Abstract:AIM: To evaluate the epidemiological and etiological factors of microbial keratitis seen in tertiary hospitals in West and East Malaysia.

METHODS: A total of 207 patients were enrolled. Patients referred for microbial keratitis to Sungai Buloh Hospital and Kuala Lumpur Hospital in West Malaysia and Queen Elizabeth Hospital and Kuching General Hospital in East Malaysia were recruited. Risk factors were documented. Corneal scrapings for microscopy and culture were performed.

RESULTS: The most common risk factor in West Malaysia was organic trauma(28.5%)followed by non organic trauma(18.3%); 27.7% of trauma cases was work related with 34.2% involving male foreign workers. The most common risk factor in East Malaysia was contact lens wear(32.9%). Pseudomonas aeruginosa was the most common organism isolated in both places. The most common fungal pathogen in West Malaysia was Fusarium spp representing 60% of all positive fungal cultures.

CONCLUSION: In West Malaysia organic trauma was the most common risk factor seen in public hospitals here whereas, contact lens wear was the most common risk factor in East Malaysia(P<0.05). Fungal keratitis was more commonly seen in West Malaysia.

Abstract:AIM: To assess the anterior corneal astigmatism(ACA)and posterior corneal astigmatism(PCA)patterns across various age groups. We also evaluated the association between magnitudes and axes of the ACA and PCA across these age groups.

METHODS: The present study was a cross-sectional analysis of clinical data of 381 eyes. We converted the clinical astigmatic notation to vector notation for analysis of ACA and PCA. We estimated the correlation between magnitude and axes of the ACA and PCA in the whole population and in four age groups(5-19, 20-39, 40-59, and ≥ 60y). We used random effects linear regression models for estimating the association between the magnitudes of ACA and PCA.

RESULTS: The mean of the magnitude of the ACA(3.59D)and the PCA(0.50D)was highest in children(5 to 9y). Overall, the magnitude of the ACA ranged from 0D to 10.0 Diopters(D)and the magnitude of the PCA ranged from 0 to 3.5 D. There was a significant correlation between the ACA and the PCA in the younger age group(r=0.85, P<0.001). In those 60y or older, the PCA increased by 0.04 units(95% confidence intervals: 0.005, 0.07; P=0.03)with each unit increase in the ACA, the increase was the smallest in this age group.

CONCLUSION: It will be prudent to measure the both the magnitude and axis of the PCA, particularly in those above 60y rather than rely on rule-of-thumb calculations based on ACA parameters for IOL power calculation.

Abstract:AIM: To evaluate the potential posterior segment effects of topical application of brimonidine-purite 0.15% through measurement of choroidal thickness(CT)in healthy eyes using enhanced depth imaging spectral-domain optical coherence tomography(EDI-SD-OCT).

METHODS: Thirty-two eyes of 32 healthy subjects were included in this prospective, placebo-controlled interventional clinical trial. They received one drop of topical preservative-free artificial tears as placebo for the first day and one drop of brimonidine-purite 0.15% for the second day. Intraocular pressure, ocular perfusion pressure(OPP), and EDI-SD-OCT were performed at baseline, at 1, 3 and 5h after the treatments.

RESULTS: Compared to the measurements obtained at baseline, the CT measurements obtained after the topical application of brimonidine-purite 0.15% significantly increased at the sub-fovea(P=0.001), at temporal 1500 μm to the fovea(P=0.003)and at nasal 1500 μm to the fovea(P=0.003). Choroidal thickness was unchanged in placebo group during the study(P >0.05). There was no significant reduction in the OPP in both groups(P >0.05). There were no adverse events during the study.

CONCLUSIONS: Contrary to expectations, topical administration of brimonidine-purite 0.15% resulted with thickening of sub-foveal, temporal and nasal CT. This might be related to altered auto-regulation mechanisms in choroidal vessels.

Abstract:AIM: To evaluate if early ethambutol toxicity can be detected by comparing pre-and post-treatment anatomical and visual function using retinal nerve fiber thickness, pattern visual evoked potentials and conventional optic nerve function tests.

METHODS:This was a prospective study involving 72 eyes of 36 patients treated with ethambutol according to directly observed treatment short-course(DOTS)strategy in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. The visual acuity and optic nerve function tests were performed by a single investigator. Likewise, Humphrey automated perimetry, optical coherence tomography(OCT)measurement of the retinal nerve fibre layer(RNFL)and pattern visual evoked potential(PVEP)were performed by a single technician. The examinations were performed before initiating ethambutol treatment and 3mo after that.

RESULTS: There was no change in visual acuity, colour vision, light brightness, red saturation and fundus findings pre and post ethambutol. However, there was a statistically significant deterioration in the mean deviation of the visual field post treatment(P=0.010). There were also significant changes on OCT and PVEP, with increased RNFL thickness in all quadrants(P<0.05)and PVEP delayed P100 peak latency and amplitude(P<0.001).

CONCLUSION: Ethambutol toxicity is a known complication of tuberculosis treatment. Early detection of this toxicity may prevent severe irreversible visual loss. The use of OCT to detect RNFL thickness and PVEP to assess P100 latency and amplitude can assist in the detection of subclinical anatomical and visual function changes prior to development of abnormalities on conventional optic nerve function tests.

Abstract:AIM: To determine the pattern and prevalence of ocular disorders among artisans with a view to make recommendations to the appropriate ministries for the formulation of necessary policies to preserve the ocular health status of these artisans.

METHODS: This was a descriptive cross sectional study in which the sample population was selected using the proportion to size technique and simple random sampling.

RESULTS: There was a high prevalence of degenerative conjunctival disorders among the artisans with pingueculum topping the list at 30.1%. Automobile mechanics had the highest prevalence for conjunctival disorders, corneal opacities, and allergic conjunctivitis. Superficial foreign bodies(74.4%)were the most common work related injury observed while 13.6% of the artisans developed cataract from work related injuries.

CONCLUSION: Governmental policies targeted at preserving and maintaining the ocular health of the artisans is needed to reduce the prevalence of ocular disorders noted in this study.

Abstract:AIM: To study the effect of diallyl trisulfide(DATS)on experimental corneal neovascularization(CNV)in rats induced by corneal suture and detect the expression of vascular endothelial growth factor(VEGF)and p-AKT in rats cornea.

METHODS: The rat model of corneal neovascularization(CNV)was induced by corneal suture. Rats were randomly divided into Group A: physiological saline control group containing DMSO(10 rats); Group B: 25μmol/L DATS treatment group(10 rats); Group C: 50μmol/L DATS treatment group(10 rats); Group D: 100μmol/L DATS treatment group(10 rats); Group E: 200μmol/L DATS treatment group(10 rats). The occurrence and development of CNV were observed by slit-lamp microscope at 7d after suture, and the area of CNV were calculated.Two weeks later, HE staining was used to observe the pathological organization form of each cornea, and RT-PCR and Western blot were used to detect the expression of VEGF mRNA and protein expression of VEGF and p-AKT between each groups.

RESULTS: The blood vessel area of Group C, D and E was compared with that of Group A, the difference was statistically significant(P<0.05); HE slice showed corneal edema, angiogenesis and inflammation infiltration situation gradually reduced comparing with the Group A, with the increase of concentration of DATS. RT-PCR showed the expression of VEGF mRNA in Group B, C, D, and E decreased compared with the Group A, and the difference was statistically significant(P<0.05). Western-blot showed that the expressions of VEGF and p-AKT in Group B, C, D and E decreased gradually compared with those in Group A, and the difference was statistically significant(P<0.05).

CONCLUSION: DATS can inhibit corneal neovascularization of the rats induced by suture. Its mechanism may be associated with suppression of VEGF secretion, down-regulation of VEGF and inactivation of p-AKT.

Abstract:AIM:To verify the safety application of MIL60 in the treatment of corneal neovascularization both in vivo and in vitro.

METHODS: We observed the biological characteristics of human corneal epithelial cells. The cell proliferation was analyzed using CCK-8 assay, which also used to test the toxicity of MIL60 and the solvent on cultured human corneal epithelial(HCE). FACs was used to analyze the apoptosis of HCE after treated with MIL60. Also we evaluated the effect of subconjunctival injection of MIL60 on corneal epithelial healing model in normal rat and rats with epithelium defect through slit lamp-microscopy, Draize scores and histopathology way.

RESULTS: The proliferation speed of HCE in three groups was the same. MIL60 did no harm on the proliferation of HCE and the apoptosis of HCE, and has no effect on corneal epithelial healing and other parts of the ocular in rats without inflammation cells infiltration.

CONCLUSION: When given subconjunctival injection, Mil60 does no harm to the proliferation and apoptosis of HCE, and is safe with ocular application.

Abstract:AIM: To investigate the combination therapeutic effect of Ginkgobalide B(GKB)and retinal stem cells(RSCs)transplantation on glaucoma in rats.

METHODS: Rats were divided randomly into five groups: control group, glaucoma group, RSCs group, GKB group and RSCs combination therapy group. A chronic glaucoma model was established in rats, accordingly. The morphological changes in ocular tissues were analyzed by HE staining. Retinal ganglion cells apoptosis were analyzed by TUNEL staining. The protein expressions of Bcl-2, Bax, Cleaved caspase-3 and Cleaved caspase-9 were determined by Western blot. The mRNA levels of Bcl-2 and Bax were determined by qPCR.

RESULTS: HE staining revealed that RSCs transplantation or GKB treatment decreased fiber interstitial edema and vacuole, as compared to glaucoma group. Furthermore, this improvement was more pronounced in combination therapy group than in single treatment alone. Combination therapy significantly inhibited retinal ganglion cells apoptosis, increased Bcl-2 mRNA and protein expression,but decreased Bax mRNA and protein expression. Moreover, the protein expression of Cleaved caspase-3 and Cleaved caspase-9 expression were decreased after combination therapy.

CONCLUSION: Our data demonstrate that combination of Ginkgobalide B and retinal stem cells transplantation can inhibit retinal ganglion cells apoptosis and protect against glaucoma. These effects may be associated with the regulation of Bcl-2, Bax, Cleaved caspase-3 and Cleaved caspase-9 expression.

Abstract:AIM: To compare the effect of compound electrolyte solution and lactated Ringer's solution on corneal function in cataract phacoemulsification, and to provide scientific basis for clinical selection of appropriate perfusion fluid.

METHODS: The patients with senile cataract were randomly divided into control group with lactated Ringer's solution as anterior chamber perfusion and experimental group with compound electrolyte as anterior chamber perfusion. Surgical removal of cataract and phacoemulsification with intraocular lens implantation were taken. The corneal endothelial cell density, central corneal thickness, hexagonal cell ratio and endothelial cell coefficient of variation were measured at preoperative and postoperative points.

RESULTS: Totally 60 patients successfully completed all follow-ups, the experimental group of 30 cases, the control group of 30 cases. The density of corneal endothelial cells in experimental group was significantly higher than those in the lactated Ringer's solution group at 1 and 3d after operations(P=0.030, 0.046). The coefficient of variation of corneal endothelial cells in lactated Ringer's solution group was higher than that in compound electrolyte group at 1 and 14d after operation(P=0.025, 0.014). The visual acuity of the compound electrolyte group was better than that of the lactated Ringer's solution on the first day after operation(P=0.04).

CONCLUSION: In the phacoemulsification of senile cataract, the compound electrolyte perfusion has better histocompatibility, which can maintain the stability of corneal endothelial cell structure and reduce corneal endothelial cell injury. The compound electrolyte perfusion solution is more suitable for senile cataract phacoemulsification surgery.

Abstract:AIM: To explore the effect of phacoemulsification combined with goniosynechialysis for cataract patients with glaucoma.

METHODS: From May 2013 to December 2014, 120 eyes of 113 patients with cataract and glaucoma admitted to our department were selected, and their clinical data were retrospectively analyzed. Among them, 88 eyes received phacoemulsification combined with goniosynechialysis(Group A), 32 eyes received phacoemulsification(Group B). All the patients were followed up at 1wk, 1, 2, and 6mo and 1a postoperatively. The visual acuity, intraocular pressure, visual field, anterior chamber depth and angle changes before and after the surgery were compared between the two groups.

RESULTS: Vision: at each follow-up time point, their vision was improved significantly than before the surgery(P<0.05)in both the groups, and Group A was significantly better than that in Group B(P<0.05). Intraocular pressure: compared with preoperative data, it decreased significantly at each follow-up time point(P<0.05), and Group A significantly decreased much more compared with Group B(P<0.05). Visual field: compared with preoperative data, it increased significantly at each follow-up time point(P<0.05), and Group A significantly had better effect than Group B(P<0.05). After the surgery, the anterior chamber depth were evidently higher than those before the surgery(P<0.001), and Group A significantly had higher anterior chamber depth than Group B(P<0.05). The angle grading after the surgery were improved remarkably than before the operation(P<0.05), and Group A was significantly superior to Group B. There were no serious complications in the two groups.

CONCLUSION: Compared with simply phacoemulsification, phacoemulsification combined with goniosynechialysis is safer, and has better effectiveness for cataract patients with glaucoma. In addition, the latter has advantages in increasing the depth of the anterior chamber, and improving the openness of angle, as well as improving the vision and visual field, while reducing the intraocular pressure.

Abstract:AIM: To observe the effect of panretinal photocoagulation(PRP)combined with anti-vascular endothelial growth factor(VEGF)drugs in the treatment of severe non proliferative diabetic retinopathy(NPDR), and to investigate the influence of the treatment on the prognosis of NPDR patients.

METHODS: Totally 120 patients(227 eyes)with NPDR diagnosed by fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)were randomly divided into observation group(60 cases, 112 eyes)and control group(60 cases, 115 eyes). Patients in the observation group were treated by PRP combined with anti-VEGF drugs, while patients the control group were treated with PRP alone. The clinical efficacy and complications of the two groups were compared. Before and after treatment, the best corrected visual acuity(BCVA), central macular thickness(CMT), levels of serum VEGF and angiopoietin 2(Ang-2)in the two groups were analyzed.

RESULTS: The total effective rate of the observation group was significantly higher than that of the control group(P<0.05). Compared with before treatment, BCVA of the two groups in the time of 2wk, 1, 3 and 6mo after treatment improved significantly(P<0.05). And the BCVA of the observation group at each time point after treatment was better than that of the control group(P<0.05). Compared with before treatment, the CMT and the levels of VEGF and Ang-2 in the observation group decreased significantly starting at 2wk after treatment(P<0.05). While those in the control group decreased significantly starting at 1mo after treatment(P<0.05). The levels of VEGF and Ang-2 in the observation group at each time point after treatment was lower than that of the control group(P<0.05). CMT of the observation group were significantly lower than that of the control group in the time of 1, 3 and 6mo after treatment(P<0.05). There was no significant difference in the total complication rate between the two groups(P>0.05).

CONCLUSION: PRP combined with anti-VEGF drugs could effectively improve vision of NPDR patients, alleviate macular edema, and improve the clinical efficacy.

Abstract:AIM: To systematically evaluate the effects of non-steroidal anti-inflammatory drugs(NSAIDs)administrated at different time points on the incidence of cystoid macular edema(CME)following phacoemulsification.

METHODS: The Cochrane Library, PubMed, BMC, National Knowledge Infrastructure(CNKI), and VIP databases were searched to identify the clinical randomized controlled trials of comparing effects of NSAIDs administered at different time points on the incidence of CME and the central foveal thickness following phacoemulsification. The experiment group received topical NSAIDs preoperatively and postoperatively, while the control group received topical NSAIDs postoperatively. The RevMan software 5.2 and Stata software 12.0 were used in the Meta-analysis.

RESULTS: Six studies were included in this Meta-analysis. No statistically differences were observed in the incidence of CME after 1wk postoperatively(OR=1.58, 95%CI: 0.48-5.18, P>0.05), in the incidence of CME after 1mo postoperatively(OR=0.78, 95%CI: 0.30-2.00, P>0.05), in the central foveal thickness after 1wk postoperatively(WMD=-7.20, 95%CI: -15.17 to 0.77, P>0.05), and in the central foveal thickness after 1mo postoperatively(WMD=-3.98, 95%CI: -14.05 to 6.08, P>0.05). However, statistically significant differences were found in the incidence of CME after 3mo postoperatively (OR=0.22, 95%CI: 0.11-0.43, P<0.01)and in the central foveal thickness after 3mo postoperatively(WMD=-18.25, 95%CI: -33.80 to -2.70, P<0.05).

CONCLUSION: A combination of NSAIDs administrated preoperatively and postoperatively can reduce the incidence of the CME and the thickness of the macular centrall. Thereby, the effects of administrating NSAIDs both preoperatively and postoperatively have more advantages than that of administrating NSAIDs postoperatively alone.

Abstract:AIM: To investigate and evaluate the effectiveness and safety of tobramycin and dexamethasone ointment in the treatment of blepharitis.

METHODS: We searched in Pubmed, Medline, Embase, Elsevier, Cochrane Library, Wangfang database, CNKI, VIP database, Sinomed database, and gray literature were performing manual. The efficiency, intraocular pressure, adverse reactions and extract valid data were evaluated.

RESULTS: Totally 8 controlled trials were enrolled, including 970 patients. Compared with control groups, the efficiency and the intraocular pressure in experiment group had a statistically significant increase(RR=1.75, 95%CI=1.29-2.37, P=0.0003; SMD=1.30, 95%CI=0.85-1.75, P<0.00001), and there was no statistic difference in adverse reactions(RR=1.64, 95%CI=0.86-3.10, P=0.13).

CONCLUSION: Tobramycin and dexamethasone ointment in treatment of blepharitis is effective with no adverse effects. Due to the quality of the literature is low, there is still need high quality randomized controlled trials.

Abstract:Age-related eye diseases are a set of ophthalmic diseases caused by aging and irreversible degeneration in the eye. Glaucoma, cataract, and age-related macular degeneration(AMD)are some of the common age-related eye diseases. Inflammation and oxidative stress play important roles in the initiation and progression of these diseases. Resveratrol, a natural plant antitoxin, fights oxidative stress and inflammation by regulating multiple cellular transduction pathways; and it has become a focal point in anti-aging research and has seen significant research progress during recent years. At the present, investigation into the relationship between resveratrol and age-related eye diseases is still in its infancy. This paper focuses on elaborating new research progress on resveratrol's role in age-related eye diseases.

Abstract:Retinalvein occlusion(RVO)is the most common retinal vascular disease. The main causes of visual impairment and blindness are macular edema and retinal neovascularization. Drug therapies are the effective and safe method in the treatment of RVO currently. The main drugs conclude corticosteroid drugs, anti-vascular endothelial growth factor drugs, thrombolytic drugs and traditional drugs. This article reviews the recent progress in RVO in order to provide some valuable references for clinical treatment.

Abstract:Bone marrow mesenchymal stem cells(BMSCs)are a class of cells that can differentiate into different kind of corneal cells both in vitro and in vivo, which include corneal epithelial cells, limbal epithelial cells and corneal stromal cells. BMSCs could differentiate into corneal epithelial cells after transplantation, which can not only repair the damaged corneal, but also relieve inflammatory injury caused by the inflammatory cell infiltration. The other function of BMSC transplantation is to reduce the rejection after corneal transplantation by inhibiting cell damage and apoptosis. BMSC can also express a variety of factors on the carrier, these factors paly the important role in promoting the proliferation of limbal stem cells. These findings above provide a new direction for the fundamental study of ophthalmology, and put forward new clinical treatment ideas for corneal disease, both of them have broad protect for development. In this paper, the research status and progress of BMSC in the repair of corneal injury are reviewed.

Abstract:Anti-vascular endothelial growth factor(VEGF)drugs can effectively treat the diseases which related with the formation of pathological angiogenesis. However, after the intravitreal injection of anti-VEGF drugs, the distribution of this drugs in our eyes will have certain impact on different organizations, due to its specifical mechanism of action. Previously, the studies mainly concentrated on the structures which are rich in vascular tissues. Nevertheless, the structures which are lack of vascular tissues is often overlooked. This article viewed the influence of lens after intravitreal injection of anti-VEGF drugs on early development of the lens, and when it was injected during or after the cataract operation.

Abstract:Given the poor prognosis of proliferative diabetic retinopathy(PDR), the morbidity of PDR has also increased recent years. Modern surgery has undergone a very impressive development over the last 10a due to the evolution of methods, techniques and extension of surgical indications. In this article, we will review the current choices of the surgery time, perioperative managements, as well as the methods of the vitrectomy.

Abstract:Optical coherence tomography angiography(OCTA)is a new technology of angiography in recent years. In addition to the advantages of traditional OCT, it can observe blood flow in different retinal and choroidal segmentation slab. By using the pseudo-color, abnormal vascular structure can be distinguished from normal vascular structure of the retina. Dye injection is not needed with OCTA, which is different from fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA). OCTA provides more and more accurate blood flow information. However, like other biometric technology, OCTA has its limitations and shortcomings. This review will analyze and summarize the operating principle of OCTA, its application in ophthalmology, as well as its advantages and limitations.

Abstract:AIM: To compare the changes of surgically induced corneal higher-order aberrations after phacoemulsification with 2.8mm clear corneal incisions at different sites.

METHODS: The clinical data of 100 cases(100 eyes)of patients with cataract treated by phacoemulsification with 2.8mm clear corneal incision in our hospital from March 2015 to April 2016 were analyzed retrospectively. According to the site of incision, they were divided into Group A(temporal clear corneal incision, n=55)and Group B(upper clear corneal incision, n=45). Changes of the best corrected visual acuity(BCVA), surgically induced astigmatism(SIA)and corneal topography were compared between the two groups before surgery, at 1d, 1wk, 1 and 3mo after surgery. The corneal wavefront aberrations were measured by wavefront aberration analyzer, and the changes of higher-order aberrations in corneal 6mm range were recorded.

RESULTS: The BCVA of two groups decreased at 1d, 1wk, 1 and 3mo after surgery(P<0.05), and the BCVA of Group A at 1d, 1wk, and 1mo after surgery was lower than that of Group B(P<0.05). SIA of the two groups decreased at 1wk, 1 and 3mo after surgery(P<0.05), and the SIA of Group A at different time points after surgery were lower than those of Group B(P<0.05). The surface asymmetry index(SAI)and the surface rule index(SRI)of the two groups increased at 1d after surgery, and were gradually decreased at 1wk, 1 and 3mo after surgery. The SRI and SAI in Group A were lower than those in Group B at 1d and 1wk after surgery(P<0.05). The total corneal higher-order aberrations(tHOAs)and four-order spherical aberration(SA)showed significant differences between the two groups at 3mo after surgery(P<0.05).

CONCLUSION: The application of 2.8mm temporal clear corneal incision in phacoemulsification can promote the recovery of visual acuity, reduce the effect of surgery on corneal shape, and reduce corneal higher-order aberrations.

Abstract:AIM: To observe the tear film and corneal endothelial cell density in cataract patients with high myopia.

METHODS: From January 2016 to December 2016,38 cases(38 eyes)with high myopia and cataract were selected as study group, 24 males(24 eyes)and 14 females(14 eyes), average 65.2±2.37(60-72)years old. Age-related cataract patients without high myopia were as control group, 22 males(22 eyes)and 16 females(16 eyes), average 64.4±2.43(61-70)years old. The tear film and corneal endothelial cell density of the two groups were observed at 3, 7, 14d and 1mo after operations.

RESULTS: Between the two groups of preoperative SⅠt, BUT, FL, subjective rating, corneal endothelial cell density comparison, there were no statistically significant difference(P>0.05). In the two groups at 3, 7, 14d and 1mo after operations, BUT, FL, corneal endothelial cell density, subjective score comparison, the difference had statistical significance(P<0.01). Two groups after 3, 7, 14d comparative differences of SⅠt were statistically significant(P<0.01), not statistical significant at postoperative 1mo(P>0.05). At postoperative 3, 7, 14d, 1mo, FL, subjective rating, corneal endothelial cell density of the two groups were compared with preoperative, the difference was statistically significant(P<0.01).In the two groups at 3, 7, 14d after operation, SⅠt compared with the same group preoperative difference was statistically significant(P<0.01), no statistical significance when postoperative 1mo compared with preoperative(P>0.05). BUT of high myopia patients with age-related cataract surgery, at 3, 7, 14d and 1mo after operations decreased than preoperative, the difference was statistically significant(P<0.01). Age-related cataract patients without high myopia at 3, 7, 14d after operation decreased than preoperative, the difference was statistically significant(P<0.01), there was no statistically significant difference between preoperative and postoperative 1mo(P>0.05).

CONCLUSION: Phacoemulsification cataract surgery in the treatment of high myopia cataract patients is safe and reliable, and less influence on tear film and corneal endothelial cell density.

Abstract:AIM: To compare the clinical effects of improved phacoemulsification through limbus tunnel incision versus manual small-incision cataract surgery on ophthalmic operation vehicle.

METHODS: Totally 261 patients(261 eyes)were enrolled in non-randomized controlled retrospective study. There were 160 eyes of Group A were treated with improved phacoemulsification through limbus tunnel incision; 101 eyes of Group B were treated with manual small-incision cataract extracapsular extraction. Both of the two groups were implanted PMMA IOL during the surgery and were follow-up for postoperative 30d. The surgical operation time and surgical complications of the two groups were compared. Uncorrected visual acuity(UCVA)and surgery induced astigmatism(SIA)were recorded at postoperative 1, 7 and 30d.

RESULTS:The operation time of improved phacoemulsification through limbus tunnel incision was shorter than that of manual small incision cataract extraction(t=-6.419, P<0.001). UCVA greater than or equal to 0.5 of Group A were 110(68.8%), 115(71.9%)and 121(75.6%)at postoperative 1d, 7d and 30d, and that of Group B were 55(54.5%), 63(62.4%)and 68(67.3%). UCVA of Group A was better at postoperative 1d(χ²=5.441, P=0.020). The differences of UCVA greater than or equal to 0.5 between the two groups were not statistically significant at postoperative 7d and 30d. The overall difference of SIA between the two groups was not statistically significant(F=2.135, P=0.145). The difference of SIA within the two groups was statistically significant(P<0.001)in different point time. The difference in the methods of improved phacoemulsification through limbus tunnel incision and manual small incision cataract extraction was not sifnificant on SIA in different time points(F=1.314, P=0.264). There was no statistically significant difference between the two groups in posterior capsular rupture and corneal edema(P>0.05), but the difference in the anterior chamber reaction between the two groups was statistically significant at postoperative 1d(χ²=5.293, P<0.05).

CONCLUSION: Improved phacoemulsification through limbus tunnel incision has advantages over shorter operation time, better visual recovery, few syndromes and is worth promoting on ophthalmic operation vehicle.

Abstract:AIM: To study and analyze the clinical effect of single incision and double incision phacoemulsification, foldable intraocular lens implantation combined with trabeculectomy triple surgery in the treatment of glaucoma with cataract.

METHODS: The study was from January 2016 to February 2017 in our hospital including 68 patients(79 eyes)with glaucoma and cataract. All patients were divided into two groups(observation group and control group); the control group only take single incision surgery; the observation group was taken two incision triple operation method for treatment. The follicular formation, intraocular pressure(IOP)changes, visual acuity changes, anterior chamber depth and anterior chamber open degree were compared between the two groups.

RESULTS:At 1mo after the surgery, functional follicular formation rate was 98% in observation group, higher than the control group(71%)with significant difference(P<0.05). The control group and the observation group the mean preoperative IOP, best corrected visual acuity, uncorrected visual acuity had no significant difference(P>0.05). In observation group, postoperative mean IOP, best corrected visual acuity, uncorrected visual acuity was 12.45+3.01mmHg, 0.17±0.03, 0.19±0.02, significantly different compared control group(P<0.05). Anterior chamber depth and anterior chamber open degree increased in the two groups at 1mo after operation. The changes of observation group were more than control groups(P<0.05). In control group, there were 5 eyes with corneal edema, 4 eyes with transient shallow anterior chamber, 3 eyes with transient high IOP, 3 eyes with inflammatory exudation. In observation group, there were 4 eyes with corneal edema, 3 eyes with transient shallow anterior chamber, 3 eyes with transient high IOP, 2 eyes with inflammatory exudation. After one-week treatment, those side reaction recovered, without hyphema, pupillary capture or other severe complications.

CONCLUSION: The two incision triple surgery in the treatment of glaucoma with cataract patients get better results, effectively reduce intraocular pressure, improve the patients' best corrected visual acuity and uncorrected visual acuity, more formation rate of function follicular, increase the anterior chamber depth, it is safe and reliable.

Abstract:AIM: To investigate the clinical efficacy of pars plana vitrectomy and Baerveldt glaucoma implant(PPV-BGI)in the treatment of refractory glaucoma.

METHODS: One hundred twenty-nine refractory glaucoma patient's clinical data from March 2013 to December 2015 that underwent PPV -BGI were retrospectively reviewed. Among them, 63 eyes were neovascular glaucoma(NVG)and 69 eyes were other types of glaucoma(non-NVG). The changes of intraocular pressure(IOP), surgical results, visual acuity(VA), the number of glaucoma medications, complications, and the success rate of surgery were analyzed.

RESULTS: Cumulative success rates for the NVG group and non-NVG group were 46.0% and 81.2%, respectively, within 1a after surgeries, the difference was significantly(P<0.05). Preoperative IOP was 30.4±10.2mmHg in the non-NVG group and 40.1±10.4mmHg in the NVG group, and IOP was reduced to 14.9±4.1mmHg in the non-NVG group and 17.8±4.9mmHg in the NVG, and the difference was significantly(P<0.05). Number of glaucoma medications decreased from 2.7±1.2 in the non-NVG group and 2.9±1.4 in the NVG group preoperatively to 0.51±0.96 in the non-NVG group and 0.96±1.18 in the NVG group, and the difference was significantly(P<0.05). Improvement in VA of in the NVG group and non-NVG group were observed in 14 eyes of 13 patients and 38 eyes and 37 patients respectively, and the difference was significantly(P<0.05). The postoperative complications of 1d and 1a follow-up in NVG group was significantly higher than non-NVG group(P<0.05).

CONCLUSION: PPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities, especially in eyes with NVG.

Abstract:AIM: To investigate the changes of choroidal thickness in patients with severe non-proliferative diabetic retinopathy(NPDR)after vitreous injection of ranibizumab, and to analyze the relationship between the thickness of choroid and the visual acuity of the patients.

METHODS: Eighty patients with severe non-proliferative diabetic retinopathy were selected from January 1, 2014 to January 1, 2017. All patients were divided into observation group and control group according to the random number table, 40 cases in each group. The control group was treated in a conventional manner, and the observation group was injected with ranibizumab in the vitreous. The thickness of the choroid in the macular area and the thickness of the retinal neuroepithelium in the macular area were compared between the two groups before and after treatment. The changes of the corrected visual acuity were analyzed at 1mo before and after treatment. The relationship between the thickness of the choroid and the thickness of the retinal neuroepithelium and the best corrected visual acuity were compared. The complications and adverse events were compared between the two groups after 6wk of treatment.

RESULTS: The thickness of the choroid and the retinal neuroepithelium in the macular area before were 219.57±51.24μm and 474.76±95.56μm, respectively, in the observation group and the control group, 217.56±50.36μm and 473.27±96.48μm, respectively. The thickness of the choroid and the thickness of the retinal neuroepithelium in the macular area after treatment were 180.15±42.06μm and 382.18±84.26, 202.48±48.28μm and 407.88±44.25μm, respectively. The difference between the two groups was statistically significant(P<0.05). The best corrected visual acuity in the observation group and the control group were 0.47±0.19 and 0.53±0.25 respectively(P<0.05). There was a positive correlation between the choroidal thickness and the best corrected visual acuity in the macular fovea(regression coefficient=1.12, S=0.48, OR=1.376, P<0.05). There was a positive correlation between retinal neuroepithelial thickness and best corrected visual acuity in the macular area(regression coefficient =0.95, S=0.27, OR=1.020, P<0.05). There were 2 eyes(5%)with subconjunctival hemorrhage, 1 eyes(2.5%)of glaucoma, 1 eyes(2.5%)of vitreous hemorrhage, 0 of choroidal detachment, retinal detachment in 0 in observation group at 6wk after treatment. There were 4 eyes(10%)with subconjunctival hemorrhage, 2 eyes(5%)of glaucoma, 2 eyes of vitreous hemorrhage(5%), 2 eyes of choroidal detachment(5%), retinal detachment in 2 eyes(5%)in the control group, and the difference between the two groups on the complications and adverse reactions was statistically significant(P<0.05).

CONCLUSION: The choroidal thickness of patients with macular edema in severe non-proliferative diabetic retinopathy is correlated with the best corrected visual acuity. Intravitreal injection of ranibizumab can effectively reduce the macular fovea choroidal thickness, reduce macular edema and improve vision, and less complications.

Abstract:AIM: To evaluate the efficacy of half-dose verteporfin photodynamic therapy for central serous chorioretinophathy(CSC)in patients aged above 45 years old.

METHODS: Thirty-two eyes of 30 patients aged above 45 years old with central serous chorioretinophathy were included, and all the eyes received half-dose verteporfin photodynamic therapy(PDT). Best-corrected visual acuity(BCVA), central macular thickness(CMT)and subretinal fluids absorption(SRF)were measured before and after treatment(1,3 and 6mo).

RESULTS: The rate of SRF absorbing completely was 44% at 1mo, 63% at 3mo and 75% at 6mo. The difference in cure rate of the three time points was statistically significant(χ²=6.621, P=0.037). All the patients were divided into two groups according to the duration, patients in Group A were treated less than 6mo, Group B were ≥6mo. The mean LogMAR BCVA in the two groups were respectively 0.6149±0.4117 and 0.8167±0.4370 before treatment and the mean CMT were 409.47±129.422μm and 395.82±153.756μm before treatment. The difference between the two groups in the LogMAR BCVA was not statistically significant(F=0.303, P=0.823), but the time difference within the subjects was statistically significant(F=32.837,P<0.001). In Group A, the differences of the LogMAR BCVA at pre-treatment,1mo and 3mo was all statistically significant(P<0.05), but the differences of the LogMAR BCVA at 3mo and 6mo was not statistically significant(t=2.024,P=0.063). In Group B, the differences of the LogMAR BCVA at any two time points were all statistically significant(P<0.05). The difference between the two groups in the CMT was not statistically significant(F=0.064,P=0.978), but the time difference within the subjects was statistically significant(F=26.447,P<0.001). In Group A,the differences of the CMT at any two time points were all statistically significant(P<0.05). So were in Group B(P<0.05).

CONCLUSION: Half-dose verteporfin PDT was effective in treating CSC aged above 45 years old, it still could improve BCVA and subretinal fluids absorption.

Abstract:AIM: To explore the curative effect of 20G and 25G three-channel pars plana vitrectomy in the treatment of idiopathic macular epiretinal membrane, and to provide a theoretical basis for the minimally invasive treatment of idiopathic macular epiretinal membrane.

METHODS: Medical records were retrospectively analyzed to explore curative effect. From January 2014 to December 2016, 60 patients(60 eyes)with idiopathic macular pucker in our hospital for eye treatment were selected. They were grouped according to different operation way, in 28 patients(28 eyes)using three-channel 20G pars plana vitrectomy as the control group, 32 patients(32 eyes)with 25G no-suture conjunctival vitrectomy as observation group. Two groups of patients were evaluated at 3mo after treatment for visual acuity, OCT examination, comfort, and we recorded the operation time, complications and recurrence.

RESULTS: The operating time of observation group was 18-25min, average 20±2.15min, the control group was 22-35min, 28±2.07min on average,the difference was statistically significant(P<0.05). At the time of the last follow-up, visual acuity of two groups improved compared with preoperative, without vision decrease. In observation group vision improved in 69%, significantly higher than that of control group(50%), difference was statistically significant(χ²=7.287, P<0.05). Preoperative intraocular pressure of two groups was not significantly different. intraocular pressure of two group at postoperative 1d reduced compared with preoperative(F_time=31.34, P<0.01; F_group=17.43, P<0.01). There was no statistically significant difference at 7d and 1mo compared with preoperative(P>0.05). Preoperative OCT on macular thickness of the two groups had no statistically significant difference. At 7d, 1 and 3mo after treatment, epiretinal membranes disappeared in all patients, and the macular thickness reduced, the macular edema relieved(P<0.05). At postoperative 3mo, two groups of patients were found no recurrence of epiretinal membranes. At 7d, 1 and 3mo after treatment, differences between the two groups on macular thickness had no statistical significance. At postoperative 1d, in the control group there were foreign body sensation, swelling, and tears, pain and discomfort, 20 patients with eye conjunctival congestion, edema, conjunctival suture to cause discomfort, the symptoms relieved after treatment. In observation group, 12 patients with mild conjunctival congestion and edema, dotted hemorrhage at the wound in 4 eyes, 5 eyes appeared lower intraocular pressure(6-8mmHg). without special treatment, Postoperative bleeding and edema stopped at 7d, intraocular pressure returned to normal. Patients of observation group did not have foreign body sensation, swelling and discomfort symptoms. At the time of the last follow-up, in the two groups, no iatrogenic retinal detachment, cataract, endophthalmitis and other serious complications occurred.

CONCLUSION: The 20G of three-channel pars plana vitrectomy and 25G the no-suture conjunctival vitrectomy are equal for idiopathic macular epiretinal membrane, 25G vitrectomy operation time is short with better patient comfort.

Abstract:AIM: To study the effect of lutein intervention on visual function of patients with early age-related macular degeneration(AMD).

METHODS: Totally 200 early AMD patients were divided into lutein intervention group(20mg/d)and placebo group by a randomized, double-blind, placebo-controlled trail. Questionnaire investigation, serum lutein concentration and visual function were conducted at baseline, 12, 24, 36 and 48wk respectively.

RESULTS: The serum lutein concentration in lutein intervention group was higher than the baseline(P<0.05)and those of placebo group at 12, 24, 36 and 48wk after intervention(P<0.05). The spatial frequencies of contrast sensitivity(CS)at low(3 cycles/degree)and medium(6 cycles/degree)in lutein intervention group, macular pigment optical density(MPOD)and best-spectacle corrected visual acuity(BCVA)were higher than those of placebo group(P<0.05). Contrasted to baseline, the low and medium spatial frequencies of CS in lutein intervention group were higher(P<0.05), while, there were no statistical significance in MPOD and BCVA between before and after treatment(P>0.05).

CONCLUSION: Lutein intervention can improve the visual function of patients with early AMD.

Abstract:AIM: To investigate the curative effect of Shuxuetong injection combined with intravitreal injection of ranibizumab and laser photocoagulation in the treatment of macular edema(ME)secondary to branch retinal vein occlusion(BRVO).

METHODS: Totally 70 patients(70 affected eyes)with ME secondary to BRVO treated from January 2015 to December 2016 were randomly divided into the control group and the observation group by random number table method, 35 patients(35 affected eyes)in each group. The control group were treated by intravitreal injection of ranibizumab and laser photocoagulation, and on the basis, the observation group were treated with Shuxuetong injection. The clinical curative effect and complications were compared between the two groups. At 1wk, 1 and 3mo after treatment, the best corrected visual acuity(BCVA)and central retinal thickness(CRT)were checked again.

RESULTS: The total effective rate of treatment in the observation group was slightly higher than that in the control group(91% vs 80%; P>0.05)while the markedly effective rate in the observation group was higher than that in the control group(43% vs 20%; P<0.05). At 1wk, 1 and 3mo after treatment, BCVA and CMT in the two groups decreased(P<0.05), and they were lower in the observation group than the control group at the same time point(P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05).

CONCLUSION: The treatment of ME secondary to BRVO with Shuxuetong injection combined with intravitreal injection of ranibizumab and laser photocoagulation can effectively reduce CRT and improve visual acuity, with high safety.

Abstract:AIM: To investigate the curative effect of 1g/L bromfenac sodium eye drops on high myopia astigmatism in patients after sub-Bowman keratomileusis.

METHODS: Totally 48 cases(96 eys)of High myopic astigmatism(-6.00DRESULTS: At different time points, uncorrected visual acuity, intraocular pressure, K1 value, K2 value, the degree of astigmatism of the two groups were statistically significant(P<0.05). Compared with preoperative, distance visual acuity increased at postoperative 1d, 1wk, 1 and 3mo; at postoperative 1 and 3mo intraocular pressure decreased(P<0.05). Compared with the control group, the patients in the experimental group had better uncorrected visual acuity at postoperative 3mo and lower intraocular pressure at postoperative 1 and 3mo(P<0.05). Compared with preoperative, K1, K2 value of two groups decreased at postoperative 1 and 3mo, the degree of astigmatism increased(P<0.05). There was no significant difference in K1, K2 and astigmatism between the two groups at postoperative 1 and 3mo(P>0.05). The symptoms and signs of the two groups were similar, and there was no haze phenomenon after operation. The DLK evaluation of the experimental group was better than that of the control group(P<0.05).

CONCLUSION: The 1g/L bromfenac sodium eye drops and fluorometholone eye drops have similar efficacy in the treatment of SBK after operation, but it can effectively reduce the risk of DLK and intraocular pressure, avoid the adverse reactions caused by glucocorticoid, and is an effective treatment plan.

Abstract:AIM:To observe the clinical efficacy after LASIK with corneal flap created by femtosecond laser and microkeratome.

METHODS: The ophthalmic myopia patients after LASIK with corneal flap created by femtosecond laser or microkeratome in our hospital, 50 cases(100 eyes)each, were inspected for uncorrected vision, residual diopter, dry eyes survey, higher order aberrations at 1, 3 and 6mo after surgeries.

RESULTS: There were no statistical differences between two groups of uncorrected vision and residual diopter in 6mo after surgery(P>0.05). The incidence of dry eye comparison for postoperative 1 and 3mo were significantly different(P<0.05), but there were no statistical differences for postoperative 6mo(P>0.05). The higher order aberrations of the two groups increased after surgery, the differences were significant compared with preoperative(P<0.05). At 1mo after surgeries, horizontal coma aberration, vertical coma aberration and spherical aberration were not significantly different(P>0.05). At 3 and 6mo after surgeries, horizontal coma aberration and vertical coma aberration were not significantly different(P>0.05).

And the change of spherical aberration after LASIK with corneal flap created by femtosecond laser was less than that with microkeratome(P<0.05).

CONCLUSION:LASIK with corneal flap created by femtosecond laser is a safe, effective and stable surgical approach. The incidence of dry eye is low; the postoperative visual quality is better than LASIK with corneal flap created by microkeratome.

Abstract:AIM:To analyze the clinical efficacy of conjunctival flap covering combined with subconjunctival injection of fluconazole on patients with severe fungal corneal ulcer.

METHODS: Totally 50 cases with severe fungal corneal ulcer were collected in our hospital from January 2012 to December 2015. The cases were randomly divided into observation group and control group, 25 cases in each group. All the cases were monocular sick. The control group took single drug treatment, but the observation group were given with conjunctival flap as an extra. The clinical efficacy, best corrected visual acuity and adverse effects rate were observed. And, the relapse of the two groups was followed for 1a.

RESULTS: After 1mo of treatment, the clinical curative effect of the observation group was significantly higher than the control group(P<0.05), and corrected visual acuity of the observation group was higher than the control group(P<0.05); the adverse reaction rate of the observation group was lower than the control group(P<0.05).After 1a follow-up, the observation group only had 1 case of recurrence, control group had 8 cases with recurrence, the recurrence rate of the observation group was significantly lower than the control group(P<0.05).

CONCLUSION:The conjunctival flap combined with subconjunctival injection of fluconazole has good application value in severe fungal corneal ulcer patients, can effectively improve the clinical curative effect and the visual acuity, and can effectively reduce the incidence of adverse reactions and recurrence rate.

Abstract:AIM: To determine the incidence of intraoperative floppy iris syndrome(IFIS)in patients undergoing phacoemulsification in a Chinese hospital, and to assess new risk factors and predictive factors for IFIS.

METHODS: A prospective, observational case series. In the consecutive cataract surgeries performed in one year, the medicine administration, pupil size(PS)before and after mydriasis, and signs of IFIS were recorded.

RESULTS: Totally 807 patients(1 068 eyes)underwent cataract surgeries. Among the 1 068 eyes, signs of IFIS were noted in 34 eyes. Strong positive correlations were showed between finasteride(6.4%, OR=5.885), tamsulosin(25%, OR=21.578), reserpine(16.7%, OR=12.947), clozapine(66.7%, OR=139.467), post-panretinal photocoagulation(14.3%, OR=10.789)and IFIS. Pupil size was inversely related to IFIS incidence(P<0.001). A dilated pupil smaller than 7.25mm could predict IFIS(P<0.001).

CONCLUSION: The incidence rate of IFIS was 3.18%. Reserpine, clozapine and post-panretinal photocoagulation emerged as new risk factors for IFIS. A small dilated pupil may imply IFIS occurrence.

Abstract:AIM: To compare the clinical outcome of anterior chamber intraocular lens(IOL)at Ⅰ stage versus sclera-fixed IOL at Ⅱ stage in complicated cataract surgeries with inadequate capsular support.

METHODS: Complicated cataract surgeries with anterior chamber IOL(ACIOL)or scleral-fixated IOL implantation from January 2003 to December 2014 when capsular support was inadequate were included and analyzed. Postoperative best-corrected visual acuity(BCVA)were compared. Postoperative complications were recorded and analyzed.

RESULTS: Totally 84 eyes and 79 eyes were included in the ACIOL group and in the scleral-fixated IOL group, respectively. The mean postoperative logarithm of minimal angle of resolution(LogMAR)BCVA at 1a was 0.30±0.64 and 0.33±0.34 in the ACIOL group and the scleral-fixated IOL group, respectively(t=0.407, P=0.712). The mean latest LogMAR BCVA was 0.67±0.55 and 0.62±0.50 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively(t=0.225, P=0.545). There were more early postoperative complications in the ACIOL group(χ²=14.613, P<0.001). No difference in late postoperative complications was found between the two groups(χ²=0.231, P=0.267). Regression analysis suggested that ACIOL and scleral-fixated IOL implantation had similar latest postoperative LogMAR BCVA(t=0.397, P=0.957); however the existence of late complications were related with a worse final visual outcome(t=22.156,P<0.001).

CONCLUSION: The long-term differences in the visual outcomes and complication profiles after ACIOL at Ⅰ stage or scleral-fixated IOL implantation at Ⅱ stage in a complicated cataract operation are not found when capsular support is inadequate.

Abstract:AIM: To evaluate the visual outcome of Oculentis Mplus intraocular lens(IOL).

METHODS: Totally 20 eyes in 20 patients received phacoemulsification and Oculentis Mplus intraocular lens implantation were as test group, and 20 eyes(Aspira-aA IOL)were as control group. The following postoperative examinations were performed after operation for 3mo: uncorrected visual acuity of distance and near, refractive results, UBM examination, the rate of wearing spectacles and the complications.

RESULTS: At 3mo after surgery, distance visual acuity of test group with Oculentis Mplus IOL were 0.10±0.03,the difference with control group was not significant(t=1.74, P>0.05). Eyes in test group had an uncorrected near acuity 0.11±0.04, the difference with control group was significant(t=15.53, P<0.05). The rate of wearing spectacles was 5% in test group and 100% in control group. The rate of uncomfortableness was 5% in test group.

CONCLUSION: The implantation of Oculentis Mplus IOL not only has a good distance uncorrected visual acuity, but also with better near visual acuity. The surgery is safe, reliable and no special complication induced.

Abstract:AIM: To investigate the effect of Ahmed glaucoma drainage valve implantation on corneal endothelial cell density and intraocular pressure in patients with neovascular glaucoma.

METHODS: Totally 200 cases(200 eyes)of patients with neovascular glaucoma in our hospital from June 2013 to June 2016 were enrolled in this study. All patients were treated with glaucoma drainage valve implantation. The medical records of the patients were retrospectively analyzed; the evaluation of operation completion was made; intraocular pressure at preoperative and postoperative 1wk, 1mo, 1a was detected using non-contact tonometry; the corneal endothelial cell density at preoperative and postoperative 1wk, 1mo and 1a was tested by corneal endothelial microscopy, and visual acuity of patients before operation and at 1a after operation was recorded. All patients' complications and intervention methods were followed-up and recorded.

RESULTS: All patients' complete success rate was 81.0%, the conditional success rate was 92.0%. The proportion of preoperative and postoperative vision without light perception, hand moving to 0.01,0.02-0.05, 0.06-<0.10, ≥0.10 had significant difference(P>0.05). Intraocular pressure before treatment was 42.43±3.43mmHg, and were 13.45±2.34mmHg, 15.89±2.67mmHg, 16.34±2.88mmHg at 1wk, 1mo and 1a after operation respectively, showing significant difference(F=4570.62, P<0.001). Before treatment, corneal endothelial cell density was 2453.67±342.34/mm², and were 2216.67±332.32/mm², 2087.34±326.45/mm², 1959.67±303.34/mm² at 1wk, 1mo and 1a after operation respectively,holding significantly different(F=83.42, P<0.001). There were macular degeneration 20 eyes of hyphema, 13 eyes of low pressure, 8 eyes of drainage valve displacement and 21 eyes of shallow anterior chamber.

CONCLUSION: Ahmed glaucoma drainage valve implantation for neovascular glaucoma can effectively control intraocular pressure but the presence of corneal endothelial cell loss exists, can effectively protect and recover residual vision of patients, relief complications and recover it after simple intervention,it is an effective method for neovascular glaucoma.

Abstract:AIM:To study the efficacy of conbercept intravitreal injection combined with retinal laser photocoagulation therapy and simple laser photocoagulation therapy on macular edema(ME)secondary to retinal vein occlusion(RVO).

METHODS: Forty-eight patients(53 eyes)with macular edema secondary to retinal vein occlusion diagnosed by clinical examination from October 2014 to March 2015 were retrospectively analyzed. Among them, 28 patients(31 eyes)were treated with conbercept intravitreal injection combined with retinal laser photocoagulation, which was defined as Group A. And simple laser group contained 20 patients(22 eyes), which was defined as Group B. The clinical data including the patients' best-corrected visual acuity(BCVA)and central retinal thickness(CMT)before treatment and 1wk and 3mo after treatment were observed.

RESULTS: Followed up for 3mo, the average BCVA values of A and B were 0.44±0.25,0.56±0.24, respectively and the average CMT were 330.50±121.71, 354.67±102.79μm at first week of treatment. There was no significant difference in BCVA and CMT of Group A compared with Group B. There was statistically significant in BCVA and CMT of Group A and Group B compared with before treatment(P<0.05). The average BCVA values of A and B were 0.24±0.18, 0.39±0.20, respectively and the average CMT were 252.62±83.01, 332.67±102.33μm at third month of treatment. There were statistically significant differences between the two groups and compared with before treatment(P<0.05), and Group A was superior to Group B.

CONCLUSION: Conbercept intravitreal injection combined with retinal laser photocoagulation therapy and simple laser photocoagulation treatment of macular edema secondary to retinal vein occlusion are both effective that macular edema is significantly reduced, and vision is stable and improved. But for serious cases, conbercept intravitreal injection can reduce retinal edema at first, then combine with retinal laser photocoagulation which has obvious therapeutic effect and it is better than simple laser photocoagulation treatment.

Abstract:AIM: To analyze of refractive status after vitrectomy combined with phacoemulsification in patients with vitreoretinal disease and cataract.

METHODS: A total of 150 patients with vitreoretinal disease and cataract were treated in our hospital from January 2014 to November 2016. According to the random number table method they were divided into two groups: combination group(75 cases)with vitrectomy combined with phacoemulsification, the control group(75 cases)with vitrectomy first, then phacoemulsification surgery. The recovery of visual acuity and the change of the axial length of the eyes were observed. The patients were followed up for 6mo, and the postoperative complications were recorded.

RESULTS: After treatment, number of patients in the two groups with visual acuity ≥0.1 were significantly improved compared with before treatment(P<0.05), and the percent in combination group was 95%, higher than 63% in the control group(P<0.05). There were no significant changes in the axial length before and after the operation in the two groups(P>0.05), and there was no significant difference between the groups before and after treatment(P>0.05). The refractive status of combination group shifted to myopia, that of control group shifted to hyperopia, two groups had no statistically significant difference on numerical prediction(P<0.05). The difference was statistically significant on the actual values(P<0.05). The complication rate in the combination group was 24%, which was lower than 40% in the control group, and the difference was statistically significant(P<0.05).

CONCLUSION: Vitrectomy combined with phacoemulsification on vitreoretinal diseases with cataract patients is effective, and safety, clinical application value is higher.

Abstract:AIM: To explore the effect of compound Xueshuantong capsule combined with calcium dobesilate in patients with early diabetic retinopathy.

METHODS: Totally 120 patients with early diabetic retinopathy were selected, and they were randomly divided into study group and control group according to the random number table method, each had 60 cases. Patients in the control group were treated with compound Xueshuantong capsule, and the patients in the study group were treated with compound Xueshuantong capsule combined with calcium dobesilate. We observed and compared the clinical symptoms(hemangioma volume, hemorrhagic spot area, macular thickness, visual gray value, visual acuity, threshold sensitivity within 30°), inflammatory factors(serum hs-CRP, VEGF, IGF-1), clinical efficacy and adverse events.

RESULTS:(1)The hematoma volume, hemorrhage spot area, macular thickness and visual gray value of the two groups were lower than those before treatment(t_{study group}=24.81, 19.59, 8.567, 17.79, t_{control group}=12.02, 8.60, 10.32, 10.85; P<0.05); visual acuity, threshold sensitivity within 30°were significantly higher than before(t_{study group}=-5.24, -8.79, t_{study group}=-2.26, -3.39; all P<0.05). After treatment, hemangioma volume, haemorrhagic area, macular thickness and visual gray value of the study group were lower than those of the control group, visual acuity and threshold sensitivity within 30°were higher than those of the control group(t=-12.97, -9.47,-13.54, -5.59, 2.65, 4.05; all P<0.05).(2)The levels of hs-CRP, VEGF and IGF-1 in the two groups were lower than those before treatment(t_{study group}=34.30, 23.33, 42.118, t_{control group} =18.68, 17.46, 26.73; all P<0.05). The levels of hs-CRP, VEGF and IGF-1 in the study group were significantly lower than those in the control group(t=-14.79, -7.43, -15.35, all P<0.05).(3)The total effective rate was 92.0% in the study group, which was higher than 70.8% in the control group(χ²=16.352, P<0.05).(4)The incidence of adverse reactions was 10% in the study group and 13% in the control group. There was no significant difference in the incidence of adverse reactions between the two groups(χ²=0.32, P>0.05).

CONCLUSION: Compound Xueshuantong capsule combined with calcium dobesilate in the treatment of early diabetic retinopathy can effectively improve the clinical symptoms of retinal defects, the mechanism of action is related to the level of inflammatory factors, the clinical efficacy is better, security is high.

Abstract:AIM: To investigate the correlation between carotid artery disease and fundus arteriosclerosis in patients with cerebral infarction.

METHODS: Totally 120 patients with acute cerebral infarction were randomly divided into two groups. The patients were diagnosed with bilateral carotid artery and non-mydriatic fundus camera. Fouty-two patients transient ischaemic attack(TIA)underwent cerebral angiography. The data were recorded for analysis.

RESULTS: The degree of fundus arteriosclerosis in patients with cerebral infarction was positively correlated with blood pressure(r=0.361, P=0.015). There was a significant correlation between retinal arteriosclerosis grade and carotid atherosclerosis(r=0.392, P=0.011). The degree of fundus arteriosclerosis was correlated with cerebral arteriolar lesion, higher than it with carotid artery disease(r=0.465, 0.392, P=0.037).

CONCLUSION: Carotid arteriosclerosis, fundus arteriosclerosis and cerebral arteriolar lesions in patients with cerebral infarction have a significant correlation with hypertension, and fundus arterial examination has important clinical value in judging cerebral arteriosclerosis.

Abstract:AIM: To compare the retinal nerve fiber layer(RNFL)thickness in patients with different severities of obstructive sleep apnea-hypopnea syndrome(OSAHS)versus normal controls.

METHODS: This was an observational case-control study. Totally 79 patients presenting with snoring and daytime sleepiness who underwent overnight polysomnography(PSG)to determine OSAHS severity were recruited, and subsequently referred for ophthalmologic evaluation. The data including intraocular pressure(IOP), RNFL thickness etc was collected.

RESULTS: A total of 73 subjects were recruited, including 53 patients with OSAHS and 20 normal control subjects. IOP was significantly higher for the moderate and severe OSAHS group than for the control group(both P<0.05). The RNFL in the average and superior quadrants were significantly thinner for the moderate and severe OSAHS group than for the control group(both P<0.05). AHI was negatively correlated with RNFL thickness in the superior quadrants, and with average RNFL thickness(r=-0.316, -0.205; both P<0.01). Negative correlations were also identified between RNFL thickness in the superior quadrants and the ODI(r=-0.24, P=0.005). Positive correlations were identified between SaO₂ on PSG and RNFL thickness in the superior quadrants(r=0.277, P=0.001).

CONCLUSION: RNFL of the patients with OSAHS is thinned. Furthermore, it is observed that the greater severity of OSAHS, the greater the loss of RNFL. Among the four quadrants observed, the most affected quadrant was the superior quadrant.

Abstract:AIM:To compare and analyze the diagnostic value of iris fluorescein angiography(IFA)combined with fundus fluorescein angiography(FFA), indocyanine green angiograph(ICGA), fundus fluorescein angiography in the diagnosis of early diabetic retinitis(DR).

METHODS: Totally 70 patients(136 eyes)with early diabetic retinopathy enrolled in our hospital from August 2015 to August 2016 were selected in this study. All patients were respectively treated with ICGA, FFA and IFA+FFA, and the detection results of three kinds of imaging methods were analyzed.

RESULTS: There were 120 pathological eyes(88.2%)were detected by FFA, 124 pathological eyes(91.2%)were detected by ICGA, 130 pathological eyes(95.6%)were detected by IFA+FFA, and there was no significant difference in the detection rate between the three methods(P>0.05). FFA detected 48 eyes with neovascularization, 18 eyes with vitreous hemorrhage, 38 eyes with macular edema, 16 eyes without perfusion area; ICGA detected 49 eyes with neovascularization, 38 eyes with macular edema, 17 eyes with vitreous hemorrhage, 20 eyes without perfusion area; IFA+FFA detected 17 eyes with proliferative diabetic iridopathy(DI), 22 eyes with non-proliferative DI, 5 eyes with NVG, 92 eyes without DI.

CONCLUSION: In the diagnosis of early diabetic retinopathy, iris fluorescence angiography, fundus fluorescein angiography and indocyanine green angiography all have good diagnostic value, but IFA+FFA can detect the diabetic retinopathy in time and provide the help for the timely treatment.

Abstract:AIM: To observe the effect of nerve growth factor treatment on traumatic optic nerve contusion and evaluate its therapeutic effect.

METHODS: From January 2012 to January 2016, 48 cases(50 eyes)with optic nerve contusion were treated. Retrospective study was carried out and the patients were randomly divided into two groups, treatment group 24 cases of 24 eyes, 26 eyes of 24 cases in the control group; the treatment group mainly used mouse nerve growth factor injection 30μg, 1 times daily intramuscular injection of medication, 6wk, with the application of high pressure hyperbaric oxygen therapy, glucocorticoid and vitamin treatment; the treatment of control group was the same as treatment group, but without the injection of mouse nerve growth factor. Visual acuity, visual evoked potential(VEP)and mean sensitivity(MS), and mean deviation(MD)were examined in all patients at 6wk after the treatment.

RESULTS: After treated for 6wk, there were significant differences in the best corrected visual acuity(P<0.05)between the two groups. VEP P100 latency of treatment group was 98.76±6.93ms, amplitude was 5.22±1.64μV, those of the control group were 116.52±8.82ms, 4.28±1.75μV, both significantly different between the two groups(P<0.05). The differences on MS and MD were significant(P<0.05).

CONCLUSION: The treatment of traumatic optic nerve contusion with nerve growth factor injection has more obvious curative effect.

Abstract:AIM: To study the effect of tarsal gland massage combined with medication in treatment of meibomian gland dysfunction(MGD).

METHODS: Totally 100 patients(189 eyes)with MGD were selected in our hospital from December 2014 to December 2016. The patients were randomly divided into control group and observation group. Patients in the control group were treated with routine drugs, while the patients in the observation group were treated with routine massage. We observed and compared the clinical efficacy of two groups of patients before treatment, 1wk, 1 and 3mo after treatment for the subjective symptoms, tear film break-up time, tear secretion test, ocular surface disease index, corneal staining score of the patients in the 3 groups.

RESULTS: The total effective rate of the observation group was 93.6%, which was significantly higher than that of the control group(P<0.05). Two groups of patients after treatment of subjective symptoms, ocular surface disease index, corneal staining score decreased, tear break-up time, Schirmer test was increased compared with before treatment(P<0.05). The decrease of subjective symptoms, ocular surface disease index, corneal staining score, the increase of tear film break-up time, tear secretion test in the observation group were higher than those in the control group(P<0.05).

CONCLUSION: Massage combined with medication can improve the clinical efficacy of MGD.

Abstract:AIM: To investigate the current status of diabetic patients with low vision in Tangshan, and to explore the risk factors of low vision.

METHODS: A sampling survey was conducted to select 2 000 diabetic residents in Tangshan area from January to December 2016 to examine the incidence of diabetic low vision in Tangshan area. The diabetic patients with low vision included in the observation group, another 2 times the number of cases of diabetes with normal vision were selected as control group. Logistic regression was used to analyze the related history data of two groups of patients were investigated, to analyze the risk factors to low vision.

RESULTS: Of the 2000 diabetic patients involved in visual acuity examination, there were 189 patients(276 eyes)with poor vision, the incidence rate was 6.90%. Among them, 102 patients(102 eyes)with monocular vision deficit(2.55%), binocular vision was poor in 87 cases(174 eyes,4.35%). Logistic multivariate regression analysis showed that the age, course of disease and retinopathy of diabetes were the major risk factors of low vision in diabetic patients.

CONCLUSION: The incidence of low vision in diabetic patients in Tangshan area is low. The age, course of disease and retinopathy of diabetes are the main causes of low vision. Therefore, strengthening the retinopathy visual examination, early prevention and treatment, in elderly patients, and patients with long course of disease, can reduce the occurrence and development of low vision in patients with diabetes mellitus.

Abstract:AIM: To investigate the efficacy and visual sensitivity of occlusion therapy combined training for children with ametropic amblyopia.

METHODS: Totally 85 children(85 eyes)with anisometropic amblyopia treated in our hospital from January 2013 to January 2015 were selected. All patients were given occlusion therapy combined training. Statistical analysis of clinical efficacy and visual sensitivity changes were taken, and the changes of visual acuity, AULCSF, S_max, Fr_max were analyzed.

RESULTS: The visual acuity after therapy was significantly better than that before treatment(1.12±0.29 vs 0.45±0.25, P<0.01); AULCSF, S_max and Fr_max all increased, the difference between the two groups was statistically significant(P<0.05). The sensitivity of the same spatial frequency was significantly higher than that before treatment, the difference was statistically significant(P<0.05), and the contrast sensitivity decreased gradually with the increase of spatial frequency. There were statistical differences in the total effective rate of different refractive degrees after treatment(P=0.001). Mild group and moderate group had no significant difference on the total clinical efficiency difference(χ²=3.091, P=0.079); between mild group and severe group total effective rate was significantly different(χ²=11.471, P=0.001); the moderate and severe groups total clinical efficiency were no significantly different(χ²=3.359, P=0.067). In addition, the total efficiency rate of wearing glasses under the age of 6 was significantly higher than that after 6 years old(95% vs 77%), statistical difference between the two groups was significant(P<0.05).

CONCLUSION: Masking therapy combined with comprehensive training, in the treatment of children with ametropic amblyopia, and wearing a corrective spectacles, is desirable, especially for children under 7 years of age.

Abstract:AIM: To measure ocular biometric values with sexual and age and determine the relationship between the differences using the Lenstar 900.

METHODS: Totally 413 myopes 826 eyes, 200 males(400 eyes)and 213 females(426 eyes), were enrolled in this study and were divided into 3 groups: Group Ⅰ(<5 years), Group Ⅱ(5-10 years), Group Ⅲ(>10 years). Central corneal thickness(CCT), anterior chamber depth(ACD), lens thickness(LT), axial length(AL), white-to-white distance(WWD)and pupil diameter(PD)were measured by Lenstar 900. The differences between age groups and gender groups were compared using the LSD and SNKk methods in variance analysis. Pearson correlation coefficient to assess AL, CCT, ACD, LT, WWD, PD in children and adolescents.

RESULTS: There were significant difference in CCT between ages groups(P<0.05)which increased with the age. There were significant differences both in ACD and AL between sexual groups. With analysis of Person, CCT showed a significantly positive correlation with WWD and PD(r=0.208, 0.167; P<0.05)and ACD showed a significantly positive correlation with AL, WWD, PD(r=0.620, 0.238, 0.192; P<0.05). LT showed a significantly negative correlation with ACD, AL and WWD(r=-0.271, -0.186, -0.227; P<0.05). WWD showed a significantly positive correlation with PD(r=0.273, P<0.05).

CONCLUSION:CCT has gradually thickening trend with ages. Men are more than women in ACD and AL. CCT shows positive correlation with WWD and PD and ACD shows positive correlation with AL, WWD, PD. LT shows negative correlation with ACD, AL and WWD. WWD showed positive correlation with PD.

Abstract:AIM: To perform a clinical analysis of 1 500 cases of outpatients with ametropia in Hebeisheng Eye Hospital, to provide a theoretical basis for diagnosis, treatment, and prevention of patients with ametropia.

METHODS: Totally 1 500 cases(2 840 eyes)of outpatient with ametropia were chosen as the research objects in Hebeisheng Eye Hospital from June 2013 to July 2014. All cases were treated with TOPCON RM-8800 computer optometry instrument for objective optometry, and used TOPCON phoropter for subjective optometry. The combination of the two instruments was taken to determine the diopter later. Diopter and axial distribution of the myopic astigmatism and hyperopic astigmatism were observed, age of astigmatic patient, distribution of astigmatism axis were observed as well. Meanwhile, a total of 150 cases were chosen randomly to measure their corneal curvature, anterior chamber depth, axial length and other static refractive index. All indexes were compared with those of the normal people subsequently, such as amplitude of accommodation, negative relative accommodation, positive relative accommodation, sensitivity of accommodation and other dynamic refractive index.

RESULTS: Ametropia types of all patients were mainly simple myopia, simple myopia astigmatism, compound myopic astigmatism, simple hypermetropia, simple hyperopia astigmatism, compound hyperopic astigmatism and mixed astigmatism, the proportion were 38.99%, 3.27%, 23.94%, 4.68%, 1.34%, 13.52%, 15.25% respectively. There were 773 eyes with myopia astigmatism. The proportion of people with a myopia astigmatism diopter of above -0.25 to -0.50, -0.75 to -1.00, -1.25 to -1.50, above -1.75 were 31.05%, 38.55%, 16.56%, 13.84%. There were 421 eyes with hyperopia astigmatism, the proportion of people with hyperopia astigmatism diopter of 0.25-0.50, 0.75-1.00, 1.25- 1.50, >1.75 were 26.60%, 24.94%, 16.63%, 31.83%. Static refractive index of 150 patients(300 eyes)showed that corneal curvature was(41.23±2.43)φ/D, anterior chamber depth was 3.71±0.43mm, axial length 23.45±1.43mm. Dynamic refractive index showed that the amplitude of accommodation 10.56±2.32D, negative relative accommodation 2.31±0.47D, positive relative accommodation -1.82±0.67D, sensitivity of accommodation 11.34±2.21D. All kinds of static and dynamic refractive indexes, the length of ocular axis were statistically different from those of the normal population(P<0.05). Regular astigmatism number rate in 1 194 cases of astigmatism eyes of 3-7 years old, 8-18 years old, 19-45 years old, 46-60 years old were 35.85%, 11.98%, 45.64%, 6.53%. Among 150 cases of patients(300 eyes), there were 152 eyes of equivalent sphere mirror ≤-0.5D, 48 eyes of equivalent sphere mirror ≥0.5D, 100 eyes of equivalent sphere mirror between -0.5D to 0.5D. And there were 150 eyes of equivalent sphere mirror ≤-0.5D, 50 eyes of equivalent sphere mirror ≥0.5D, 100 eyes of equivalent sphere mirror between -0.5D to 0.5D in a total of 300 eyes of 150 normal people.

CONCLUSION: The 1 500 cases of patients with ametropia(2 840 eyes)contains mainly simple myopia and compound myopic astigmatism, diopter range in myopia astigmatism were chiefly -0.25 to -0.50, -0.75 to -1.00, hyperopia diopter range consists of >1.75 mostly, among the patients with astigmatism, the older the age, the bigger the number of people with irregular astigmatism, static and dynamic refractive index of patients with ametropic eye shows apparent difference with that of the normal population.

Abstract:AIM: To evaluate the therapeutic effects of the fine sight training with the smartphones and pads on hyperopia amblyopia of children.

METHODS: One hundred and twenty children(120 eyes)with hyperopia amblyopia were randomly divided into two groups in this prospective study. All the children in these two groups received the basic treatments of spectacle correction, penalization therapy and amblyopia trainings. The treatments of red-light blinking and grating as well as traditional fine sight training were used for the children in the control group. However, the smartphones and pads were applied instead of the traditional performances for the fine sight training in the experimental group. Best corrected visual acuity of every child was tested for every 3mo, to observe the time for the visual improvement and efficacy.

RESULTS: In comparison with the control group, significant shorter time(80.54±30.87d, P<0.05)for promoted one line of LogMAR visual acuity and average treatment time(15.34±7.24mo, P<0.05)were harvested in the experimental group. The efficacy in the experimental group was significantly higher than that in the control group(Z=-2.37, P=0.02).

CONCLUSION: The fine sight training with the smartphones and pads can improve vison faster than traditional methods and decrease the time of therapy in children with hyperopia amblyopia, thus providing a new strategy for the treatment of hyperopia amblyopia.

Abstract:AIM: To assess the effect of press-on prisms in patients with acute-onset comitant esotropia and diplopia, focusing primarily on vision-related quality of life and binocular vision.

METHODS: Retrospective case-series study. Totally 16 acute-onset comitant esotropia patients with diplopia who received treatment in the Huzhou Central Hospital were included in this study from March 2014 to March 2017. Vision-related quality of life before press-on prism correction and 1mo after press-on prism correction were performed with the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire(CHI-NEI-VFQ-25). In each time of follow-up, we made a minute examination, includes worth four dot test and stereo tests. Data was statistically analyzed with paired sample t test, Chi-square test and Fisher's exact test.

RESULTS: Except the degree of eye pain, color vision and perimetry, the indicators from CHI-NEI-VFQ-25 table including general health status, overall vision, mental health, social role difficulties, social functional, near activities, distant activities, independency and driving of acute-onset comitant esotropia patients with diplopia were obviously significant improved 1mo after press-on prism correction(P<0.05). One month after press-on prism correction, the fusion function and stereo acuity were significant enhanced(P<0.05).

CONCLUSION: Press-on prism correction may be helpful for binocular vision recovery in acute-onset comitant esotropia patients with diplopia, so as improve the vision-related quality of life.