Abstract:AIM:To investigate the formation of rats' choroidal neovascularization(CNV)induced by acrolein.

METHODS:Twelve Sprague-Dawley rats were randomly divided into three groups. Acrolein 200μL(2.5 mg/kg/d)was poured into the rats' stomach for 4wk as acrolein 4wk and for 8wk as acrolein 8wk group. The same volume of fresh water was also done to the rats as the control group. Remove all eye balls and embed into paraffin with HE staining.

RESLUTS:The RPE-Bruch membrane was intact with no obvious abnormality in the control group and acrolein 4wk group. Lost in the continuity of RPE and the movement of choroidal neovascularization were found in the acrolein 8wk.

CONCLUSION:The long time use of acrolein can induce the formation of choroial neovascularization in rats.

Abstract:AIM: To compare the central corneal thickness(CCT), keratometry(K)reading, anterior chamber depth(ACD), and axial length(AL)measured with Lenstar and Pentacam with those obtained with the ultrasound(US)pachymetry in the cataract patients.

METHODS: A total of 158 eyes of 158 patients were examined in this study. The CCT, average K, ACD and AL obtained by Lenstar and/or Pentacam were compared with those obtained from US pachymetry using repeated-measures analysis of variance, Pearson correlation coefficients and Bland-Altman analyses.

RESULTS: The mean CCT obtained using Lenstar and Pentacam were 536.54±27.90μm and 541.46±29.85μm(t=-5.439; P<0.001). The mean Km obtained using Lenstar and Pentacam methods were 43.87±1.45D and 43.86±1.44 D(t=-0.348, P>0.05). The mean ACD measured using the Pentacam, Lenstar, and US pachymetry were 2.73±0.38mm, 2.71±0.38mm, and 2.85±0.40 mm, respectively(F=309.94, P<0.001), and they were positively correlated(r=0.989, 0.978, and 0.977; P<0.001)and the coefficient of variation was small(3.12%). The mean AL obtained by US pachymetry and Lenstar were 24.28±1.70mm and 24.52±1.73 mm, respectively(t=-19.482, P<0.001, r=0.996; P<0.001). The Bland-Altman analysis showed that the three methods were comparable for CCT, Km, ACD and AL.

CONCLUSION: Although there were statistically significant differences, the measurements obtained by the Lenstar and the Pentacam were highly repeatable and the instruments easy to use.

Abstract:AIM: To see the causative factors, associations and outcomes of posterior capsule rupture(PCR).

METHODS: A retrospective cohort study was done of all patients with PCR from 2007 to 2014 in Melaka Hospital. Associations between ocular comorbidities, lens related complications, surgeon grade, type of cataract surgery, whether done alone or in combination, with the occurrences of PCR were studied. The final visual outcome of cases with PCR was studied.

RESULTS: PCR was the commonest intraoperative complication(n=623, 4.8%)among 12 846 patients. Ocular comorbidities and status of the lens did not cause PCR. Experience and seniority of surgeons were significantly associated with PCR. Medical officers had more PCRs than gazetting specialists(P=0.0000), who inturn had more PCRs than specialists(P=0.000). Each type of cataract surgery done was also significantly associated with PCR-phacoemulsification(phaco), phaco convert to extracapsular cataract extraction(ECCE)and intracapsular cataract extraction(ICCE)(P=0.000), lens aspiration(P=0.020), and ECCE(P=0.003). Specialists got good outcomes compared to trainees without PCR occurring(P=0.001)and also with PCR occurring(P=0.013). However, no difference was observed in the occurrence of PCR in complicated cases between specialists and trainees. Vision was compromised mainly by astigmatism following PCR. Impaired vision(P=0.000)and poor vision(P=0.000)were more than good vision. Poor vision was more in PCR compared to other complications.(P=0.000).

CONCLUSION: PCR occurs in all types of cataract surgeries and is the main intraoperative complication causing poor vision. Good outcomes were significantly more when specialists got PCR compared to trainees. Junior surgeons should practice in wet labs and be given more cases.

Abstract:AIM: To investigate the effect of anterior uveitis in Behçet's disease(BD)on neutrophil to lymphocyte ratio(NLR).

METHODS:Retrospective research. The patients who were admitted to Kayseri Training and Research Hospital between 2004-2013 and fulfilled the BD criteria are accepted in the study. The records of 735 patients with BD were screened and 135 of them were taken to the study. Sixty-eight of them had anterior uveitis, the rest(n=67)did not have any ophthalmological pathology. The patients' total blood counts were taken at the same visit that anterior uveitis was noted. Then the neutrophil to lymphocyte ratio were calculated.

RESULTS:In the anterior uveitis group the mean NLR was 2.55±0.96. In the ophthalmologically normal group it was 1.67±0.50. NLR was determined higher in the anterior uveitis group(P<0.05).

CONCLUSION: The NLR is found higher in the Behçet's disease with anterior uveitis patients when compared with the ophthalmologically normal patients.

Abstract:AIM: To study the incidence, epidemiology, and clinical characteristics of incidental malignant periocular tumors at the royal medical services hospitals of Jordan.

METHODS: Retrospective medical charts of 327 patients with malignant periocular tumor diagnosis at Jordan military hospitals between 2004 and 2015 were reviewed. Study variables included age, gender, city where patient lived, the presenting complaint(not caused by or related to tumor), clinical and histological diagnosis, size of the tumor, location, and surgical procedure.

RESULTS:A total of 327 charts reviewed, 46(14.1%)patients were found to have incidental malignant periocular tumor. Males where affected more than females with a ratio of 2:1. The average age was 66.39±10.59(22-83y). The most common presenting symptom or disease was blurring of vision secondary to cataract(44%), followed by combined cataract and other associated complaints such as epiphora in 21.7%.

Preliminary clinical diagnosis corresponded with histological diagnosis in 95.7% of skin cancer. The average size of the lesions was 1.04×0.85 mm²(0.2×0.2-3.0×3.0 mm²). There was no significant relationship between the maximum diameter of the tumor and age of the patient,(P=0.105). The most frequent location of tumors was the lower eyelid(30.4%)followed by the medial canthus(26.1%). The follow up period ranged between 6mo and 3y(average 9.3mo).

CONCLUSION: Incidental malignant periocular malignant tumors were relatively common in this study, which urges excision of any suspicious lesion particularly young patients. A prospective study is needed to investigate the reasons why some patients neglect these lesions.

Abstract:AIM:To evaluate visual evoked potentials(VEPs)in healthy infants.

METHODS:Thirty-four neurologically and ophthalmologically healthy infants aged 2-10mo were enrolled. Flash VEPs were implemented, with main peak P3 latency, amplitude and differences of latency and amplitude between sides being investigated.

RESULTS:In all cases main peak was registered. Its average latency was 138-140 ms and main amplitude 7-9 μV. Latency was variable.

CONCLUSION:We propose that latency or amplitude deviation in this population may not happen due to pathological condition, but merely due to ongoing myelination of visual pathways and cortex modeling. Caution needed in attributing the main cortical peak as P3 or some other waves numbers. Cortical nature of the main flash visual evoked potentials peak in infants aged 1-3mo is doubtful.

Abstract:AIM: To explore the mechanism of Smad1 during form-deprivation myopia development in C57BL/6 mice model.

METHODS: Sixty 3-week-old C57BL/6 mice were randomly divided into experimental groups and normal groups(NC)which totally include four groups: form-deprived 3wk group(FDM3W, n=20), form-deprived 4wk group(FDM4W, n=20), FDM3W normal control group(FDM3W-NC, n=10)and FDM4W normal control group(FDM4W-NC, n=10). Mice in experimental groups were treated with diffuser wearing on right eyes(MD-T), and their left eyes were naturally exposed as their self-control group(MD-C). The normal control groups were free of all the treatments, but the same measurements were performed at the same time-point. Refractive status was examined at 3 and 4wk after treatments in all mice. The histological analysis was applied to assess the changes of the sclera and the retina. The immunohistochemical staining and quantitative real-time PCR(QRT-PCR)were applied to investigate the expression of Smad1 protein and mRNA in retina.

RESULTS:(1)There was no significant difference between right and left eyes in every group before experiment. The normal control eyes showed physiological farsighted development and the MD eyes demonstrated relatively myopization. After experiments, a significant myopia shift had been induced in MD-T compared with MD-C and NC(P<0.05).(2)Histopathologic examination showed posterior sclera and retina in MD-T were thinner than in MD-C and NC groups. Compared with MD-C and NC groups, the expression of Smad1 in retina in MD-T was significantly decreased(P<0.01).

CONCLUSION:The expression of Smad1 in retina of form-deprived myopia was down-regulated, and Smad1 likely to be involved in the development of myopia through the transduction of retinal signal.

Abstract:AIM: To investigate the effect of P2X₇ on hypoxia-induced apoptosis of retinal ganglion cells in mice.

METHODS: According to the different factors, retinal ganglion cells of the mouse were randomly divided into four groups: control group(G1), hypoxia group(G2), hypoxia + agonist(BzATP)group(G3), hypoxia + antagonistic agent(BBG)group(G4). Methyl thiazolyl tetrazolium(MTT)method was used to detect the survival rate of cells; the rate of cell apoptosis was determined by Annxin V/PI staining flow cytometry; Western Blot analysis was employed to detect the protein expressrion levels of cleave-caspase-3 and cleave-PARP.

RESULTS: Compared with control group, the results significantly indicated the survival rate of cells decreased and the rate of apoptosis increased treated with hypoxia. In addition, the protein levels of cleave-caspase-3 and cleave-PARP were remarkably higher than the control group. BzATP markedly augmented the apoptosis induced by hypoxia, and BBG pretreatment observably decreased the hypoxia-induced apoptosis.

CONCLUSION: P2X₇ purinoceptor could be activated by hypoxia, and participate in the apoptosis of retinal ganglion cells.

Abstract:AIM:To explore the differences of expression pattern of microRNA(miRNA)in plasma from Vogt-Koyanagi-Harada(VKH)syndrome patients and normal controls, searching for diseases-relating biomarkers.

METHODS:Blood samples from 10 cases of VKH patients and 10 cases of normal control were collected to extracted total RNA in plasma. The cDNA was synthesized by reverse transcription, and then underwent real time PCR in a 96 well plate from miRCURY LNA^TM Universal RT microRNA PCR panels.Original Ct value was obtained. The Exiqon GenEx qPCR analysis software was used to analyse the original data and the differential miRNAs was obtained and analyzed by bioinformatics.

RESULTS:The panels contained 179 miRNAs classes from human individuals. In comparison with the healthy controls,there were 20 differential miRNAs, in which 12 miRNAs were up regulated and 8 miRNA were down regulated(all P<0.05). These microRNAs participated in the regulation of various signaling pathways.

CONCLUSION:The VKH patients and healthy controls have significantly different expression profiles of microRNA.The differential expression of microRNA may be involved in the pathogenesis of VKH.

Abstract:AIM:To study the clinical effect of trabeculectomy combined with mitomycin and retinal condensation on neovascular glaucoma and their influence on ocular hemodynamics.

METHODS:A total of 45 patients(45 eyes)with neovascular glaucoma treated with trabeculectomy, mitomycin and retinal condensation were selected, and the postoperative clinical effect, visual acuity, intraocular pressure(IOP)and complications were observed. The color Doppler imaging technique was used to detect hemodynamics index of contralateral and ipsilateral eye before and 2wk after surgeries.

RESULTS:All the patients were followed up for 3～6mo. The successful rate was 84%, the rate of forming functional filtering bleb was 82%, and the complication rate was 27%. The IOP at 1, 3 and 6mo after surgeries decreased significantly compared with pre-operation(P<0.05), and the corrected visual acuity improved significantly at 1, 3 and 6mo after treatments(P<0.05); at 1, 3 and 6mo after treatments, the hemodynamic parameters including PSV, EDV, RI of ipsilateral eye improved significantly compared with those before surgeries(P<0.05).

CONCLUSION:Trabeculectomy combined with mitomycin and retinal condensation has high success rate on treating neovascular glaucoma, which can effectively control IOP, improve vision and ocular hemodynamics.

Abstract:AIM: To assess the visual function prognosis after vitrectomy for patients with proliferative diabetic retinopathy(PDR)at stage Ⅵ and the impacting factors and to evaluate visual function using multifocal electroretinogram(mfERG).

METHODS: One hundred and thirteen cases(130 eyes)with PDR at stage VI treated with standard vitreoretinal surgery were retrospectively analyzed. According to the OCT examination before surgeries and ocular fundus during surgeries, the reviewed cases were divided into two groups: patients with traction retinal detachment and maculopathy(99 cases with 113 eyes)and without maculopathy(14 cases with 17 eyes). Eyes underwent OCT and mfERG examination. Visual acuity preoperative and postoperative, mfERGP1 wave amplitudes, morphology features of macular,complications and prognoses were analyzed.

RESULTS: The rate of improved visual acuity postoperatively was 63.1%(82/130). The vision was 0.05 or better in 19 eyes(14.6%)preoperatively, and in 61 eyes(46.9%)postoperatively, in which the vision of 56 eyes were >0.1. In patients without maculopathy, the rate of visual improvements were 88.2% and there were 94.1% with the vision >0.1, which were both better than patients with significant maculopathy group(59.3% and 35.4%), and the differences were significant(P<0.05).The amplitude densities of P1 wave in the 6 rings were markedly increased after vitrectomy, and they turned to be better with time(P<0.05).The amplitude densities of P1 wave in rings(1+2)of eyes without maculopathy were higher than eyes with maculopathy(P<0.05).

CONCLUSION: The visual function of eyes with PDR at stage VI is improved after vitrectomy. The amplitude densities of P1 wave in the 6 rings increase markedly after vitrectomy, and they turn to be better with time. The improvement of visual function in severe PDR without maculopathy group is better than that in severe PDR with maculopathy group after vitrectomy.

Abstract:AIM:By comparing the changes of biomechanical properties of the cornea after small-incision lenticule extraction(SMILE)and those after Q value guided femtosecond laser-assisted laser in situ keratomileusis(FSLASIK), to study the stability of biomechanical properties of the cornea after these two kinds of surgery and provide objective data for clinical operation.

METHODS: Prospective comparative cases. One hundred and two cases(200 eyes)with myopia and myopic astigmatism were divided into 2 groups, 51 cases(100 eyes)for SMILE, and 51 cases(100 eyes)for Q value guided FS-LASIK. Corneal hysteresis(CH)and the corneal resistance factor(CRF)were quantitatively assessed with the Ocular Response Analyzer(ORA)preoperatively and 1d, 2wk, 1 and 3mo postoperatively.

RESULTS: The decrease in CH and the CRF were statistically significant in both groups(P<0.01). However, the changes subsequently stabilized with no further deterioration(P>0.05). There were no statistically significant differences between the biomechanical changes in the two groups at any time(P>0.05).

CONCLUSION: Both SMILE and Q value guided FS-LASIK can cause biomechanical decreases in the cornea. After 1d postoperatively, the decreases are nearly stable. There are no significant differences between the effect of SMILE and Q value guided FS-LASIK on the biomechanical properties of the cornea.

Abstract:AIM: To compare posterior capsule opacification(PCO)after phacoemulsification cataract surgery with implantation of two different hydrophobic acrylic intraocular lenses(IOLs).

METHODS: Such databases as PubMed(1980-Sep 2015),CBM(1990-Sep 2015),VIP(1989-Sep 2015),CNKI(1990-Sep 2015)and WanFang Data(1990-Sep 2015)were searched to collect the randomized controlled trials(RCTs)about AcrySof 3-piece IOL vs Sensar 3-piece IOL for PCO or incidence of Nd:YAG laser capsulotomy.According to the inclusion and exclusion criteria,two reviewers independently screened the literatures,extracted data and assessed the quality of the included studies,then Meta-analysis was conducted using RevMan 5.2 software.

RESULTS: A total of 5 RCTs involving 1 036 eyes(AcrySof group: 553 eyes, Sensar group: 483 eyes)were included, with a follow-up duration of 6mo～2a.The results of Meta-analysis showed that:(1)the incidence of PCO was significantly lower in AcrySof group than that in Sensar group(OR=0.67,95%CI:0.45～0.99,P=0.04);(2)the incidence of Nd:YAG laser capsulotomy after surgeries was similar between AcrySof group and Sensar group(OR=0.57,95%CI:0.32～1.02,P=0.06);(3)in an above 2a long-term follow-up subgroup analysis, AcrySof group indicated a significantly lower incidence of PCO(OR=0.60,95%CI:0.40～0.91,P=0.02), while the Nd:YAG laser capsulotomy incidence was similar between the two groups(OR=0.60,95%CI:0.33～1.09,P=0.09).

CONCLUSION: AcrySof 3-piece IOL seems to have a stronger preventive effect on PCO than Sensar 3-piece IOL. For the quantity limitation of the included studies,this conclusion still needs to be further proved by more high-quality RCTs.

Abstract:AIM: To systematically evaluate the change of vision and diopter in 1wk to 1a in the patients with high myopia receiving orthokeratology treatment.

METHODS: Such databases as PubMed, EMbase, CBM, CNKI, VIP, and WanFang Data were searched. The retrieval time was from inception to September 2015, and the language was in both Chinese and English. After extracted the data and assessed the quality of the included studies, the Meta-analysis was performed by using RevMan 5.3 software.

RESULTS: A total of 6 studies involving 909 eyes were included. The results of Meta-analysis showed that, compared with that before wearing orthokeratology, the visual acuity improved in orthokeratology group at 1wk, 1, 3, 6mo and 1a \〖1wk: MD=-0.34, 95%CI(-0.55, -0.14), P=0.001; 1mo: MD=-0.50, 95%CI(-0.69, -0.30), P<0.01; 3mo: MD=-0.54, 95%CI(-0.70, -0.37), P<0.01; 6mo: MD=-0.49, 95%CI(-0.50, -0.47), P<0.01; 1a: MD=-0.46, 95%CI(-0.64, -0.29), P<0.01\〗. After wearing orthokeratology 1a, diopter also be effectively controlled \.

CONCLUSION: Orthokeratology is an effective control method to correct high myopia and high myopia development. But further studies are still required for its long-term effect.

Abstract:Congenital ectopic lentis is defined as a kind of connective tissue disease with obvious genetic predisposition that lens dislocates caused by imbalance of the traction of lens as a result of zonular fiber defect or dysplasia. We get further understanding of the molecular etiology and nosogenesis of congenital ectopic lentis under guidance of scientific research in recent years.Main suspicious disease-causing genes will be reviewed in this paper to provide reference for clinical diagnosis and treatment.

Abstract:Glaucoma is characterized by optic atrophy and visual field defect. The pathological elevated intraocular pressure is the leading risk factor for glaucoma. The pathological characteristic of glaucoma is apoptosis of retinal ganglion cells(RGCs)and their axon loss. Changes of the amounts and compositions of the extracellular matrix(ECM)play a crucial role in the structure of trabecular meshwork, lamina cribrose of opitic nerve head and the apoptosis of RGCs. The expression of transforming growth factor-β2(TGF-β2)increases in trabecular meshwork and aqueous humor for glaucomatic patients, which leads to elevated intraocular pressure by secretion and accumulation of ECM. Elevated intraocular pressure causes changes in ECM of optic nerve head and retina, resulting in blocked transport of neurotrophins, the high level of matrix metalloproteinase(MMPs)-9 and low level of laminin respectively, which eventually lead to the apoptosis of RGCs. Therefore, it is important to understand the relationship between ECM and glaucoma, which may provide a new direction for glaucomatous pathogenesis and therapy.

Abstract:Refractory Glaucoma is a kind of intractable eye disease with strong destruction and high blindness rate, the failure rate of which is very high.The mainly reason is fibroblasts hyperplasia and scarring on filtration mouth that hindered the drainage and diffusion of aqueous. Combined trabeculectomy, glaucoma drainage device implantation, and cyclophotocoagulation are the common surgical procedures for refractory glaucoma. So far, glaucoma drainage device implantation is regarded as the first-line choice. The authors focus on the clinical efficacy and prospect of the surgery way for refractory glaucoma.

Abstract:The study on the relationship between choroidal thickness and glaucoma has been widespread concerned. In recent years, more and more studies show that enhanced depth imaging spectral-domain optical coherence tomography(EDI-OCT),which is an effective tool to study the change in vivo choroid, has important clinical value in the evaluation of choroidal change in various types of glaucoma.

Abstract:Corneal neovascularization(CNV)is caused by the unbalance of corneal avascularity maintaining factors, and then the limbus capillary invades the transparent corneal tissue. CNV is one of the common causes of blindness. In recent years, with the developing of immunology, molecular biology and pharmacology,we have made a lot of breakthroughs about the pathogenesis and treatment of CNV. However, there is no effective medicine and therapy for CNV. In this article we reviewed the pathogenesis, molecular mechanism of CNV, and focus on the progress of therapies.

Abstract:Diabetic retinopathy(DR)is one of the severe complications of diabetes, which could lead to severe visual impairment. Retinal ganglion cell(RGC)apoptosis has been confirmed both in vivo and in vitro prior to the definite micro-vascular damages. RGC impairment contributes to an early deterioration of vision. Hyperglycemia, oxidative stress, neuron growth factor deficiency and glutamate excitotoxicity were found to be involved in retinal ganglion cell apoptosis. Some neuron protective agents have been showed to prevent the apoptosis of RGC in experimental diabetic retinopathy. Clinical evidences about effectiveness and security also suggested potential treatments for the diabetic retinal neuron.

Abstract:Diabetic retinopathy is one of the microvascular abnormal diseases. In the late stage of disease progression, the antibody of vascular endothelial growth factor can significantly inhibit the formation of new blood vessels and improve macular edema, which is widely used in clinical. However, the aggravation of pro-fibrotic influence after long-term treated by the medicine also attracts a wide range of attention. Connective tissue growth factor, as an important cytokine in intraocular fibrosis, over expressed after treated by the drug, is considered to be one of the most important factors in the side effect of the drug, and is also a potential therapeutic target. After finishing the current research, the regulation mechanism of connective tissue growth factor, includes two ways, regulation of gene expression and direct binding to other cell factors or receptors. Because of its special four module structure, it has many kinds of cell factor specific binding sites, and its regulation mode is more dependent on the latter, which promotes or inhibits the expression of several important cytokine pathways. In diabetic retinopathy, its expression goes throughout the disease process. The accumulation of connective tissue growth factor plays an important role in promoting the thickening of basement membrane and the formation of new blood vessels in the early stage of the clinical stage and the formation of the new blood vessels. In this paper, the regulatory mechanism of connective tissue growth factor and the research progress of this factor in DR are systematically expounded.

Abstract:Optical coherence tomography angiography(OCTA)is a new emerging technology of the optical coherence tomography(OCT)in recent years. It's a noninvasive and fast retinal vascular imaging technology with high resolution, and has been gradually applied to make diagnosis, gives treatment and follow-up for various types of retinal vascular diseases, such as diabetic retinopathy, choroid neovascularization, etc. OCTA has the unique advantages of layered observing the structure and shape of the chorioretinal vascular at different levels, and quantifying the blood flow index of designated scope and the flow area of lesions. However, OCTA requires high solid vision and good cooperation of patients, even has the limitations to observe the retinal scope and retinal vascular barrier function. With overcoming these limitations, it's helpful for us to improve the understanding of retinal vascular diseases, consummate the diagnosis and treatment and observation of retinal vascular diseases.

Abstract:Mucins produced by corneal and conjunctival epithelia, conjunctival goblet cells and lacrimal apparatus are important components of preocular tear film, which play important roles as clearing molecules, lubricating agents, antimicrobial agents, dis-adhesive molecules, protective cell surface barrier, osmosensors and signal transmitter. The understanding of the functional roles of mucins and the regulatory steps governing its synthesis and secretion is necessary to develop effective treatment strategies for dry eye.

Abstract:AIM:To analyze the postoperative visual acuity, and preoperative and postoperative complications in cataract patients in Tibet Plateau area who received small incision cataract extraction without phacoemulsification as compared to in those who received phacoemulsification.

METHODS:Four hundred and thirteen cataract patients admitted to ophthalmology departments in traditional Tibetan medicine hospital in Tibet Autonomic Region from October 2014 to January 2015 were collected. They were randomized into the group(200 patients with 200 eyes)receiving phacoemulsification combined with intraocular lens implantation as Phaco group and the group(213 patients with 213 eyes)receiving small incision cataract extraction combined with intraocular lens implantation as small incision group. The two groups were compared for uncorrected visual acuity at 1 and 5d postoperatively, and the preoperative and postoperative complications.

RESULTS:At 1 and 5d postoperatively, there were 150 eyes(70.4%)and 196 eyes(92.0%)with visual acuity ≥0.5 in the small incision group, respectively. There were 156 eyes(78.0%)and 185 eyes(92.5%)in the Phaco group. The difference value of visual acuity before and at 1d after the operation of Phaco group was higher than that of small incision group(P<0.05); while the difference value of visual acuity between 5d and 1d after the operation showed no different between Phaco group and small incision group(P=0.33). According to Emery Standard, the number of eyes with visual acuity ≥0.5 showed no statistically significant differences between two groups in the patients with nuclear-grade I, Ⅳ and Ⅴ(P>0.05); however, it was statistically significant differences between two groups in the patients with nuclear-gradeⅡ and Ⅲ(P<0.01). But there was no statistical significance for corneal edema or iris reaction between the two groups(P>0.05).

CONCLUSION:This study showed that age-relative cataract is still one of the most common pathogenesis in Tibet. Surgery is the only option for the best treatment effect so far. On postoperative 1d, the visual acuity of the patients with nuclear-gradeⅡ and Ⅲ in the Phaco group improved more than those in the small incision group. While, there was no significant difference in patients with nuclear-grade I, Ⅳ and Ⅴ. No differences were found on corneal edema, iris reaction or other complications. Therefore, small incision cataract extraction can achieve similar effect in the absence of condition for phacoemulsification.

Abstract:AIM:To evaluate the efficacy and safety of Ahmed glaucoma valve(AGV)implantation surgery using different methods.

METHODS:This was a retrospective study of patients with refractory glaucoma in whom AGV implantation was performed between June 2011 and September 2014. According to the method of tube insertion into the anterior chamber, the sample was divided into two groups, needle-generated scleral tunnel and scleral flap. The surgical success rate, intraocular pressure(IOP), number of antiglaucoma medications used, best correct visual acuity, postoperative complications, and operation duration were analyzed between the two groups.

RESULTS:Compared with preoperative data, the two groups showed statistically significant decrease on IOP and the number of antiglaucoma medication used at all follow-up points(P<0.01). Differences on mean postoperative IOP, mean number of postoperative antiglaucoma medications, and best correct visual acuity were not significant between the two groups at all follow-up intervals. Kaplan-Meier survival curves showed that the success rate was 79% for the needle-generated scleral tunnel group and 80% for the scleral flap group at the follow-up endpoint of 1a. There was no significant difference between the two groups(P=0.932); however, statistically significant differences were detected when flat anterior chamber complications between the needle-generated scleral tunnel group(6%)and the scleral flap group(24%)were compared(P=0.032).

CONCLUSION:AGV implantation may be an effective method in managing refractory glaucoma, since the two methods have similar efficacy. However, the needle-generated scleral tunnel technique application could greatly decrease the incidence of flat anterior chamber complications and decrease the duration of the operation.

Abstract:AIM: To evaluate the changes of anterior scleral thickness in acute angle-closure glaucoma patients with high intraocular pressure(IOP)after phacoemulsification and intraocular lens implantation with ultrasound biomicroscope.

METHODS: The prospective clinical study enrolled 65 cases(72 eyes)with primary acute angle-closure glaucoma and cataract of whom IOP were all over 50mmHg. IOP of all patients were still over 45mmHg with shallow anterior chamber after general and topical medical management. Phacoemulsification and intraocular lens implantation combined with goniosynechialysis were performed after vitreous aspiration in all patients. Ultrasound biomicroscope was performed preoperatively and at 1, 6mo postoperatively. The anterior chamber depth(ACD), anterior scleral thickness(AST)and angle opening distance at 500μm from the scleral spur(AOD₅₀₀)were measured at superior, temporal, nasal and inferior to detect the changes of anterior segment parameters.

RESULTS: The ACD were 1.532±0.316, 3.337±0.652 and 3.458±0.482mm preoperatively and at 1 and 6mo postoperatively, and there were significant differences between before and postoperatively(P<0.01). The postoperative nasal and inferior AST obviously increased(P<0.05), but the postoperative superior and temporal AST increased a little(P>0.05).Compared with preoperative, the mean AOD₅₀₀ increased by 0.007, 0.006, 0.014 and 0.019mm at superior, temporal, nasal and inferior, and the differences were significant compared to those before surgeries(all P<0.01).

CONCLUSION: For acute angle-closure glaucoma patients with shallow anterior chamber and sustained high IOP and can't be managed with drugs, cataract surgery can deepen the central ACD, increase the anterior scleral thickness, and widen the anterior chamber angle. But the change of scleral thickness needs larger sample study.

Abstract:AIM: To investigate the effect of phacotrabeculectomy with intraocular lens implantation and trabeculectomy on the ocular surface in patients with primary angle closure glaucoma.

METHODS: We had seleted 60 eyes in 60 hospitalized patients with primary angle closure glaucoma and cataract. They were divided into group A and B randomly. Each group has 30 eyes of 30 cases. Group A was performed with phacotrabeculectomy with intraocular lens implantation and group B was performed with trabeculectomy. Ocular surface tests were performed in all subjects on the day before surgeries,1wk,1and 3mo after surgeries, respectively, including non-invasive keratograph first tear break-up time(NIKf-BUT),Schirmer's I test(SⅠt), and corneal and conjunctival lissamine green staining score.

RESULTS: The postoperative NIKf-BUT of group A and B were significantly shorter than those preoperative(all P<0.01). The NIKf-BUT of group A(2.78±1.44, 3.72±0.94, 5.95±0.81s)were significantly shorter than those of group B(4.54±1.68, 5.14±1.01, 8.34±1.15s)at the postoperative 1wk,1 and 3mo(t=-4.341,-5.636,-9.29,all P<0.05). The SⅠt of group A and group B at the postoperative 1 wk and 1 mo were significantly less than preoperative SⅠt(all P<0.01). The SⅠt of group A(8.57±2.47, 8.10±2.41mm)were significantly less than those of group B(10.07±2.07, 9.53±2.29mm)at postoperative 1wk and 1mo(t=-2.549,-2.636,all P<0.05). The postoperative corneal and conjunctival lissamine green staining score of group A and group B were significantly higher than preoperative score(all P<0.01). The score of group A(3.50±1.17, 2.27±0.91)were significantly higher than group B(2.50±1.33, 1.33±0.88)at the postoperative 1wk and 1mo(t=3.092,4.036, all P<0.01).

CONCLUSION: There was stronger effect of phacotrabeculectomy with intraocular lens implantation for the ocular surface in patients with primary angle closure glaucoma than trabeculectomy. It should be actively taken more measures to reduce damage of ocular surface during operations and to keep the stability of tear film at the postoperative stage.

Abstract:AIM:To evaluate the effect of Ranibizumab(lucentis)combined with macular grid pattern photocoagulation in the treatment of macular edema caused by branch retinal vein occlusion(BRVO).

METHODS:Forty-two patients(42 eyes)diagnosed as macular edema caused by BRVO by fundus fluorescence angiography(FFA)and optical coherence tomography(OCT)were enrolled. The patients were randomized divided into two groups:group 1(combined therapy group)received lucentis intravitreal injection combined with macular grid pattern photocoagulation; group 2(photocoagulation therapy group)received macular grid pattern photocoagulation only. The best corrected visual activity(BCVA), central macular thickness(CMT)and complications were compared between the two groups at 1, 3 and 6mo after treatments.

RESULTS:Compared to before treatments, at 1, 3 and 6mo after treatments:the changes of BCVA and CMT were significant different in group 1(P<0. 05). Compared with before treatments, at 1mo after treatments:changes of BCVA and CMT had no significant differences in group 2(P>0. 05); but at 3 and 6mo after treatments:BCVA and CMT improved gradually and the differences were significant in group 2(P<0. 05).The changes of BCVA and CMT between the two groups were statistically significant at 1, 3 and 6mo after treatments(P<0.05).

CONCLUSION:Ranibizumab intravitreal injection combined with macular grid pattern photocoagulation therapy can effectively reduce macular edema caused by BRVO, improve vision acuity. Compared with macular grid pattern photocoagulation therapy, combination therapy works more quickly, and reduces macular edema more.

Abstract:AIM: To analysis the clinical effect of Ranibizumab with laser photocoagulation for diabetic macular edema.

METHODS: Forty-two cases(72 eyes)of patients with diabetic macular edema collected from April 2014 to June 2015 in our hospital were randomly divided into observation group and control group. The observation group was given ranibizumab with laser photocoagulation therapy, and the control group was only given laser photocoagulation treatment. Macular edema subsiding, macular fovea retinal thickness change and vision improvement were compared between the two groups.

RESULTS: The total effective rate of the observation group was 94%, that of the control group was 78%, and the difference between the two groups was statistically significant(P<0.05). Before the treatment, macular foveal retinal thickness of the observation group was 486.58±85.26μm, that of the control group was 479.61±83.37μm, and the difference between the two groups was not statistically significant(P>0.05). At 3mo after treatments, the macular fovea retinal thickness of the observation group was 315.85±43.7μm that of the control group was 418.85±46.97μm. At 6mo after treatments, the macular fovea retinal thickness of the observation group and the control group was 245.58±25.67 and 369.85±36.48μm respectively, and the difference between the two groups was statistically significant(P<0.05). The vision improvement rates of the observation group and the control group were 78% and 50% respectively, and the difference between the two groups was statistically significant(P<0.05).

CONCLUSION: The treatment effect of ranibizumab with laser photocoagulation therapy for diabetic macular edema is remarkable, and recommended in clinical promotion.

Abstract:AIM: To apply optical coherence tomography(OCT)in the detection of retinal nerve fiber layer(RNFL)thickness in senile cataract patients and to analyze the changes of RNFL and the correlation with the patient's visual acuity after phacoemulsification.

METHODS: Fifty-one senile cataract patients(70 eyes)received the phacoemulsification. The patients were divided into diabetes mellitus(DM)group and non-DM group. There were 30 cases(38 eyes)in non-DM group and 21 cases(32 eyes)in DM group. After treatments, OCT was applied to detect the patients' RNFL thickness at different time periods(at 3, 14d, 1, 3 and 6mo after treatments). At different time periods, RNFL thickness was detected to analyze its correlation with the best corrected visual acuity(BCVA).

RESULTS: At 3 and 14d after treatments, RNFL thickness of non-DM group was not different from that of DM group(P>0.05); at 3 and 6mo after treatments, RNFL thickness of non-DM group was smaller than that of DM group(P<0.05); the uncorrected visual acuity of the two groups before treatments had no statistical significant differences compared with those at 3,14d and 1mo postoperatively(P>0.05); the uncorrected visual acuity of DM group at 3, 6mo postoperatively was significantly lower than those of non-DM group(P<0.05); at 14d, 1 and 3mo after treatments, the RNFL thickness of non-DM group was negatively correlated with the patient's visual acuity(P<0.05); at 14d, 1, 3 and 6mo after treatments, RNFL thickness of DM group was negatively correlated with the patient's visual acuity(P<0.05).

CONCLUSION: OCT is a good detecting parameter for the change of RNFL thickness and the change of RNFL thickness is an important cause of the changes of the patient's visual acuity.

Abstract:AIM: To investigate the clinical efficacy and benefit of short-pulse pattern scan laser(PASCAL)photocoagulation for proliferative diabetic retinopathy(PDR).

METHODS:Twenty-eight PDR patients(42 eyes)underwent short-pulse PASCAL pan-retinal photocoagulation(PRP)were analyzed.The best corrected visual acuity was ≥0.1 in 36 eyes, <0.1 in 6 eyes. Diabetic macular edema(DME)was found in 11 eyes.Short-pulse PASCAL PRP was performed and completed in one time. Macular edema was treated by single spot and/or PASCAL macular mode.Visual acuity, fundus examinations, fundus fluorescein angiography(FFA), optical coherence tomography(OCT)and visual field were analyzed at the one-year follow-up period.

RESULTS: All the cases had no pain during the short-pulse PASCAL treatment.One year after treatments,the final visual acuity was improved in 6 eyes,kept stable in 28 eyes and decreased in 8 eyes; neovascularization were regressed in 18 eyes(43%), stable in 12 eyes(29%), uncontrolled in 12 eyes(29%). Five eyes(12%)received vitrectomy due to vitreous hemorrhage.Compared with before operation, retina thickness in central fovea of macula and visual field had no obvious change after one-time PASCAL PRP(P>0.05).

CONCLUSION:The one-time short-pulse PASCAL PRP could stabilize the progress of PDR safely, effectively and simply.

Abstract:AIM:To evaluate the clinical efficacy and safety of technetium-99 methylene diphosphate(⁹⁹Tc - MDP)with glucocorticoid therapy for Graves ophthalmopathy.

METHODS:A total of 96 patients with Graves ophthalmopathy were randomly divided into two groups, The control group assigned to receive methylprednisolone injection pulse therapy and oral prednisone tablets in the intermittent period. The experimental group was given the treatment of ⁹⁹Tc - MDP injection based on therapy of the control group. Then the clinical efficacy and safety of the two therapies were compared.

RESULTS:The clinical symptoms of the two groups were improved. The efficiency rate of the experimental group was higher than that of the control group, especially on the degree of exophthalmos, and the difference was statistically significant(P<0.05). The activity of Graves ophthalmopathy had been improved in the two groups, with no significant difference(P>0.05). The experimental group did not have serious adverse reactions associated with ⁹⁹Tc-MDP.

CONCLUSION:There are obvious improvements in patients with Graves ophthalmopathy treated by ⁹⁹Tc - MDP combined with glucocorticoid, especially in the degree of exophthalmus and with less adverse reactions, which deserves promotion.

Abstract:AIM:To compare the difference of accommodation response under the variety reading conditions including computer screen, mobile phone screen and printed texts. The investigation also included the accommodation response under these conditions with different distances, brightness, dynamic and static testing status.

METHODS:Thirty volunteer subjects were included with normal vision function. The reading target on computer screen, mobile screen and paper were used, respectively. Grand Seiko WAM 5500 infrared automatic refractometer was applied to measure accommodation response. The influence of different reading conditions on accommodation was compared using variance analysis with SPSS17.0.

RESULTS:Accommodation lag under the computer screen with high brightness was 0.52±0.24D, that under papers was 0.73±0.28D, that under mobile phone was 0.72±0.29D. Accommodation lag under the computer screen with high brightness was less than that under mobile phones and paper, the differences were statistically significant(P<0.05). The accommodation lag under mobile phones and paper had no statistical difference. Accommodation microfluctuations and pupil size under the mobile phone was slightly largerer than the accommodation lags under the other conditions, but the difference was not statistically significant.

CONCLUSION:Accommodation lag under the computer screen with high brightness is relatively smaller than that under mobile phone or paper. There is no significant difference between those under phones and paper. With the brightness of computers in a certain range, there is no effect for accommodation response.

Abstract:AIM: To evaluate the changes of corneal refractive power and surgically induced astigmatism(SIA)after small incision non-phacoemmulsification surgery for high myopic eyes with cataract in middle aged and senile people.

METHODS: A retrospective study was done in 145 eyes of 103 middle aged and senile patients with high myopia and cataract who underwent small incision non-phacoemulsification surgery in our hospital. The keratometer was used to measure corneal horizontal refractive power(K1), vertical corneal refractive power(K2)and their axial on postoperative 3d, 1wk, 1 and 3mo. SIA was calculated by sine law and cosine law method.

RESULTS: There was statistically significant difference on average corneal astigmatism at 3d and 1wk compared with that before surgeries(P<0.05). SIA were respectively +1.34±0.12, +0.89±0.27 and -0.42±0.26 at 1wk, 1 and 3mo postoperatively, and the differences were statistically significant(P<0.05). K1 increased by 1.59D and K2 decreased by 1.98D at 3d postoperatively, and there was significant difference between them(P<0.01). The difference between before surgery and after surgeries of K1 decreased in 3mo, which was also similar with the K2. The absolute value of differences between K1 in 3mo were smaller than those of K2, and there were significant differences between them at different time points(P<0.05).

CONCLUSION: Corneal astigmatism is a little larger in short term after small incision non-phacoemulsification surgery for high myopia patients with cataract. The surgery method needed to be improved.

Abstract:AIM:To observe the long-term effectiveness and corneal complications by orthokeratology in myopia patients.

METHODS:A retrospective analysis was conducted for 324 patients(620 eyes)with myopia who weared orthokeratology lens with standardized examination and strict recheck. The change of uncorrected visual acuity, myopic diopter, corneal curvature, visual quality and the complications after continuous wearing orthokeratology for 6mo, 1 and 2a were observed.

RESULTS:The uncorrected visual acuity was 0.15±0.14 before orthokeratology, 0.95±0.07 at 6mo after wearing, 0.93±0.10 after 1a, 0.90±0.10 after 2a, which was increased significantly in every group compared with that before wearing(P<0.01). The myopic diopter was -3.34±1.43D before wearing orthokeratology, -0.73±0.67D at 6mo after wearing, -0.93±0.57D after 1a, -0.97±0.66D after 2a, which was decreased apparently in every group compared with that before wearing(P<0.01). The corneal curvature was 43.27±1.23D before wearing orthokeratology, 40.69±1.22D at 6mo after wearing, 40.64±1.21D after 1a, 40.36±1.16D after 2a, which was decreased significantly in every group compared with that before wearing(P<0.01). During the period of orthokeratology wearing, 397 eyes had mild corneal epithelial injury(0～Ⅱ), the incidence rate was 64.0%, which was relieved after promoting restoration drugs for corneal epithelium. The corneal epithelial injury at Ⅲ degree occurred in only 5 eyes, and the incidence rate was 0.8%. Only 1 patient had to stopped wearing orthoeratology for filamentary keratitis and cured with drugs. The pressure mark occurred in 106 eyes, and the incidence rate was 17.1%. Diplopia or double image happened in 144 eyes, and the incidence rate was 23.2%. Dazzle occurred in 161 eyes, and the incidence rate was 26.0%. These problems could disappeared with time or after adjusting lenses.

CONCLUSION:Long-term orthokeratology wearing can efficiently improve the uncorrected visual acuity, decrease the myopic diopter and corneal curvature. The standardized examination and strict recheck can ensure the safety of orthokeratology.

Abstract:AIM: To evaluate the changes of corneal endothelium density, central corneal thickness, corneal curvature and eye axial length for teenager myopia patients after wearing orthokeratology over night for 6mo.

METHODS: Retrospective case-observational study was adopted.Forty-four myopia teenagers(86 eyes)aged 7～17 wearing overnight orthokeratology contact lens were observed and analyzed using ultrasonic diagnostic apparatus, non-contact corneal endothelial microscope and corneal topography. Changes and relative coefficient of corneal endothelium density, central corneal thickness, corneal curvature and eye axial length were examined before and after wearing overnight orthokeratology contact lens for 6mo.

RESULTS:After wearing over night orthokeratology contact lens half a year, visual acuity was stable at 1.0～1.2 without serious complications. No significant differences were found in the density of corneal endothelial cells, corneal curvature and depth of anterior chamber comparing to before wearing. Central cornea thickness was smaller and length of eye axis increased after wearing for 6mo and significant differences were seen(P<0.05). The coefficient of variation was observed between density of corneal endothelial cells and length of eye axis(right eye:P=0.005,left eye:P=0.013), central cornea thickness and length of eye axis(right eye:P=0.019,left eye:P=0.006)after wearing orthokeratology contact lens for 6mo.

CONCLUSION:After wearing overnight orthokeratology for 6mo, eye axis length still increased, corneal endothelial cells density decreased and central cornea thickness thinned.

Abstract:AIM:To investigate the clinical effect and safety of modified Synder-Thompson posterior scleral reinforcement for pathological myopia in teenagers.

METHODS:Forty eyes in 21 teenagers with pathological myopia who underwent the posterior scleral reinforcement using bovine pericardium(PSR group)were retrospectively studied, and at the same time 26 eyes in 13 age- and myopia-matched children who wore spectacles were analyzed as the control group. They were followed for 3a. The changes of best-corrected visual acuity, myopic diopter and axial length before and after treatments were measured and compared between the two groups.

RESULTS:The mean spherical equivalent degree after 3a in PSR group was -12.90±3.22D, and which in the control group was -13.40±1.85D. The mean spherical equivalent degree at the end of the follow-up period in the PSR group and the control group were increased by -1.13±0.45D and -1.93±0.44D respectively, and the difference between the two groups was statistically significant(P<0.01). The best-corrected visual acuity were increased by 0.25±0.11 and 0.16±0.07 respectively, and the difference between the two groups was statistically significant(P<0.01). The increase of axial length were 0.71±0.34 and 1.18±0.40mm respectively, and the difference between the two groups was statistically significant(P<0.01). There was no serious complication such as retinal detachment, anterior segment ischemia syndrome, rejection reaction and intraocular hemorrhage in the PSR group after the surgery.

CONCLUSION:Posterior scleral reinforcement surgery can not only effectively slow down high myopic axial progression and control the myopia development, but also elevate the visual acuity.

Abstract:AIM: To investigate the therapeutic effect of rectus recession combined with the rear suspension scleral fixation for patients with restrictive strabismus caused by thyroid associated ophthalmopathy(TAO).

METHODS: The clinical data of 48 patients(71 eyes)with severe TAO were retrospective analyzed from January 2013 to January 2015.The patients with severe TAO were divided into the exophthalmos(EM)group with 25 patients(35 eyes), compressive optic neuropathy(CON)group with 12 patients(20 eyes)and exposure keratopathy(EK)group with 11 patients(16 eyes).The rectus recession combined with rear suspension scleral fixation treatment was performed in all patients. The visual acuity, clinical activity score(CAS), and diplopia situation of each group were recorded and compared preoperatively and at 6mo postoperatively.

RESULTS: The postoperative best corrected visual acuity(BCVA)of the three groups were significantly higher than those before operation(P<0.01). The postoperative exophthalmos of CON group, MP group and EK group were significantly more improved than those before operation(P<0.01). The eyeballs of patients in CON group retracted significantly more than the other two groups(P<0.01). The CAS was significantly lower after operations than that before operations(P<0.01). The diplopia in patients in CON group decreased more than the other two groups(P<0.05).

CONCLUSION: Rectus recession combined with the rear suspension scleral fixation can help improve the restrictive strabismus caused by TAO, visual acuity, eyeballs to roll back, eliminate the diplopia and to improve the life quality of patients.

Abstract:AIM:To estimate the prevalence and molecular epidemiology of Leber hereditary optic neuropathy(LHON)in the south of North China.

METHODS:Patients suspected with LHON who went to Hebei Ophthalmic Hospital(formerly Xingtai Eye Hospital)from December 2001 to December 2014, were conducted mtDNA(mitochondrial DNA)screening. The patients whose origin were Xingtai, the sourth of North China, were screened out. The LHON families were given detailed follow-up, pedigree investigation and examinations of visual acuity, fundus, color vision, visual field and other clinical exam to diagnose the sick ones in the pedigrees. We took the resident population which date was from the sixth national census in 2010 in Xingtai area as the base, then conducted statistically analysis for those pedigrees to roughly estimate the incidence and molecular genetics characteristics of LHON in this area.

RESULTS:From December 2001 to December 2014, the 463 people from four generations in 33 LHON families were investigated, and 72 patients were diagnosed as LHON, 65 males and 7 females. One patient was found with mutation at T3866C,60 at G11778A,8 at T14484C,2 at G11696A+G11778A, and 1 at G3460A. In the sixth national census in 2010, the population aged 0～64 in Xingtai area was 6 592 466, and the prevalence of LHON was 1.092/100 000(95%CI:0.964～1.22/100 000), and the incidence of G11778A, which was the most common one, was 0.91/100 000(95%CI:0.79～1.03/100 000).

CONCLUSION:The incidence of LHON in Xingtai China is high, the lower limit of prevalence is about 1.092/100 000, and the ND4 is the hot spot region. The mutation at G11778A is the most common one. Male patients were significantly more than female patients.

Abstract:AIM: To survey the prevalence of trachoma in children in Nanzheng County of Shaanxi Province and provide the basis for the prevention and treatment.

METHODS: An epidemiological survey was carried out in Nanzheng County in 2013. Children aged 3～7 years were selected by a cluster sampling. Fifty elementary school children and 1 533 preschool children were selected for rapid assessment and extend screening of trachoma. All children were examined under magnifying glass by oculist. A simplified trachoma classification system which was recommended by the World Health Organization was adopted in the survey. Statistical significance was calculated using Chi-square tests.

RESULTS: For the 50 students aged 6～7 in rural area, there was no active trachoma cases in rapid assessment. In the extended screening in 1 533 children aged 3～6 in country town, no case of active trachoma, trachomatous trichiasis or corneal diseases were examined.

CONCLUSION: No active trachoma case was detected in Nanzheng county,which was far below the proportion of 5% in non endemic area according to the WHO criteria and is not a public health problem in Shaanxi province.

Abstract:AIM:To discuss the application effect of individually performed titanium mesh in infraorbital wall fracture reconstruction.

METHODS:Sixty-seven patients(67 eyes)diagnosed as infraorbital fracture from January 2011 to February 2014 were performed reconstruction with individually performed titanium mesh. The recovery of incision, visual acuity, eyeball mobility, diplopia and proptosis were monitored by post-operation follow-up which lasted for 1a.

RESULTS:No infection, titanium mesh transposition, prolapse, deformities, exclusion or ectropion were occurred in the follow-up period. The eyeball embole was less than 2mm by bilateral proptosis contrast. The diplopia in 5 eyes were disappeared in 4 and approved in one. The eyeball descent in 2 cases was disappeared. The visual acuity was the same compared with pre-operation. The rate of disappeared diplopia at primary position was 93% and improved significantly in the other 3 patients. The rate of disappeared diplopia at peripheral visual field was 86% and improved significantly in the other 2 patients.

CONCLUSION:The reconstruction effect of individually performed titanium mesh in infraorbital wall fracture was satisfied and safe.

Abstract:AIM:To investigate the visual quality after multifocal artificial lenses(MIOLs)implantation through coaxial micro-incision in age-related cataract patients.

METHODS:This was a retrospective non-random case control study. Forty-eight patients(60 eyes)with age-related cataract who underwent coaxial micro-incision phacoemulsification and implantation of AcrySof ReSTOR intraocular lens from February 2013 to August 2014 in the First Affiliated Hospital of Huzhou University were selected as trial group. Thirty-six general information matched senile cataract patients(50 eyes)who underwent coaxial micro-incision phacoemulsification and implantation of monofocal intraocular lens were served as controls. The postoperative uncorrected distance visual acuity and uncorrected near visual acuity, daily visual satisfaction were observed and compared.

RESULTS:Two groups were implanted with intraocular lens successfully. In trial group, at 3mo postoperatively uncorrected distance visual acuity was 0.75±0.25, uncorrected near visual acuity was 0.70±0.18. Patients' daily visual satisfaction was 96%. In control group, at 3mo postoperatively uncorrected distance visual acuity was 0.79±0.36, uncorrected near visual acuity was 0.31±0.11. Patients' daily visual satisfaction was 75%. There were statistically significant differences at 3mo postoperatively on uncorrected near visual acuity and daily visual satisfaction between the two groups(P<0.05), but was no statistically significant difference on postoperative uncorrected distance visual acuity(P>0.05).

CONCLUSION:The trial group(multifocal artificial lenses implantation)is superior to control group on uncorrected near visual acuity and daily visual satisfaction. Two groups have equal result on uncorrected distance visual acuity at 3mo postoperatively.

Abstract:AIM:To observe the clinical effect of comprehensive operation for neovascular glaucoma(NVC).

METHODS:Thirty-nine cases(39 eyes)with late neovascular glaucoma in our hospital from October 2010 to October 2013 were treated with cyclocryotherapy, retina condensation combined with trabeculectomy and anterior vitrectomy. The clinical data were retrospectively analyzed.

RESULTS:All the patients were followed up for 6～12mo. The mean postoperative intraocular pressure(IOP)of 39 cases(39 eyes)was 12.94±2.33mmHg(1mmHg=0.133kPa)at 1wk, compared with preoperative IOP(57.31±6.72mmHg), which was decreased obviously. The pain was alleviated. During follow-up period, IOP of 35 eyes was normal(17.25±2.24mmHg)without using IOP-lowing drugs and the postoperative IOP was decreased to the normal range after using 1～2 kinds of drugs in 4 cases. The iris neovascularization of all patients eliminated at different extent. Conjunctival filtering blebs of 34 cases were dispersion and those of 5 cases were flat. No shallow anterior chamber or eyeball atrophy occurred during follow-up period.

CONCLUSION:The therapy of cyclocryotherapy, retina condensation combined with trabeculectomy and anterior vitrectomy is safe and effective to reduce IOP and relieve suffering in patients with NVG.

Abstract:AIM: To evaluate the clinical effect of trabeculectomy combined with biological amniotic membrane implantation and mitomycin C for acute primary angle closure glaucoma.

METHODS: Twenty-five cases(25 eyes)with acute primary angle closure glaucoma underwent trabeculectomy combined with biological amniotic membrane implantation and mitomycin C. Clinical observations were carried out on the postoperative visual acuity, intraocular pressure, anterior chamber formation, filtering bleb and complications.

RESULTS:Except one patient whose postoperative visual acuity decreased, the visual acuity of others did not changed or improved, and the visual acuity at 1, 3, 7d, and 1mo were significantly different(P<0.05). At 3d to 1wk after operations, the visual acuity reached stable state. There were statistically significant differences on intraocular pressure before and after operations in all patients(P<0.01). The intraocular pressure remained stable during 1a after surgeries. The operation also maintained anterior chamber, formed functional filtering blebs and reduced the risk of complications.

CONCLUSION: Trabeculectomy combined with biological amniotic membrane implantation and mitomycin C is a safe and effective method for acute primary angle closure glaucoma.

Abstract:AIM:To study the reliability of visual electrophysiological examination(pattern visual evoked potentials, P-VEP), fundus photography, visual field and optical coherence tomography(OCT)to evaluating chronic angle-closure glaucoma.

METHODS:Visual electrophysiological examination, fundus photography, visual field and OCT were used to evaluate the chronic angle-closure glaucoma in 96 cases(109 eyes). The correlations were analyzed according to the results of P-VEP, fundus photography, visual field and OCT.

RESULTS:In 96 cases(109 eyes), P-VEP was positive in 72 eyes(66.1%). The P-VEP was no obvious abnormal in 37 eyes(33.9%). Visual field inspection successfully acquired positive cases images in 84 eyes(77.1%), no obvious abnormal in 25 eyes(22.9%). Fundus photography captured positive cases in 87 eyes(79.8%), no obvious abnormal in 22 eyes(20.2%). OCT image captured positive cases in 94 eyes(86.2%), no obvious abnormal in 15 eyes(13.8%). The positive rate of OCT was higher than that of visual field examination, fundus photography, P-VEP examination(P<0.05). The capability of obtaining anterior chamber image by OCT and the three-mirror examination showed no significant difference(P>0.05).

CONCLUSION:Visual electrophysiological examination, visual field, fundus photography and OCT can evaluate the visual function in patients with chronic angle-closure glaucoma for comprehensive assessment.

Abstract:AIM:To explore the clinical effect of needle revision combined with 5-fluorouracil(5-FU)for the disfunctional blebs after trabeculectomy.

METHODS:Needle revision combined with subconjunctival injection of 5-FU treatment was conducted on 30 eyes in 26 patients with disfunctional blebs at clinic visits at 1～4wk immediately after trabeculectomy. The morphology, intraocular pressure(IOP)and complications of the filtering blebs were observed, and all the patients were followed up for 3mo.

RESULTS:The morphology of filtering blebs was normal in 24 eyes after needle revision treatment. The pre-treatment IOP was 26.4±2.8mmHg, and the post-treatment IOP was 14.1±1.1mmHg, and the difference was statistically significant(P<0.05). The cure rate was 70%(21 eyes), effective rate was 17%(5 eyes), and the total was 87%. Common complications included subconjunctival hemorrhage, corneal epithelium dot stripped and hyphema.

CONCLUSION:The combination of needle revision and 5-FU has a good effect for failed filtering blebs after trabeculectomy. It is worthy promotion in clinical treatment.

Abstract:AIM:To investigate the therapeutic outcomes of idiopathic retinal vasculitis, aneurisms and neuroretinitis(IRVAN)syndrome by different treatments.

METHODS:Seven patients(14 eyes)with IRVAN were enrolled in this study and divided into different stages. There were 4 eyes in stage Ⅱ and 10 eyes in stage Ⅲ. The visual acuity(VA)was ≥0.6 in 6 eyes, 0.3 in 4 eyes, and ≤0.1 in 4 eyes. Treatment involved retinal laser photocoagulation for peripheral retinal ischemia area in the 4 eyes in stage Ⅱ and panretinal laser photocoagulation(PRP)for the 10 eyes in stage Ⅲ. Two eyes in stage Ⅲ were also treated with intravitreal injection of ranibizumab and 4 eyes with vitrectomy before PRP. Visual acuity and fundus situations were measured after the treatments. The follow-up time was 6mo ～ 10a.

RESULTS:After treatments, the final VA was improved in 6 eyes, remaining unchanged in 6 eyes, and decreased after improved in 2 eyes. It was as following:≥0.6 in 9 eyes, 0.3～0.6 in 4 eyes, and ≤0.1 in 1 eyes. Four eyes in stage Ⅱ maintained a good vision, but one of them had a new ischemia area. We treated it with PRP and there was no progression now. In stage Ⅲ, there were 2 eyes with unchanged VA, 2 eyes with improved VA, 2 eyes with improved VA after giving ranibizumab, 4 eyes with vitreous hemorrhage and with better VA after treatments, and in the 4 eyes, 2 eyes kept stable and another two had recurrent vitreous hemorrhage for several times and ended with poor vision. Fundus examination showed the closure of hemorrhage area and optic disc or retinal neovascularization shrinked.

CONCLUSION:PRP is effective for eyes in stage Ⅱ. Eyes in stage Ⅲ could be treated with intravitreal injection of ranibizumab or vitrectomy in addition to PRP. Early PRP is effective to stop the progression.

Abstract:AIM:To investigate the clinical effect of intravitreal injection of Ranibizumab for macular edema caused by central retinal vein occlusion(CRVO).

METHODS: Selected 30 patients(30 eyes)from March～September 2015 in our hospital with CRVO complicated by macular edema were treated with intravitreal injection of ranibizumab, 1 time per month, 1～3mo as one course. After treatments, all patients were followed up for 3mo. The best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness and macular edema regressive rate and fundus fluorescein angiography were compared and analyzed.

RESULTS:With the increase of injection times of ranibizumab, BCVA in patients had a gradual increase(P<0.05). Central macular thickness significantly decreased(P<0.05), and IOP had no significant change(P>0.05). After the 1st, 2nd and 3th injection, the macular edema regressive rates were 47%, 68%, 94%.

CONCLUSION:Intravitreal injection of ranibizumab can significantly relieve the macular edema caused by CRVO and improve BCVA of the patients.

Abstract:AIM:To observe the clinical efficacy of puncta drainage and Nd:YAG laser dacryocystoplasty with silicone tube stents for acute dacryocystitis complicated by abscess formation.

METHODS:A total of 28 patients who were diagnosed as acute dacryocystitis with abscess formation during the period from December 2011 to December 2014 were treated with puncta drainage and Nd:YAG laser dacryocystoplasty with silicone tube stents. The silicone tube stents were removed after 6mo, and the patients were followed up for at least 6mo. The situation of epiphora, suppurating, abscess absorption and other complications were observed.

RESULTS:In the first 6mo postoperatively, improvement or absence of the epiphora, unobstructed lacrimal duct occurred in all the patients, and there was no recurrence of the lacrimal inflammation or pyorrhea. The silicone tube stents were removed at 6mo postoperatively, the follow-up period was 6mo after removal of the silicon tube stents. There were 13 eyes cured and 7 eyes improved, and the total effective rate was 71%. No improvement was observed in 8 eyes, accounting for 29%.

CONCLUSION:The puncta drainage and Nd:YAG laser dacryocystoplasty with silicone tube stents is an effective treatment for acute dacryocystitis complicated by abscess formation. But the recurrence rate is high, and another surgery is needed in such cases.

Abstract:AIM:To compare the canalicular diameter when eyes opened and closed using ultrasound biomicroscope.

METHODS:Twenty volunteers(20 eyes)with nasolacrimal duct obstruction were included. The lower canaliculus of one eye in every volunteer was detected and measured with ultrasound biomicroscope when eyes opened and closed. Before measurements sodium hyaluronate was injected through the upper lacrimal puncta until it overflowed from the lower lacrimal puncta. The length of the vertical canaliculus, anteroposterior diameter of the vertical canaliculus at the proximal, middle, distal, anteroposterior diameter and vertical diameter of the horizontal canaliculus at the proximal, middle, distal were measured. According to elliptical area formula S=πab(a =1/2 anteroposterior diameter,b=1/2 vertical diameter), transverse area of the horizontal canaliculus at the distal, middle and proximal were calculated. The differences of measurement when eyes opened and closed were compared by paired t test.

RESULTS:When eyes opened and closed, the length of vertical canaliculus of inferior canaliculus were respectively 2.56±0.33 and 2.76±0.34mm; anteroposterior diameters at the distal part were respectively 0.29±0.04 and 0.32±0.04mm; those at the middle were respectively 0.32±0.03 and 0.35±0.04mm; those at the proximal were respectively 0.38±0.02 and 0.40±0.04mm and those differences between opened and closed eyes were statistically significant(t=-5.346, -5.12, -4.94, -4.682; P<0.05). When eyes opened and closed, the transverse ereas of horizontal part of lower canaliculus at the distal were respectively 0.88±0.18 and 0.95±0.15mm²; those at the middle were respectively 0.67±0.04 and 0.75±0.08mm²; those at the proximal were respectively 0.51±0.10 and 0.56±0.15mm² and those differences between opened and closed eyes were statistically significant(t=-7.453, -6.73, -6.43; P<0.05).

CONCLUSION:Compared with the opened eyes, the vertical length of lower canaliculus become shorter, the anteroposterior diameter of vertical canaliculus and transverse areas of horizontal canaliculus become smaller.

Abstract:AIM:To investigate the application of RetCamⅢ in the screening of infants' ocular diseases.

METHODS:RetCamⅢ images were taken in 89 infants aged 6 months to 2 years who needed screening for retinopathy from July 2013 to July 2015, two of which received fundus fluorescein angiography(FFA)examination under general anesthesia.

RESULTS:In the 89 infants, there were familial exudative vitreoretinopathy(FEV)in 19 cases, persistent hyperplastic primary vitreous in 16 cases, retinoblastoma in 12 cases, external exudative retinopathy in 12 cases, congenital coloboma of choroid in 9 cases, congenital nystagmus in 8 cases, optic disc hypoplasia in 6 cases, retinopathy of prematurity at advanced stage in 5 cases and optic neuritis in 2 case. Based on FFA examination, one of the two infants received FFA was diagnosed as optic neuritis, the other was diagnosed as FEV.

CONCLUSION:RetCamⅢ that plays an important role in early diagnosis and visual rehabilition can be trusted to screen the retinopathy in infants.

Abstract:AIM:To evaluate the therapeutic effect of periorbitally injected triamcinolone acetonide(TA)for thyroid-associated ophthalmopathy.

METHODS:Thirty-six patients(60 eyes)diagnosed as thyroid-associated disease by many related academics were collected in the past two years, 12 male(18 eyes)and 24 female(42 eyes), 12 cases with monocular, 24 with binocular, aged 23～40 years, mean 33±5 years. Their course of diseases were 2mo～4a, mean 15mo.The therapy of TA:20mg for each eye once, every 3～4wk, 3～4 times as one course. The injection point and method:the patient took the supine position, the skin around the ocular was disinfected twice with entoiodine; the patient was asked to look upward, the needle entered at the 1/3 lateral-mid point; then the needle reached the equator along the paries superior orbitae; after that, the direction of the needle changed to slightly towards inferior nasal; the depth was about 35mm; the patient was asked to move his eyeball towards different directions; 1mL of the medicine was injected to the retrobulbar after making sure the eyeball was not injured and no blood in the syringe if its plunger was draw back; sterile gauze was pressed against the eyeball and make sure there was no hemorrhage or other discomforts. Observation for the therapeutic effect, including the improvement of eye symptoms and signs, after one course.

RESULTS:TA had a significant efficience for relieving phengophobia(χ²=19.326,P<0.01),epiphora(χ²=8.500,P<0.01),eye-bulging(χ²=8.500, P<0.05), sensation of dryness(χ²=8.025,P<0.01), eyelid-swollening(χ²=8.743,P<0.01), but ocular movement, diplopia and Von Graefes symptom were not improved(separately P were 0.144,0.530,0.589, all P>0.05).Besides, protopsis(16.082±2.503mm)as compared to(16.875±3.143mm)and Dalrymple symptom(0.950±1.167mm)as compared to(3.100±1.633mm)were exactly improved(P<0.01)after treatments.But intraocular pressure(IOP)of our group did not increase before and after treatments(P=0.081).

CONCLUSION:Periorbitally injected TA can improve protopsis,Dalrymple symptom and local ocular symptoms, and all patients we treated were at an normal IOP. But ocular movement, diplopia and Von Graefes symptom were not improved.

Abstract:AIM:To study the differences of accommodative responses between the two eyes under 3 different polarized viewing conditions.

METHODS:Fifteen volunteers with emmetrope were recruited into this study(aged 18～38), 6 males and 9 females. Three different viewing conditions were set up by using polarizing glasses and liquid crystal display:(1)right eye could see the visual target on the screen, but left eye cannot see it;(2)left eye could see the visual target on the screen, but right eye cannot see it;(3)both eyes could see the target. Accommodative responses were measured by infrared auto-refractor when fixating at the target at 5, 2, 1, 0.5 and 0.33m under the above 3 viewing conditions. The differences of accommodative responses under different viewing conditions were compared by using variance analysis of repeated measuring and t test.

RESULTS:Significant differences of accommodative responses between the two eyes were found under condition(1)and(2)at all the fixating distance. The accommodative responses in used eyes which can see the visual target were higher than in non-used eyes which cannot see the visual target(P<0.05). No differences of accommodative responses were found under condition(3)at all distance(P>0.05).

CONCLUSION:Ciliary muscles in the used eyes were more relatively tonic than non-used eyes under binocular open viewing condition. The imbalance of accommodative responses between two eyes may be one of the risk factors resulting into the occurrence of myopia.

Abstract:AIM: To compare the repeatability and agreement between different instruments on peripheral retina refractive error measurement.

METHODS: Streak retinoscopy, Shin-Nippon K5001 Auto-refractor and Aberrometor(COAS)were used to measure 28 participants' central and peripheral retinal field refractive errors.

RESULTS: Spherical equivalent value(M)were repeatable on Aberrometor and Shin-Nippon K5001 Auto-refractor(mean difference≤±0.10D),with poor repeatability on streak retinoscopy. There were good agreement between Aberrometor and Shin-Nippon K5001 Auto-refractor measurements.

CONCLUSION: Aberrometor and Shin-Nippon K5001 Auto-refractor both are valid tools for the central and peripheral refractive error measurement.

Abstract:AIM:To observe the changes of ocular surface inflammation and tear film state before and after the operation after preoperative targeted therapy for Meibomian gland in the patients scheduled for IntraLase-LASIK with Meibomian gland dysfunction(MGD).

METHODS: Thirty-five patients(70 eyes)scheduled for IntraLase-LASIK with different degrees of MGD from March to September 2014 were enrolled in this study. All patients were randomly divided into 2 groups, 17 patients(34 eyes)in the observation group accepted preoperative targeted therapy for Meibomian gland; 18 patients(36 eyes)in the control group did not give the treatment for Meibomian gland, the rest treatments were the same. The change of conjunctival congestion, photophobia, dry symptom score and tear break-up time(BUT)were observed at 1d and 1wk after IntraLase-LASIK.

RESULTS: At 1d and 1wk postoperatively, the scores of conjunctival congestion, photophobia, dry symptom and BUT of the observation group were all lower than those of the control group, and the differences were significant(P<0.05).

CONCLUSION: For the patients scheduled for IntraLase-LASIK with MGD, preoperative targeted therapy for Meibomian gland can reduce the postoperative symptoms of ocular surface irritation, stabilize the tear film, improve the postoperative effect and improve the comfort of patients.

Abstract:AIM:To analyze the operation time selection and effect observation of the surgery for children with partially accommodative esotropia to provide the reference for treatments.

METHODS:Fifty-two children with partially accommodative esotropia received surgeries in our hospital were selected, and they were divided into group A(10 cases), group B(25 cases)and group C(17 cases)according to operation time. The patients in group A were taken surgical treatment when the disease was diagnosed within 1a, those in group B were taken treatments within 1～3a, while those in group C were treated over 3a. The operation efficacy was compared.

RESULTS:There were 88% >6 years children developed stereo vision after surgeries, which was significantly higher than those < 3 years(30%, P<0.05).The chance for the patients to develop stereo vision was obviousely correlated with the operation time. The rates of patients who develop stereo vision after operations were 80% in group A and 76% in group B, both of which were significantly higher than that(41%)in group C(P<0.05). The efficacy rates of group A and group B were 90%, 88% respectively, both of which were significantly higher than that(71%)of group C(P<0.05).

CONCLUSION:Children with partially accommodative esotropia should receive surgical treatment as early as possible once they are 6 years old. The surgical amount should be decided by the esotropia deviation and the uncorrected visual acuity.