Abstract:AIM: To determine epidemiological, clinical profile and access the impact of HIV in its occurrence in 55 eyes of conjunctival squamous cell carcinoma.

METHODS: A cross sectional study, 55 eyes of 54 patients affected by conjunctival squamous cell carcinoma(CSCs)presented in the Ophthalmology Department of University Hospital of Treichville in Abidjan were included. Data were collected: interrogatories, ophthalmologic examination, histopathologic finding, HIV serology, therapeutic(surgery, chemotherapy), follow-up and prognosis. The statistical analysis was performed using Epi-info version 6.0 and a statistical comparison was performed using the Chi-square test with a significance threshold set at 5%.

RESULTS: The age ranged 7-75y(median age 42.28). A female predominance was observed with a sex-ratio of 0.89. The average consultation period was 18mo, with extremes ranging from 6-60mo. Physically 53% of our eyes(29 eyes)presented a functional loss of the eye. And 42 out of the 54 patients were HIV positive with 28 cases of HIV1 infection, 4 cases of HIV2 infection and 10 cases of HIV1 and 2 co-infection. Lymphocyte typing was performed for 28 out of 42 patients with CD4 cell counts <200/mL in 33% of cases, between 200 and 500 in 19% of cases and 500/mL in 12% of cases. It was noted 42 cases(76%)of invasive differentiated squamous cell carcinoma, and 13 cases(24%)of squamous cell carcinoma in situ. Forty localized tumors underwent tumor resection(73%)associated with a postoperative adjuvant topical chemotherapy in 6 cases. Socioeconomic status showed 39% of patients were economic cally inactive. The average follow up period of our patients was 29mo.

CONCLUSION: HIV infection is a risk factor for the occurrence of conjunctival squamous cell carcinoma especially in sub-Saharan Africa where the fight against the infection although boosted in these recent years is far from achieving all objectives. The poor prognosis of conjunctival squamous cell carcinoma reflects the low socioeconomic status of patients, the inadequate medical care in our facilities, the prohibitive cost of anticancer drugs and the link between this disease and HIV/AIDS.

Abstract:AIMS:To investigate the etiological factors and various effects of severe vitreous hemorrhage(VH)in Northern China.

METHODS: Files on patients presenting with VH treated with vitrectomy between January 2011 and January 2014 were retrieved from medical records.

RESULTS:A total of 1 335 eyes of 1 275 patients(735 males, 540 females)presenting with VH were included in this study. Proliferative diabetic retinopathy(PDR), retinal vein occlusion(RVO), either retinal detachment or retinal hole(RD/RH), ocular trauma, Eales disease, and either age-related macular degeneration or polypoidal choroidal vasculopathy(AMD/PCV)constituted the etiology of VH in more than 90% of the patients. The most common causes of VH were ocular trauma(40%), PDR(19.5%), and Eales disease(19.1%)in the youth group, PDR(34.4%), RVO(30.8%), and RD/RH(12.2%)in the middle-aged group, and RVO(35.7%), PDR(26.6%), RD/RH(14.6%), and AMD/PCV(8%)in the elder group.

CONCLUSION:PDR, RVO, and ocular trauma are usually the main causes of VH. Within each group, the most common causes of VH were ocular trauma and Eales disease in the youth group, PDR, RVO, and RD/RH in the middle-aged group, and RVO, PDR, RD/RH, and AMD/PCV in the elder group. In addition, we found that males with ocular trauma are at high risk for VH, PDR and Eales disease often present bilateral VHs, and PDR and RVO have a high risk of recurrence.

Abstract:AIM: To examine the association between high density lipoprotein(HDL)3 cholesterol, nitrite plus nitrate(NOx)and total antioxidant status in diabetic retinopathy patients compared to controls.

METHODS: This was a prospective, case-control study. One hundred and six participants were subdivided into three groups. Eighty-four type 2 diabetes patients with and without retinopathy and 22 healthy controls were included in this study. Serum HDL₃ concentrations were assayed and serum NOx levels were determined in all patients. Total antioxidant capacity was measured using the ferric reducing power of plasma(FRAP)assay.

RESULTS: Among the subjects with diabetes mellitus(DM), fasting glucose, HbA1c and triglycerides were significantly higher than the healthy controls. HDL₃ level was 14.4(12.0)mg/dl in healthy subjects, 18.1(12.6)mg/dl in the diabetic retinopathy group and 14.0(12.5)mg/dl in diabetic patients without retinopathy, and was statistically similar between the groups(P=0.262). HDL level was similar between groups in our population. FRAP level was lower in patients with DM compared to healthy controls(P=0.003), but was not different between the DR and the non-DR groups(P=0.913).

CONCLUSION: In our study, we demonstrated that HDL and HDL₃ subgroup levels didn't significantly differ between DM2 patients with DR and without DR and healthy controls. Determination of HDL₃ cholesterol, in addition to total HDL cholesterol, may not predict the actual risk for diabetic retinopathy. Serum NOx was observed to be higher in diabetic participants and FRAP level was low.

Abstract:AIM: To analyze the management of patients with macula-on retinal detachment who received surgical treatment in our department. Placing special emphasis on the time elapsed between diagnosis and surgery, we sought to establish whether a relationship exists between time to surgery and loss of visual acuity.

METHODS: A retrospective study in which the medical records of 77 patients with macula-on retinal detachment who underwent surgery in Hospital Universitario Fundación Jiménez Díaz were reviewed.

RESULTS: A total of 77 patients, 72 were included in the study. The primary anatomic success rate was 94.44%(68/72), and the success rate in all patients after either 1 or 2 interventions was 98.61%(71/72). The mean time before surgery was 5.3±2.26d. Seven patients(9.72%)lost two or more lines of vision. A statistically significant relationship was found between loss of visual acuity and patient age(P=0.001). Our findings also suggest a possible link between the need for further surgical intervention to reattach the retina and decline in visual acuity test(P=0.045). We failed to find a statistically significant relationship between loss of visual acuity and days until surgery(P=0.100)or type of surgery(P=0.578)or status of the crystalline lens(P=0.413).

CONCLUSION: It is important that each hospital study how this type of retinal detachment is being managed in order to optimize the use of available resources and guarantee the most favorable anatomic and functional outcomes possible.

Abstract:AIM: To study the pattern of mechanical ocular injuries in patients visiting a rural referral center.

METHODS: The study was conducted in the department of Ophthalmology, Dr. Rajendra Prasad Government Medical College(RPGMC), Kangra(Himachal Pradesh)for a period of 12mo from 1^st Jan 2013-31^st Dec 2013 which included data collection, data organization, presentation, data analysis and data interpretation followed by a period of follow up extending to a period of 1mo. A total of 200 patients were studied which included all patients of mechanical ocular injuries that visited our department either directly or were referred from other public or private institutions during the study period. It was a prospective study in which all the patients were interviewed with the aid of a questionnaire and underwent a detailed ocular examination. The injuries were classified according to the international ocular trauma classification into open globe and closed globe injuries. The injuries of the lid and adnexa and the cranial nerve palsies were considered as separate entities and data analysis was done with MS Excel 2007 worksheet using the Epi info7 software.

RESULTS: A total of 21,710 patients attended the out-patient department(OPD)during the study period out of which 200 patients were of mechanical ocular trauma which formed 0.921% of the total OPD attendance. The patients ranged in age from 1-80y with a mean age and standard deviation of 33.12±20.48y. In those patients 151 patients(75.5%)were males and 49(24.5%)were females. The male to female ratio was 3:1. Out of the 200 patients studied, 100 were injured at home, 19 in the playground, 29 had occupational injuries, 38 were injured in road side accidents, 10 were injured due to assault, 3 at school and 1 patient was injured during a stampede that occurred in a religious camp. The visual acuity at presentation was upto 6/12 in 47%, <6/12 to 6/36 in 13.5%, <6/36-1/60 in 6%, <1/60 to PL(perceive light)positive in 22% and PL negative in 4% patients. In 7.5% patients the visual acuity could not be assessed on the Snellen's chart. Most of the patients had closed globe injuries(54.5%)followed by involvement of the lid and adnexa(23%). And 19.5% had open globe injuries and 3% had involvement of the cranial nerves.

CONCLUSION: Ocular injuries are common and preventable causes of monocular blindness.

Abstract:AIM: To investigate the anti-aging effect and its potential mechanisms of simvastatin on retinas of physiological aging rats.

METHODS: Totally 40 three-month old healthy SD rats which had no eye diseases, were randomly assigned into two groups: simvastatin group(n=20)and control group(n=20). All rats were cultivated under the same conditions until they were nine-month old when interventions started to be given. Simvastatin group was given intragastric administration of 5mg/kg simvastatin every day until 17-month old. Control group was given intragastric administration of same amount of saline gavage. Retinal thickness was measured by HE staining, while Cu-Zn-SOD, NOX2, Bcl-2 and Bax were determined by immunohistochemistry(IHC).

RESULTS:HE staining showed that the retinal structure was clearer; the morphology of cell was more homogeneous; the number of cells was more stable and the structure of retinal pigment epithelium was more compact when compared with control group. Thickness of retinal neuroepithelium layer and retinal pigment epithelium increased significantly in the simvastatin group. Immunohistochemistry analysis showed that the expressions of Cu-Zn-SOD and Bax statistically increased while the NOX2, Bcl-2 as well as Bcl-2/Bax decreased in simvastatin group when compared with control group(P<0.05).

CONCLUSION: Simvastatin plays a protective role in retinal aging by decreasing oxidative stress reaction and promoting cell apoptosis.

Abstract:AIM: To investigate the relationship between development of blood-retinal barrier and formation of selenite nuclear cataract in rat.

METHODS: Activity of GPx, MDA level in lens and selenium content in the eyeballs of different ages rats were determined. Besides, lanthanum hydroxide \〖La(OH)₃\〗 tracer method was used to detect development status of blood-retina barrier at different ages.

RESULTS: The result showed that the enzyme activity of GPx was highest in young rats before open eyes, but then decreased gradually with age. Distribution of La(OH)₃ in retinal pigment epithelial layer of 20-day-old rats was significantly less than 11-day-old rats. Injecting sodium selenite to 9-day-old rats, lanthanum hydroxide increased obviously and extended to the inner layers of the retina after 48h, and the retinal pigment epithelial layer was damaged seriously; while injecting sodium selenite to 18-day-old rats with the same dose, number of lanthanum hydroxide decreased significantly and did not extend to the inner layer after 48h.Before opening eyes, the content of MDA in the lens of rats was the highest, and decreased significantly after opening eyes. The Se group was 5 times as that of the control group. Besides, in these groups of rats, selenium content in the eyeballs and MDA level in the lens were in agreement with the change of La(OH)₃ distribution.

CONCLUSION: These results indicated that antioxidant capacity in the eyelid unopened rats is not the main reason for selenite induced cataract formation. The real reason is that blood-retina barrier development is not mature in the eyelid unopened rats.

Abstract:AIM: To study the pathogenesis of transient intraocular pressure(IOP)after laser iridectomy with Krypton laser combined with Q-switched Nd:YAG laser.

METHODS: Totally 42 healthy rabbits(84 eyes)provided by the Animal Experimental Center of our hospital were selected, including 18 female rabbits, 24 male rabbits, average weight 2.24±0.31kg, and they were randomly divided into 6 groups, 7 rats in each group(14 eyes). We observed the change of intraocular pressure after laser iridectomy surgery at 20min, 2, 6, 18, 24h and the nitric oxide(NO), malondialdehyde(MDA), superoxide dismutase(SOD), 6-keto-prostaglandin(6-keto-PGF1α)and nitric oxide synthase(NOS)content in aqueous.

RESULTS: There was no significant difference in intraocular pressure, NO, NOS, SOD, MAD and 6-keto- PGF1α before operation(P>0.05). The intraocular pressure increased after operation, and the difference was statistically significant(P<0.05)at 20min, 2 and 6h after operation, and decreased at 18h after operation, 24h after operation(P>0.05). The levels of NO, NOS and SOD in the aqueous humor of the two groups decreased 20min, 2 and 6h after the operation(P<0.05), while increased after 6h, increased more at 18 and 24h.The difference with control group was no more significant(P>0.05). The levels of MDA and 6-keto-prostaglandin in the aqueous humor increased after the operation, and the difference was statistically significant at 20min, 2 and 6h after operation(P<0.05), while decreased at 18 and 24h and the difference with control group was not significant(P>0.05).

CONCLUSION: The increase of transient intraocular pressure after laser iridectomy may relate to the increase of malondialdehyde, 6-keto-prostaglandin content and the decrease of superoxide dismutase and nitric oxide in the aqueous humor after operation.

Abstract:AIM: To study the effect of oxaliplatin on the survival rate of Y79 after down-regulation of Mcl-1 by SiRNA.

METHODS: Y79 cells were cultured in RPMI1640. The cultured cells were stimulated with 0.25μmol/L of oxaliplatin. The expression of Mcl-1 protein was detected by Western blot after 6, 16 and 24h respectively. Cells in logarithmic phase were collected and used for single-cell suspension. Then they were transfected with empty plasmid, Mcl-1-homo-991, Mcl-1-homo-1114 and Mcl-1-homo-1235. After 6h, fluorescence microscope was used to observe the transfection efficiency and the optimal one was selected. The cells were divided into Group A and transfected with empty plasmids. The cells transfected with Mcl-1 were divided into Group B and Group C. Group A and Group C were treated with 0.25μmol/L oxaliplatin for stimulating induction, and the apoptotic rate was compared after 24h.

RESULTS: The expression of Mcl-1 in Y79 stimulated by oxaliplatin was the most after 24h of culture. Mcl-1-homo-991 significantly inhibited the expression of Mcl-1 in Y79 after transfection. There was no significant difference in the apoptosis rate in Group A(11.1%±1.2%)and in the control group(6.1%±0.6%)(P>0.05). The apoptotic rate of Group C(49.2%±2.7%)was significantly higher than that of Group B(20.8%±1.9%). At the same time, the apoptotic rates of these two groups were significantly higher than those of Group A and control group, the difference was statistically significant(P<0.05).

CONCLUSION:Downregulation of Mcl-1 by siRNA can reduce the drug resistance of Y79, thereby enhancing the apoptosis of Y79, and reducing the survival rate of Y79.

Abstract:AIM:To study the effects of phacoemulsification on ocular surface and corneal endothelial cells in cataract patients with diabetes mellitus.

METHODS: This study used a retrospective analysis of the clinical data to compare curative effect, the research object was 98 cases(98 eyes)of cataract patients with phacoemulsification from January 2016 to December 2016 in our hospital. Patients were divided into the observation group and the control group according to whether diabetes merged. The observation group had 50 cases of cataract patients with diabetes, the control group had 48 cases of pure cataract patients. Two groups of patients underwent phacoemulsification surgery and transparent corneal incision, surgeries were completed by the same doctor, no xeroma before surgery. Preoperative glycemic control was normal for diabetic patients, no changes in eye fundus. Observation of ocular surface at postoperative 1, 3, 7d and 1mo was taken. Dry eye symptoms, lacrimal film breakup time(BUT), corneal fluorescein staining(FL)score, SchirmerⅠtest(SⅠt)and corneal endothelial cell density were compared.

RESULTS: Dry eye symptom score of the two groups before and after operation had significant difference; data of the observation group at postoperative 7d and 1mo was significantly higher than that of the control group, there was statistical significance(P<0.05), there was no significant difference at 1 and 3d after operation(P>0.05). BUT of the two groups before and after surgery showed significant difference; data of the observation group at 7d and 1mo after operation was significantly lower than that of the control group, there was statistical significance(P<0.05); at 1 and 3d after operation there was no significant difference(P>0.05). The FL score of the two groups before and after surgery had significant difference, and at 3,7d and 1mo after operation, data of the observation group was significantly higher than that of the control group, there was statistical significance(P<0.05); there was no significant difference at postoperative 1d(P>0.05). The two groups' before and after surgery SⅠt had significant difference, at 1, 3, 7d and 1mo after operation, data of the observation group was significantly higher than that of the control group, there was statistical significance(P<0.05). Corneal endothelial cell density showed apparent difference of the two groups before and after surgery; at 1, 3, 7d and 1mo after operation, data of the observation group was significantly lower than that of the control group, there was statistical significance(P<0.05).

CONCLUSION: Phacoemulsification has significant effects on tear film break-up time, SⅠt and dry eye symptoms in patients with diabetes mellitus, which may be related to the impaired repair ability of diabetic patients.

Abstract:AIM: To study the clinical efficacy of integrative therapy in the treatment of non-proliferative diabetic retinopathy.

METHODS: Ninety patients(90 eyes)in our hospital with non-proliferative diabetic retinopathy were randomly divided into three groups. All three groups were treated with diabetes drugs to control blood sugar. The first group was treated with western medicine, the second group was treated with Chinese medicine decoction Traditional Chinese Medicine(TCM)treatment, and the third group was treated with the combination of those two methods. All patients were recorded and analyzed changes of clinical effects after 6 courses of treatment.

RESULTS: After 6 courses of treatment, the total efficacy rate of the third group was 86%, markedly higher than that of the first group(57%, P<0.05)as well as the second group(60%, P<0.05). The integrative group improved more markedly in terms of vision, macular edema absorption, and ERG b-wave amplitude restoration, the difference being statistically significant(P<0.05)when compared to the first and the second group.

CONCLUSION: Integrative treatment of diabetic retinopathy could effectively improve the therapeutic effect in patients with non-proliferative retinopathy.

Abstract:AIM: To observe the therapeutic effect of visual perception training combined with total nutrition meal sequential therapy in the treatment of myopic amblyopia.

METHODS: Totally 73 children(135 eyes)with myopic amblyopia were divided into control group(36 cases, 67 eyes)and treatment group(37 cases, 68 eyes)according to random number table. The control group were treated with traditional spectaculars and grating covering combined with fine eyesight training; the treatment group were treated with visual perception training combined with total nutrient meal sequential therapy. The visual acuity, diopter and average diopter of two groups were compared before and after treatment at 3, 6mo and 1a. The curative effect of two groups of children was compared after 1a treatment. And the adverse reactions were recorded in two groups during the treatment period. The recurrence rate of amblyopia in 1a follow-up was compared between two groups.

RESULTS: The difference of visual acuity between two groups was not significant at 3mo(P>0.05). The visual acuity of the treatment group was significantly higher than that of the control group at 6mo and 1a(P<0.05). There was no significant difference in diopter between the two groups after 3, 6mo and 1a(P>0.05), but the average annual refractive changes in the treatment group were significantly lower than that in the control group(P<0.05). The basic cure rate and total effective rate of the treatment group were significantly higher than that of the control group(P<0.05). There were no severe adverse reactions occurred between two groups during the treatment period. The recurrence rate of amblyopia in the treatment group was significantly lower than that in the control group(P<0.05)after 1a follow-up.

CONCLUSION: Visual perception training combined with total nutrition meal sequential therapy in the treatment of myopic amblyopia in preschool children can significantly improve patients' visual acuity, reduce the average annual diopter changes, improve the therapeutic effect, reduce the recurrence rate of amblyopia.

Abstract:AIM: To study the clinical effect of Conbercept and Ranibizumab for macular edema(ME)with meta-analysis.

METHODS:We searched Pubmed, EMBASE, Cochrane Library Central Register of Controlled Trials(CENTRAL), Google scholar, ClinicalTrials.gov, CNKI, VIP and wanfang database for studies which published between January 1 2012 and July 1 2017, on the comparison of conbercept with ranibizumab for the clinical effect of secondary macular edema. The primary endpoints were visual acuity(VA)and central macular thickness in this study to assess the efficiency of the drugs. Review Manager 5.3 and Stata 12.0 were used for data analysis with the pooled odds ratios(OR), mean difference and 95% confidence interval(CI).

RESULTS: Eleven RCTs involving 812 patients met inclusion criteria and included in this meta-analysis, including 414 eyes in conbercept group and 398 eyes in ranibizumab group. Macular edema in this study were secondary to age-related macular degeneration, diabetic retinopathy and retinal vein occlusion. No significant differences in improvement of vision acuity(P=0.09)or reduction of CMT(P>0.05)were noted at the end of 3mo between two groups. Compared to ranibizumab, conbercept showed a better effectiveness in macular edema alleviation in the end of 6mo in the present study(OR=-58.50, 95%CI: -108.04 to -8.95; P=0.02).

CONCLUSION: Despite evidence from the meta-analysis of the RCTs suggesting a strong difference of the effectiveness for macular edema between conbercept and ranibizumab, more clinical trials are still needed to confirm our results because of the heterogeneity in the collected data.

Abstract:Hydroxyapatite(HA)orbital implant has been widely used since it was developed due to its many advantages. It is one of the ideal materials to fill the orbital volume after enucleation or evicseration. However, it still causes complications, and some complications such as severe eye exposure may require reimplant surgery. The paper reviews the clinical application of HA orbital implant, the possible factors leading to complications of HA orbital implantation and the treatments for several common complications. The review aims to provide some help to readers.

Abstract:Cataract refers to the degenerative changes in lens quality caused by various causes of reduced transparency or color change. Surgical treatment is the main treatment modality at present. Among them, phacoemulsification has become the main surgical treatment for cataract because of its advantages such as short operation time, small incision and quicker healing. Today, cataract surgery has gradually shift to refractive surgery, and is no longer simply as cataract surgery. But after cataract phacoemulsification, the symptoms and visual quality are different. The main causes include refractive error, postoperative dry eyes and postoperative corneal astigmatism. This article reviews the factors that influence the visual quality of cataract phacoemulsification and its future trends.

Abstract:Choroidal melanoma(CM)has the largest number in uveal malignant tumors and is the common intraocular malignant tumor among adults. Its morbidity takes the second place in intraocular malignant tumors in China, following retinoblastoma. This study reviewed pathological feature, pathogenesis, imaging examination and progress on therapeutic research of choroidal melanoma in recent years.

Abstract:Age-related macular degeneration(ARMD)and Stargardt's macular dystrophy(SMD)are two kinds of degenerative retinal diseases that respectively lead to irreversible vision loss of the elderly and juvenile population. However, the severe visual impairment in dry ARMD and SMD remains untreatable. In recent years, with the advancement of stem cell technology, stem cell-derived RPE cell transplantation therapy of retinal degeneration has become new research hotspot and direction. This article reviewed the progress of stem cell based approaches for treating retinal degenerative diseases and discussed the prospect and challenges in this field.

Abstract:Retinal angiomatous proliferation(RAP), also known as “type 3 neovascularization”, is a well-recognized variation of neovascular age-related macular degeneration(nARMD). Neovascularization is the basic pathological characteristic. Current view on the origin of the neovascularization is the deep retinal capillaries. The main clinical features include retinal pigment epithelium detachment(PED)and reticular pseudodrusen. These two features have close relation to the retinal pigment epithelium(RPE)tear and geographic atrophy(GA), respectively, which may ultimately result in severe irreversible visual impairment. The disease has a rapid natural course and the majority of patients in early stage can develop into vision loss within 6mo. However, classical therapeutic managements, such as laser therapy, have limited efficacy and poor prognosis. Recently, RAP has been further understood with the application of OCT angiography and other new technologies in diagnosing, staging and monitoring RAP. Varieties of research on intravitreal injection of anti-vascular endothelial growth factor(VEGF)treatment to RAP have also revealed its promising results and proved its safety as well as effectiveness. All these have provided new knowledge on choosing the optimal treatment regimen in clinical.

Abstract:Familial exudative vitreoretinopathy(FEVR)is a hereditary disease associated with abnormal angiogenesis in the pediatric period. The most prominent finding of the disease is avascularity in the peripheral retina.Whereas, the phenotypic features are variable. In some minor cases, missed diagnosis would happened due to asymptom, while, in severe FEVR, neovascularization, retinal exudation, retinal folds, macular heterotopy and retinal detachment may occur and give rise to extremely poor vision or even blindness. Mutations in the FZD4, LRP5, NDP, TSPAN12, ZNF408, and KIF11 genes have been reported to contribute to FEVR with X-linked recessive, autosomal dominant, and autosomal recessive inheritance manners. We have summarized aspects of pathogenesis, clinical features and classification, mutations genes as well as diagnosis and treatment of FEVR in this review.

Abstract:Adult orbital xanthogranulomatous disease is a group of rare orbital and ocular adnexal disorders, which is classified as class II non-Langerhans histiocytic proliferations. This disease can be classified into 4 subtypes based mainly on systemic involvement: adult-onset xanthogranuloma, necrobiotic xanthogranuloma, Erdheim-Chester disease and adult-onset asthma and periocular xanthogranuloma. Diagnosis depends on its characteristic clinical manifestations and pathologic features. Therapeutic approaches are derived from anecdotal evidences, which include corticosteroid, immunosuppressive agent, surgical debulking and chemotherapy. The management of this disease varies with different subtypes, as well as associated systemic presentations. This review summarizes advances of etiopathogenesis, clinical features, diagnosis and treatment.

Abstract:Corneal confocal microscopy can be used in the real-time, noninvasive, high-resolution corneal structure at the cellular level, which has been widely used in corneal disease research. This review summarizes recent advances in corneal confocal microscopy in the study of infectious keratitis, dry eye, keratoconus, diabetic peripheral neuropathy, and clinical studies to guide corneal transplantation.

Abstract:AIM: To investigate the effect of Toric intraocular lens(IOL)on the treatment of cataract with corneal astigmatism and its effect on visual function.

METHODS: The clinical data of patients with cataract and corneal astigmatism after phacoemulsification in our hospital from August 2013 to August 2016 in our hospital were retrospectively analyzed. The patients were divided into spherical IOL group and Toric group according to the difference of their implanted IOL. The treatment satisfaction of the two groups was observed, and the difference of visual acuity, diopter, optic function and complications between the two groups were compared.

RESULTS: The visual acuity and total astigmatism of the two groups before treatment had no difference(P>0.05). At 3mo after treatment, the visual acuity and total astigmatism of patients in the Toric IOL group were better than those of the spherical IOL group, the differences were statistically different(P<0.05). At 1 and 3mo after operation, the axial rotation of the Toric IOL group was lower than that of the IOL group. There was no difference between the two groups in visual function before operation(P>0.05). After treatment, the BCVA, area under the log contrast sensitivity function(AULCSF), contrast sensitivity maxium(Smax)and cut-off spatial frequency(CutSF)of the patients in the Toric group were lower than those of the spherical IOL group at the end of the treatment, the difference was statistically significant(P<0.05). Two groups of patients were no endophthalmitis, secondary glaucoma, macular edema and iridocyclitis complications; no significant difference between the two groups on patients satisfaction(χ²=0.002, P=0.964).

CONCLUSION: Toric IOL has a better therapeutic effect on patients with cataract and corneal astigmatism. It can improve the visual acuity and optic function in patients with cataract.

Abstract:AIM: To compare and analyze the clinical efficacy of different artificial tears for patients with xerophthalmia after phacoemulsification.

METHODS: Retrospective analysis on the clinical data of 150 cases(150 eyes)treated by phacoemulsification in our hospital from March 2014 to April 2017. And according to the artificial tears used, they were divided into Group A(control group)and B(application of sodium hyaluronate eye drops), Group C(used carbomer gel eye drops),50 cases 50 eyes in every group. We compared and analyzed the BUT, FL, SⅠt findings, OSDI scores preoperatively and 1wk, 1 and 3mo postoperatively, and visual acuity before and 3mo after operation in the three groups.

RESULTS: There were no differences in BUT, FL, SⅠt and OSDI scores between the three groups before and at 1wk after the operation(P>0.05). At 1mo after operation, the levels of BUT and SⅠt in Group B and Group C were higher than those in Group A, and the scores of OSDI and FL were lower than those in Group A(P<0.05); between Group B and Group C there was no difference in BUT, FL, SⅠt levels and OSDI score(P>0.05). After 3mo, the levels of BUT and SⅠt in the Group B and Group C were higher than that in the Group A, and the FL level and OSDI score were lower than those in the Group A(P<0.05); the levels of BUT and SⅠt in the Group C were higher than those in the Group B, and the FL level and the OSDI score were lower than those in the Group B(P<0.05). The visual acuity of the three groups was improved at 3mo after the operation(P<0.05), and there was no difference in LogMAR visual acuity between the three groups before and 3mo after operation(P>0.05).

CONCLUSION: different types of artificial tear can improve the symptoms of dry eyes in patients age-related cataract after phacoemulsification, in which carbomer eye drops or lipid containing artificial tears improve postoperative dry eye symptoms and signs, and will not affect the recovery of visual acuity.

Abstract:AIM:To evaluate the efficacy of phacoemulsification and intraocular lens(IOL)implantation combined with goniosynechialysis in the treatment of primary chronic angle closure glaucoma.

METHODS: Eighty patients(96 eyes)with primary chronic angle closure glaucoma were divided into observation group(40 cases, 46 eyes)and control group(40 cases, 50 eyes). The treatment group was treated with phacoemulsification, intraocular lens implantation and goniosynechialysis, while the control group was treated with phacoemulsification and intraocular lens implantation. The best corrected visual acuity, intraocular pressure, visual field mean deviation(MD), mean sensitivity(MS)and the central anterior chamber depth of the two groups before and after the surgery were compared, and the occurrence of complications in patients with postoperative were record.

RESULTS:The best corrected visual acuity, visual field, intraocular pressure and central anterior chamber depth of the two groups before operation showed no significant differences(P>0.05). The best corrected visual acuity, visual field, intraocular pressure and central anterior chamber depth between the groups at 6mo postoperatively showed statistically significant(P<0.05). There was no serious complications in the two groups, and the difference between the two groups showed no statistically significant(χ²=0.351, P=2.095).

CONCLUSION:The application of the phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of primary chronic angle closure glaucoma is more effective than the simple use of phacoemulsification and intraocular lens implantation.

Abstract:AIM: To study the effects of timolol and latanoprost on optic disc parameters and retinal nerve fiber layer thickness of high intraocular pressure type POAG patients, and to provide guidance for clinical research.

METHODS: Totally 240 patients(336 eyes)with high intraocular pressure type POAG in our hospital from November 2013 to November 2015 were randomly divided into control group and observation group, and each with a total of 120 cases(170 and 166 eyes, respectively). The patients in control group only received latanoprost treatment, while the observation group was treated with timolol and latanoprost treatment. After 3mo of treatment, we observed the therapeutic effects, and measured the optic disc parameters and retinal nerve fiber layer thickness. The incidence of adverse reactions was observed in the following 1a.

RESULTS: The patients of observation group and the control group after treatment showed the improvement rates of 97.6% and 80.6%, respectively, and the observation group was significantly better than the control group, the two groups showed statistically significant(P<0.05). The eye rim area, rim volume, rim volume and diameter of two groups after treatment were higher than before(P<0.05), while those of the observation group was significantly higher than control group(P<0.05). Two groups of patients with vertical cup to disc diameter decreased obviously(P<0.05), the observation group was significantly lower than the control group, the difference was statistically significant(P<0.05). Between the two groups of patients, during the period, incidences of dry eyes, corneal and conjunctival hyperemia, infiltration blurred vision and other complications had no significant difference(P>0.05), and the 1a follow-up of patients showed no other adverse reactions.

CONCLUSION: The use of timolol and latanoprost therapy for high intraocular pressure type POAG patients showed that the patients improve obviously, the visual acuity has more improved and the parameters of optic disc and retinal nerve fiber layer thickness are also improved.

Abstract:AIM: To investigate the efficacy and safety of minimally invasive vitrectomy with 23G and 25G+ in the treatment of rhegmatogenous retinal detachment.

METHODS: From August 2015 to August 2016, 130 cases of rhegmatogenous retinal detachment patients were chosen as the research object. According to the random number table method, 130 patients were divided into experimental group and control group, 65 cases in each group. The experimental group received 25G+ minimally invasive vitrectomy, the control group was given 23G minimally invasive vitrectomy. The operation time, complication rate, retinal reattachment, visual acuity, intraocular pressure and postoperative complications were compared between the two groups.

RESULTS: The operative time was 69±11min in control group and 66±12min in the experimental group(P>0.05). The experimental group had 3 cases of iatrogenic retinal breaks, intraoperative complication rate was 4.6%, the control group of 5 cases of iatrogenic retinal breaks during the operation, the complication rate was 7.7%(P>0.05). The experimental group disposable retinal reattachment rate was 96.9%, the final reduction rate was 90.8%; the control group disposable retinal reattachment rate was 93.9%, the final reduction rate was 87.7%, those differences between the experimental group and the control group were no significant(P>0.05). At the end of the follow-up visual acuity of experimental group was logMAR 0.241±0.062, control group 0.253±0.057, significantly different compared with before treatment(P<0.05), while not different between the two groups(P>0.05). intraocular pressure of the two groups were not significantly different before and after surgery(P>0.05). The complication rate was 44.6% after operation in the experimental group, the complication rate was 63.1% in control group(P<0.05).

CONCLUSION: The 25G+ minimally invasive vitrectomy in the treatment of rhegmatogenous retinal detachment is safe and effective, less operative trauma, rapid postoperative recovery, less postoperative complications compared with 23G vitrectomy.

Abstract:AIM: To observe the effect of two kinds of bandage contact lenses on epithelial erosions and corneal thickness after vitreoretinal surgery for proliferative diabetic retinopathy(PDR).

METHODS: In this prospective, nonrandomized, comparative clinical study, 69 eyes of 69 patients with PDR were divided into two groups. They underwent vitreoretinal surgery. Group A, 36 eyes of 36 cases, the bandage contact lens with diameter of 13.8mm were covered on corneal surface during surgery under noncontact wide-angle viewing systems. Group B, 33 eyes of 33 cases, the bandage contact lens with diameter of 14.0mm were covered on corneal surface during the same surgery. Visual acuity, intraocular pressure, slit-lamp examination, corneal fluorescein sodium staining, count of corneal endothelium cells, measure of corneal thickness before and after operation were assessed.

RESULTS: Pre-operation, corneal fluorescein sodium staining positive rate was 42% in Group A and 42% in Group B(χ²=0.004, P=0.949). At 1d after surgery, the positive rate of was 47% in Group A and 45% in Group B(χ²=0.022, P=0.883). At 2d after surgery, the positive rate of was 44% in Group A and 45% in Group B(χ²=0.007, P=0.933). At 3d after surgery, the positive rate of was 44% in Group A and 42% in Group B(χ²=0.029, P=0.886). At 7d after surgery, the positive rate of was 42% in Group A and 39% in Group B(χ²=0.037, P=0.848). Count of corneal endothelium cells showed no significant difference between Group A and Group B(P>0.05). Count of corneal endothelium cells of Group A before surgery and at 7d after surgery were 2779.25±329.55 /mm², 2777.14±331.17 /mm², without significant difference(t=0.551, P=0.585); those of Group B were 2678.61±335.64/mm², 2672.45±336.25 /mm², without significant difference(t=1.774, P=0.086). Measure of corneal thickness was 519.25±23.42μm before surgery and 542.03±25.94μm after surgery in Group A(t=-6.854, P<0.001). Measure of corneal thickness was 525.64±20.97μm before surgery and 551.33±27.87μm after surgery in Group B(t=-7.204, P<0.001).

CONCLUSION: Two kinds of bandage contact lenses are used in vitreoretinal surgery in diabetic patients. The corneal epithelial integrity shows no difference before and after surgery. Both the bandage contact lens could protect the corneal epithelium and maintain good corneal transparency during vitreoretinal surgery.

Abstract:AIM: To investigate the changes of serum levels of vascular endothelial growth factor(VEGF), Endostatin(ES), thrombospondin(TSP), tissue kallikrein(TKLK)and soluble intercellular adhesion molecule-1(sICAM-1)in patients with diabetic retinopathy(DR)and its clinical significance.

METHODS: Selected 60 patients with non-proliferative diabetic retinopathy(NPDR group), 60 patients with proliferative diabetic retinopathy(PDR group)were enrolled in this study. Sixty diabetic patients without diabetic retinopathy(DM group)and 60 healthy people(control group)were also enrolled. Collection time was from January 2014 to December 2016. Serum levels of VEGF, ES, TSP, TKLK and sICAM-1 were measured and compared.

RESULTS: The levels of serum VEGF, TKLK and sICAM-1 in PDR group were significantly higher than those in NPDR group, DM group and control group(P<0.05). The ES of PDR group was significantly lower than that of NPDR group, DM group and control group(P<0.05). The levels of VEGF, TKLK and ES in the NPDR group were significantly higher than those in the DM group and the control group(P<0.05). The serum VEGF in the NPDR group was positively correlated with the levels of ES, TKLK and sICAM-1(P<0.05). The serum VEGF of PDR group was positively related to the levels of TKLK and sICAM-1(P<0.05). There was no significant relationship between serum VEGF with ES and TSP in PDR group(P>0.05).

CONCLUSION: The levels of serum ES, TSP, TKLK and sICAM-1 in patients with DR have changed significantly, and the process of retinopathy has been affected by regulating the level of VEGF.

Abstract:AIM: To investigate the correlation of matrix metalloproteinase -9(MMP-9), glycated albumin(GA), glycosylated hemoglobin(HbA1c)and adipokines(including visfatin, resistin and leptin)with diabetic retinopathy(DR).

METHODS: From March 2015 to March 2017, 74 patients with DR were treated in our hospital, including 40 patients(80 eyes)with non proliferative diabetic retinopathy(NPDR)and 34 patients(68 eyes)with proliferative diabetic retinopathy(PDR), and diabetes mellitus 40 patients(80 eyes)with non DR(NDR)and 40 healthy volunteers(80 eyes)were selected as controls, the levels of MMP-9, GA, HbA1c, visfatin, resistin and leptin in each group were detected.

RESULTS: PDR group visfatin was 4.41±0.82ng/mL, was significantly lower than the NPDR group, NDR group and control group(P<0.05), while, resistin, leptin and MMP-9 were 9.01±1.04ng/mL, 17.96±2.03μg/L and 740.06±84.43μg/L, GA and HbA1c were 26.14%±4.57% and 17.60%±1.91%, significantly higher than those of NPDR group, NDR group and control group(P<0.05). NPDR group visfatin was 6.44±0.79ng/mL, was significantly lower than that of NDR group and control group(P<0.05), while, resistin, leptin and MMP-9 were 7.80±0.87ng/ml, 15.68±1.98μg/L and 634.12±80.22μg/L, GA and HbA1c were 22.06%±4.38% and 12.46%±1.69%, significantly higher than those of NDR group and control group(P<0.05). MMP-9, GA, HbA1c were positively with DR levels(r_s=0.523, 0.461 and 0.414, P<0.05); visfatin was negatively correlated with DR levels(r_s=-0.433, P<0.05), resistin and leptin were positively correlated with DR levels(r_s=0.401 and 0.460, P<0.05).

CONCLUSION: MMP-9, GA, HbA1c, and adipokines may play a role in the development and progression of DR, in which MMP-9 is associated with adipokines, both are not significantly related to the levels of GA and HbA1c.

Abstract:AIM: To compare the treatment efficacy of vitrectomy with macular epiretinal membrane(MEM)peeling combined with or without air tamponade for idiopathic macular epiretinal membranes(IMEM).

METHODS: Forty-two cases of IMEM patients(46 eyes)associated with cataract were randomly divided into two groups. Twenty-five eyes of 23 cases in Group A were performed with vitrectomy with macular epiretinal membrane peeling combined with air tamponade. The other 21 eyes of 19 cases in Group B only underwent vitrectomy and macular epiretinal membrane peeling(without air tamponade). The visual acuity and central macular thickness(CMT)were compared between the two groups before and after the surgery. The intraoperative and postoperative complications were also observed in both groups in the mean time.

RESULTS: There was no statistical significant difference between two groups in age, visual acuity and CMT before operation(P>0.05). By 1wk, 3 and 6mo follow-up after operation, mean visual acuity improved significantly; mean CMT decreased obviously in both groups after the operation and the difference was statistically significant(P<0.05). But for mean visual acuity and CMT, there were not statistically significant difference between two groups postoperatively at the same time(P>0.05),there was no correlation between postoperative mean visual acuity and CMT in the two groups. No serious complications occurred during and after operation.

CONCLUSION: Vitrectomy with macular epiretinal membrane peeling can be a safe and effective treatment for IMEM, meanwhile air tamponade in vitreous cavity does not reveal more advantages in the treatment.

Abstract:AIM: To observe the changes of anterior and posterior corneal curvature and anterior chamber depth after small incision lenticule extraction(SMILE)for low and high myopic astigmatism.

METHODS: Sixty-three cases(88 eyes)undergone SMILE in our hospital were included. The patients were divided into two groups based on astigmatism degree: the Group A: -2.00D to -4.00D astigmatism, the Group B: -0.25D to -1.00D astigmatism. Patients were examined at 1wk, 1 and 3mo after operations. Visual acuity, intraocular pressure, refraction, corneal curvature and anterior chamber depth were recorded. The change of anterior and posterior corneal curvature and anterior chamber depth was compared. Spearman correlation analysis and independent t test were used for statistical analysis.

RESULTS: Surgery was done well in all patients without complications. No statistically significant difference was found between the two groups in posterior corneal curvature and anterior chamber depth preoperatively, postoperatively 7d,1 and 3mo(P>0.05). One week postoperatively, the anterior corneal curvature was statistically significant from that of preoperative in both groups(P<0.05), while there were no significant differences at 1 and 3mo after operation(P>0.05).

CONCLUSION: No significant change of anterior and posterior corneal curvature and anterior chamber depth was found after SMILE for correcting low and high myopic astigmatism. One week after SMILE the anterior corneal curvature become stable.

Abstract:AIM: To observe the clinical efficacy of Yiqi Yangxue Qufeng therapy(Heijing Tuiyi Decoction)in current patients with herpes simplex keratitis.

METHODS: Totally 58 cases with recurrent herpes simplex keratitis patients were selected, then randomly divided into treatment group and control group. Patients in the control group were be treated with recombinant human interferon α-2b eye drop and ganciclovir ophthalmic gel, patients with iridocyclitis and corneal endothelitis were treated with compound tropicamide eye drops for mydriasis. Fluorometholone eye drops was used to treat eye diseases according to the circumstances, while patients in the treatment group were treated by Heijing Tuiyi Decoction on the basis of the control group. All patients were be treated for 4wk, observed the clinical therapeutic effect and recurrence rate of the disease within 6mo.

RESULTS: There was significant difference in the clinical curative effect and the recurrence rate between the 2 groups(P<0.05). Compared with before treatment, the CD4+ ratio and CD4+/CD8+ ratio significantly increased after treatment, and significantly higher than that of the control group(P<0.01); CD8+ of treatment group significantly decreased and was significantly lower than the control group(P<0.01).

CONCLUSION: Yiqi Yangxue Qufeng method of traditional Chinese medicine Heijing Tuiyi Decoction combined with conventional antiviral medicine treatment, is better for patients with herpes simplex keratitis, prevent its recurrence, improve clinical efficacy, thereby improves the life quality of patients.

Abstract:AIM: To clinical effect of 25G+ vitrectomy combined with intravitreal injection of Conbercept for severe proliferative diabetic retinopathy(PDR).

METHODS: A clinical case control study. A total of 35 patients(42 eyes)with severe PDR who underwent 25G+ vitrectomy in our hospital from October 2014 to August 2016 were randomly divided into two groups: A and B. Among them, 18 cases(22 eyes)was given conbercept intravitreal injection combined with vitrectomy as Group A; 17 cases(20 eyes)was only given vitrectomy without conbercept injection were Group B. Observation of operation duration, intraoperative complications, the incidence of vitreous hemorrhage(RVH), macular foveal thickness(CFT)at 3mo after operation were observed, best corrected visual acuity(logMAR BCVA), and macular foveal thickness(CFT)at 6mo after operation were observed too.

RESULTS: The operative time of Group A and B was 58.23±8.18min and 72.41±10.31min, the difference was statistically significant(t=2.9, P=0.002). During the operation, the main complications were iatrogenic hiatus and intraoperative bleeding, Group A of 2 eyes and 1 cases, Group B of 7 eyes and 6 eyes, the difference was statistically significant(P=0.041, 0.027). The incidence of vitreous hemorrhage(RVH): at 3mo after operation, that in Group A was 2 eyes, and in Group B was 8 eyes, the incidence of vitreous hemorrhage was statistically significant between the two Groups(P=0.030). The best corrected visual acuity was 0.92±0.35 in Group A and 1.04±0.43 in Group B at 6mo postoperatively, but there was no significant difference between the two groups(t=0.241, P=0.212), but compared with the preoperative visual acuity improved obviously, the difference was statistically significant(t=4.614, t=7.355; P<0.01). CFT: at 3mo after operation, that of Group A was 273.42±25.21μm, Group B was 284.58±27.44μm, there was no significant difference between the two groups(t=0.488, P=0.179), but there were significantly decrease, the difference was statistically significant(t=3.152, t=4.933; P<0.01); at 6mo after operation, CFT of Group A was 238.16±16.35μm, Group B was 247.04±17.43μm, there was no significant difference between the two groups(t=0.571, P=0.133), but there were significantly decrease, the difference was statistically significant(t=2.474, t=4.802; P<0.01).

CONCLUSION: The 25G+ vitrectomy combined with preoperative conbercept intravitreal injection in patients with severe proliferative diabetic retinopathy can effectively improve vision and reduce macular edema,compared with simple vitrectomy, the operation time can be shortened, the incidence of complications can be reduced, and the incidence of vitreous hemorrhage in 3mo after operation can be significantly reduced.

Abstract:AIM: To investigate the clinical efficacy of intravitreal injection of Ranibizumab and 577nm laser in the treatment of retinal vein occlusion combined with macular edema.

METHODS: Totally 64 patients(64 eyes)with retinal vein occlusion accompanied by macular edema were treated in our hospital from June 2014 to March 2017. Among them, 40 cases(40 eyes)were in the central retinal vein occlusion group, 24 cases(24 eyes)were in the branch retinal vein occlusion group. They were treated with intravitreal injection of ranibizumab 0.5mg, and the laser photocoagulation of 577nm was performed at 5 to 7d after injection. Meanwhile, 42 patients who did not wish to be treated with injection were treated with laser treatment only. The changes of the indexes before and after treatment were compared.

RESULTS: The average number of blocking group repeated injection of branch retinal vein for 1.71±0.79, while the average number of patients with repeated injection of central retinal vein occlusion was 2.11±0.80. All patients requiring repeated injections interval was greater than 30d. At 1mo after treatment, there was no patients with decreased visual acuity in branch retinal vein occlusion group, while there were 6 eyes with that in central retinal vein occlusion group, 14 eyes in simply laser group. The mean best corrected visual acuity(LogMAR)of the three groups was 0.87±0.60, 0.57±0.48 and 0.54±0.32, respectively, were significantly lower than that before treatment(1.26±0.53, 0.86±0.39, 0.76±0.26; P<0.05). The mean macular retinal thickness before treatment was 683.24±211.83, 557.39±128.29 and 545.82±129.76μm, were significantly higher than those at the last follow-up 412.09±257.38, 356.29±133.02 and 322.78±109.55μm(P<0.05). There were 6 cases of subconjunctival hemorrhage in patients treated with laser therapy combined with laser therapy. The intraocular pressure increased to 25mmHg in 2 eyes in 2 patients and recovered after symptomatic treatment.

CONCLUSION: Intravitreal injection of ranibizumab combined with 577nm laser treatment can greatly enhance the visual acuity, effective decrease macular retinal thickness in patients with retinal vein occlusion and macular edema.

Abstract:AIM:To analyze the clinical efficacy of Ranibizumab in the treatment of wet age-related macular degeneration(ARMD).

METHODS: Clinical data of patients with wet age-related macular degeneration received treatment of ranibizumab at our hospital from 2015 to 2017 were analyzed. At 1mo after treatment, the clinical efficacy, ocular hemodynamics and ocular inflammation were evaluated.

RESULTS: A total of 41 patients were analyzed. After treatment, patients got significantly increased in LogMAR(0.651±0.067 vs 0.321±0.049; t=25.460, P<0.01)and decreased in central foveal thickness(239.1±51.9μm vs 452.9±69.8μm; t=15.740, P<0.01). There was no serious complication during treatment period. After treatment, the levels of TNF-α(13.1±4.1ng/L vs 16.1±3.5ng/L; t=3.563, P<0.01)and IL-6(12.1±1.9ng/L vs 13.8±2.5ng/L; t=3.467, P<0.01)in aqueous fluid decreased significantly. There was no significantly changes of blood flow volume of central retinal artery and ophthalmic artery at peak systolic velocity and end diastolic velocity before and after treatment(P>0.05).

CONCLUSION: In the treatment of wet age-related macular degeneration, the ranibizumab shows a good therapeutic effect without serious adverse drug reactions.

Abstract:AIM:To investigate the clinical effect of scleral buckling with nondrainage of subretinal fluid in the treatment of rhegmatogenous retinal detachment.

METHODS: A total of 111 patients(113 eyes)with rhegmatogenous retinal detachment in our hospital from January 2012 to January 2017 were retrospectively reviewed. All the patients were identified as fulfilling the criteria of rhegmatogenous retinal detachment. Localization and scleral cryotherapy of retinal breaks with binocular indirect ophthalmoscopy in all eyes were performed during the operations. Simple scleral pressure were performed in 98 eyes. Intravitreal injection of sterile air were performed in 15 eyes. Scleral cryotherapy were performed in all cases with retinal degeneration and breaks. Anterior chamber puncture were performed before ligation suture. The final retinal reattachment rate, best corrected vision acuity, intraocular pressure and complications were observed.

RESULTS: The mean follow-up period was 6mo after operation. The final retinal reattachment rate at 6mo was 97.4%. There were 91 eyes(80.5%)with improved visual acuity after operation. High intraocular pressure can be controlled after operation. Complications were occurred in 7 eyes in the operation, 3 eyes postoperatively.

CONCLUSION: The surgery of scleral buckling with nondrainage of subretinal fluid have few complications and is effective.

Abstract:AIM: To evaluate and characterize the macular thickness and macular volume in patients of different stages of diabetic retinopathy with special-domain optical coherence tomography(SD-OCT).

METHODS: Totally 40 patients(78 eyes)with diabetic retinopathy were recruited in the study from January 2016 to January 2017 in our hospital. According to the international clinical classification of diabetic retinopathy, 20 cases(40 eyes)were categorized as non-proliferative diabetic retinopathy(NPDR)group and 20 cases proliferative diabetic retinopathy(PDR)group(38 eyes). All subjects were examined and analyzed with Early Treatment Diabetic Retinopathy Study(ETDRS)subfields, which were embedded in HS(Haag-Streit)with diameter of 1, 3 and 6mm.The changes of retinal thickness and volume of the macular center were measured.

RESULTS: The thickness of macular foveolar in NPDR group and PDR group were 252.57±31.36μm, 362.47±20.81μm. The retinal thickness of inner superior subfield(ISM)and inner nasal subfield(INM)were the thickest; that of inner inferior subfield(IIM)was next to ISM and INM, and that of inner temporal subfield was the thinnest. Of the outer subfields, the retinal thickness of outer superior subfield(OSM)was the thickest; that of outer nasal subfield(ONM)was next to OSM, and that of outer temporal subfield(OTM)and outer inferior subfield(OIM)was the thinnest. The value of macular central concave thickness and retinal thickness in each quadrant of the NPDR group were less than those of the PDR group, the difference was statistically significant(P<0.05). The volume(V)of macular center in NPDR group and PDR group were 0.20±0.02mm³, 0.28±0.16mm³, the upper and nasal sides of the middle part of the partition were the largest, the inferior and the temporal side were the smallest. The nasal side of the outer loop was the largest, the upper was the second, the temporal side and the inferior were the smallest. The volume of macular central fovea and the retinal volume in each quadrant of the NPDR group were smaller than those of the PDR group, the difference was statistically significant(P<0.05).

CONCLUSION: The changes of retinal thickness and volume in macular central fovea were related with the progression of diabetic retinopathy. Using OCT to analyze the macular thickness and macular volume in different stages of diabetic retinopathy, helps physicians to understand the morphological changes of macular region and its surrounding macular degeneration with the severity of diabetic retinopathy, and provide a basis for better analysis of the changes of the structure of macular in different severity diabetic retinopathy.

Abstract:AIM: To evaluate the effect of bupivacaine in non-catheter infiltration anesthesia during vitretomy operation.

METHODS: Fifty-eight patients(58 eyes)with vitreous retinal surgery were selected. Patients were randomly divided into observation group(28 eyes)and control group(30 eyes). The observation group were received non-catheter infiltration anesthesia. The control group were received traditional Sub-Tenon's block(STB). Degree of pain, basic vital signs, the duration of anesthesia and analgesia grade were recorded and compared between two groups.

RESULTS: No significant difference was found in the 11-point numeric rating scale(NRS-11 scoring)of anesthesia process, sclera incision, intraocular operation and the end of operation between two groups(P>0.05). The difference were not significant in heart rate and blood pressure between two groups(P>0.05). There was statistically significant difference in the duration of anesthesia between two groups(P<0.05).

CONCLUSION: Both groups can provide the same anesthetic effect. Compared to STB, non-catheter infiltration anesthesia takes short time, and it is a safe and effective anesthesia methods. In addition, compare to the mixture of bupivacaine and lidocaine injection, bupivacaine injection can provide the same anesthetic effect.

Abstract:AIM: To analyze the effect of Conbercept for exudative age-related macular degeneration(ARMD).

METHODS: There were 21 eye of 21 patients with exudative ARMD from January 2016 to January 2017 included. All the patients were treated with intravitreal injection of conbercept 0.5mL(0.5mg)and followed up for 3mo. The best corrected visual acuity(BCVA)and central macular thickness(CMT)before and 1wk, 1 and 3mo after treatment were observed.

RESULTS: The BCVA and CMT before and 1wk, 1 and 3mo after treatment were 0.9±1.4, 0.7±1.2, 0.5±1.1 and 0.4±0.9. BCVA after treatment were different at different time(F=49.12, P<0.001); BCVA at 1wk and 1mo after treatment were not different compared with before treatment(P>0.05); that at 3mo were significantly different compared with before(P<0.05). There were 19 eyes with improved BCVA at 3mo after treatment, unchanged in 2 eyes. CMT before and at 1wk, 1 and 3mo were 404.25±68.76, 354.25±43.12, 271.75±32.30, 218.30±24.70μm. CMT at different time were significantly different(F=2 487.45, P<0.001); CMT at 1wk, 1 and 3mo were different compared with before treatment(P<0.001). There were no severe complications found.

CONCLUSION: Intravitreal injection of conbercept for exudative ARMD is remarkable.

Abstract:AIM: To compare the outer nuclear layer(ONL), inner and outer segments(IS/OS), photoreceptor cell layer in healthy people and diabetic retinopathy by frequency-domain optical coherence tomography(OCT).

METHODS: Totally 100 eyes of 50 healthy people were selected as control group. According to conventional mydriasis for examination of fundus and fundus fluorescein angiography(FFA)examination, all diabetic cases were divided into 3 groups: normal retina group(NDR), non-proliferative diabetic retinopathy group(NPDR), proliferative diabetic retinopathy group(PDR). Using OCT measure the thickness of ONL, IS/OS and photoreceptor cell layer of fovea and parafovea(nasal side and temporal side)in the four groups.

RESULTS: Compared with the control group, the ONL and photoreceptor cell layer's thickness of macular fovea and temporal parafovea in NPDR group and PDR group were statistically significant(all P<0.05). The differences between ONL and photoreceptor cell layer's thickness of macular fovea and temporal parafovea in NDR group and PDR group were not statistically significant(P>0.05). The IS/OS of macular fovea and temporal parafovea was not significantly different among those groups(P>0.05). The thickness of different layers of nasal parafovea were not different(P>0.05).

CONCLUSION: The thickness of macular fovea and temporal parafovea has relation with degree of DR; the change of photoreceptor cell layer's thickness occurs mainly in ONL, but IS/OS no change; the change in temporal parafovea more obvious than in nasal parafovea. Frequency-domain OCT can quantitatively and qualitatively observe the subtle diabetic macular changes in diabetic patients with macular disease, and provides a reliable detection for the early diagnosis and treatment.

Abstract:AIM: To observe the application of optical coherence tomography(OCT)in the diseases of traumatic macular hole.

METHODS: Twenty-five eyes of 23 patients with traumatic macular hole from January 2015 to January 2017 were enrolled in this study, including 9 eyes treated without surgeries, 16 eyes with surgeries. The image features were analyzed using OCT from ZEISS.

RESULTS: The OCT characteristics in patients with traumatic macular hole were partial or full-thickness disappearance of the neuro-epithelium. Posterior vitreous detachment was not seen in the traumatic macular hole. OCT examination revealed that 4 eyes had partial detachment of macular hole and 21 eyes had full thickness detachment. Of the twenty-one eyes, 4 eyes had simple macular hole, 10 eyes had macular full-layer division with peripheral nerve epithelium edema, 7 eyes had the macular full-layer hole with the neuro-epithelium localized detachment. In the 25 eyes, 9 eyes did not undergo the surgery, of which 7 eyes were self-healing; 16 eyes were surgically treated. Postoperative OCT showed the macular structure were normal in 12 eyes with the visual acuity improved 3 lines; retinal nerve epithelium were thinning in 4 eyes, visual acuities were not significant improved after surgery.

CONCLUSION: OCT examination is necessary for the diagnosis and treatment of traumatic macular hole.

Abstract:AIM: To investigate the therapeutic effect of endoscopic dacryocystorhinostomy in the treatment of acute dacryocystitis.

METHODS: Totally 55 patients with acute dacryocystitis was divided into two groups according to the clinical manifestations: the group of redness and swelling and the group of abscess rupture. The bleeding and pain after operation were observed. Operation effect and skin scar of lacrimal sac area was observed and compared between two groups.

RESULTS: The patients were followed up from 3mo to 2a, and effective rates of the two groups of patients were compared, which showed no statistically significant difference(χ²=0.307, P>0.05). Surgery before the abscess ruptured had the minimal impact on the appearance. The appearance impact of the group of abscess rupture was higher than that of the group of redness, and there are statistically significant difference(χ²=12.44, P<0.05).

CONCLUSION: Endonasal endoscopic dacryocystorhinostomy is an effective method on the treatment of acute dacryocystitis. Early surgery has the advantages of quick recovery, scarlessness and high efficiency. Therefore, it worthy of clinical promotion.

Abstract:AIM: To discuss the cause of lacrimal duct obstruction relapsed after lacrimal duct stent operation.

METHODS: A total of 523 patients(523 eyes)of lacrimal duct obstruction were enrolled. They were given regular examination of the eyes and nose before lacrimal duct stent operation. We analyzed the correlation between the lacrimal duct obstruction and the relevant disease. And 280 cases reoccurred lacrimal duct obstruction during the average 2a follow-up. The causes correlated with the relapsed obstruction were assessed.

RESULTS: Lacrimal duct obstruction mostly occurred secondary to the inflammation of conjunctiva or nasal mucosa. The upper site obstruction correlated with the chronic conjunctivitis, while the lower site obstruction related to the hypertrophy of inferior turbinate. Outcome of some cases were discouraging after the stents removed. The removal of the ring silicone tube usually leaded to the upper site obstruction, while the lower site obstruction usually caused by the removal of spherical silicone tube.

CONCLUSION: Lacrimal duct stent operation is a simple, safe and outpatient treatment. But the long-term effectiveness is not encouraging. We should make personal treatment according to the etiological factor, the site of the obstruction, age, and the procedure of treatment.

Abstract:AIM: To investigate the surgical method and efficacy of extraction of deep orbital magnetic foreign bodies by mean of an orbital strong magnet.

METHODS: A retrospective analysis of clinical data of patients with deep orbital magnetic foreign bodies(OMFB)in Hebei Eye Hospital from June 2014 to May 2017 was processed. A total of 23 eyes were enrolled, among them, 14 eyes of extraorbital OMFB, 9 eyes of intraorbital OMFB. The rate of extraction of foreign bodies and the postoperative complications were observed.

RESULTS: All eyes of intraorbital foreign bodies were successfully extracted with 100% success rate. Twelve of 14 eyes of extraorbital foreign bodies were extracted with 86% success rate. Mild orbital hemorrhage were found in 2 eyes. There was no other obvious complication such as visual loss, orbital massive hemorrhage or limited ocular movement.

CONCLUSION: It's an ideal surgical method to extract the deep orbital magnetic foreign bodies by mean of an orbital strong magnet, with mini-injury, high success rate, short duration and few complications.

Abstract:AIM: To investigate the early effects of 3g/L sodium hyaluronate eye drops combined with soft contact lenses on corneal epithelial healing and local comfort.

METHODS: Totally 90 patients(90 eyes)with primary monocular pterygium were randomly divided into three groups after pterygium excision surgeries(n=30, for each). Each group received pterygium excision combined with limbal stem cell autograft transplantation. The research group wore soft corneal contact lens for 7d after the surgery, and the next day all of them were given 3g/L sodium hyaluronate and levofloxacin eye drops four times a day, tobrmycin and dexamethasone ophthalmic ointment once every night. The Group B did not wear the corneal contact lens, they were given levofloxacin eye drops four times a day and tobrmycin and dexamethasone ophthalmic ointment once every night. About the Group C, the 3g/L sodium hyaluronate eye drops was added on the basis of conventional medication of Group B. The time of corneal epithelial healing after surgery and the ocular pain score in different times were observed and contrasted.

RESULTS: Mean pain score of Group A were significantly lower than Group B and C at 6h, the first day and the third day after operation(P<0.001), but there was no significant difference between the three groups at the fifth day and the seventh day(P>0.05). The first day after the surgery, there were no eyes of corneal epithelium completely healed, but the complete healing rate of Group A were significantly higher than the other two group at the second day and the third day.(P<0.05).

CONCLUSION: Early use of 3g/L hyaluronate sodium eye drops combined with soft corneal contact lenses after pterygium excision surgeries will not only accelerate corneal epithelial wound healing, but also relieve local pain, improve ocular comfort significantly.

Abstract:AIM: To study the influence factors and management of anterior chamber gas bubble during femtosecond flap creation for laser-assisted in situ keratomileusis(LASIK).

METHODS: Totally 9 671 eyes of 4 859 patients with femtosecond LASIK were included in this study. Preoperative, intraoperative and postoperative parameters of anterior chamber gas bubble patients were analyzed and compared.

RESULTS: A total of 51 cases(0.53%)occurred anterior chamber gas bubble during femtosecond flap creation. There was no statistical difference between uncorrected visual acuity of postoperative 1mo(-0.076±0.09)and preoperative best corrected visual acuity(-0.08±0.04; t=-0.34,P=0.74). And 33 eyes(65%)did not affect the pupil tracking, but there were 18 eyes(35%)unable to track the pupil successfully. There was no statistical difference in uncorrected visual acuity of postoperative 1mo between trace group(-0.06±0.08)and no trace group(-0.11±0.09; t=1.82, P=0.07). The highest incidence of anterior chamber gas bubble was at 9 point, followed by 3 point. There were no statistical differences in spherical equivalent refraction, corneal curvature, corneal diameter, anterior chamber volume, anterior chamber depth and intraoperative femtosecond laser energy between anterior chamber gas bubble eyes and the contralateral eyes(P>0.05).

CONCLUSION: Anterior chamber gas bubble formation during femtosecond flap creation for LASIK is an uncommon event. It may affect the eye tracking. There is no obvious effect on early postoperative visual acuity if intraoperative disposed properly. The direct or indirect factors of anterior chamber gas bubble formation are unclear.

Abstract:AIM:To observe the clinical effect of bilateral oblique muscle weakening on the A-V patterns strabismus correction, and dose-response relationship between bilateral oblique muscle weakening and A-V syndrome degree.

METHODS: Totally 70 patients(70 eyes)with A-V syndrome treated in our hospital from January 2012 to January 2016 were enrolled in this study, including 28 eyes of A sign and 42 eyes of V sign. All patients underwent bilateral oblique muscle reduction combined with horizontal rectus correction. The changes of the upper and lower strabismus were observed before and after operation, and the patients were followed up for 18mo. The successful rate of A-V sign and strabismus correction were observed and counted. In addition, the quantitative relationship between the degree of A-V and the degree of correction and the amount of residual after operation was compared and analyzed.

RESULTS: After operation, the oblique eye position angle difference of A-esotropia, A-exotropia, V- esotropia and V-exotropia were respectively -1.98^△±3.92^△, -2.25^△±4.88^△, 2.96^△±5.29^△, 1.91^△±4.67^△, the differences were significantly compared with preoperatively(P<0.05). The reduce amount after operation were 25.10^△±9.79^△, 24.29^△±8.63^△, 23.81^△±9.24^△, 22.79^△±8.95^△. After 18mo follow-up, the success rate of A sign correction was 96%(27/28), and the successful rate of V sign correction was 93%(39/42). A-V sign, the more the oblique angle before operation, the more the correction amount during the weakening of bilateral oblique muscle, and the postoperative oblique residual increased accordingly.

CONCLUSION: Bilateral oblique muscle weakening can effectively treat strabismus with A-V sign, and can significantly reduce the upper and lower ocular gradient. The upper and lower oblique angle of the A-V sign increase, and the corrected angle and residual volume increase with the quantitative relationship.

Abstract:AIM: To evaluate the surgical outcomes of adults who underwent extra-large recession of unilateral medial rectus(UMR)for the treatment of concomitant esotropia less than +30 prism diopter(PD).

METHODS: The medical records of 20 patients(30 eyes)who underwent surgical correction of concomitant esotropia less than +30 PD were retrospectively reviewed. Patients with esotropia who were previously treated with one or two surgical procedures of adjustable suture(10 eyes as observation group with extra-large recession of UMR as 8-9mm, 10 eyes as control group with bilateral MR recession as 4-5mm)were included in the study. The binocular alignment and adduction function were evaluated at postoperative 3d and 3mo.

RESULTS: The male-female rate of the patients was 13:7. The mean age at surgery was 28.2±19.9 years old(range: 18-42 years old). At 3d after operation, the eye position of the observation group was -3^△ to +10^△(+5.02^△±2.39^△). That of the control group was -2^△ to +10^△(+4.86^△±2.28^△). The difference between the two groups was significant(t=4.36,P<0.05). At 3mo after operation, the eye position of the observation group was +4^△ to +11^△(+4.31^△±1.65^△). That of the control group was +3^△ to +10^△(+3.91^△±2.68^△). The difference between the two groups was not significant(t=2.01,P>0.05). There was no statistic difference in the postoperative AC/A between two groups(3.09±0.15 vs 3.16±0.09; t=2.18, P>0.05 )in postoperative 3mo. Three eyes of the observation group had adduction limitation in postoperative 3d, while none of patients in control group had this. None in the two groups showed the limitation in postoperative 3mo.

CONCLUSION: The surgical correction with UMR recession less than 9mm is safe in small angle esotropia adults, without adduction limitation.