While, latent period was 113.25±9.21ms, amplitude was 4.69±1.89μV in control group. Also, VEP P100 latency of the two groups showed statistical significance(t=-3.132, P<0.05)after 42d treatment, while VEP P100 amplitude had the same conclusion(t=2.541, P<0.05). The effective rate was 82% in treatment group, while 42% in control group with significant difference(P=0.026).

CONCLUSION: Mouse nerve growth factor has significant efficacy on traumatic optic nerve contusion, the changes of VEP can accurately reflect the conclusion, and VEP has proved to be an important basis on estimating the clinical efficacy.

Abstract:AIM:To observe the visual quality of super-high myopia after implantation of the visian implantable collamer lens with centra-flow(ICL V4c)in the short-term.

METHODS: The clinical date of 78 patients(100 eyes)were collected, the preoperative uncorrected visual acuity(UCVA)was below 0.10, spherical refraction was -13.25±2.05(-11.25～-20.00)D. The preoperative and postoperative refrative condition, wavefront aberration, visual acuity and contrast sensitivity were examined.

RESULTS: The postoperative UCVA in 97 eyes(97%)were equal to or more than 0.7. Thirty-seven eyes(37%)were equal to or more than 1.0. Both the contrast sensitivity and glare contrast sensitivity under high spatial frequency were increased at postoperative 1mo, there were statistical differences(all P<0.05). Both the higher-order aberrations, coma, spherical, second coma and second spherical were increased at postoperative 1mo, there were statistical differences(P<0.05). At postoperative 1mo, 2 eyes' original lens had cloudy, 2 eyes' intraocular pressure had increased, 3 eyes had corneal reaction, 1 eye had glare and halos. At postoperative 6mo, all visual symptoms almost disappeared.

CONCLUSION: The visual quality of super-high myopia after implantation of ICL V4c was improved obviously in short-term.

Abstract:AIM: To analyze the impact of age on children with amblyopia and the correlation between pattern visual evoked potential(PVEP)test results and age.

METHODS: A total of 136 cases(272 eyes)of children with ametropic amblyopia in our hospital from June 2012 to June 2014 were analyzed. Based on the best corrected visual acuity(BCVA): BCVA ≥0.5, 0.3≤BCVA<0.5, BCVA<0.3, subjects were categorized into three groups: mild group, moderate group and severe group, each group was further divided into two subgroups based on age: <6 years and ≥6 years. The latency(LP100)and amplitude(AP100)of each group were tested by PVEP, an independent samples t test was used to analyze the differences between each age subgroups. Then, age was subdivided into 4 sections(4～<6 years, 6～<8 years, 8～<10 years, ≥10 years), take BCVA as the dependent variable, a Logistic multivariate regression model whose parameters included age, spherical equivalent, gender, type of amblyopia was established to analyze the correlation between age and amblyopia diagnosis.

RESULTS: With an increase in the degree of amblyopia, the LP100 increased and the AP100 decreased. The differences between 3 groups in the LP100 and AP100 were statistically significant(F=135.22, 16.74; P=0.007<0.01); Within the mild, moderate and severe amblyopic groups, the LP100 of the ≥6 years group were longer than those of the <6 years group(t=8.36, 5.37, 2.48; P=0.00, 0.00, 0.02), and the AP100 of the former were less than those of the latter(t=6.76, 4.88, 2.85; P=0.00, 0.00, 0.01). Age was an independent risk factor for amblyopia diagnosis(P <0.01, 95% CI=0.714～0.785).

CONCLUSION: Age is independently associated with the diagnosis of ametropic amblyopia, to different ages of children, the same vision represent different functional significance. In measuring the severity of amblyopia in children, different ages respond to adopt different standards.

Abstract:AIM:To analyze the differences and correlations between ganglion cell complex(GCC), peripapillary retinal nerve fiber layer(pRNFL)and mean defect(MD), mean sensitivity(MS)of visual field(VF)in craniopharyngioma patients, to evaluate the feasibility of optical coherence tomography(OCT)in diagnosis of the visual pathway damage of craniopharyngioma patients.

METHODS:Ninety-five craniopharyngioma patients treated in Beijing Tiantan Hospital, from September 2014 to April 2015 received the VF test by Octopus 900 automated perimeter with the central 30 degree program and the mean thickness measurements of GCC and pRNFL by RTVue OCT. Spearman rank correlation coefficient(r_s)was used to assess the correlation between GCC, pRNFL and MD, MS. The changes of VF and optic disc were analyzed.

RESULTS: Abnormal pRNFL findings occurred in 53.1%(93/175), which included optic disk edema 3.4%(6/175), atrophic changes of optic nerve 47.4%(83/175)and glaucoma-like optic neuropathy 7.4%(13/175). Various visual field defect was 71.4%(125/175). The average thickness of binocular pRNFL(r_sOD=-0.411, r_sOS=-0.354)and GCC(r_sOD=-0.400, r_sOS=-0.314)had correlation with MD(P<0.01). The average thickness of pRNFL(r_sOD=0.412, r_sOS=0.342)and GCC(r_sOD=0.414, r_sOS=0.299)had correlation with MS(P<0.01).

CONCLUSION: The average thickness of pRNFL and GCC has correlation with VF damage, can evaluate the optic nerve damage of craniopharyngioma patients quantitatively. The thinner the thickness of pRNFL and GCC is, the serious damage of visual function is. During the clinical work, visual field test combined with OCT are helpful to find and assess the damage of visual pathway and prognosis.

Abstract:AIM: To investigate the efficacy of applying problem-based learning(PBL)method in clinical internship of eight-year program medical students in Department of ophthalmology.

METHODS: Totally 40 medical students of eight-year program, who were clinical interns from January 2013 to March 2014 in Department of Ophthalmology, Xijing Hospital, the Fourth Military Medical University, were randomly divided into PBL teaching group(PBL group)and traditional teaching group(control group), 20 students in each group. In PBL group, students positively participated in clinical internship leading by PBL teaching, whereas in control group, students were guided by teachers in pattern of traditional teaching. Practical effects of different teaching methods were comprehensively evaluated by questionnaire and examination results.

RESULTS: In analysis of final examination, PBL group had higher scores than control groups in the quiz, case analysis and overall performance with statistical significance between the two groups(P<0.05), as for score of multiple-choice and glossary questions, differences between the two groups were not statistically significant(P>0.05). From the data of intern self-assessment questionnaire, PBL group was superior to control group in comprehensive analysis capabilities, motivation to learn, and learning outcomes with statistically significant differences(P<0.05). Whereas concerning stimulating interest of students and satisfaction of teaching mode, the difference between the two groups was not statistically significant(P>0.05). From the intern evaluation by teachers, PBL group was superior to control group in pre-intern preparation, full and accurate expression of views in class and clinical logic(P<0.05), however, there was no difference in communicative abilities with patients between the two groups(P>0.05).

CONCLUSION: PBL teaching is suitable for internship learning in Department of Ophthalmology for eight-year program medical students. PBL method can improve student's capabilities of clinical comprehensive analysis and contribute to develop the ability to solve clinical problems positively.

Abstract:AIM: To observe the value of confocal corneal microscopy in guiding the use of bandage contact lens(BCL)in long-term for recurrent corneal erosions(RCE)syndrom.

METHODS: Thirty-six patients(36 eyes)with RCE wearing BCL in our hospital from March, 2014 to September, 2014 were randomly selected. Eye pain and irritation symptoms, corneal epithelial healing, confocal microscopy images and complications were observed before and after the patients wearing BCL at 2, 4, 8 and 12wk.

RESULTS: After 30min wearing BCL, eye pain and irritation symptoms got a different degree of relief, completely disappearing in 26 eyes(72%)and obviously relief in 10 eyes(28%). The mean corneal epithelial healing time was 5.68±0.73d. Confocal corneal microscopy showed that the morphology and arrangement of basal epithelial cells and the shape and density of subbasal nerve plexus returned to normal at 2, 4, 8 and 12wk. The inflammatory cells in the anterior stroma near corneal epithelial basal cells disappeared gradually. There was no serious complication during the period wearing bandage lens.

CONCLUSION: BCL guided by confocal corneal microscopy for REC can avoid removing lens prematurely, and it is a simple, safe and effective method for making basilar membrane and bowman layer closely adhered to reduce recurrence.

Abstract:AIM: To study the clinical effect of 1g/L fluorometholone drops combined with soft corneal contact lens in the treatment of patients with filamentary keratitis.

METHODS: A total of 30 patients(45 eyes)were included in this study and were randomly divided into two groups: 16 patients(23 eyes)were in treatment group and 14 patients(22 eyes)in control group. In the treatment group, after removed filaments, the patients wore soft corneal contact lens and received corticosteroid eye drops(1g/L fluorometholone drops)and artificial tears(sodium hyaluronate). In the control group, patients received only artificial tears(sodium hyaluronate)after removed filaments. Clinical effects of the two groups were record. The patients were followed up for 3mo.

RESULTS: The total clinical effective rate of the patients in the treatment group was significantly higher than that in the control group(22 eyes vs 17 eyes, 96% vs 77%). The difference between two groups had statistical significance(U=1.992, P=0.046).

CONCLUSION: The results suggest that 1g/L fluorometholone drops combined with soft corneal contact lens is effective to patients with filamentary keratitis.

Abstract:AIM: To observe the effects of phacoemulsification and extracapsular cataract extraction with small incision on corneal endothelial cells in patients with high mypia combined with cataract.

METHODS: In the study, 86 patients(86 eyes)with high mypia combined with cataract from September 15^th, 2014 to December 31^th, 2014 were selected and randomly divided into two groups, group A(46 cases, 46 eyes)with phacoemulsification and group B(40 cases, 40 eyes)with extracapsular cataract extraction with small incision. Visual acuity, the density of corneal endothelial cells and the proportion of hexagonal cells were observed at preoperative 1d and postoperative 7d, 1 and 3mo.

RESULTS: After treatment, visual acuity was improved significantly in both groups(P<0.05), with no statistical difference between two groups(P>0.05). Compared with preoperative 1d, there were significant differences for the density of corneal endothelial cells and the proportion of hexagonal cells at postoperative 7d, 1 and 3mo(P<0.05), but with no statistical difference between two groups(P>0.05).

CONCLUSION: Phacoemulsification and extracapsular extraction with small incision have a certain extent damage on corneal endothelial cells in patients with high mypia and cataract. However, both two surgical approaches show equivalent efficacy in improving visual acuity of patients with high mypia combined with cataract.

Abstract:AIM: To study the effect of diclofenac sodium hydrodissection combined with nuclear rotation on preventing posterior capsular opacification after cataract phacoemulsification.

METHODS: Eighty patients(86 eyes)received cataract phacoemulsification in our hospital from January, 2013 to December, 2014 were enrolled and randomly divided into observation group and control group. The patients in observation group were received diclofenac sodium hydrodissection with nuclear rotation, and the patients in control group were received equilibrium liquid hydrodissection. Then degree of posterior capsular opacification, visual acuity and corneal endothelial cells count in two groups were compared.

RESULTS:(1)Posterior capsular opacification degree: posterior capsular opacification degree of patients in observation group were better than that of control group(Z=6.982, P<0.05);(2)Visual acuity: at 1, 2, 3 and 4wk after operation, the visual acuity of patients in observation group was higher than that in control group(0.37±0.07 vs 0.23±0.04, 0.68±0.09 vs 0.35±0.05, 0.77±0.09 vs 0.48±0.06, 0.91±0.12 vs 0.68±0.08; F=6.583, 8.983, 7.182, 5.492, P<0.05).(3)Corneal endothelial cells: at 1, 2, 3 and 4wk after operation, there were no significant difference for corneal endothelial cells count between two groups(F=1.841, 1.003, 0.077, 0.390, P>0.05).

CONCLUSION: Diclofenac sodium hydrodissection combined with nuclear rotation can effectively reduce the incidence of posterior capsular opacification and can be safely used for intraocular treament.

Abstract:AIM: To research the protective effect of reverse phacoemulsification on corneal endothelium in cataract surgery.

METHODS: Sixty patients(60 eyes)with senile cataract were randomly divided into two groups, the conventional phacoemulsification group and the reverse phacoemulsification group. The preoperative general and special ophthalmic examinations were routinely conducted. The gender, age, grade of nuclear hardness, corneal endothelial counts, intraocular pressure, anterior chamber depth, and axis shaft of each patient were carefully recorded. The phacoemulsification and the foldable intraocular lens implantation of two groups were individually accomplished through conventional phacoemulsification and reverse phacoemulsification. The average ultrasonic energy and the valid ultrasound time of phacoemulsification during operation were recorded, the average compound ultrasonic energy(average ultrasonic energy × valid ultrasound time)was finally calculated, and surgical complications during operation were recorded at the same time. The corneal endothelial counts and intraocular pressure of two groups were inspected at postoperative 3d.

RESULTS: According to statistics, there was no significant difference for patients with basic situation between two groups(P>0.05). After treatment with different phacoemulsification methods, the intraocular pressure at postoperative 3d and the accepted average compound ultrasonic energy of patients were showed no significant differences(t=-0.95, P=0.924>0.05; t=0.34, P=0.735>0.05). However, there was significant difference for loss number of corneal endothelial at postoperative 3d(t=-9.89, P<0.01).

CONCLUSION: The protective effect of reverse phacoemulsification on corneal endothelial and decreasing damages is better than that of the conventional phacoemulsification, and it is worth of popularization in clinical practice.

Abstract:AIM:To evaluate the efficacy of 25G vitrectomy surgery for malignant glaucoma.

METHODS: Thirteen eyes of 11 patients with malignant glaucoma who had a history of primary angle-closure glaucoma were analyzed retrospectively from September 2012 to October 2013 in our hospital. All patients had undergone a prior surgery of trebeculectomy combined with iridectomy. The pre-operative mean best corrected visual acuity(BCVA)in LogMAR was 0.70±0.13 and the mean intraocular pressure(IOP)was 41.3±12.7mmHg. Corneal edema, ciliary body edema and very shallow anterior chamber with a mean value of 0.69±0.17mm were showed by ultrasound biomicroscopy(UBM). Anterior vitrectomy and posterior capsulotomy were performed with 25G vitrectomy system in all eyes. Seven phakic eyes underwent phacoimulsification combined IOL implantation surgery during vitrectomy.

RESULTS: The patients were followed up for 6～18mo with an average of 11.7±5.4mo. BCVA at the last follow-up improved to 0.29±0.08 and the mean IOP was 18.6±3.9mmHg. UBM results showed that ciliary body edema was eliminated, the iris was flattened and the anterior chamber was deepened with a mean depth of 2.48±0.31mm at 1mo after surgery. Postoperative complications included corneal edma, Descemet membrane folds, anterior chamber inflammation, fibrotic exudation, local iris posterior synechia and hypotony(IOP≤5mmHg). One eye had high IOP of 26.4mmHg and required long-term topical antiglaucoma medication to control the IOP≤21mmHg. No complications such as corneal endothelium decompensation, IOL capture, intraocular hemorrhage, infection and uncontrolled IOP were observed.

CONCLUSION: 25G vitrectomy is safe and effective for treating malignant glaucoma, controls IOP and reduces complications associated with traditional vitrectomy. Combined vitrectomy with phacoemulsification may improve the success rate and visual function.

Abstract:AIM: To investigate surgical options and clinical outcomes of treating retinal redetachment after the initial silicone oil tamponade.

METHODS: Nineteen eyes of 19 patients who had been performed silicone oil tamponade underwent 23G scleral double-channel retinal reattachment surgery in silicone oil. Visual acuity, intraocular pressure(IOP)and retinal reattachment with its complications were evaluated postoperatively.

RESULTS: Retinal reattachment was achieved in 17 patients(17 eyes)after surgery, with the success rate of 89%. Best corrected visual acuity(BCVA)at 1wk after surgery ranged from 0.4 to HM/BE. Three days after surgery, IOP >21mmHg was observed in 6 eyes and then decreased after the therapy of lowering IOP. The IOP ranged from 16.3～24.6mmHg at 3mo postoperatively.

CONCLUSION: 23G scleral double-channel retinal reattachment surgery in silicone oil is an effective, convenient and safe method to treat retinal redetachment after initial simply silicone oil tamponade at the early stage.

Abstract:AIM: To study the characteristics and variability of flash electroretinogram(F-ERG)in normal adults of different age stages.

METHODS: Thirty cases(60 eyes)of healthy physical examinaees were divided into two groups according to age: 20～30 years old group(15 cases, 30 eyes )and 40～50 years old group(15 cases, 30 eyes), F-ERG was recorded according to standard of International Society for Clinical Electrophysiology of Vision(ISCEV), and the parameters and coefficient of variation in the two groups were compared.

RESULTS: Compared with 20～30 years old age group, the implicit time was extended and the amplitude decreased in the 40～50 years old age group, especially amplitude of the dark adaptation of 3.0, light adaptation of 3.0 and oscillatory potentials showed statistical significance(P<0.05); In all the observation indexes, the coefficient of vartation of implicit time was the minimum, the secondary was the amplitude, and the biggest was amplitude of oscillatory potentials.

CONCLUSION: Compared with 20～30 years old age group, the implicit time of ERG is extended and the amplitude is decreased in the 40～50 years old age group. The coefficient of variation of implicit time is the minimum.

Abstract:AIM: To study the clinical effect of alprostadil combined with glucocorticoids in the treatment of acute optic neuritis(AON).

METHODS: Seventy patients(70 eyes)with AON from January, 2012 to June, 2014 were randomly divided into two groups. 35 patients in observation group were used 10ug alprostadil with 10mL normal saline(NS)by intravenous injection, once/d for 7d/one treatment course, and 10mL NS was used by intravenous injection in 35 patients of control group. Besides, the two groups were treated with the combined therapy as follows: 20mg methylprednisolone was injected periglomerularly beside the eyeballs, once /3d for 3 times; 800～1 000mg of methylprednisolone through intravenous drip for 3d, once/d; after 3d, oral administration of prednisone acetate for 1wk, 1mg/(kg·d); after 1wk, the dose decreased to 5mg/wk until withdraw. Simultaneously, oral administration of ranitidine capsules, calcium carbonate and vitamin D₃ tablets were combined in the supportive treament. The differences of curative effect between two groups were comparatively analyzed.

RESULTS: In the observation group, 25 eyes(71.4%)were markedly effective, 7 eyes(20.0%)were valid and 3 eyes(8.6%)were invalid, and the total effective rate was 91.4%. In the control group, 15 eyes(42.9%)were markedly effective, 14 eyes(40.0%)were valid and 6 eyes(17.1%)were invalid, and the total effective rate was 82.9%. The difference of total effective rate between the two groups was not statistically significant(P=0.477), but there was a significant difference in markedly effective rate between the two groups(χ²=5.833, P=0.016).

CONCLUSION: Alprostadil combined with glucocorticoids is effective for AON, and it is worth of advocation.

Abstract:AIM: To observe theclinical effect of acute infectious endophthalmitis by vitrectomy surgery with silicon oil tamponade.

METHODS:The clinical data of 23 patients(23 eyes)diagnosed with acute endophthalmitis in our hospital from January, 2008 to February, 2013 were retrospectively analyzed, excluding the patients with intraocular foreign body. All the patients were undergone routine closed three-channel vitrectomy with silicon oil, including 6 eyes(complicated with traumatic cataract)with Ⅰ lensectomy and Ⅰ intraocular lens(IOL)implantation, 3 eyes(complicated with traumatic cataract)with Ⅰ lensectomy and Ⅱ IOL implantation, 4 eyes(complicated with cataract during silicon oil tamponade)with Ⅱ lensectomy and Ⅱ IOL implantation, 5 eyes(4 eyes with traumatic endophthalmitis and 1 eye with entophthalmia caused by glaucoma filtering bleb leaking)reserved lens, 1 eye(post-cataract surgery entophthalmia)with Ⅰ IOL explantation and Ⅱ IOL implantation, and 4 eyes(post-cataract surgery entophthalmia)reserved lens.

RESULTS:Within follow-up 6～24mo, inflammation after vitrectomy surgery with silicon oil tamponade was controlled in all the 23 patients(23 eyes). Final visual acuity was improved in 21 eyes(91%). The intraocular pressure(IOP)of 2 eyes were over 30mmHg. IOP of 1 eye was controlled after silicon oil removed, and IOP of the other eye after silcon oil extraction was still high and needed to be controlled by IOP lowering drugs.

CONCLUSION: The patients of acuteinfectious endophthalmitis should undergo vitrectomy with silicon oil tamponade as early as possible, which can effectively controli endophthalmitis and improve visual acuity.

Abstract:AIM:To discuss clinical pathological features of orbit IgG4 related disease(IgG₄-RD).

METHODS: The clinical pathological materials of 23 patients(35 eyes)with orbit IgG₄-RD were collected. They were observed in terms of histology and immunohistochemistry, and its clinical and pathologic characteristics were summarized.

RESULTS: There were 23 patients(35 eyes)with orbit IgG₄-RD(8 male patients, 9 eyes; 15 female patients, 26 eyes), with an average age of 52.1 year-old(from age 28 to 72). 19 patients(30 eyes)occured in lacrimal gland and 4 cases(5 eyes)in other places, and they went to hospital for lacrimal gland cyst or exophthalmos. There were 11 cases in one side and 12 cases in both sides. The disease lasted from 1mo to 10a, averaging 27mo. It recureded in one patient(1 eye)after 1mo. In general inspection: Gray nodular goiter, thin fibrous coat wrapping around the lacrimal gland could be observed. Histologic characteristics: lacrimal gland bubble and catheter group shrinked or even disappeared, substituted by lymphocyte, plasma cells and lymphoid follicle and accompanied with fibrosis. Immunohistochemical staining: IgG₄ positive plasma cells of 23 cases(35 eyes)was >50/HPF, and IgG₄/IgG ratio of positive plasma cells was >40%.

CONCLUSION: Orbit IgG₄-RD mainly occures in lacrimal gland tissue, and expression of IgG₄ can be detected through histologic characteristics and immunohistochemical staining. IgG₄-RD should be screened, prevented and treated in the early phase.

Abstract:AIM:To analyze the spectrum characteristics of hospitalized patients with lacrimal duct obstruction diseases(LDOD)and evaluate the prevalence and risk factors.

METHODS: In this retrospective review, the medical data of 578 hospitalized patients(709 eyes)with LDOD, including age, gender, ethnicity, occupation, long-time living area, past surgical history, past eye-lid trauma history, ocular inflammation, nasal diseases and occlusion location were analyzed.

RESULTS:The age of LDOD patients was among 6mo～72 years, average 39.7±8.42 years. Gender ratio was 1:1.66(217:361)between male and female. On ethnicity, 64.2% of subjects were Han, 22.3% of subjects were Hui, 11.3% of subjects were Dongxiang, and 2.2% of subjects were other minority ethnicity. On occupation, 62.5% of subjects were peasants, 17.0% of subjects were workers, 7.1% of subjects were drivers, while other occupations took 14.4% parts in total. On long-time living area, about 61.3% of subjects lived in rural area, 23.7% of subjects lived in town, and rest 15.1% lived in city. On past surgical history, 87.5% of subjects never underwent surgery, about 10.6% of subjects underwent surgery, including 1.9% underwent more than one time. Among all patients about 4.0% of subjects had past eye-lid trauma history. Occlusion mostly located in nasolacrimal duct, lacrimal duct, canalicular and punctum.

CONCLUSION:The etiology of LDOD is multifactorial, has characteristics on age, gender, ethnicity, occupation, ocular inflammation, nasal diseases and other factors. A better understanding of the association between ethnicity and LDOD by epidemiology investigation may help its prevention and treatment in ethnic minority areas.

Abstract:AIM: To analyze the pathogenic bacteria and drug sensitivity on infants with dacryocystitis and provide the basis for the rational drug use.

METHODS: Lacrimal sac secretions from 83 infants(86 eyes)with dacryocystitis were used to do bacterial cultures and drug sensitivity tests.

RESULTS:In all 86 eyes, specimens of 84 eyes were positive in bacterial culture, and the pathogenic bacteria positive rate was 97.7%. Totally 94 bacterial strains were isolated from lacrimal sac secretions. The positive rates of gram-positive bacteria were 71.3%(67 strains)and gram-positive bacteria were sensitive to rifampicin, levofloxacin and chloramphenicol. The positive rates of gram-negative bacteria were 28.7%(27 strains), and gram-negative bacteria were sensitive to levofloxacin, chloramphenicol, fusidic acid and ceftazidime.

CONCLUSION: Gram-positive bacteria are the preponderant pathogenic bacteria of dacryocystitis in infants, and the most common of which are streptococcus viridans and staphylococcus epidermidis. The results of drug sensitivity tests show that drug resistance rate of gram-positive bacteria are higher than that of gram-negative bacteria. Levofloxacin and chloramphenicol are effective to infants with dacryocystitis.

Abstract:AIM: To assess the effect and safety of laser ablation and electrolysis treatment in treating trichiasis.

METHODS:Fifty cases(76 eyes)of trichiasis patients were divided into two groups and treated with laser ablation and electrolysis treatment. Post-operative stimulation signs, complications and recurrence were recorded in following 6mo.

RESULTS: The first-time success rate of laser ablation was 81%, recurrence rate 19% and total success rate 94%. The first-time success rate of electrolysis treatment was 49%, recurrence rate 63% and total success rate 72%. There were significant differences in the rate of first-time success, recurrence and total success between two groups(P<0.05). There were fewer symptoms, complications and no scar in patients with laser ablation. After electrolysis treatment, scar occurred in 5 eyes.

CONCLUSION: Laser ablation in treating trichiasis has the advantage of fewer symptoms, complications and high curative rate, and it is an effective and safe clinical promotion.

Abstract:AIM: To survey civil aviator contrast sensitivity(CS)of different ages and analyze the characteristic of it in order to obtain the normal reference value.

METHODS: Four hundred eyes of 200 commissioned civil aviators from Civil Aviation General Hospital from September, 2013 to July, 2014 were randomly divided into four groups: group A(age 20～29), group B(age 30～39), group C(age 40～49), group D(age 50～59), and 50 people in each group(100 eyes). All of the eyes naked vision had to be ≥1.0, with no eye disease and associated systemic diseases. The CS of different spatial frequencies was measured with OPTEC 6500 under light and dark room.

RESULTS: The CS curves of groups were all presented with inverted U shape, and the CS was highest in intermediate frequency area(3.0c/d and 6.0c/d). Compared with that in the rest three groups, the values of CS at spatial frequency(6, 12 and 18c/d)under light room were decreased in group D, with statistical significance(P<0.01). Compared with that in the rest three groups, the values of CS at spatial frequency(1.5, 3 and 6c/d)under dark room were decreased in group D, with statistical significance(P<0.01).

CONCLUSION: This survey objectively reflects the characteristics of civil aviator CS of different ages, and provides reference date for further study on civil aviator visual function characteristics and obtaining the normal reference value of civil aviator CS.

Abstract:AIM: To investigate the clinical features, characteristics of fundus fluorescein angiography(FFA)indocyanine green angiography(ICGA), risk factors, diagnostic methods and therapies of ocular complications subsequent to radiotherapy of nasopharyngeal carcinoma(NPC).

METHODS: Thirty-three patients(63 eyes)with hypopsia subsequent to radiotherapy of NPC admitted to Chenzhou No. 1 People's Hospital from March 2007 to March 2012 were investigated retrospectively.

RESULTS: All cases manifested as progressive, painless hypopsia in binocular or monocular. Fifty-six eyes received FFA and ICGA. Forty-eight eyes showed radiation retinopathy, including 2 eyes with central retinal artery occlusion, 3 eyes with central retinal vein occlusion, 2 eyes with retinal pigment epithelial changes, 1 eye with epiretinal membrane and the remaining 40 eyes appeared cotton woolspots at posterior pole and hemorrhage. Thirty-six eyes manifested as radiation optic neuropathy, of them, optic border of 27 was clear, and that of 9 eyes was unclear. Two eyes were typical macular choroidal neovascularization(CNV), 1 eye was choroidal metastasis, 4 eyes presented choroidal abnormal circulation, 2 eyes displayed anterior uveitis and 7 eyes manifested vitreous hemorrage.

CONCLUSION:Ocular complications subsequent to radiotherapy of NPC are complicated and diverse, the most common damage is radiation retinopathy and radiation optic neuropathy, whereas the small number of them are characterized by macular CNV, arterio-venous obstruction and abnormal choroid.