Abstract:AIM: To present a different approach called dynamic stromal hydration. Though common, conventional hydration technique should be standardized to ascertain wound integrity at the time of stromal hydration during cataract surgery. No explicit criteria exist to suggest that hydration of wound edges is adequate.

METHODS: This study was designed as prospective, randomized, comparative study. Leakage sites were detected by continuous irrigation. At that point, stromal hydration was performed in consideration of the leakage points. The wound edges were hydrated until no further leakage could be visually detected. Trypan blue 0.0125% was applied over the wound sites, and each wound was individually observed for leakage. On the day after surgery, Seidel's test was performed to assess wound integrity.

RESULTS: All 120 eyes in the experimental group were evaluated, including all 360 wound sites-120 left side ports, 120 right side ports, and 120 main incisions-as were all 120 eyes in the control group. Though the dye test revealed leakage of aqueous humour from only 29 wound sites of 22 eyes(8.0% of 360 wounds)in the experimental group, leakage appeared in 41 wound sites of 30 eyes(11.3% of 360 wounds)in the control group. When groups were compared in terms of leakage, the difference was statistically different(P=0.042).

CONCLUSION: Dynamic stromal hydration-meaning standardized conventional stromal hydration-is a direct observational technique that allows the easy evaluation of wound integrity at the time of stromal hydration by way of observing wound dynamics.

Abstract:Glaucoma is a multifactorial neurodegenerative disease that can result in permanent vision loss by damaging optic nerves due to higher pressure in the eye. Although most of the fundamental pathophysiological mechanisms involved in glaucoma are undetermined but alteration in ocular blood flow(OBF)in tissues such as optic nerve, retina, choroid and iris is an important risk factor for glaucoma. Various factors such as limited knowledge of the factors causing optic nerve damage, confusion in the measurement assays and lack of therapies, make hindrances in the understanding of glaucoma. Researchers are continuously accumulating evidence to suggest that alterations in OBF play important role in the pathogenesis of glaucoma but most of the times they have diverse and contradictory conclusions regarding changes in the OBF and risk of glaucoma. In this article we have reviewed different aspects of glaucoma and the effect of OBF in the disease progression

Abstract:AIM: To investigate the changes in spectral domain optical coherence tomography(SD-OCT)quantitative and qualitative parameters in a group of patients with age-related macular degeneration(AMD)that underwent bevacizumab intravitreal injections(IV). We assessed if one or more of these parameters can be used as prognostic factors of the post treatment visual acuity(VA).

METHODS:Totally 66 eyes of 61 patients, with treatment naive AMD, that were treated with at least 3 monthly bevacizumab IV, were retrospectively studied. SD-OCT quantitative \〖central foveal thickness(CFT), external limiting membrane(ELM)and ellipsoid zone(EZ)lengths\〗 and qualitative parameters were studied and compared before and after IV. We also tried to establish correlation between these parameters and before/after treatment VA.

RESULTS:Mean VA(logMAR), CFT(μm), ELM length(μm)and EZ length(μm)changed from pre-IV values of 0.62±0.41, 419.3±110.0, 378.2±377.2 and 156.4±253.7 to post-IV values of 0.53±0.44, 325.8±117.9, 547.1±421.5 and 173.1±207.1. There was correlation between pre-IV VA and pre-IV CFT(rs=0.27), ELM length(rs=-0.30)and ELM disruption(rs=0.43). There was also correlation between post-IV VA and post-IV ELM length(rs=-0.40). Post-IV VA showed correlation with pre-IV VA(rs=0.66), ELM length(rs=-0.35)and ELM disruption(rs=0.46).

CONCLUSION: In our study group pre-IV VA, ELM length and ELM disruption can be used as post-IV VA prognostic factors.

Abstract:AIM: To observe the curative effect of excision combined with concavity-convex amniotic membrane transplantation in the treatment of intraepithelial epithelioma.

METHODS:Totally 24 cases of intraepithelial neoplasia(24 eye)diagnosed in our department were studied. The tumors of 12 cases were removed and the wound were covered by the concavity-convex amniotic membrane in the conjunctiva and part of the resection, and other 12 were covered by the amniotic membrane. The effect of these two surgeries were assessed via observing the epithelial healing, degradation of biological amnion, tear break-up time, tumor recurrence and other complications. The resection of the tumor were analyzed histopathologically.

RESULTS: The pathological results of all the patients were epithelial carcinoma. There were 24 patients that diagnosed -intraepithelial epithelioma pathologically. The conjunctival epithelium healed rapidly and were completed in 5d after operation in both groups. The amniotic membrane was completely degraded in about 14d. Postoperative visual acuity improvement was not statistically significant in two groups. All patients were followed up for more than 1y. The recurrence rates were significantly lower in concavity-convex amniotic membrane group than that in amniotic membrane group.

CONCLUSION: Tumor resection combined with concavity-convex amniotic membrane transplantation is an effective operation method for the treatment of intraepithelial epithelioma.

Abstract:AIM: To study the clinical profile of ocular injuries in children in a tertiary care center in Northern India.

METHODS: This was a hospital based descriptive study. All children of ocular injuries up to 16y of age were included. Data regarding the socio-economic status, medical/surgical treatment, and condition at discharge were recorded. Follow-up to 3mo was done in the study. Initial and final visual acuity was recorded. Ocular Trauma Classification Group guidelines and Birmingham Eye Trauma Terminology were used for the definitions and classifications of ocular trauma. Socio-economic status grading is done according to modified B.G. Prasad classification and Kuppuswamy's socio-economic scale.

RESULTS: Out of 42 children, male to female ratio was 3.6:1.Maximum number(50%)of injuries occurred between 11-16y of age. Most of the children(59.52%)belonged to lower socio-economic class and were from arural background. Ocular injuries occurred at home in 20(47.61%)children followed by 6(14.28%)each in school, playground, and street. Open globe injuries were seen in 19(45.24%)children and 23(54.75%)children had closed globe injuries. Injuries by wooden stick, stone, firework, fall, toy were 12(28.57%), 5(11.90%), 3(7.14%), 3(7.14%), and 2(4.76%). Seventeen(40.47%)children required medical management and 25(59.53%)were treated surgically.

CONCLUSION:Male children in rural regions and of lower socio-economic background were more prone to ocular injuries. Children were more risk of ocular injuries at home. Wooden sticks and stone were the commonest cause of ocular injuries. Ocular morbidity and poor visual outcome were seen more in open globe injuries. Further population-based studies are required to reinforce findings of present study. Based on this, a long term strategy can be planned to prevent ocular injuries in children in this region.

Abstract:AIM: To evaluate the accuracy of the Plusoptix A09 photorefraction with and without cycloplegia compared to an autorefractometer in pediatric patients.

METHODS: We assessed the refractive status of 180 eyes in 90 pediatric patients. Refractions were measured with the Plusoptix A09 photorefractor(Plusoptix GmbH, Nürnberg, Germany)with and without cycloplegia and compared with those obtained by autorefractometer(Topcon KR-8900, Tokyo, Japan)after cycloplegia. Spherical equivalent, spherical power cylindrical power and cylindrical axis J0, J45 values measurements were analyzed with Bland-Altman analysis.

RESULTS: The mean age of the patients was 7.48±3.01(range 3 to 13y). Between the non-cycloplegic Plusoptix A09 photorefractometer and the cycloplegic autorefractometer measurements, there was significant difference between spherical power and spherical equivalent values(P<0.001)but there was no significant difference between cylindrical power, J0 and J45 values(P>0.05). Between the cycloplegic Plusoptix A09 photorefractometer and the cycloplegic autorefractometer measurements, there was significant difference between spherical power and spherical equivalent values(P<0.001)but there was no significant difference between the cylindric power, J0 and J45 values(P>0.05). Bland-Altman correlation analysis revealed an excellent correlation for the spherical power, cylindrical power and spherical equivalent measurements, but poor correlation for J0 and J45 values between the non-cycloplegic, cycloplegic Plusoptix A09 and the cycloplegic autorefractometer measurements.

CONCLUSION: To determine refractive errors in children, the Plusoptix A09 measurements with and without cycloplegia can give reliable results. But it is inadequate when measuring the cylindrical axis and high refractive values. This device can be an effective option to detect and screen refractive errors in uncooperative children.

Abstract:AIM: To investigate the detrimental effect of glucocorticoid(GC)on the retinal neurons of diabetes mellitus(DM)rats.

METHODS: The DM model was induced by intraperitoneal injection(IP)of streptozotocin in adult male rats, and the solution of RU486 was configured with dimethyl sulfoxide(DMSO). RU486 treatment group with glucocorticoid receptor antagonist RU486 and diabetic group with DMSO by intraperitoneal injection was in successful DM model. Naive rats were injected with DMSO as control group. Three months later, we detected the body weight and blood glucose and GC concentration of serum. The changes of retinal ganglion cell(RGC)density was investigated by HE staining. The expression of growth associated protein-43(GAP-43, a marker of neuronal axon regeneration)and synaptophysin(SYN, a marker of synaptic number)were semi-quantity analyzed by the optical density of immunofluorescence and Western blot.

RESULTS:Compared with the control group, the body weight and density of RGC and expression of SYN in diabetic group were significantly lower(P<0.01), the blood glucose and GC concentration of serum and expression of GAP-43 in diabetic group were significantly higher(P<0.01). Compared with the diabetic group, the density of RGC and expression of GAP-43, SYN in RU486 group were significantly higher(P<0.01).

CONCLUSION: Inhibition of GC could ameliorate the axonal degeneration of retinal neurons in diabetic rats, and loss of the number of synapses, and restore the RGC density of retina. The results suggest that long-term elevation of GC may be involved in the occurrence and development of diabetic retinopathy.

Abstract:AIM: To construct a recombinant eukaryotic expression vector of rat beta defensin-2(rBD-2), transfect it into the rat corneal epithelial cells with lipofection, determine the expression of target gene in the transfected cells, and discuss the potentiality of recombinant plasmid expressed in corneal epithelial cells, hoping to provide an experimental foundation for further study on the antimicrobial activity of rBD-2 in vitro and in vivo and to assess the probability of defensins as a new application for infectious corneal diseases in the future.

METHODS: The synthetic rBD-2 DNA fragment was inserted between the XhoI and BamHI restriction enzyme cutting sites of eukaryotic expression vector pIRES2-ZsGreen1 to construct the recombinant plasmid pIRES2-ZsGreen1-rBD-2, then transformed it into E.coli DH5α, positive clones were screened by kanamycin and identified with restriction endonucleases and sequencing analysis. Transfection into the rat corneal epithelial cells was performed by lipofection. Then the experiment was divided into three groups: rat corneal epithelial cell was transfected with the recombinant plasmid pIRES2- ZsGreen1-rBD-2, rat corneal epithelial cell was transfected with the empty plasmid pIRES2-ZsGreen1 and the non-transfected group. The inverted fluorescence microscope was used to observe the transfection process. At last, the level of rBD-2 mRNA expressed in the transfected cells and the control groups are compared by the real-time fluoresence relative quantitative PCR.

RESULTS: The recombinant eukaryotic expression vector of pIRES2-ZsGreen1-rBD-2 was successfully constructed. The level of rBD-2 mRNA in transfected cells was significantly higher than that in control groups through the real-time fluorescence relative quantitative PCR.

CONCLUSION: The recombinant eukaryotic expression vector pIRES2-ZsGreen1-rBD-2 could be transfected into rat corneal epithelial cells, and exogenous rBD-2 gene could be transcripted into mRNA in the transfected cells.

Abstract:AIM: To investigate the role of regulatory T cells in the pathogenesis of autoimmune dry eye and to analyze the expression of endogenous regulatory T cells and related cytokines in the lacrimal system to provide a more effective treatment for autoimmune dry eye disease treatment programs.

METHODS: Rabbit lacrimal gland epithelial cells isolated and cultured for a period of time were separately cultured and mixed with isolated peripheral blood lymphocytes in a ratio of 1: 1 and cultured with 5-Bromo-2-deoxyUridine(BrdU)to detect the proliferation of peripheral blood lymphocytes, and the activated autologous peripheral blood lymphocytes were transferred to donor rabbits via ear vein. The rabbits were used as the rabbit model of autoimmune dry eye and the normal rabbits which did not induce the disease as the control group. Before and after the experiment, tear film rupture time and tear secretion at 2,4,6,8wk,were observed. At 4 wk after the transfusion the rabbits were sacrificed for the collection of bilateral upper and lower lacrimal gland and conjunctiva, and pathological HE staining, and then extract the total RNA in lacrimal gland. The expression of IL-17, TNF-α, IL-6 and TGF-γ was detected.

RESULTS: BrdU detected peripheral lymphocyte proliferation rate of 3.72. Compared with the normal group, the time of rupture of the tear film decreased(P<0.05), and the tear of the model group was significantly lower than that of the control group(P<0.05). The expression of IL-17, TNF-α, TGF-γ and IL-6 in the model group were significantly higher than those in the control group(P<0.05). The expression of IL-10 and TGF-β was significantly lower than those of the control group(P<0.05). The ratio of CD4⁺ CD2⁺ Treg cells in lacrimal gland tissue and spleen was higher in control group. The proportion of CD4⁺CD25⁺ Treg cells in model group decreased(P<0.05).

CONCLUSION: IL-17, TNF-α, IL-6 and TGF-γ play important roles in inflammatory reaction of lacrimal gland and the immunodepression active by CD4⁺CD25⁺Treg cells decreases when the rabbit model of dry eye is involved.

Abstract:AIM: To observe the expression of erythropoietin(EPO)on the corneal of rabbit and evaluate the inhibition effect of EPO siRNA on corneal neovascularization(CNV).

METHODS: Totally 22 healthy rabbits were randomly divided into 2 groups, which were experimental group and normal control group. Both eyes of rabbits in experimental group were chosen to establish corneal neovascularization model by alkali burn. The morphologic change of corneal was observed with slit lamp microscope and the area of CNV was calculated every day. After alkali burn, the right eye of the experimental group was accepted EPO siRNA injection under the conjunctiva, and the left eye was assigned to be experimental control group. The corneal with CNV was collected for immunohistochemistry at 3d, 7d, 14d, 21d after alkali burn, and the expression of EPO was measured.

RESULTS: CNV began growing at the 3d after alkali burn in experimental group, and it was vigorous growing at 7d-14d period. The result of immunohistochemistry shows that the expression of EPO increased after the operation. Compared with experimental group, the rabbits who were treated by EPO siRNA was found with less neovascularization on their corneal, and the expression of EPO decreased. There were statistical significance between the two group at different time(P<0.05).

CONCLUSION: EPO is likely to play an important role on CNV growth, and EPO siRNA can inhibit the growth of CNV by restraining the expression of EPO.

Abstract:AIM: To study the effect of miR-410 on the regulation of angiotensin Ⅱ type 1 receptor(AT1R)in retinal pigment epithelium(RPE)cells of age-related macular degeneration(AMD)patients.

METHODS: The experiment was divided into AMD patients, cataract patients and normal people group. AT1R was the target gene of miR-410 by bioinformatics, and the normal RPE cells were cultured in the simulated microenvironment of AMD and cataracts and the expression of miR-410 was detected. Then miR-410 mimics was transfected into cells, and the expression of mRNA and protein of AT1R were detected by Q-PCR and Western blot respectively. The relationship between miR-410 and AT1R was confirmed by the dual luciferase reporter assay.

RESULTS: The miR-410 expression of in RPE cells with AMD was significantly reduced(P=0.0006, 0.0008)compared with cataract and normal controls. The miR-410 can regulate the function of AT1R by dual luciferase reporter gene experiment and the inhibition rate was about 40%. In addition, miR-410 inhibition rate was about 40%-50% to AT1R mRNA and protein expression by cell experiment.

CONCLUSION: AT1R was a target gene of miR-410 in cell experiments, and it is demonstrated that increasing the expression of miR-410 in RPE cells with AMD can suppress the expression of AT1R.

Abstract:AIM:To study ATOH7 and RFTN1 sequence variations in patients with juvenile primary open-angle glaucoma(JOAG).

METHODS: In 298 controls(age≥60y)and 52 JOAG(age<35y), we collected samples from the patients and controls of study, extracted the DNA, and then the single exon of ATOH7 was sequenced by direct sequencing. Additional single nucleotide polymorphisms the RFTN1 SNP(rs690037)and at upstream ATOH7(rs1900004 and rs3858145)were genotyped by Taqman assay.

RESULTS: No any coding mutation was detected in JOAG. There were no significance in allele frequencies and haplotypes between JOAG and control group of rs7916697, rs61854782, rs1900004、rs3858145 and rs690037, so no SNP was associated with JOAG(P>0.05).

CONCLUSION: Although preliminary study has showed combination of ATOH7 and RFTN1 SNPs could increase the risk of getting adult-onset primary open angle glaucoma, ATOH7 and RFTN1 are not associated with juvenile primary open-angle glaucoma in this study, so different types of open-angle glaucoma may be differences in genetic mechanism and be worthy of further study.

Abstract:AIM: To investigate the relationship of IL-6 gene -572C/G polymorphism in patients with type 2 diabetic retinopathy(T2DM)and diabetic retinopathy(DR)in Dali Bai population.

METHODS: The polymorphisms of IL-6 gene -572C/G was analyzed by polymerase chain reaction-restriction fragment polymorphisms assay(PCR-RFLP)in 150 patients with T2DM \〖NDR(without DR)group 57 cases, NPDR(with non-proliferative diabetic retinopathy)group 77 cases, PDR(with proliferative diabetic retinopathy)group 16 cases\〗 and 100 healthy control group in Dali Bai population. The genotypes frequency, allele frequency of IL-6-572C/G gene and clinical data were compared between groups. The statistics software SPASS22.0 was used for statistical analysis.

RESULTS: The genotype and allele frequencies of IL-6 gene -572C/G between groups were compared statistically significantly(P<0.05); the incidence of T2DM in healthy control subjects with C allele significantly decreased in comparison with the carriers of G allele(OR=1.182, 95% CI: 1.059-1.319, P=0.004); the incidence of DR in T2DM with G allele significantly increased in comparison with the carriers of C allele(OR=1.667, 95% CI: 1.195-2.326, P=0.003), but there was no statistical difference between PDR group with NPDR group for -572C/G polymorphism(P>0.05). There was statistical significant between T2DM group, NPDR + PDR and control groups in fasting blood glucose, triglycerides, body mass index(P<0.05), PDR group was compared with NPDR group only in difference between fasting plasma glucose(P<0.05). The hypertension in individuals suffering from T2DM increased in comparison with not combing hypertension(OR=3.730, 95% CI: 2.060-6.754, P=0.000), and suffering from DR increased obviously(OR=3.997, 95%CI:2.099-7.612, P=0.000). The clinical data showed no significant difference(P>0.05)among different genotypes.

CONCLUSION: These results suggest that the -572C/G polymorphism in the promoter of IL-6 gene is associated with T2DM and DR in Dali Bai population, but the clinical data is not coordinative risk factor. G allele is a risk factor in the pathogenesis of T2DM and DR, but not for the progress in NPDR to PDR process, C alleles is a protective factor T2DM and DR. Hypertension, fasting blood glucose, triglycerides, body mass index were risk factors for T2DM and DR, fasting blood glucose condition in DR progress has an important role.

Abstract:BIGH3 gene plays an important role in ocular diseases. On the one hand, it is closely related to the occurrence of corneal diseases. BIGH3 gene can inhibit corneal neovascularization, lead to corneal dystrophy, participate in keratoconus formation. On the other hand, it can lead to the formation of neovascularization in diabetic retinopathy. The latest experiments show that TGF beta secreted by macrophages can promote the expression of BIGH3 mRNA and BIGH3 protein, and promote apoptosis of retinal endothelial cells and pericytes, which leads to the formation of neovascularization in diabetic retinopathy. This article will describe the new progress of BIGH3 gene in ocular diseases from several aspects as mentioned above.

Abstract:Diabetic retinopathy(DR)is one of the most serious complicationsand leading causes of blindness for diabetic patients. In recent years, the incidence of DR shows a trend of rising year by year, which is a serious threat to the patients' physical and mental health. Autophagy is a very important physiological process that the cellular contents are processed by the primary lysosomes when the body is under the environment of substance and energy metabolism disorder. Autophagy belongs to one kind of the body's important defense mechanisms. According to the related clinical research data, autophagy can delay the occurrence and development of the chronic complications of diabetes to some extent, such as DR, peripheral neuropathy and diabetic nephropathy. There is a close relationship between autophagy and various relative factors of DR, such as oxidative stress and hypoxia. Therefore, the pathogenesis and treatment measures of DR have become critical research topics in clinical practice.

Abstract:Ocular refraction is mainly decided by the axial length, corneal power and lens power. Of these three refractive elements, only the change of cornea has aroused the most controversial discussion. Cornea has changed varying with refractive state and population characteristics. This paper is designed to review the information currently available concerning the change of the cornea in emmetropia and myopia.

Abstract:Mitogen-activated protein kinase(MAPK)signal pathway family are important signal transduction pathways, which widely exit in cells. They are able to make particular physiological responses induced by multiple extracellular signals or stimulus, such as changes of osmotic pressures, ischemic/reperfusion, inflammation and so on, that means they can mediate cell proliferation, differentiation and apoptosis. The physiological responses mediated by MAPK signal pathway make great scene to the progression and healing of eye wounds, therefore researchers may highlight the pathway in research.

Abstract:Cyclosporine A is a new and potent immunosuppressant with high specificity and is widely used in controlling a variety of immunological rejection after organ transplantation. Research found that cyclosporine A suppresses the immune rejection in moderate to severe dry eye syndrome treatment. For mooren ulcers and autoimmune eye diseases, it has a significant effect. The application progress of Cyclosporine A in clinical ophthalmology is now reviewed.

Abstract:AIM:To study the concentration changes of the serum magnesium, calcium, potassium, sodium and chloride ions of the patients of Leber congenital amaurosis(LCA).

METHODS:Based on the retrospective study and the simple size in the statistics, 50 cases of LCA patients and 99 cases of normal people were tested the serum ions by professionals in hospital according to the single blind study. Data were analyzed statistically between LCA and normal groups.

RESULTS: In the clinical serum ions test of LCA group, the concentration of calcium and potassium were 2.338±0.090mmol/L and 4.164±0.356mmol/L respectively, which were significantly higher than those of the normal group(all P<0.05), but the concentration of magnesium was 0.835±0.059mmol/L, which was significantly lower than the normal group(P<0.05). There were no significantly differences in remainder two serum ions concentration of LCA groups,comparing with the normal group(all P>0.05).

CONCLUSION: In the patients with LCA, abnormal concentration changes of magnesium, calcium and potassium will be needed to concern of the ophthalmologist, which is probably related with the occurrence of LCA.

Abstract:AIM: To observe the clinical surgical effect of brown hard nuclear cataract, and discuss the surgical skills.

METHODS: Totally 80 eyes of 80 patients with level V cataract were randomly stratified, divided into two groups. We operated with sclera tunnel incision phacoemulsification in Group A(40 eyes), combined with manual cataract extraction. Sutureless large-incision-manual cataract extraction(SLIMCE)was used in Group B(40 eyes). All cases were implanted posterior chamber folding intraocular lens. We compared the best corrected visual acuity, corneal astigmatism, operation time, intraoperative complications, corneal edema, intraocular pressure and corneal endothelial cells in two groups of different postoperative time.

RESULTS: The postoperative best corrected visual acuity at 3 and 7d of Group A were better than those of Group B(P<0.05), and there was no difference in the 1d and 1mo after surgery(P>0.05). The corneal astigmatism of 1mo after surgery was much smaller in Group A, and there was a significant statistical difference between two groups(P<0.05). Less intraopretative complications happened in Group A, but there was not statistical difference between two groups(by Fisher's exact test, P=0.36). There was a significant statistical difference in corneal edema of these two groups at 1d after surgery(χ²=5.70, P<0.05). There were no significant differences in operation time, postoperative corneal edema, intraocular pressure and corneal endothelial cells in two groups at 7d(P>0.05).

CONCLUSION: Sclera tunnel incision phacoemulsification combined with manual nuclear extraction would be a preferred surgical technique for level V cataract.

Abstract:AIM: To discuss the effect of the cystotome-assisted prechop technique performed in hard nuclear cataract phacoemulsification.

METHODS: One hundred and twenty-six patients(158 eyes)of age-related cataracts with nucleus density at grade Ⅲ-Ⅳ were randomly divided into two groups. Group A was performed a manual prechop technique using a surgeon-bent cystotome after the capsulorhexis, while group B was performed traditional phaco-chop without prechop technique. The average power(AP), actual ultrasonic time(U/S time), accumulated energy complex parameter(AECP)of machine, average density of endothelial cells, endothelial cells loss, uncorrected visual acuity(UCVA), corneal edema and intraoperative complications were compared between groups.

RESULTS: The AP, U/S time and AECP of Group A were significantly lower than that of Group B(P<0.05). At postoperative day 1, the corneal edema of Group A was slighter than the control with significant difference(P<0.05), so was the UCVA. While there was no significant difference of UCVA between groups at postoperative 1wk. The average corneal endothelium density of Group B was significantly lower than that of Group A at postoperative 1wk, and the average cell loss was higher than that of Group A. Two eyes of group A had posterior capsular rupture compared to 4 eyes of Group B.

CONCLUSION: Compared with traditional phaco-chop, the cystotome-assisted prechop technique presents shorter intraoperative ultrasound time and lower energy, while contributes to less corneal endothelial cell loss and better early postoperative UCVA.

Abstract:AIM: To analyze the clinical efficacy and postoperative impacts of coaxial micro-incision phacoemulsification on patients with cataract, and explore the application value of the surgical method.

METHODS: Totally 300 patients(300 eyes)who received the coaxial micro-incision phacoemulsification were randomly divided into the observation group(150 case)and the control group(150 case). Patients in the observation group and control group were treated by coaxial micro-incision phacoemulsification and traditional coaxial phacoemulsification, respectively. The effective phaco time(EPT), average ultrasound energy(AVE), intraoperative anterior chamber stability and postoperative recovery time were compared between the two groups, as well as the uncorrected visual acuity(UCVA), the surgically induced astigmatism(SIA)and the loss rate of corneal endothelial cells at 1d, 1wk, 1 and 3mo after surgery.

RESULTS: No significant difference of EPT, AVE and the rate of patients with stable anterior chamber were found between the two groups(P>0.05), as well as the UCVA, SIA and the corneal endothelial cells in patients before surgery(P>0.05).The postoperative recovery time of patients in the observation group was obviously shorter than that in the control group(P<0.05). At 1d, 1wk and 1mo of postoperative, the UCVA of patients in the observation group were better than those in the control group(P<0.05). In 1wk, 1 and 3mo of postoperative, the SIA of patients in the observation group were lower than those in the control group(P<0.05). And in all the time of postoperative, the loss rate of corneal endothelial cells of patients in the observation group were lower than those in the control group(P<0.05). Between the two groups, significant difference of the UCVA, SIA and the loss rate of corneal endothelial cells were found in the different time points after surgery(P<0.05).

CONCLUSION: The coaxial micro-incision phacoemulsification had a high clinical value as it possesses the advantages of more rapid UCVA recovery, less influence on SIA and less loss of corneal endothelial cell.

Abstract:AIM: To explore the application value of polishing anterior capsule and equator in the phacoemulsification and intraocular lens implantation.

METHODS: Totally 112 cases of cataract patients in our hospital from May 2012 to January 2015 were selected as research objects. They were divided into unpolished and polished group according to whether the anterior capsule and equatorial part polished or not with the informed consents, 56 cases in each group. The patients were followed up for 18mo after phacoemulsification and intraocular lens implantation. The clinical efficacy of the two groups was compared.

RESULTS: The complication rates of the two groups were 7.1% and 16.1%, that of the polished group was lower and the difference was statistically significant(P<0.05). The lens position(effective lens position, ELP), refractive state, uncorrected visual acuity compared with unpolished group were statistically significant(P<0.05).

CONCLUSION: Polishing anterior capsule and equator can significantly improve the effect of phacoemulsification combined with intraocular lens implantation in the treatment of cataract.

Abstract:AIM: To explore the application value of glycosylated hemoglobin after cataract surgery in diabetic patients.

METHODS: Selected 120 patients with cataract surgery from May 2014 to May 2016 in ophthalmology department of our hospital, were divided into diabetic group(80 patients with 110 eyes)and control group(40 patients with 48 eyes). According to the HbA1c levels, diabetic group was divided into high HbA1c group(HbA1c>7.0%)and low HbA1c group(HbA1c≤7%). The total macular volume and central retinal thickness were observed before and at 1mo after the cataract operation in the three groups.

RESULTS: The central retinal thickness of the macular area in the diabetic group was significantly higher than that in the control group(P<0.05). The total volume of macular foveal retinal thickness before and at 1mo after the operation in the high HbA1c group were significantly higher than those of low HbA1c group and the control group(P<0.05). The indexes of preoperative and 1mo postoperative of low HbA1c group were slightly higher than those of the normal control group(P>0.05).

CONCLUSION: HbA1c is positively correlated with macular retinal thickness after cataract surgery, and it can be used for monitoring the occurrence and development of macular edema after cataract surgery. For patients whose preoperative HbA1c is higher than 7%, the application of active intervention is needed to protect the visual function.

Abstract:AIM: To examine the micrangium through optical coherence tomography(OCT)in diabetic patients and to quantify the thickness of macular retia at different timing.

METHODS: Control group(Group A)had 40 patients with 59 eyes, who were all diagnosed as cataract but no diabetes history. Experiment group(Group B)had 49 patients with 52 eyes, and patients were all diagnosed as Type 2 diabetes for over 2a with cataract. All patients were examined using OCT before and after operation, including regular eye examinations. At 1d, 1wk and 1mo after operations, those data were examined again, except OCT.

RESULTS: Compare to patients both had cataract and diabetes, cataract patients showed a better visual acuity after operation(χ²=8.38,P=0.004). Thickness of central fovea of macula: for patients both had cataract and diabetes, their central fovea of macula thickened significantly in 1wk after operation. However, for patients only had cataract, thickness of their central fovea of macula did not increase until 1mo after operation. Thickness of strata neuro- epithelium at central fovea of macula area: for patients both had cataract and diabetes, their strata neuro- epithelium thickened in 1d after operation. However, for patients only with cataract, it did not happen until 1mo. Thickness of pigmentary epithelium at central fovea of macula area: for patients both had cataract and diabetes, their pigmentary epithelium thickened in 1wk after operation. However, for patients only with cataract, it was not until 1mo.

CONCLUSION: Patients with cataract and diabetes are more likely to develop macular hydroncus after operation, and it is more serious than patients with cataract alone. Blood-retinal barrier damage is the major cause for retinal damage after phacoemulsification. Corrected visual acuity is along with the thickness of pigmentary epithelium at central fovea of macula area.

Abstract:AIM: To study the nerve fiber layer thickness and other parameters of optic disc in patients with retinitis pigmentosa.

METHODS: Totally 40 patients(80 eyes)with retinitis pigmentosa from April 2015 to April 2016 in our hospital were selected as the observation group and 40 healthy subjects as control group. All the subjects were examined by OCT. Disc parameters of retinal nerve fiber layer(RNFL)thickness, rim volume, cup volume, cup vertical diameter ratio, cup level diameter ratio, cup area ratio, rim area, cup area, disc area in temporal, superior, nasal and inferior quadrant were compared.

RESULTS: The thickness of the whole circle, nasal, temporal, superior and inferior RNFL in the eyes of RP group was significantly higher than those in the normal control group, the difference was statistically significant(P<0.05); RP eyes group with rim volume, cup volume, cup vertical diameter ratio, cup level diameter ratio, cup area ratio, rim area, cup area, disc area parameters were significantly higher than those in normal control group, the difference was statistically significant(P<0.05).

CONCLUSION: The mean thickness of RNFL in patients with retinitis pigmentosa at temporal, nasal, the whole circle compared with healthy subjects are thicker, while cup volume, cup vertical diameter ratio, cup level diameter ratio, cup area ratio, rim area and cup area increased.

Abstract:AIM: To study the concentration of vascular endothelial growth factor(VEGF)in aqueous humor in patients with wet age-related macular degeneration(wAMD)before and after Ranibizumab treating at high altitude and the correlation of VEGF concentration with central fovea macula thickness.

METHODS: The patients with wAMD in our hospital from Jun. 2014. to Oct. 2015 were retrospectively analyzed, diagnosed after best corrected visual acuity, intraocular pressure, fundus examination, fundus color photography, fluorescence fundus angiography(FFA)and optical coherence tomography(OCT)inspection. Seventy- six patients with cataract without choroidal neovascularization(CNV)were selected as control group. In the 76 patients(76 eyes), 46 were male, 30 were female, aged 40-80(55±11.18). The course was 0.3-6mo. The corrected visual acuity was 0.01-0.6. The intraocular press was 15.24±3.12mmHg. The CNV in all cases was within the range of the 500μm in diameter. Under surface anesthesia, Ranibizumab(0.5mg)was injected into vitreous cavity. Before and after injection, aqueous humor was obtained and used to detect the concentration of VEGF through ELISA. Best corrected visual acuity, slit lamp microscope, intraocular pressure, OCT and FFA were observed after treatment.

RESULTS:The clinical curative effect is the best at 1mo after treatment with statistical significance(P<0.05). The concentration of VEGF in aqueous humor in wAMD patients before treatment(95.48±50.09pg/mL)was higher than that of control group(43.01±16.17pg/mL). The concentration of VEGF decreased at 1mo after treatment as 31.89±14.14pg/Ml(P<0.05). The concentration of VEGF was positive related with central fovea macula thickness(P<0.05).

CONCLUSION: For wAMD patients, Ranibizumab injection is effective for it reduces the concentration of VEGF in aqueous humor and the central fovea macula thickness. The VEGF concentration in aqueous humor and foveal retinal thickness has a positive correlation.

Abstract:AIM: To measure the foveal avascular zone(FAZ)area and to investigate the characteristics of the FAZ area in normal eyes, using optical coherence tomography(OCT)angiography.

METHODS: This was a cross-sectional study. The FAZ area was measured in 69 participants, for a total of 138 eyes, using RTVue-100 OCT. The relations between the FAZ area and the potential factors were evaluated by univariate and multivariate linear regression analysis. Differences between the right and left eyes were calculated, and values were compared by means of a paired t test. Pearson correlation analysis was performed to assess the relationships of the FAZ area between the right and left eyes.

RESULTS: The mean FAZ area was 0.30±0.11mm² in all subjects. For the male subjects, the mean FAZ area was 0.29±0.13mm², and for the female subjects 0.31±0.09mm², with no significant difference(t=-1.346,P=0.180). The FAZ area did not correlate with all the potential factors. The mean FAZ area in the right eye was 0.30±0.11mm², and in the left eye was 0.30±0.10mm²,with no significant difference(P=0.943). There was a strong correlation between the right and left eyes for the FAZ area.

CONCLUSION: OCT angiography is a noninvasive method of visualizing and measuring the FAZ area in normal subjects. The FAZ area does not correlate with old age, sex and other factors. It shows significant interocular symmetry in normal subjects.

Abstract:AIM: To observe the efficacy of single time intravitreal injection of ranibizumab(IVR)in patients with diabetic macular edema(DME).

METHODS: Twenty-nine cases of DME patients who complied with diagnostic criteria for clinically significant macular edema were enrolled in this retrospective study. All the patients receive single dose IVR(0.05mL, 10mg/mL), and no other eye treatments were performed before this operation. All data were recorded before and after injection of 4, 8, and 16wk. Best corrected visual acuity(BCVA), central foveal thickness(CFT), the integrity of the foveal photoreceptor layer on optical coherence tomography were analyzed. The data of photoreceptor integrity and photoreceptor defect group also were recorded and analyzed.

RESULTS: BCVA was significantly improved at 4 and 8wk after IVR(P=0.009,0.003), macular edema was relieved, and CFT was significantly lower in the same time(P<0.01,P=0.001). But the drug action was weakened in 16wk, BCVA was poorer than that in 4 and 8wk(P=0.043,0.019), macular edema recurred CFT increased(P<0.01,P=0.005). BCVA and CFT value were not statistically significant different between 4 and 8wk(P=0.074,0.420). There was no significant change in BCVA before and after surgery in photoreceptor complete group(P=0.076), but CFT was lower obviously(P=0.001). BCVA and CFT value were better in photoreceptor defect group after IVR in 4wk(P<0.01,P<0.01). There was significant correlation between visual acuity and photoreceptor integrity before and after treatment in 4wk(P=0.015, 0.024).

CONCLUSION: Patients with DME treated with ranibizumab obtained great improvements in vision and macular edema in the short term. Macular photoreceptor integrity was closely related to the vision. IVR may also repair the macular photoreceptor damage.

Abstract:AIM: To compare the effect of pars plana vitrectomy(PPV)combined with internal limiting membrane peeling(ILMP)for macular hole retinal detachment(MHRD).

METHODS: Totally 78 patients with MHRD from December 2013 to December 2015 in our hospital were randomly divided into control group(39 patients 43 eyes)and experimental group(39 patients 40 eyes). The control group was treated with PPV, experimental group with PPV combined with ILMP. We observed the therapeutic effect and recorded the occurrence of postoperative complications. After 6mo follow-up, the vision improvement of the two groups were compared as the average of the best corrected visual acuity(BCVA)before and at 3, 6mo after surgery.

RESULTS: The reattachment rate of experimental group was 92%(37/40)with significant difference compared with control group(χ²=6.882, P=0.009). The improvement of visual acuity in the experimental group was better than that in the control group(χ²=14.216, P<0.001). The postoperative BCVA of the experimental group at 3 and 6mo was significantly higher than that of the control group(t=7.119, P<0.001; t=10.573, P<0.001). There were less patients with the situation of increased intraocular pressure and visual field defect(χ²=11.323, P=0.001; χ²=8.573, P=0.003). The lens opacity occurrence rate had not significantly changed(χ²=1.835, P=0.176).

CONCLUSION: MHRD patients treated with PPV combined with ILMP recovered better and the incidence of complications was lower. It can improve the patient's retinal restoration effect more.

Abstract:AIM: To study the intravitreal injection of voriconazole and liposomal amphotericin B combined with vitrectomy on treatment of fungal endophthalmitis.

METHODS: Selection of 27 cases(54 eyes)with fungal endophthalmitis caused by Aspergillus fumigatus infection from September 2014 to September 2016 in our hospital to accept the treatment were as the research objects. The 27 patients were randomly divided into control group and study group 1, study groups 2, each group of 9 patients. After vitrectomy, drug sensitivity test of three groups, drug testing for liposomal amphotericin B and voriconazole, were taken. After the application of oral voriconazole for three groups of patients with atropine ointment, and daily dressing, patients in study group 1 and 2 received intravitreal injected of voriconazole and liposomal amphotericin B respectively. The degree of corneal opacity, vitreous opacity and visual acuity were observed after operation.

RESULTS: Aspergillus fumigatus were sensitive to amphotericin B and voriconazole. Comparison of corneal opacity: at 1d after operation, the differences between control group with study group 1 and 2 were not significant(P>0.05); the differences on the other time points were significant(P<0.05); the differences between group 1 and 2 at different time were not significant(P>0.05). Comparison of aqueous flare: at 1d after operation, the differences between control group with study group 1 and 2 were not significant(P>0.05); the differences on the other time points were significant(P<0.05); the differences between group 1 and 2 at 1 and 15d after operation were significant(P<0.05), the differences at other time points were not significant(P>0.05). Comparison of vitreous body opacity: except for at 1d after operation, the difference between control group and study group 1 were significant(P<0.05); except for at 1, 4 and 6d after operation, the difference between control group and study group 2 were significant(P<0.05); the differences between study group 1 and 2 were not significant(P>0.05), except for at 6d after operation.

CONCLUSION: Intravitreal injection of voriconazole and liposomal amphotericin B combined with vitrectomy can be an effective treatment for fungal endophthalmitis. Compared with liposomal amphotericin B, voriconazole is better for early and middle stage of fungal endophthalmitis.

Abstract:AIM: To study the effectiveness and safety of 3D printing pre-shaped titanium mesh in the repair of orbital fracture compared with the conventional titanium mesh.

METHODS: The clinical data of 72 eyes of 72 patients who received surgery for orbital fracture from June 2015 to March 2016 in our department were retrospectively analyzed.All patients were divided into two groups, including pre-shaped titanium mesh implantation group(observation group), 40 cases, conventional titanium mesh implantation group(control group), 32 cases. The control group was treated by physicians according to the experience of manual bending and shaping titanium mesh implantation ipsilateral orbital pad,when the observation group by the physicians directly in the pre-shaped titanium mesh of 3D printing. The eyeball exophthalmos, eye movement and diplopia were evaluated in the next 1, 3 and 6mo after the operation, and we compared the differences between the two methods at different time points and the differences of the indexes between the two materials at the same time point.

RESULTS: The cure rate of the observation group and the control group about eyeball exophthalmos values was 84% and 59%, the difference of the two groups was statistically significant(P<0.05). The cure rates of diplopia of the two groups were 80% and 70% without significant difference(P>0.05). The cure rate of limited ocular movement of observation group was 73%, that of control group was 66%, there was no statistical significance(P>0.05). During the follow-up period, there was no infection in the two groups, no titanium mesh shift, extrusion, deformation and rejection or other complications.

CONCLUSION: Pre-shaped titanium mesh shaping orbital implantation with no need for shaping the mesh in the operation, can shorten the operation time, make accurate reconstruction of orbital wall, reduce complications and improve the curative effect.

Abstract:AIM:To investigate the effect and local influence of atropine and anisodamine eye drops on adolescent pseudomyopia.

METHODS:Totally 110 cases of juvenile pseudomyopia were randomly divided into two groups, the control group was given 10g/L atropine sulfate eye gel, and the observation group was treated with 5g/L raceanisodamine eye drops. The efficacy of two methods, the changes of axial length and intraocular pressure before and after treatment, and the incidence of adverse reactions were compared.

RESULTS: There was no significant difference in cure rate between the two groups(χ²=0.533, P=0.465), but the effective rate of observation group was significantly better than the control group(χ²=3.907, P=0.048). Compared with the same group before treatment, the length of the axial length of the two groups increased in different degrees,and the increase value of the observation group was significantly higher than that of the control group, the difference was statistically significant(P<0.05), however, there was no significant difference between the two groups after treatment(P>0.05). The intraocular pressure of the two groups was significantly lower than that of the same group before treatment, and the difference between the two groups after treatments was not statistically significant(P >0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group(χ²=18.939, P<0.05).

CONCLUSION: Anisodamine eye drops in the treatment of juvenile pseudomyopia has obvious curative effect, its efficacy and safety are better than atropine eye gel.

Abstract:AIM:To discuss the clinical features and operation methods on small-diopter intermittent exotropia.

METHODS:Totally 206 in-patients with small-diopter intermittent exotropia(IXT)in different operation groups, from September 2013 to September 2014,were observed for the eyesight, refraction, dominant eye, exotropia degree, synoptophore and near stereopsis before and after operation. Three types were divided in 206 cases. One hundred and thirty-two cases of basic IXT were the first type, in which 52 cases underwent nondominant eye unilateral recess-resection(nondominant eye unilateral recess-resection, ndR& R), 40 cases underwent dominant eye unilateral recess-resection(dominant eye unilateral recess-resection, dR& R), 40 cases underwent bilateral lateral rectus recession(bilateral lateral rectus recession, BLR-rec). Sixty-one cases of convergence insufficiency IXT were the second type, in which 40 cases underwent ndR& R, 21 cases underwent bilateral medial rectus amputation. Thirteen cases of divergence excess IXT were the third type, in which 7 cases underwent ndR& R, 6 cases underwent BLR-rec. The rates of the orthophoria, undercorrection, overcorrection and the recovery of synoptophore and near stereopsis after surgery in 1, 6, 12, 24mo were compared in 3 types.

RESULTS: The clinical features of 206 cases with small-diopter IXT were: in the most cases, between 5 and 12 years old; nondominant eye was left eye; the eyesight of nondominant eye was lower than another eye; refraction status were myopia, astigmatism and anisometropia; basic IXT was the most common type; exotropia degree was between 40^△ and 60^△; some cases owned binocular function and near stereopsis. Comparison of operation methods in 3 groups: orthophoria comparisons in basic IXT among ndR& R group, d R& R group and BLR-rec group were significant difference(P<0.05)after operation in 12 and 24mo. Orthophoria comparison in insufficiency IXT between ndR& R group and BMR-amp group was not significant difference(P>0.05)after operation. The operation of divergence excess IXT was effective. Orthophoria comparison in ndR& R group between basic IXT and convergence insufficiency IXT was significant difference(P<0.05)after operation in 6, 12 and 24mo. Synoptophore and near stereopsis of some cases were improved after operation.

CONCLUSION:Early surgical treatment of the pediatric patients with small-diopter IXT is benefit for the establishment of binocular function and stereopsis. Adult surgical treatment can improve the appearance and alleviated eyestrain. In 206 cases, the operation method of ndR& R is obvious curative effective in each type of small-diopter IXT. The operation methods of BMR-amp and BLR-rec are obvious effective in insufficiency intermittent and divergence excess IXT.

Abstract:AIM: To study the clinical application of Clifford Terry slippery knot combined with adjustable suture in strabismus surgery.

METHODS: By adopting the method of retrospective study, from May 2012 to May 2016, 45 patients(71 eyes)underwent conventional strabismus correction and 45 patients(70 eyes)who underwent Clifford Terry slanting correction were selected as control subjects the study subjects. The patients were followed up for 1d-12mo. Observation of postoperative eye, adjusted eye position and whether or not had a second operation were taken. Postoperative eye position was compared with preoperative eye position.

RESULTS: After Clifford Terry suture combined with adjustable suture, 42 cases with 67 eyes reached the anteroposterior position on the first day, one eye reached overcorrection, two eyes undercorrection. Correscted rate was 96%. After elasticity adjusted by Clifford Terry slippage adjustment, corrected rate was 100%. Eye position of the study group at 1, 3, 6 and 12mo postoperative had no significant difference compared with control group. Conjunctival dehiscence, muscle slippage, the postoperative complications such as infection did not appear in the two groups.

CONCLUSION: Clifford Terry technique is simple in operation and easy to adjust the suture tightness after operation. Combined with adjustable suture in strabismus surgery, the target eye position can be easily reached in the operation or early after operation under surface anesthesia, the risk of second operation can be reduced. This operation is better than adjustable suture alone.

Abstract:AIM: To compare the imaging features of fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)in choroidal metastases, and to provide the basis for the accurate diagnosis of choroidal metastases.

METHODS: Six patients(8 eyes)with definite primary malignant tumor lesion were diagnosed, and fundus photographs were taken after mydriasis. FFA and ICGA were simultaneously contrasted with Heidelberg fundus angiography to compare the similarities and differences between the two imaging examinations.

RESULTS: FFA showed a low fluorescence at the early stage, a needle-like or spot-like fluorescence at the middle stage and a strong fluorescence band at the late stage, and a weak fluorescence at the edge of the lesion in some cases. The ICGA showed a low fluorescence. There was no significant change in intensity, only 1 case in the reverse phase of the central and focal lesions around the strong fluorescence.

CONCLUSION: FFA and ICGA for choroidal metastases have a more characteristic performance, both helpful for the diagnosis of choroidal metastases.

Abstract:AIM: To assess the effect of overnight orthokeratology on tear film and cornea biological characteristics in adolescents.

METHODS: Thirty-five myopia patients(70 eyes)worn overnight orthokeratology and fifteen myopia patients(30 eyes)worn frame glasses were involved in our study with complete follow-up information. We measured average tear breakup time(aBUT), basal tear secretion, corneal thickness and corneal curvature and corneal endothelium, then analyzed the differences in tear film stability and corneal biological characteristics between myopia patients of the both groups.

RESULTS: Compared with the frame glasses group, there was no significant difference in the difference of aBUT, basal tear secretion difference and corneal thickness between before and after wearing overnight orthokeratology(P=0.0922、0.0891、0.4181); there was significant difference in the difference of corneal curvature, corneal thickness, the coefficient of variation of corneal endothelial cell, and the percentage of corneal hexagonal endothelial cells between before and after wearing overnight orthokeratology(P=0.0000、0.0005、0.0002). No serious complications occurred in ocular surface in all follow-up cases.

CONCLUSION: Long-term overnight orthokeratology had no significant effect on tear film stability, but would increase the coefficient of variation of the corneal endothelial cell and reduce the percentage of corneal hexagonal endothelial cells. In order to diminish implications and guarantee the safety of orthokeratology, it should be closely observed, regular care.

Abstract:AIM: To investigate the effect of soft corneal contact lens on the recovery of corneal epithelial defects and the comfort in patients with diabetic retinopathy after vitrectomy.

METHODS: Twenty patients(20 eyes)with diabetic retinopathy whose corneal epithelium defected after vitrectomy were randomly divided into 2 groups. The trial group(10 eyes)received the combination treatment of wearing soft corneal contact lenses and eyedrops to promote corneal epithelial repair, and the control group(10 eyes)only received eyedrops. The corneal epithelial healing time was observed postoperatively. And the scores of the comfort in patients between two groups were compared.

RESULTS: The average duration of corneal epithelial defects was 4.1±1.20d in the trial group, and 14.2±6.07d in the control group, which was statistically significant different between the two groups(P<0.05). After treatment, the patients in the trial group felt more comfortable compared with the ones in the control group. There was no significant statistical difference about the scores of the comfort between the two groups at postoperative 3mo(P>0.05).

CONCLUSION: The soft corneal contact lens could effectively treat patients with corneal epithelial defects after vitrectomy, and improve their comfort.

Abstract:AIM: To study the surgery method, risk factors and prevention of extracapsular cataract extraction(ECCE)and posterior chamber intraocular lens(PC-IOL)implantation through microcoria in leprosy patients in order to minimize the surgical complications.

METHODS: Totally 72 leprosy patients(83 eyes)with cataract were treated by cutting the sphincter muscle of pupil to enlarger the pupil, then performing ECCE and PC-IOL. The visual acuity and complications were retrospectively analyzed.

RESULTS: At 6mo postoperatively, best corrected visual acuity was ≥0.5 in 20 eyes(24%), 0.1 to<0.5 in 33 eyes(40%), <0.1 in 14 eyes(17%), no change in 16 eyes(19%). The postoperative complications: uveitis in 26 eyes(31%), posterior capsular rupture in 14 eyes(17%), posterior capsular opacification in 21 eyes(25%), secondary glaucoma accounted in 13 eye(16%).

CONCLUSION: Because of long course, lepra reaction and persistent iritis, the leprosy patients are suffered from nerve damage and atretopsia, which make the surgery hard to complan, the complications increased, and the postoperative visual acuity is poor.

Abstract:AIM: To observe the curative effect of trabeculectomy combined with phacoemulsification in patients with primary angle-closure glaucoma(including acute or chronic angle-closure glaucoma)complicated with cataract and the complications influences.

METHODS: Sixty patients(60 eyes)with glaucoma and cataract treated in our hospital from January 2014 to July 2016 were randomly divided into control group(30 eyes)and observation group(30 eyes). Trabeculectomy were used in the control group. Trabeculectomy combined with phacoemulsification was performed in the observation group. The clinical efficacy and complication rate of the two groups were compared.

RESULTS: There was no significant difference in the postoperative visual acuity between the observation group and the control group(P>0.05). The intraocular pressure of observation group was significantly lower than that of control group(P<0.05). In the observation group, the postoperative anterior chamber depth was greater than that in the control group(P<0.05). The postoperative complication rate in the observation group was 7% which was significantly lower than that in the control group(23%, P<0.05).

CONCLUSION: Trabeculectomy combined with phacoemulsification are the ideal treatment for primary angle-closure glaucoma with cataract. The complication rate is relatively low.

Abstract:AIM:To investigate the effect of double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for the treatment of glaucoma complicated with cataract.

METHODS:Selected 36 patients(40 eyes)with acute or chronic angle-closure glaucoma and cataract in our hospital from June 2014 to January 2016 were treated with double incision trabeculectomy combined phacoemulsification and intraocular lens implantation. All patients were followed up for 1mo to observe preoperative and postoperative visual acuity, anterior chamber depth, scope of anterior chamber angle open and intraocular pressure. At the same time, we observed the patients' postoperative filtering bleb and intraoperative and postoperative complications.

RESULTS: Intraocular pressure before treatment were between 19-36mmHg, the average was 26.02±2.42 mmHg, and after the treatment intraocular pressure was patients between 11-22mmHg, the average was 13.62±4.38 mmHg, preoperative and postoperative intraocular pressure had the obvious difference(t=33.273, P<0.05). Preoperatively 85.0%(32 cases, 34 eyes)was with vision less than 0.3, and 53%(19 cases, 21 eyes)after surgery with eyesight over 0.3. All of the eyes formed good filtering bleb after surgery. Scope of anterior chamber angle open, anterior chamber angle open distance and central anterior chamber depth after operation increased in 36 cases compared with preoperative(t=5.832, 5.924, 33.293, P<0.05). There were 7 eyes with mild edema of the cornea, all disappear within 3d after surgery; one eye with bleeding when the iris was cut and absorbed after 2d; 4 eyes with fibrin effusion on lens surface and anterior chamber and absorbed with 6d. There were not any other severe complication in this study.

CONCLUSION: Double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for glaucoma with cataract can effectively improve the patient's vision, and can better control the intraocular pressure after surgery.

Abstract:AIM: To study the sensitivity and specificity of Ic-VEP in diagnose of early and middle stage glaucoma.

METHODS: All the participants included glaucoma patients and normal people came from Beijing Aier-Intech Eye Hospital from October 2014 to October 2016. All the participants performed slit lamp examination, fundus examination, Goldmann applanation tonometer, Humphery visual field examination, retinal nerve fiber layer(RNFL)thickness and macular ganglion cell complex(GCC)thickness examination and Ic-VEP. The sensitivity and specificity of Ic-VEP in diagnose of glaucoma were main results.

RESULTS: The sensitivity and specificity of Ic-VEP in diagnose of glaucoma is 82% and 92% respectively. The area under ROC curve was 0.872. Consistency of Ic-VEP and GCC thickness in moderate glaucoma was good(Kappa value=0.75).

CONCLUSION: Ic-VEP is a useful new method for the diagnosis of early and middle stage glaucoma.

Abstract:AIM: To study the retinal function in patients with diabetic macular edema after photocoagulation.

METHODS: A total of 30 eyes in 19 patients with diabetic macular edema(DME), who were diagnosed through fundus fluorescein angiography, consecutively recruited from March 2010 to March 2014 and were treated with macular grid pattern photocoagulation. Multifocal electroretinogram(mfERG)system(version 3.15)was performed before and after photocoagulation therapy for 3mo. All data were statistically analyzed.

RESULTS: The amplitude densities of a-ware and b-ware for the fovea increased after macular grid pattern photocoagulation therapy, and there were significantly changes relative to its preoperation(t=-3.7683, P<0.01; t=-3.6570, P<0.01). No remarkable changes in the latency of a-ware and b-ware of fovea were measured before and after photocoagulation(t=1.7103, P>0.05; t=1.5623, P>0.05 ). Compared with pretreatment, the amplitude densities of a-ware and b-ware at macular were statistically larger(t=4.8337, P<0.01; t=-2.0376, P<0.05). The latency of a-wave and b-wave at macular was significant longer after treatment(t=-2.1892, P<0.05; t=-3.5024, P<0.01). There were no significant differences in the amplitude densities of a-ware and b-ware at paramacular after therapy(t=-1.4387, P>0.05; t=-0.1766, P>0.05). It was significant longer in the latency of a-wave and b-wave at paramacular after photocoagulation(t=-2.0905, P<0.05; t=-2.5646, P<0.05).

CONCLUSION: The laser photocoagulation treatment for DME can improve the retinal function at fovea, which benefits the vision acuity. Unfortunately,it induces extensively damaging effects on the macula and paramacular.

Abstract:AIM: To analyze the influencing factors affecting retinal blood vessel morphology in patients with diabetes mellitus.

METHODS: Totally 312 patients with type 2 diabetes mellitus in our hospital from January 2012 to September 2016 were selected as study subjects. The patients were examined by fundus photography and related laboratory. As grouping factors in the patients'age, sex, disease duration, smoking, drinking, hypertension, hyperlipidemia or diabetic nephropathy, we compared the incidence of retinal vascular changes in different groups. The meaningful factors were introduced into the Logistic regression equation again. Independent risk factors for retinal vascular changes in patients with diabetes mellitus were screened out.

RESULTS:In 312 cases of patients with type 2 diabetes mellitus,169 cases were accompanied with retinal vascular abnormalities, and 143 cases were not associated with retinal vascular abnormalities. Univariate analysis showed that age, duration of disease, hypertension, hyperlipidemia or diabetes nephropathy were significantly correlated with retinal vascular morphological changes(P<0.05). Sex, smoking or drinking had no significant correlation with retinal vascular abnormality(P>0.05). Retinal vascular abnormalities were used as the dependent variable, and the above mentioned factors were grouped as independent variables. By Logistic stepwise regression analysis showed that the course of disease, patients with hypertension or diabetic nephropathy were the independent risk factors of abnormal retinal vascular morphology(P<0.05).

CONCLUSION: The independent risk factors for the occurrence of retinal vascular changes in patients with diabetes mellitus are increased course of disease, hypertension or diabetic nephropathy. Early diagnosis and intervention, to take measures and control blood pressure, reduce kidney damage can reduce the incidence of diabetic retinopathy, and macrovascular disease caused by diabetes, the incidence of adverse cardiovascular and cerebrovascular events.

Abstract:AIM: To observe the change in full-field electroretinogram(ERG)in patients with nonproliferative diabetic retinopathy(NPDR)after panretinal photocoagulation(PRP)2d and 2mo, and evaluate the effects of Difrarel protecting dark adaptation function.

METHODS: Fifty-five cases with NPDR were randomly divided into the observation group and the control group.Both groups were treated with panretinal photocoagulation.Difrarel tablets was added in the observation group,and Vitamin B was added in the control group. We administered these drugs to the patients for 2mo continuously and the changes in ERG were observed after 2d and 2mo treatment. The amplitude of wave b(bA), and the peak time of wave b(bT)were observed and the data were treated statistically with SPSS 20.0 and test t in pairs.

RESULTS: The bT of the two groups before and at 2mo treatment had no difference inner group or inter-group(P>0.05). But there was obvious difference in bA of control group at 2mo after treatment compared with before treatment(P<0.05), significantly more increased amplitude of observation group than that of control group(P<0.05).

CONCLUSION: The function of each layer of PDR's retina has been damaged obviously and cannot get well after PRP. The patients with diabetic retinopathy combined with Difrarel tablets and PRP can better restore vision and improve the dark adaptation function.

Abstract:AIM: To study the application of intravitreal injection of anti-vascular endothelial growth factor(VEGF)inpatients with fundus neovascularization disease in No.2 Foshan People's Hospital between 2013 to 2015.

METHODS: Retrospective analysis of inpatients of Foshan Second People's Hospital from January 2013 to December 2015, searched the inpatient management system with the term "intravitreal injection", excluded patients with intravitreal injection of TA and antibiotics, and queried the diseases involved. Then summarized the amount of inpatients of each disease as comparison.

RESULTS: Totally 239 eyes underwent injection in 3a. The proportion of male and female was even. No statistical difference among the youth,the middle age and the old group. The amount of injections was increased year by year. The main diseases underwent anti-VEGF injection was retinal vein occlusion(RVO), choroidal neovascularization retinopathy(CNV), diabetic retinopathy(DR)and polypoidal choroidal vasculopathy(PCV). Anti-VEGF injection ratio(injection/total)of the four diseases in the same year and each disease of different year were significantly statistic different. Among the four main disease, anti-VEGF injection was the most accepted in CNV patients, and anti-VEGF injection ratio was the most improved in PCV patients.

CONCLUSION: Anti-VEGF intravitreal injection as a new treatment for fundus neovascular diseases was increasingly accepted by patients.

Abstract:AIM: To evaluate the condition of Meibomian gland in different age groups patients with dry eye.

METHODS: There were divided into A to H groups according to age that 301 patients(598 eyes)with dry eye in our hospital of November 2015 to April 2016, a total of eight groups. We evaluated the condition of Meibomian gland of them through the OCULUS Keratograph, including the loss of the Meibomian gland, the shape of the Meibomian gland, eyelid ester and obstructed or not of the Meibomian gland orifices, etc.

RESULTS: There had lost of the Meibomian gland of all patients with dry eye in this study, the differences between the eight groups were statistically significant(χ²=336, P<0.05).The number of Meibomian gland of group A had no loss. The differences between the B～H groups were statistically significant(F=36.4357,P<0.05). Glands shape had become thin when the age was more than forty, getting worse as the growth of the age gradually. The differences eyelid ester and obstructed or not of the Meibomian gland orifices between the A～H groups were not statistically significant.

CONCLUSION: The OCULUS Keratograph can provide the objective and precise condition of Meibomian gland in each group of patients with dry eye for us, and the change rule of quantitative results. it can provide the diagnosing judgment for the patients of dry eye, and provide methods for clinical treatment.

Abstract:AIM:To detect oxidative DNA damage marker 8-hydroxy-2-deoxyguanosine(8-OHdG)in primary pterygium and normal conjunctival tissues, explore the role of oxidative DNA damage in the pathogenesis of pterygium.

METHODS: Totally 35 primary pterygium specimens were collected during surgery and 5 normal conjunctival specimens which above the normal temporal bulbar conjunctiva were collected. The expressions of 8-OHdG in pterygium tissues were detected by immunohistochemical method and compared with the normal conjunctival tissues. The difference of 8-OHdG expression between the two groups was compared.

RESULTS: There were 24(69%)pterygium specimens positive for 8-OHdG staining, limited to the nuclei of the epithelial layer. No substantial staining was visible in the subepithelial fibrovascular layers. All normal controls were negative for 8-OHdG staining. The difference of 8-OHdG expression between the two groups was statistically significant(P=0.007).

CONCLUSION: The increased levels of 8-OHdG in the pterygium tissues indicate that oxidative DNA damage maybe play an important role in the pathogenesis of pterygium.

Abstract:AIM: To investigate the clinical characteristics and surgical effects in patients with Duane retraction syndrome(DRS).

METHODS: Totally 13 patients with DRS during June 2011 to December 2015 were analyzed retrospectively. The data including clinical types and manifestations, surgical methods and outcomes were reviewed and analyzed.

RESULTS: There were 11 male cases and 2 female cases who all had no ocular and systemic anomalies. The left eye was involved in 9 cases, the right eye was involved in 3 cases and 1 case involved in both eyes. Six cases were type Ⅰ,1 case was typeⅡand 6 cases were type Ⅲ. Eleven cases had abnormal head posture(AHP), 9 cases had the up- or down-shoot phenomenon. The surgical treatment was designed according to subtypes and clinical features which included medial rectus recession, lateral rectus recession, recession of both horizontal rectus muscles and lateral rectus recession combined with Y splitting. After surgery, horizontal deviation was less than ±10^△ in all patients, and AHP disappeared in 4 cases and improved in 7 cases. The up- or down-shoot and global retraction disappeared in 5 cases and improved in 4 cases. Simultaneously, the restriction of ocular motility was improved in all patients.

CONCLUSION: The clinical features of DRS are variant in different types. Detailed examination before surgery and reasonable surgical design are important in treatment of patients with DRS.

Abstract:AIM: To investigate the clinical curative effect of double loop insertion of silicone rubber tube combined with "Z" flap repair in the treatment of laceration of eyelid with canaliculus laceration.

METHODS: The paper reviewed 45 cases of laceration of eyelid with laceration canaliculus, caused by trauma, which were treated in my hospital from January 2014 to January 2016. In the process of anastomosis of lacrimal duct and suture of eyelid laceration, either the method of single spinal anesthesia tube placement on skin contraposition suture or the method of dual annular silicone tube placement combined with the word "Z" flap repair was used. We compared the two methods and studied the possible complications like eyelid varus and valgus, lacrimal point valgus, eyelid scar, anastomotic dehiscence again.

RESULTS: Out of the 22 cases in which the patients chose the single spinal anesthesia tube implantation on skin suture, 21 cases succeeded and patients received lacrimal duct patency results after extubation; and 1 case anastomosis failed. Complications: 20 cases had different degree of complications and the impact on their appearances were significant. Out of the 23 cases in which the patients chose double passage annular silicone tube joint prosthesis implantation Z flap, 23 received extubation results lacrimal patency or almost patency, the anastomosis of patients was successful. Complications: in two cases, patients had mild eyelid entropion and pomatum varus. Both eyelid deformity and severe wound tear did not occur in all cases again. Scar was not obvious. The success rate of anastomosis between the two groups was not significantly different(P=0.4889). To compare the rate of complications, there were significant differences(χ²=30.42, P<0.05).

CONCLUSION: The application of dual ring implantation silicon tube combined with the word "Z" flap repair in the treatment of lacrimal canaliculi laceration of eyelid laceration ensured the success rate of lacrimal canalicular anastomosis, greatly improved the eye appearances, and reduced the incidence of postoperative complications.

Abstract:AIM: To analyze the influence and safety of KTP laser combined with drainage tube implantation for lacrimal duct obstruction patients.

METHODS: Totally 200 patients(200 eyes)randomly selected from June 2012 to September 2015 in our hospital was diagnosed with lacrimal duct obstruction and treated with KTP laser combined drainage tube implantation. The ocular surface condition, including tear break-up time, fern-like crystals, dry eye symptoms questionnaire, lissamine green staining, corneal fluorescein staining, were assessed before and 1mo after surgery.

RESULTS: At 1mo after surgery, the tear secretion increased significantly. After extubation, tear secretion decreased significantly compared to the preoperative(P<0.05). The results of the questionnaire showed that the symptoms improved significantly after surgery. There were no significant differences between tear break-up time, fern-like crystals and conjunctival goblet cells before and after surgery, or after extubation.

CONCLUSION: KTP laser combined with drainage tube implantation can improve the symptoms and quality of life for lacrimal duct obstruction patients.

Abstract:AIM: To explore the effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction.

METHODS: Totally 70 patients(70 eyes)with chronic dacryocystitis and nasolacrimal duct obstruction in our hospital from December 2011 to December 2014 were selected, and were randomly divided into control group and study group. The control group were treated with nasal cavity lacrimal sac anastomosis under nasal endoscope, and the study group were treated with nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope. Total effective rates and fistula areas at 1, 6 and 12mo before and after operation were compared between the two groups.

RESULTS: At 1mo after operation, there was no significant difference in total effective rates between the control group(97%)and the study group(100%; P>0.05). At 6mo after operation, the total effective rate in the study group(97%)was significantly higher than that in the control group(77%; P<0.05). At 12mo after operation, the total effective rate in the study group(94%)was significantly higher than that in of the control group(71%; P<0.05). There was no significant difference in fistula areas between the two groups at 1mo after the operation(P>0.05), while fistula areas in the study group were larger than those in the control group at 6 and 12mo after operation(P<0.05).

CONCLUSION: The effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction are remarkable.

Abstract:AIM: To study serum soluble intercellular adhesion molecules -1(sICAM-1), soluble vascular cell adhesion molecule -1(sVCAM-1)and expression of miRNA-146a in peripheral blood mononuclear cells(PBMC)and its significance in patients with thyroid associated ophthalmopathy(TAO).

METHODS: From June 2014 to December 2015 in our hospital, 37 patients with TAO(TAO group), 40 patients with hyperthyroidism without TAO(non eye disease group)and 30 healthy people(control group)were enrolled and the serum concentrations of sICAM-1, sVCAM-1 and expression of miRNA-146a in PBMC were detected.

RESULTS: The serum sICAM-1 and sVCAM-1 of TAO group were 366.14±67.28g/L, 211.07±27.45g/L level was significantly higher than those of non eye disease group(286.62±51.09μg/L, 179.83±25.09μg/L)and healthy group(234.51±38.969μg/L, 164.51±22.57μg/L)(P<0.05). In TAO group, miRNA-146a(0.071±0.016)in PBMC was lower than that in non eye disease group(0.381±0.084)and healthy group(1.105±0.216)(P<0.05). The serum levels of sICAM-1 and sVCAM-1 were significantly higher in non eye disease group than in healthy group(P<0.05), and the expression of RNA-146a in PBMC was lower in the non eye disease group than in the healthy group(P<0.05). The serum levels of sICAM-1 and sVCAM-1 in the mild TAO group were significantly lower than those in the moderate-severe groups and extremely severe group(P<0.05), and the miRNA-146a expression in the mild TAO group was higher than those in the moderate-severe group and extremely severe group(P<0.05). The serum levels of sICAM-1 and sVCAM-1 were significantly lower in the moderate-severe group than those in the extremely severe group(P<0.05), and the expression of miRNA-146a in the moderate -severe group was significantly higher than that in the extremely severe group(P<0.05).

CONCLUSION: Serum sICAM-1, sVCAM-1 in TAO patients is with high expression, miRNA-146a in PBMC in TAO patients with low expression, and related to the degree of patient's condition.

Abstract:AIM: To summarize the eye infection distribution of pathogens and drug resistance characteristics in our hospital in latest 5a, hoping to provide a theoretical basis for clinical anti-infective therapy and nosocomial infection control.

METHODS:In this study, we collected positive strains isolated from the hospitalized patients in Renmin Hospital of Wuhan University from January 2011 to December 2015. Data were analyzed with WHONET 5.6 software.

RESULTS: A total of 4 486 cases of ophthalmic inpatients were included in the study, 736 strains of pathogenic microorganisms were isolated, including 510 gram-positive bacteria, 107 gram-negative bacteria and 119 fungi. The most common type of gram positive bacteria as the epidermis staphylococcus(247 strains), followed by coryne bacterium(153 strains). The most common type of gram negative bacteria for pseudomonas aeruginosa(39 strains). The most common type of fungi for sickle bacterium(77 strains), followed by aspergillus strain(31 strains). The staphylococcus was sensitive to rifampicin, trimethoprim, linezolid, vancomycin and teicoplanin. The Streptococcus pneumoniae was sensitive to levofloxacin, linezolid, vancomycin and teicoplanin. The drug sensitive rates of non-fermenters to cefoperazone/sulbactam and colistin, enterobacteriaceae to imipenem, meropenem and levofloxacin were all 100%. The detection rates of methicillin-resistant staphylococci and penicillin-resistant Streptococcus pneumoniae were 37.5% and 40.0%, respectively.

CONCLUSION:We should strengthen the monitoring of pathogen resistance, to keep abreast of the epidemic characteristics of ophthalmic infection pathogens and drug resistance trends, which are of great significance for the rational application of antibiotics in clinical anti-infective treatment, reducing the emergence of drug-resistant bacteria and hospital infection control measures.