Abstract:AIM: To evaluate the effects of genipin cross-linking on bullous keratopathy in rabbits.

METHODS: Nine female New Zealand white rabbits with bullous keratopathy were used as an experimental model. They were randomized into three groups. Corneas in Group A(treatment group, n=3)were immersed in 0.25% genipin at 24℃ for 40min; those in Group B(control group, n=3)were immersed in 0.9% sodium chloride solution at 24℃ for 40min; and those in Group C(blank control group, n=3)received no treatment. Follow-up examinations were performed within 2wk after treatment, including slit-lamp microscopy, central corneal thickness(CCT), evaluations of body weight and stress responses, histopathological analyses, and terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)for detecting stromal cell apoptosis.

RESULTS: Compared to Groups B and C, remission of corneal edema, corneal healing, disappearance of epithelial bullae, a significant decrease in CCT(P<0.05), and a significant increase in body weight(P<0.05)were found in Group A. Animals in Group A became more active and showed less aggression and violent resistance behavior. More regular and dense arrangement of collagen fibers in the corneal stroma and formation of blue strips of cross-linking products were observed in Group A. Cell apoptosis occasionally occurred in the corneal stroma of Group A, while no cell apoptosis was observed in Groups B and C.

CONCLUSION: Genipin cross-linking treatment for bullous keratopathy in rabbits results in remission of corneal edema and relief of pain. We hypothesize that genipin cross-linking strengthens collagen fibers in corneal stroma to avoid the formation of corneal edema and bullae.

Abstract:AIM:To explore the corneal biomechanical properties of the elderly with different axial length(AL)and corneal curvature by Corneal Visualization Scheimpflug Technology(Corvis ST).

METHODS: A cross-sectional study. A total of 220 patients(426 eyes)undergoing phacoemulsification were collected in this study. One of them whose the AL was 22-24 mm and the corneal curvature was 42-44 D were divided into male and female groups(44 eyes and 49 eyes, respectively). One of them whose the corneal curvature was 42-44 D were divided into 22-24 mm, 24-26 mm, and more than 26 mm groups according to AL(99 eyes, 22 eyes and 12 eyes, respectively). One of them whose the AL was 22-24 mm were divided into 42-44 D, and more than 44 D according to corneal curvature(88 eyes, 102 eyes, respectively). Corvis ST was used to measure the biomechanical parameters of the cornea. The differences in the parameters between different groups were analyzed using the independent-samples t-test or one-way analysis of variance and correlation analyses were performed using Pearson correlation analysis.

RESULTS: When comparing the corneal biomechanical parameters, no statistically significant differences were found between male and female groups(P>0.05). The first applanation length and second applanation length among different corneal curvatures were statistically significant(P<0.05). There was statistically significant only for the difference of the second applanation length and central cornea thickness between two groups of 22-24 mm and 24-26 mm(P<0.05). There was statistically significant for the difference of the second applanation length, deformation amplitude, central cornea thickness, the first applanation time, intraocular pressure and corrected intraocular pressure between the two groups of 22-24 mm and more than 26 mm(P<0.05). But there was no statistically significant differences of the parameters between groups of 24-26 mm and more than 26 mm(P>0.05). The patient's AL was positively correlated with deformation amplitude, intraocular pressure and corrected intraocular pressure(r=0.263, P=0.002; r=0.463, P=0.000; r=0.449, P=0.000), and there is negative correlation between the patient's AL and central cornea thickness, the second applanation length(r=-0.240, P=0.006; r=-0.344, P=0.000).

CONCLUSION: The corneal curvature and ocular AL may be the factor affecting the corneal biomechanical properties. The longer AL, the thinner corneal thickness, the more easily the corneal is deformed, and with the increase of the AL, intraocular pressure also increases. When discussing whether the preparation of the cataract incision is affected by the patient's own factors, the different corneal curvatures and AL shall be considered.

Abstract:AIM:To investigate the changes in anterior segment morphology using the Pentacam Schiempflug imaging system after uneventful phacoemulsification in pseudoexfoliation syndrome(PES).

METHODS:We enrolled 42 cataractous eyes of 31 PES patients undergoing cataract extraction in this prospective study, 42 cataractous eyes of 27 patients without pseudoexfoliation comprised a control group. Intraocular pressure(IOP),anterior chamber depth(ACD), anterior chamber volume(ACV), anterior chamber angle width(ACA)and pupil diameter(PD)measurements were obtained preoperatively, and at 1 and 3mo postoperatively with the Pentacam. For the variables between the pre- and post operative periods; t-test was used.

RESULTS: In PES group, the mean preoperative IOP level was significantly higher than the control group(P=0.017). In both groups, the differences in ACD, ACV, ACA and IOP values measured preoperatively and postoperatively at 1, and 3mo were statistically significant(P<0.05). When two groups were compared with each other, while reduction in IOP levels were more dramatic in PES group; increase in ACD,ACV and ACA were similar in both groups. Preoperative PD measurements were statistically higher than postoperative values(P<0.05)in PES group. Changes in IOP, ACD, ACV, ACA and PD were stabilized at 3mo postoperatively in both groups.

CONCLUSION:Uneventful phacoemulsification significantly reduces IOP, increases ACD,ACV and ACA in eyes with and without PES. Changes in ACD, ACV, ACA, PD and IOP remain stable at 3mo postoperatively. Although IOP reduction is more evident in PES group, cataractous eyes with and without PES exhibits similar anterior segment features after surgery. An early cataract extraction in pseudoexfoliation not only provides a wide and deep anterior chamber, but also leads to a stabile IOP control similar to eyes without PES.

Abstract:AIM: To compare the optic nerve function and visual evoked potential(VEP)between optic neuritis patients and normal individuals.

METHODS: A cross-sectional study was conducted at the Eye Clinic of Hospital Universiti Sains Malaysia(HUSM)between September 2011 and February 2013. We recruited twenty optic neuritis patients with a single episode of idiopathic optic neuritis occurring between 3mo and 2y prior to examination, and twenty control subjects. Ocular examination included visual acuity, colour vision, contrast sensitivity, visual field and pattern VEP. Independent t-test was conducted to compare the differences in the means of optic nerve function and VEP parameters between the optic neuritis group and control group. In parameters that were not normally distributed, Mann-Whitney test was used to compare the medians between the two groups.

RESULTS: In the optic neuritis group, the mean age was 30.8y. The mean duration between the episode of optic neuritis and the time of evaluation was 6.6mo. The visual acuity was poorer in the group with optic neuritis, with the mean LogMAR score(0.52)being significantly higher in this group than in controls(P=0.001). Colour vision was likewise decreased, with a mean score of 63.0% in the optic neuritis group(P=0.001). Contrast sensitivity was reduced in all four spatial frequencies; 3CPD(P=0.029), 6CPD(P=0.026), 12CPD(P=0.002)and 18CPD(P=0.006)in patients with optic neuritis. There was also a statistically significant loss of visual field in this group(P≤0.001). Although subjects with optic neuritis had a slightly prolonged VEP P100 latency compared to normal subjects, this difference in VEP latency was not significant using checkerboard pattern 1 or 2. Higher VEP amplitude was observed in optic neuritis subjects, but the difference between groups was not statistically significant.

CONCLUSION: There were significant reductions in optic nerve functions(i.e. visual acuity, colour vision, contrast sensitivity and visual field)at a mean of 6mo after an acute attack of optic neuritis. However, no significant differences in VEP amplitude and latency were noted between patients with optic neuritis and the control group. VEP may not be the ideal test to diagnose a previous attack of optic neuritis, as VEP parameters tend to normalize after a variable interval.

Abstract:AIM: To evaluate the use of amniotic membrane transplantation(AMT)in symblepharon.

METHODS: This non-comparative interventional case study was conducted from January 2013 to December 2015 and included a consecutive series of 14 eyes of 12 patients. Patients were selected for permanent AMT. The amniotic patches were grafted for the treatment of symblepharon. Cryo-preserved or freeze-dried amniotic membrane(AM)was used. Regarded to the 14 eyes(12 patients), their age was ranged from 26-62y, with the mean age of 43.38±11.25, 10 eyes of 8 patients(4 males/4 females)were presented with symblepharon secondary to previous pterygium surgery, and 4 eyes of 4 patients(1 male/3 females)were presented with symblepharon secondary to previous strabismus surgery, at least 6mo after the last surgery. The outcome of success was defined as restoration of a stable-depth fornix and being free of scar or inflammation, and no motility restriction during the follow up of 6mo.

RESULTS: The mean follow-up period was 7±4.2mo(range 6-9mo). In all 14 eyes, complete epithelialization of AM was observed 3wk after surgery, resulting in a non-inflamed appearance of the surgical site. Eight eyes out of total 14 eyes showed successful fornix reconstruction with success rate(57%), the fornix was deep, and no recurrence was observed. Four eyes(29%)showed partial success with moderate depth of the fornix and moderate scar. Two eyes(14%)showed failure of reconstruction of the fornix with complete fornix obliteration. The visual acuity improved after surgery in 7 eyes while remained stable in 7 eyes. Post-operative complications from the AMT was very limited as severe conjunctival reaction and motility restriction was occurred only in one eye out of 14 eyes(7%)and pyogenic granuloma occurred in 2 eyes out of 14 eyes(14%)in the first 3mo after surgery and was managed with surgical excision, with local corticosteroid injection.

CONCLUSION: AMT alone is a safe and effective method for symblepharon. Considering the potential adverse effects associated with limbal excision, also, AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders.

Abstract:AIM:To evaluate changes in peripapillary atrophy(PPA)and retinal in young adults with high myopia(HM)for three years.

METHODS:A total of 22 HM patients(n=32 eyes, >-9 D), 35-45y, were enrolled in this self-controlled retrospective review. The following parameters were measured at baseline and 3-year follow-up visits: area of optic nerve head(ONH); area of peripapillary atrophy(PPA); area of peripapillary chorioretinal atrophy(PCA); type of PPA; average retinal thickness(ART); and total central retinal volume(TCRV).

RESULTS: There were no changes in the area of ONH(t=0.95, P=0.35)between baseline and 3-year follow-up visits. In contrast, the areas of PPA and PCA were significantly greater(0.69±0.71 and 0.57±0.97mm²,respectively)at the 3-year follow-up versus baseline(t=-3.99, P=0.001 and t=-2.33, P=0.03, respectively)visits. There were no changes in the type of the PPA. ART and TCRV did not differ significantly at the 3-year follow-up versus baseline visits(P>0.05).

CONCLUSION:Increased areas of PCA and PPA are the main fundus features of HM(>-9 D)in young adults. PPA and PCA should be important morphological parameters during follow-up for HM in clinic.

Abstract:AIM: To evaluate and compare the clinical performance of 5 kinds of polyhexamethylene biguanide(PHMB)based multi-purpose solutions(MPS)manufactured in China when used with a commercially available silicone hydrogel contact lens in terms of solution-induced corneal staining(SICS), ocular response(corneal staining and ocular hyperemia), corneal infiltrative events(CIE)and ocular comfort.

METHODS: This was a prospective, open label, randomized, parallel group clinical trial. Totally 162 participants who were at least 18y old were enrolled and randomized into 5 groups of PHMB-based MPS made in China: Complete^® MPS, Hydron^® Aqua-shining moist, Baoshining^TM, Weicon^® Fresh, Weicon^® 2000 MPS(abbreviated as C, H, B, W, and W2). All participants wore balafilcon A contact lenses with monthly disposal(Bausch & Lomb Purevision^®)in conjunction with the designated MPS on a daily wear for 3mo. Clinical visits were at baseline, 2wk, 1 and 3mo. SICS and CIE were reported as first event incidence per 100 Px-months. Ocular response was graded on 0-4 scale in 0.5 steps(0=none, 4=severe)and ocular comfort was assessed via a numeric rating scale(1-10 in 1-point steps, 1=poor, 10=excellent). Ocular comfort and ocular response variables were analysed using linear mixed model. CIE and SICS were analysed using Fisher's exact test and logistic regression.

RESULTS: There were 36(22%)Pxs who dropped out. SICS incidence for each MPS were: H(26.3%),B(20.8%), W(19.4%), W2(13.4%), C(12.8%). The SICS rate of H was significantly different to W2(P = 0.012)and C(P = 0.005). There were no significant differences in ocular response, CIE incidence and ocular comfort between different MPSs(P>0.05). Pxs with SICS had significantly lower comfort during the day and at the end of than those who did not have SICS.

CONCLUSION: Differences in SICS incidence were found between MPSs but not for CIE incidence, ocular response or ocular comfort. SICS in PHMB-based MPS was found to be associated with ocular discomfort.

Abstract:AIM: To investigate the rate of compliance of contact lens users regarding hygiene and replacement of soft contact lenses, lens case and lens care solution.

METHODS: A candidate who used their lenses for a minimum of 8h a day for a period of 6mo or more was considered as a contact lens user. A semi-structured, pre-tested and validated questionnaire was used to assess the compliance among the soft contact lens users after receiving informed verbal consent. Each candidate was interviewed to collect the information about their contact lens wearing history. Age, gender, type of lens used, wearing experience(y), wearing time and schedule, duration of lens use in a day and details of care system were noted.

RESULTS: The mean(±SD)age of the total 73 participants was 23.63 ± 5.23y. The status of compliance observed was highest in the category of lens cleaning and disinfecting procedures(98%); the least was in the category of care of contact lens accessories(81%). Major non-compliance aspects identified were replacement of lens case(41%), check discard after date of the solution, cleaning lens case(22%)and failure to attend after-care visits(22%). The gender, modality of lens wear, type of lens wear and years of experience in contact lens use did not show any statistically significant difference in the level of compliance.

CONCLUSION: The results from this study demonstrated good compliance overall. However, some degree of non-compliance was present among the subjects in the care of lens accessories like contact lens case and solution. Approaches intended to improve compliance with lens care practices is considered necessary.

Abstract:AIM: To explore a way to establish a rat bone mesenchymal stem cell(BMSC)line expressing Interleukin(IL)-33.

METHODS: BMSCs were isolated from 6-week-old Wistar Rat. GV303 virus were used as a IL-33 gene carrier to tansfect isolated BMSCs.Three days later, transfected BMSCs were observed under a fluorescence microscope. The expression level of IL-33 of transfected BMSCs was detected by Western blot and ELISA.

RESULTS: The BMSCs were successfully isolated, since flow cytometry results showed that rat BMSCs CD90 and CD29 positive, CD45,CD34 and CD11b negtive. Furthermore, BMSCs were able to be differentiated to osteoblasts, adipocytes and chondrocytes respectively. Green fluorescence of GFP BMSCs was observed under the fluorescence microscope 3d after virus transfecting. Expression of IL-33 was detected by Western blot and ELISA in the transfected rat BMSCs.

CONCLUSION: A rat BMSC cell line expressing IL-33 was established by GV303 virus transfection.

Abstract:AIM:To observe the protective effect of pigment epithelium derived factor(PEDF)on retinal ganglion cells(RGCs)after acute injury of optic nerve in rats.

METHODS: Totally 60 healthy female SD rats were randomly divided into three groups: blank group, model group and experimental group, 20 rats in each group. Acute injury model of optic nerve in rats are established by crushing optic nerve. After the model of optic nerve injury was made successfully in model group, the rats were injected with balanced salt solution 5μL into vitreous cavity, and at 1 and 2wk later respectively they were injected again. In experimental group, after the model of optic nerve injury was made successfully, immediately the rats were injected with the PEDF 5μL into vitreous cavity, also at 1 and 2wk later respectively they were injected again. To observe the retinal morphologic changes and count the number of retinal ganglion cells, the specimen was given HE staining and observed under light microscope. The immunohistochemical semi quantitative method was used to detect the expression of Bcl-2 and Bax to observe the effect of PEDF on the optic nerve after injury.

RESULTS: Cell morphology of ganglion cells in experimental group was better and the number of RGCs was much more, comparing with the model group by HE staining. The expression of Bcl-2 and Bax in the experimental group was significantly different with that in the blank group and the model group(P<0.05). The expression of Bcl-2 increased and the expression of Bax decreases in the experimental group compared with the model group.

CONCLUSION: PEDF can inhibit or weak the apoptosis of RGCs cells after optic nerve injury and alleviate the injury of optic nerve by increasing the expression of Bcl-2 protein or decreasing the expression of Bax protein.

Abstract:AIM: To observe the accuracy of the experimental choroid neovascularization(CNV)changes evaluated by CD105 immunohistochemical examination.

METHODS: Twenty-four male Brown Norway(BN)rats were randomly divided into the control group(6 rats)and the experimental group(18 rats). The CNV were induced by 659nm krypton laser. And the power was 360mW, exposure time was 0.05s, spot diameter was 50μm. The formation rate of CNV and the average optical density(AOD)of leakage flare were observed by fluorescein fundus angiography(FFA)and indocyanine green angiography(ICGA)on the seventh day, the fourteenth day and the twenty-first day after laser photocoagulation. The histopathology changes of CNV and the AOD of CD105 were observed by eyeball exemplar.

RESULTS: The CNV appeared on the seventh day after laser photocoagulation, and reached the peak on the fourteenth day and twenty-first day after laser photocoagulation. The formation rate of CNV were 77.08%, 85.42%, 89.58%, at 7, 14 and 21d after laser photocoagulation. From 7 to 21d after laser photocoagulation, the AOD of leakage flare increased gradually(P<0.05). There had significant differences between 7 days' outcome and 14 days' outcome(P<0.05), and had no significant differences between 14 days' outcome and 21 days' outcome(P>0.05). From 7 to 21d after laser photocoagulation, the expression of CD105 increased gradually, and then decreased gradually, and from 14 to 21d, there had significant differences between 7 days' outcome and 14 days' outcome of AOD(P<0.05), and had no significant differences between 14 days' outcome and 21 days' outcome(P>0.05).

CONCLUSION: Immunohistochemical outcomes of CD105 are highly consistent with fundus angiography outcomes of CNV changing regularity.

Abstract:AIM: To investigate the effect of silicon oil and heavy silicone oil as two kinds of intraocular stuffing to the retinal electrophysiology of the rabbits in the medium and long term.

METHODS: Totally 28 standard rabbits were selected with right eyes operated for vitrectomy, and then, they were randomized into three groups: Group A 12 rabbis, Group B 12 rabbits, Group C 4 rabbits. Group A: vitreous body was cut-down and filled with silicon oil; Group B: vitreous body was cut-down and filled with heavy silicon oil; Group C: vitreous body was cut-down and filled with BSS. Taken into account were the experimental animals' different periods thickness of the retinal, intraocular pressure and ERG b-wave amplitude for statistical analysis.

RESULTS: Comparison between any two means of Group A, B or C surgery eyes' preoperative and postoperative at different time points: measured IOP showed no significant difference(P> 0.05); the retinal thickness mean value measured by OCT had statistically significant(P<0.05)at the postoperative 24wk; there was a conspicuous statistically significant(P<0.01)of ERG'sb-wave amplitude at the postoperative 24wk.

CONCLUSION: As the stuffing of vitreous cavity, the silicone oil or heavy silicone oil has no obvious difference to the influence of intraocular pressure for medium to longer term. But heavy silicone oil has more serious negative impact of retinal visual information transmission function, more significantly reduce of retinal thickness than ordinary silicone oil in the longer term.

Abstract:AIM: To investigate the expression of mucin in the conjunctival tissue and tear in eyes with conjunctivochalasis(CCh).

METHODS: Thirty-eight cases(38 eyes)of CCh were recruited as the CCh group and 36 cases(36 eyes)without CCh were included as the normal control group and the conjunctival tissue and tear were collected, respectively. Mucins(MUC2, MUC4, MUC5AC, MUC16)expression in conjunctival tissue were detected by immunohistochemical staining; Mucins(MUC2, MUC4, MUC5AC, MUC16)OD value in tear were determined by ELISA, the differences of which were compared between the CCh and normal control group.

RESULTS: No difference in the expression of MUC2 and MUC4 in conjunctival epithelia was observed between the two groups(P=0.315, P=0.156). There was significant difference in the expression of MUC5AC and MUC16 in conjunctival epithelia between the two groups(P=0.016, P<0.01, respectively). No significant difference in the OD value of MUC2 in tear was found between the two groups(P=0.651). The OD value of MUC4 and MUC5AC in tear were significantly lower in CCh group that in the normal control group(P<0.01, P<0.01, respectively), so was the OD value of MUC16(P=0.022).

CONCLUSION: MUC5AC and MUC16 both decreased in the conjunctiva and tear of eyes with CCh. The further study may reveal the pathogenesis of conjunctivochalasis.

Abstract:AIM:To investigate the expression changes and clinical significances of Gas6, SDF-1α and SDF-1β in serum in patients with diabetic retinopathy(DR).

METHODS: Totally 113 patients with DR were divided into proliferative group(n=45)and nonproliferative group(n=68). In the same period, 49 cases of patients with non-contracted DR diabetes were selected as the diabetic group and 42 cases of healthy subjects were selected. The indexes of blood glucose, blood lipids and hs-CRP were detected. The expressions of Gas6, SDF-1α and SDF-1β genes in serum were detected by using real-time PCR technology.

RESULTS: The HOMA-IR, TG and hs-CRP in the diabetic group, nonproliferative group and proliferative group gradually increased, the differences were statistically significant(F=39.672, 81.625, 99.872, all P<0.05). The LDL-C in the nonproliferative group and proliferative group were higher than the diabetic group and healthy subjects, while the HDL-C were lower than the diabetic group and the healthy subjects, the differences were statistically significant(F=51.974, 43.824, all P<0.05). The relative expression levels of Gas6 mRNA in proliferative group, nonproliferative group and diabetic group were higher than the healthy subjects; the relative expression levels of SDF-1α mRNA in proliferative group were higher than the nonproliferative group, diabetic group and healthy subjects. The relative expression levels of SDF-1β mRNA in proliferative group and nonproliferative group were higher than the diabetic group and healthy subjects, and the proliferative group were higher than the nonproliferative group, the differences were statistically significant(F=15.381, 21.589, 38.942, all P<0.05). Pearson correlation analysis showed that the relative expression levels of Gas6 mRNA in serum in patients with DR were positively correlated with TG, TC and LDL-C(r=0.228, 0.241, 0.209, all P<0.05), and the relative expression levels of SDF-1α mRNA and SDF-1β mRNA in serum were positively correlated with hs-CRP(r=0.297 and 0.325, all P<0.05).

CONCLUSION: The expression levels of Gas6, SDF-1α and SDF-1β genes in serum in patients with DR are elevated. They might be related to abnormal blood lipid metabolism and inflammatory response.

Abstract:AIM: To investigate the effect of preoperative injection of triamcinolone acetonide(TA)with 25G minimally invasive vitreoretinal surgery(VRS)in treating proliferative diabetic retinopathy(PDR)and the prognosis of patients.

METHODS: A total of 108 patients(108 eyes)with PDR to be treated by VRS were randomly divided into two groups. Fifty-four patients, treated with intravitreal injection of TA at 1wk before surgery were included into the VRS+TA group, and 54 cases directly treated by VRS were included into the VRS group. The surgical effect, uncorrected visual acuity(at 3mo after surgery), the best corrected visual acuity, the intraocular pressure(before surgery and at 1wk, 1 and 3mo after surgery)and complications were observed.

RESULTS: The surgical time, electrocoagulation rate, rate of iatrogenic hole and bleeding rate during surgery were significantly shorter or lower in VRS+TA group than in VRS group(P<0.05)while the intraocular filler showed no significant difference between the two groups(P>0.05). At 3mo after surgery, the uncorrected visual acuity and the best corrected visual acuity were improved significantly(P<0.05)while there was no significant difference between groups(P>0.05). At 1 and 3mo after surgery, the intraocular pressure of VRS+TA group was significantly higher than that before surgery(P<0.05)while there were no significant differences between groups(P>0.05). The rate of anterior chamber exudation was significantly lower in VRS+TA group than in VRS group(P<0.05)while there was no significant difference in the total incidence of complications between groups(P>0.05).

CONCLUSION: The application of intravitreal injection of TA in patients with PDR at 1wk before surgery can reduce the difficulty of surgery, shorten the surgical time and reduce complications, which is beneficial to the improvement of visual acuity after surgery.

Abstract:Biomechanics is the application of mechanics to biological systems. It helped to provide more understanding of normal tissue function, the effect of pathology, and the impact of treatment. The biomechanics research also is an important method to understand the prevention, onset and treatment of eye diseases. Eye ball is a closed globe which undergoes pressure from intraocular or extraocular. The pathology of eye will affect its biomechanics. Recent years, several methods about biomechanics were used to study eye diseases, such as corneal collagen crosslinking for treatment of keratoconus and corneal ectasia, posterior sclera reinforcement for treatment of pathological myopia, and so on. Here we reviewed the biomechanical research of extraocular muscle, cornea, sclera, iris and lens.

Abstract:Examinations of visual function have been widely performed with the increasing awareness of visual function recently. In addition to regular examinations in Ophthalmology and Optometry, examinations of visual function are also very important in clinic. Nowadays, they are considered as the basis of some diagnosis, and mainly divided into two methods: regular examinations of visual function and examinations based on psychophysics. In order to serve clinic and research better, the combination of them is highly required.

Abstract:As cataract surgery has developed from the simple vision rehabilitation surgery into a more challenging refractive surgery, more and more people wish to improve vision and take off glasses through surgeries. Monofocal intraocular lens can solve the distant vision problem of patients, but near vision patients still need to wear glasses due to the loss of crystal regulation. Hence, presbyopia correction intraocular lens emerged accordingly. In the past decades, we have found and endeavored to solve the problems accompanied in the application of bifocal intraocular lens. On the bifocal basis, some newly-produced and extensively-applied presbyopia correction intraocular lens in the market have become hot products. Presbyopia correction is still a huge challenge for cataract surgery, and this paper will summarize the design principles and clinical application effects of some popular types of presbyopia correction intraocular lens.

Abstract:Ciliary neurotrophic factor(CNTF)is one of the most studied neurotrophic factors. Encapsulated cell technology provides a safe and effective route for the clinical application of CNTF. A large body of evidence shows that CNTF has a neuroprotective effect on glaucoma, age-related macular degeneration, optic nerve injury and other eye diseases. This review focuses on the potential clinical application of CNTF in eye diseases.

Abstract:Pathological elevation of intraocular pressure(IOP)is the most prevalent risk factor in the development and progress of glaucoma. Up to date, all treatments for glaucoma are aimed to lower IOP through surgeries and drugs. Prostaglandin analogues are the first-line IOP-lowing drugs for glaucoma due to their ability to reduce IOP. Enough evidences have suggested that they increase aqueous humor outflow through uveoscleral pathway. More recently, people found that bimatoprost was able to increase aqueous humor outflow through trabecular meshwork-Schlemm's canal pathway. Nowadays, a large number of studies are performed to study the mechanism of prostaglandin analogues on lowing intraocular pressure.

Abstract:Recently, although the phacoemulsification of cataract is improving, various complications of surgery still exist. As that most elderly patients are suffering from both cataract and diabetes, complications of cataract surgery in these people become an important issue. In this review, we summarized the recent research on the physiological characteristics of diabetic patients' retinal conditions and the impact from surgery itself, aiming at providing a useful clinical reference.

Abstract:Diabetic retinopathy(DR)is the first blinding disease among the working age population. The main causes of visual impairment and blindness are proliferative diabetic retinopathy and diabetic macular edema. Retinal laser photocoagulation is the main method in the treatment of DR currently, but the traditional laser has many side effects and complications. In order to reduce these side effects and be more efficacy, many new retinal laser treatment systems have emerged. This article reviews the recent progress in the laser treatment of DR.

Abstract:Assessing tear film properties is essential for the diagnosis of dry eye. Although tear film break-up time and Schirmer scores have been widely accepted, they are single-value parameters and unable to evaluate the dynamics of tear film in an interblink interval. We reviewed three non-invasive and objective methods, including corneal topography, interferometry and aberrometry. And we also discussed the differences between dry eye patients and normal people detected by these methods.

Abstract:JNK,which is called the c-Jun N-terminal kinase, is a member of mitogen activated protein kinases, located in cytoplasm. The studies on JNK have been quite active recently. It not only has close connections to cell generation, differentiation and apoptosis, but also plays a crucial role in numerous diseases. This paper expounds the relationship between JNK signaling pathway and extracellular stimuli in the eye structure, and introduces the latest achievement, so as to find the new references for therapy among eye diseases.

Abstract:Bone morphogenetic proteins(BMPs)belongs to the transforming growth factor beta(TGF-β)superfamily, which was isolated from the decalcified bone matrix by Urist in 1965.As one of the members of BMPs family, BMP4 not only promotes the differentiation and development of chondrocytes, but also plays an important role in the regulation of eye cells. BMP4 can mediate apoptosis of retinal vascular endothelial cells and inhibit angiogenesis, and is expressed in adult corneal epithelium, corneal cells and corneal endothelial cells. Also, participated in the layered corneal epithelium cells proliferation. In this paper, the recent advances in the study of BMP4 in ocular tissues are summarized, and the function of BMP4 in different developmental stages of eye is briefly reviewed.

Abstract:AIM: To figure out a better teaching approach to the Standardized Training for Ophthalmic Residents.

METHODS: Totally 60 residents who underwent the Standardized Training in our center from January 2015 to June 2016 were enrolled in this study and randomized equally into 3 groups of lecture-based learning(LBL), problem-based learning(PBL), and team-based learning(TBL). And 3 mainstream teaching methods were applied according to the groups' labels. Exams were taken before and after the implementations of teaching, and the scores variations were analyzed via repeated measures ANOVA.

RESULTS: All of the 3 methods developed the knowledge of subjects, and the scores of TBL group were superior to those of LBL and PBL groups(P<0.001). Subgroup analysis showed that LBL can enhance the fundamental knowledge of trainees(vs PBL, P=0.002; vs TBL, P=0.001), whereas TBL helpt to enhance the critical skills for clinical practices(vs LBL, P<0.001; vs PBL, P<0.001).

CONCLUSION: TBL is a more suitable teaching method for the Standardized Training for Ophthalmic Residents.

Abstract:AIM:To study the curative efficacy of aspheric intraocular lens implantation after manual nuclear fragmentation in treatment of cataract and its effects on visual acuity.

METHODS: Totally 100 patients of cataract who received therapy from May 2013 to May 2016 in our hospital were selected. According to random number table, those patients were divided into the observation group(50 patients 68 eyes)and the control group(50 patients 67 eyes). The observation group was treated with small incision manual discectomy and aspheric intraocular lens implantation, the control group was treated with phacoemulsification cataract extraction and aspheric intraocular lens implantation, the operation effect of two groups were compared.

RESULTS: After operation, the corneal endothelial cell counts of the two groups decreased(P<0.05); in the observation group, the results were higher than those of the control group at 1 and 3mo after operation(P<0.05). In the observation group, the uncorrected visual acuity at 1mo after operation was better than that of the control group(P<0.05); there was no significant difference between the two groups in postoperative visual acuity after operation 3mo(P>0.05). At 1mo after surgery, the corneal astigmatism in the observation group was higher than that of the control group(P<0.05); there was no significant difference of corneal astigmatism between the two groups at 3mo after operation(P>0.05). The incidence of intraoperative complications and postoperative complications in the observation group were lower than that of the control group(P<0.05).

CONCLUSION: Aspheric intraocular lens implantation after manual nuclear fragmentation is well for cataract, which can reduce the damage to corneal endothelial cells, the complications rate is low and the postoperative visual acuity recovered well.

Abstract:AIM: To observe the clinical features and optical coherence tomography(OCT)characteristics of focal choroidal excavation(FCE).

METHODS: The medical records of patients with FCE determined by OCT during the period of time from January 2014 to January 2016 were reviewed and analyzed. All patients underwent systematic ophthalmic examinations, including visual acuity, refractive status, slit lamp, ophthalmoscopy, OCT, etc.

RESULTS: Totally 24 men(26 eyes)and 15 women(16 eyes)were included in this study(20 left eyes, 16 right eyes, and 3 cases of bilateral eyes). The average age of patients was 50.4±16.7 years old. The range of patients refraction was(-2.51±2.60)D, and best corrected visual acuity(BCVA)was 0.60±0.26. Forty-six lesions were observed in 39 patients(42 eyes), with 37 cases(80%)of the conforming type and 9 cases(20%)of the nonconforming type. The average lesion width was 648.4±249.2μm and average depth was 128.0±50.4μm. BCVA in patients with the lesion under the fovea(16, 35%)was significantly lower than that with the lesion outside the fovea(P<0.05). FCE was complicated with choroidal neovascularization(CNV)in 3 cases, macular epiretinal membranes(ERM)in one case, macular hole and(epiretinal membrane)ERM in one case, macular lamellar hole and ERM in one case. There was no significant correlation among patient's age, visual acuity, FCE width and FCE depth in linear correlation analysis(P>0.05).

CONCLUSION: FCE were mainly found in aging patients with mild and moderate myopia, mostly belonged to the conforming type in single eye. FCE was observed to complicate with macular hole, macular ERM and CNV. The visual acuity may be affected with FCE under the fovea. Further study on its etiology of FCE is needed.

Abstract:AIM: To explore the efficacy of Ex-press glaucoma drainage device on open-angle glaucoma.

METHODS: We collected the clinical data of those patients who were diagnosed as open angle glaucoma and had undergone Ex-press glaucoma drainage device implantation or trabeculectomy in the Second Hospital of Anhui Medical University from January 2014 to May 2016. The data of patients was collected and used to make a comparison involving sex, ages, best corrected visual acuity(BCVA), intraocular pressure(IOP), the amount of corneal endothelium cells and complications before and after operations.

RESULTS: There was no significantly different(P>0.05)between the Ex-press group and trabeculectomy group on postoperative BCVA at 6mo. Both groups had obvious effects on the drop of IOP after operations(P<0.001), but there was no difference between the two groups at any time after operations. Ex-press group had no significant difference at 6mo while it had in the trabeculectomy group about the amount of corneal endothelium cells comparing with preoperative. The incidence rate of overall complications about Ex-press group and trabeculectomy group was 15% and 43% respectively, it had a significant difference between two groups(P<0.05).

CONCLUSION: The Ex-press glaucoma drainage device had similar efficacy with lower complication rate and smaller influence of corneal endothelium cells comparing with trabeculectomy.

Abstract:AIM:To evaluate the safety and efficacy of Ex-press implantation combined with phacoemulsification in primary angle-closure glaucoma(PACG)patients with cataract.

METHODS:Sixty-two cases(70 eyes)of primary angle-closure glaucoma with cataract were randomly divided into clinical trail group(34 eyes)and control group(36 eyes). The clinical trail group was treated with Ex-press miniature drainage device implantation combined with phacoemulsification and intraocular lens implantation. The control group was treated with trabeculectomy combined with phacoemulsification and intraocular lens implantation. The best corrected visual acuity(BCVA), intraocular pressure(IOP), corneal endothelium and central anterior chamber depth(ACD), complications were recorded preoperatively as well as postoperatively on day 1, 7 and at 1, 3, 6, and 12mo.

RESULTS: At the last review of trail group after operation, the best visual acuity(Log MAR)was 0.53± 0.19, which was better than the preoperative visual acuity 0.83± 0.41(P=0.001). The postoperative IOP in the clinical trail group decreased, which was 7.37±2.94, 9.88±3.18, 10.84±2.68, 12.28±2.81, 12.82±2.84 and 14.14±3.41mmHg at 1d, 1wk, 1, 3, 6, 12mo compared with the preoperative one(31.3±6.85mmHg)(P<0.05). There were no differences on postoperative IOP between the two groups(P>0.05). The ACD, corneal endothelial cell density of the clinical trail group and the control group obviously increased after operation, and the difference in ACD between the two groups after operation was not statistically significant(P>0.05). The relative success rates of the clinical trail group and the control group were 97.1% and 94.4% respectively at 12mo after surgery, and the difference was not statistically significant(P>0.05).

CONCLUSION: The operation of Ex-press miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation, which can reduce IOP and improve visual acuity evidently with less complications, is a safe and effective combined operation for primary angle-closure glaucoma with cataract.

Abstract:AIM: To compare the clinical efficacy of Ahmed drainage valve implantation and 23G cyclophotocoagulation for secondary glaucoma after traumatic vitrectomy.

METHODS: Totally 48 patients(48 eyes)with secondary glaucoma after traumatic vitrectomy were randomly selected from May 2014 to January 2016. According to the principle of random grouping, the patients were divided into experimental group and control group. Experimental group: 25 eyes were implanted with Ahmed drainage valve(25 eyes)and control group: 23G 532nm laser ciliary body photocoagulation(23 eyes). The intraocular pressure(IOP)and related complications were compared between the two groups.

RESULTS: The intraocular pressure control rate was 83%(19/23)in the experimental group and 72%(18/25)in the control group, the difference was no statistically significant(χ²=0.76, P=0.19). The postoperative complication rate was 39%(9/23)of experimental group at 1wk after operation. The overall complication rate in the control group was 68%(17/25), which was significantly higher than that in the experimental group(χ²=4.02,P=0.03). At postoperative 3mo, corneal endothelial cell density of two groups decreased, compared with the preoperative, the difference was statistically significant(t=4.22, P<0.05), that of experimental group decreased by 13%, control group by 21%, with no statistical difference(P>0.05).

CONCLUSION: Ahmed drainage valve implantation and 23G cyclophotocoagulation are safe for the treatment of secondary glaucoma after traumatic vitrectomy. The operation is relatively safe, but 23G cyclophotocoagulation is more effective, for economic and practical, fewer complications.

Abstract:AIM: To observe the early complications after Nd: YAG laser peripheral iridotomy(LPI)in patients with different anterior angle status and analysis the indications for laser treatment.

METHODS:This was a retrospective case series. Totally 362 cases(512 eyes)were involved in the treatment of Nd:YAG laser peripheral iridotomy in Xijing Hospital between January 2013 to June 2015. The early complications including iridemia, intraocular pressure spike, iridocyclitis, corneal or lens injury and others after laser peripheral iridotomy were analyzed and followed up for 3mo.

RESULTS:Totally 274 females(416 eyes)and 88 males(96 eyes)were involved in the study. Among the 512 eyes identified, 248 eyes had primary angle closure glaucoma(PACG), 108 eyes had primary angle closure(PAC), 72 eyes had primary angle closure suspect(PACS), 66 eyes had no signs or symptoms(the fellow eye of PACG), and 18 eyes had secondary glaucoma or ocular hypertension with pupillary block. After LPI, 107 eyes(20.9%)had iridemia, 85 eyes(16.6%)had intraocular pressure spike, 14 eyes(2.7%)had iridocyclitis, 10 eyes(2%)had corneal injury, 2 eyes(0.4%)had lens injury, 1 eye(0.2%)had decompression retinopathy, and 2 eyes(0.4%)had exudative retinal detachment. The incidence of iridemia was highest among patients with acute PACG(33.7%, P=0.019), and the incidence of intraocular pressure spike was highest among patients with chronic PACG(23.0%, P=0.047).

CONCLUSION: The most common complications of Nd:YAG LPI include iridemia and intraocular pressure spike. Whether PACG patients are more likely to have these complications needs further study. Rare serious complications like decompression retinopathy and exudative retinal detachment should be considered. The indications and timing of LPI should also be chosen carefully according to the patient's specific condition.

Abstract:AIM:To investigate the effect of combination therapy with Ranibizumab and photodynamic therapy in the treatment of age-related macular degeneration.

METHODS: Totally 78 cases(86 eyes)with age-related macular degeneration in our hospital from January 2012 to December 2015 were selected as the subjects. The patients were randomly divided into two groups, 39 cases(42 eyes)were treated by combination as the combination group and 39 cases(44 eyes)as the control group(only treated with ranibizumab). The changes of visual acuity and choroidal neovascularization(CNV)leakage were compared between the two groups before and after treatment.

RESULTS: After treatment for 6 and 12wk, the best corrected visual acuity(BCVA)value of the combined group was higher than that of the control group, the difference was statistically significant(P<0.05); the central retinal thickness(CRT)values of the patients in the combined group were lower than those in the control group, the difference was statistically significant(P<0.05). After 12wk of treatment, the total effective rate for CNV leakage in the combined group was 90% compared with that of the control group(82%), there was no significant difference(P>0.05).

CONCLUSION: The efficacy of the combination therapy is good for CNV leakage, visual acuity and CRT in patients with age-related macular degeneration.

Abstract:AIM:To investigate the clinical safety, efficacy, predictability and stability of small incision lenticule extraction(SMILE)for the correction of myopia and astigmatism.

METHODS: This was a prospective clinical controlled study involved 547 patients(1080 eyes)with myopia and astigmatism. Out of these, 560 eyes of 285 patients were treated with SMILE and 520 eyes of 262 patients were treated with femtosecond laser assisted laser in situ keratomileusis(FS-LASIK). The patients were followed up 12mo after operation and received ophthalmologic examinations including uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), manifest refraction, slitlamp examination and corneal topography at 1d,1wk and 1,6 and 12mo. The value of decentration from pupil center was measured at 3mo.

RESULTS: The UCVA at 1d, 1wk, 1, 6 and 12mo were respectively 0.029±0.13 LogMAR, 0.001±0.11LogMAR,-0.019±0.11 LogMAR, -0.020±0.08 LogMAR, -0.011±0.10 LogMAR in SMILE group, and -0.017±0.08 LogMAR, -0.019±0.09 LogMAR, -0.031±0.10 LogMAR, -0.024±0.09 LogMAR, -0.002±0.12 LogMAR in FS-LASIK group. The UCVA in SMILE group were significantly lower than that in FS-LASIK group at 1d and 1wk(P<0.05), while no difference were observed at other time points. The spherical equivalent(SE)at 1,6 and 12mo were respectively -0.03±0.29D, -0.04±0.28D,-0.06±0.32D in SMILE group, and 0.02±0.20D,-0.01±0.29D,-0.08±0.33D in FS-LASIK group, and the difference was statistically significant at 1mo(P<0.05), except other time points. At 3mo, the mean decentration from pupil center were 0.21±0.11mm for SMILE group and 0.20±0.08mm for FS-LASIK group, there was no significant difference between the two groups(P>0.05).

CONCLUSION: SMILE is effective, predictable, stable and safe for myopia and astigmatism. However, SMILE showed slower vision recovery compared with FS-LASIK in the early postoperative period.

Abstract:AIM: To study the impact on compliance and pattern visual evoked potential of optical drugs suppress combine with auxiliary therapy for children with ametropic amblyopia.

METHODS: Totally 122 cases(189 eyes)children with ametropic amblyopia from October 2014 to October 2015 were divided into observation group, 61 cases(95 eyes)and control group, 61 cases(94 eyes). The control group given comprehensive therapeutic apparatus, CAM training comprehensive therapy, the observation group received above-mentioned combined with optical drugs suppress therapy. At 4mo after treatment, therapy compliance, pattern visual evoked potential, clinical efficacy were compared between two groups.

RESULTS: At 4mo after treatment, the efficient rate of observation group was 92.6% which was significantly higher than that of control group 81.9%(χ²=4.895, P<0.05). Therapy compliance rate was 96.7%, significantly higher than that of control group 83.6%(χ²=4.895, P<0.05). P100 amplitude of observation group(15.18±1.68μV)was significantly higher than that of the control group(12.34±1.34μV). P100 latency of observation group(93.75±10.01ms)was significantly lower than the control group(106.37±10.21ms)(t=10.322, 7.865; P<0.05, P<0.001).

CONCLUSION: Optical drugs suppress combine auxiliary therapy helps to improve visual acuity level in children with ametropic amblyopia, which may be related to enhance children's compliance, adjust pattern visual evoked potential.

Abstract:AIM: To investigate strabismus and amblyopia in preschool children in Zhongshan city and to solve the countermeasures.

METHODS: A total of 14 582 eyes of 7 291 children aged 3-7 years in urban area and urban area of Zhongshan city were randomly selected for refractive examination. Before examination, the concentration of 10g/L atropine ointment was used, to determine the corrected vision amblyopia. The ametropic amblyopia was measured by retinoscopy, and corneal mapping method was used to screen the strabismus. Then strabismus and amblyopia of preschool children in Zhongshan were analyzed.

RESULTS: Of the 7 291 preschool children, 687 had ametropia, with the rate of 9.42% and 236 amblyopia with the rate of 3.24%, 13 cases were strabismus, whit the rate of 0.18%. There were no significant differences on ametropia, amblyopia or strabismus between 3-<5 years old group and 5-7 years old group(P>0.05). Of the 236 children with amblyopia, 215 were ametropic amblyopia, account for 91.10%; 13 children with strabismic amblyopia, of which 8 concomitant esotropia, 5 concomitant exotropia; 8 children with deprivation amblyopia; the difference of children number between strabismic amblyopia and deprivation amblyopia was statistically significant(P<0.05). Of the 236 children, more 3-<5 aged children had mild amblyopia than those 5-7 aged ones(P<0.05); less 3-<5 aged children had severe amblyopia than those 5-7 aged ones(P<0.05)

CONCLUSION: The incidence of strabismus and amblyopia in preschool children in Zhongshan is relatively high. It should be screened early, and effective measures should be taken as early as possible to improve the children's vision.

Abstract:AIM: To evaluate the clinical outcomes of phacoemulsification in patients with Fuchs' heterochromic iridocyclitis(FHIC).

METHODS: In this noncomparative case series,18 eyes of 18 patients clinically diagnosed with FHIC and cataract were studied. All of them received phacoemulsification combined with intraocular lens implantation.Preoperative and postoperative visual acuity, intraocular pressure, corneal endothelial cells density were measured. Intraoperative and postoperative complications were evaluated.

RESULTS: The mean follow-up period was 9.8±3.3mo. The only intraoperative complication was peripheral iris bleeding(17%). Compared with preoperative, the best corrected visual acuity improved 6mo postoperatively(0.98±0.85 vs 0.08±0.14, P<0.001). There was no significant difference in intraocular pressure between preoperative and postoperative(15.11±2.63mmHg vs 14.94±2.49mmHg, P>0.05).The mean endothelial cells counting loss rate postoperatively was 10%±6%. Fibrin formation in the anterior chamber occurred in 2 eyes postoperatively. During follow-up, 1 eye developed anterior capsule contraction, and 4 eyes developed posterior capsule opacification.

CONCLUSION: Phacoemulsification is a safe procedure with good visual outcomes in patients with FHIC and cataract.

Abstract:AIM: To investigate the influence factors of phacoemulsification combined with anterior vitrectomy for treating malignant glaucoma.

METHODS: Totally 23 cases(25 eyes)of malignant glaucoma patients, who were in-patient in ophthalmology of Wuhan Tongji Hospital from June 2011 to June 2016, underwent phacoemulsification combined with anterior vitrectomy, were involved in this study. The intraocular pressure and related ocular anatomy parameter change and its correlation were analyzed pre-and post-operatively.

RESULTS: There were 15 cases(16 eyes), average 51±6.7 years old, had deepened anterior chamber and intraocular pressure within the normal range(reffered as effective)post-operatively, in the other 8 cases(9 eyes), average 45±7.8 years old, postoperative anterior chamber formation were poor(referred as ineffective). Surgery effective rate was 64%. As for the effective group, the postoperative anterior chamber depth(2.13±0.82mm), significantly deepened compared with preoperative(0.76±0.53mm), and postoperative intraocular pressure(15.4±4.5mmHg)significantly declined compared with preoperative(26.4±8.7mmHg). The effective group had larger preoperative scleral spur distance and ocular axial length than ineffective group, 11.25±0.39mm vs 10.86±0.49mm and 22.16±1.16mm vs 20.98±0.62mm respectively, and the difference was statistically significant(P<0.05). Age and the ocular axial length were statistically significant between effective and ineffective group by using single factor analysis results(P<0.05). By logistic regression analysis, age and ocular axial length were independent risk factors for poor postoperative treatment effect(P<0.05).

CONCLUSION: The younger age and the ocular axial length is risk factors for poor postoperative treatment effect of malignant glaucoma by phacoemulsification combined with anterior vitrectomy.

Abstract:AIM:To observe the effect of combined treatment(using intraocular pressure-lowering drugs + intravitreal injection of Lucentis + complex trabeculectomy + panretinal photocoagulation)for neovascular glaucoma(NVG).

METHODS: This was a prospective non-randomized clinical study. A total of 24 patients(24 eyes)with NVG were enrolled. After using intraocular pressure(IOP)-lowering drugs, the elevated IOP in 7 eyes was controlled within normal limits and 17 eyes within high levels. All patients were treated with intravitreal injection of Lucentis 0.50mg/0.05mL. Complex trabeculectomy were performed within 7d after injection. All patients were treated with panretinal photocoagulation after complex trabeculectomy. The regression of iris neovascularization, changes in IOP, best corrected visual acuity, intraoperative and postoperative complications and filtering bleb were analyzed after combined treatment. Patients were followed-up for 6-18mo.

RESULTS: Iris neovascularization completely regressed within 1wk in 24 eyes after intravitreal injection of Lucentis. The average IOP was 41.38±3.16mmHg before combined treatment,and 12.69±1.52mmHg in 6mo after combined treatment. The differences had statistically significant before and after combined treatment(F=25.592, P<0.05). Before combined treatment, the best-corrected visual acuity was >0.1 in 3 eyes, 0.01-0.1 in 10 eyes, non light perception(NLP)- finger counting(FC)in 11 eyes. After combined treatment, the best-corrected visual acuity was >0.1 in 5 eyes, 0.01-0.1 in 16 eyes, NLP～FC in 3 eyes, which showed statistically significant difference with the visual acuity before combined treatment(Z=-2.201, P<0.05).

CONCLUSION: Combined treatment could effectively control the IOP and preserve the visual function in patients with neovascular glaucoma.

Abstract:AIM: To study the effect of acupuncture treatment on intraocular pressure(IOP)control, corrected visual acuity, light sensitivity and visual fields mean defect in patients with glaucoma beside the original treatment.

METHODS:Totally 48 cases(62 eyes)with glaucoma whose IOP were under control were randomly divided into two groups, the observation group and control group, from January to October 2016. Patients in control group were treated with the original therapy for 3 courses, while observation group were treated with acupuncture therapy for 3 courses, 12d as one course, beside original therapy. Corrected visual acuity, light sensitivity and visual fields mean defect of the two groups before and after treatment were analyzed.

RESULTS: Corrected visual acuity, light sensitivity and visual fields mean defect of control group had no differences between before and after treatment by paired t test(P>0.05), those of observation group were significantly different(P<0.05). The three examinations were significantly better of observation group than those of control group after treatment by independent t test(P<0.05). The total effective rate of observation group was 74%, which was significantly better than that of control group(32%)(χ² = 9.329, P < 0.05).

CONCLUSION: For glaucoma patients, whose IOP were under control, acupuncture has some improvement on corrected visual acuity, light sensitivity and visual fields mean defect, and is better than single IOP-control therapy in short term effects, but a long-term effect is needed to be studied.

Abstract:AIM: To investigate the efficacy of intraoperative anterior chamber paracentesis on early stage intraocular pressure change after intravitreal injection of Conbercept.

METHODS: A prospective,randomized-controlled clinical trial was conducted on 30 eyes of 30 patients underwent intravitreal injection of Conbercept. The patients were randomly divided into Group A(15 patients with 22 treatments)and Group B(15 patients with 23 treatments)according to whether to applying anterior chamber paracentesis. IOP was measured before injection and 2, 30, 60min, 1d and 1wk after the injection with AccuPen tonometer.

RESULTS: Compared with preoperative intraocular pressure, there was no significant change in IOP of Group A(applying anterior chamber paracentesis)at any time we observed(P>0.05); while the IOP of Group B significantly increased at 2min after injection(42.4±9.3mmHg)with significant difference compared to Group A(P<0.05), and then the IOP dropped to normal(17.4±5.0mmHg)within 30min without significant difference compared to Group A(P>0.05).

CONCLUSION: Intraoperative anterior chamber paracentesis during intravitreal Conbercept can effectively control the early stage intraocular pressure raise after the injection.

Abstract:AIM: To investigate the correlation between Alzheimer's disease(AD)and the pathogenesis of glaucoma.

METHODS: Prospective observational study. Totally 24 AD subjects and 30 age- and sex-matched controls were enrolled. All of the subjects had a cup-to-disc ratio(CDR)less than 0.6 and asymmetry of less than 0.2 between right and left eyes. Retinal nerve fiber layer(RNFL)thickness and macular ganglion cell complex(mGCC)thickness were obtained using Fourier domain optical coherence tomography. The intraocular pressure(IOP)was also measured.

RESULTS: Mini-mental state examination(MMSE)scores were significantly higher in the AD group compared with controls(P<0.01). AD patients also showed lower IOP(12.7±2.8mmHg vs 14.36±3.3mmHg; P<0.05). However, these was no significant difference in RNFL thickness and mGCC thickness between the two groups(P>0.05).

CONCLUSION: Patients with AD have lower IOP, which suggesting a protection mechanism of optic nerve damage in AD patients.

Abstract:AIM: To investigate the clinical characteristics and treatment of uveitis associated with ankylosing spondylitis(AS).

METHODS: Totally 40 uveitis associated with AS patients(46 eyes)were collected from August 2012 to August 2015 in our department. Data of these patients concerning clinical characteristics, laboratory examinations and treatment were retrospectively analyzed.

RESULTS: Of the 40 patients, 28 were males(32 eyes)while the remaining 12 were females(14 eyes). The mean age of the patients at onset of AS was 29.68±7.83 years old, while the average duration was 6.95±6.12a. The history of uveitis of these AS patients was 3d to 6a, with a mean duration of 28±15d. All patients showed typical sacroiliitis with X-ray or CT examination; 37 patients(93%)were HLA-B27 positive; Erythrocyte sedimentation rate(ESR)of 27 patients(68%)increased while 18 patients(45%)showed increased C-reactive protein(CRP). Uveitis of all patients was either cured or under good control after treatment with corticosteroids and cycloplegic eye drops.

CONCLUSION: Young males suffer more than female with uveitis associated with AS, which is often characterized by unilateral onset and recurrent relapse. Clinical doctors should pay more concerns on the uveitis patients the onset of AS. Early and enough treatment were needed for these patients.

Abstract:AIM: To evaluate the efficacy and postoperative complications of different combined surgeries in the treatment of proliferative diabetic retinopathy(PDR).

METHODS: The clinical data of 72 patients(82 eyes)with PDR were retrospectively analyzed. According to the different combined methods, the patients were divided into three groups: Group A(28 eyes)underwent vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation; Group B(24 eyes)underwent vitrectomy combined with intravitreal injection of conbercept, phacoemulsification and IOL implantation; and Group C(30 eyes)underwent vitrectomy in the first phase, and then underwent silicone oil removed combined with phacoemulsification and IOL implantation in the second phase. Visual acuity and postoperative complications were observed.

RESULTS: The follow-up period was 6-12mo. The mean postoperative LogMAR BCVA of Group A(1.007±0.455), Group B(1.000±0.482)and Group C(1.033±0.531)had all improved than their preoperative BCVA respectively, the difference was statistically significant(t=5.666, 5.113, 5.496; P<0.05). There was no statistical difference compared postoperative BCVA among three groups(F=1.670, P=0.195). The main postoperative complications were anterior chamber fibrin exudation(Group A: 6 eyes, Group B: 0 and Group C: 1 eyes), temporary intraocular hypertension(Group A: 5 eyes; Group B: 4 eyes and Group C: 10 eyes), macular edema(Group A: 1 eyes, Group B: 0 and Group C: 0), neovascular glaucoma(Group A: 2 eyes, Group B: 0 and Group C: 0)and rebleeding(Group A: 2 eyes, Group B: 1 eyes and Group C: 3 eyes). There were statistical difference compared anterior chamber fibrin exudation among three groups(χ²=7.556,P=0.008). The incidence of anterior chamber fibrin exudation in Group A was significantly higher than that in Group B(χ²=5.814,P=0.016), without significant difference compared with Group C(χ²=4.469,P=0.035). There was no statistical difference compared other postoperative complications among three groups(P>0.05).

CONCLUSION: Each group could help earlier visual rehabilitation and avoid second operation for post-vitrectomy cataract. Compared with the Group C, Group A or Group B is much clearer to observe the ocular fundus and easier to operate. Anterior chamber fibrin is heavier in Group A, intravitreal injection of conbercept can reduce anterior chamber fibrin exudation in combined surgical method.

Abstract:AIM: To develop diabetic retinopathy treatment and follow-up system to screen and follow up the patients with diabetic retinopathy, and to reduce the incidence of diabetic retinopathy and blindness.

METHODS: Through the establishment of diabetic retinopathy diagnosis and follow-up system, we established diabetic retinopathy fundus image database, and to do early intervention treatment and regular follow-up of patients with diabetes.

RESULTS: Through more than 1a of follow-up and timely and effective medical intervention, significantly reduced the incidence of severe proliferative diabetic retinopathy, delayed the further vision damage.

CONCLUSION: “Diabetic retinopathy diagnosis and treatment and follow-up system” builds “health education-screening-treatment-follow-up-health management” as the main line of the “active” service system, reduces the blindness rate and the incidence of diabetic retinopathy.

Abstract:AIM: To investigate the clinical effect of Ranibizumab combined with laser for diabetic macular edema and the effect on visual acuity.

METHODS: Totally 80 patients(138 eyes)with diabetic edema who were treated in our hospital from January 2015 to December 2015 were selected, and 40 patients were randomly divided into the combined group(67 eyes in 40 patients, treated by ranibizumab and laser therapy), the control group(71 eyes in 40 cases, laser treatment only). We compared the treatment effect of the two groups and the impact on the patient's vision.

RESULTS: After treated for 1wk, 3mo, and 6mo, the BCVA(LogMAR)and central macular thickness(CMT)values of the patients in the two groups were significantly lower than those before treatment(P<0.05); the BCVA(LogMAR)and CMT values of the combined group were lower than those of the control group, the difference was statistically significant(P<0.05). After treated for 1wk, 3mo, and 6mo, IOP of the two groups was not significantly different compared with before treatment(P>0.05); IOP value of combined group compared with those of the control group, was not significantly different(P>0.05).

CONCLUSION: The combination of ranibizumab and laser treatment for diabetic macular edema can more significantly reduce macular edema, improve visual acuity.

Abstract:AIM: To assess clinical efficacy of vitrectomy combined with heavy silicone oil tamponaded for severe proliferative vitreous retinopathy.

METHODS: Totally 13 severe proliferative vitreous retinopathy(PVR)patients(13 eyes)admitted to our hospital between June 2012 and December 2015 were included. We analyzed the clinical efficacy of vitrectomy combined with heavy silicone oil tamponaded and heavy silicone oil removal combined with C₃F₈ tamponaded at late phase for 13 patients. Heavy silicone oil removal of 13 patients were performed at 10 to 17wk after heavy silicone oil tamponaded. The patients were reviewed at 1-7d after vitrectomy combined with heavy silicone oil tamponaded, 1, 2, 4 and 17wk after hospital discharge, 1-7d after the heavy silicone oil removal, 1, 2, 4, 8, 12 and 24wk after the second hospital discharge. Patients were followed up for at least 24wk after the heavy silicone oil removal. The observed indicators included the rate of retinal reattachment, the best corrected visual acuity, intraocular pressure(IOP), intraocular lens and postoperative complications.

RESULTS: During follow-up,13 eyes showed a stably reattached after heavy silicone oil tamponaded. Heavy Silicone oil of 13 patients were removed combined with C₃F₈ tamponaded for 10 to 17 wk after heavy silicone oil tamponaded. But the fifth case had retinal detachment recurrence for 4wk after heavy silicone oil removed because of macular hole and the eighth case had retinal detachment recurrence for 8wk after heavy silicone oil removed because of new superior temporal retinal hole. Follow up for 24wk, the other 11 eyes showed a stably reattached after heavy oil silicone removed. The best corrected visual acuity range of 13 eyes were in light perception to hand move before heavy oil silicone tamponaded and the best corrected visual acuity range of 13 eyes were in hand move to 20/250 for 24wk after heavy oil silicone removed. The best corrected visual acuity of the fifth case and the eighth case were count finger and hand move for 24wk after heavy oil silicone removed. Four eyes had high intraocular pressure 1wk after heavy oil silicone tamponaded which were reduced to 10-21mmHg after drug treatment. At late phase 5 eyes had drug uncontrollable high intraocular pressure which we took silicone oil removal timely. Three eyes had temporarily high intraocular pressure after heavy oil silicone removed which were reduced to 10-21mmHg after drug treatment. At late phase 3 eyes did not appear high intraocular pressure after stopping anti-glaucoma medication. Thirteen eyes had no serious complications such as anterior chamber inflammation and endophthalmitis during the treatment.

CONCLUSION: Vitrectomy combined with heavy silicone oil tamponaded and heavy oil silicone removed combined with C₃F₈ tamponaded at late phase for 13 severe proliferative vitreous retinopathy patients could achieve a satisfactory rate of retinal reattachment and improve the patients' prognostic visual acuity.

Abstract:AIM:To analyze the treatment of macular hemorrhage caused by rupture of retinal aortic aneurysm and its effect.

METHODS:Totally 7 case(7 eyes)of macular hemorrhage caused by rupture of retinal aortic aneurysm in our hospital from January 2012 to January 2016 were collected. Three cases of hemorrhage were pre-retina, in which 1 eye was observed(without treatment)and 2 eyes were treated with 532nm laser vitreous cortex incision drainage. In 3 eyes with hemorrhage in the retinal, all were given anti- vascular endothelial growth factor(VEGF)treatment. In 1 eye with both pre-retinal and in the retinal hemorrhage, combined treatment was given as the intravitreal injection + laser vitreous cortex incision and drainage and anti-VEGF therapy.

RESULTS: All 7 cases of pre-retinal and retinal hemorrhage were absorbed, visual acuity improved to varying degrees.

CONCLUSION: The treatment of macular hemorrhage caused by rupture of retinal aortic aneurysm should be treated according to the scope and location of bleeding, so as to achieve better prognosis.

Abstract:AIM: To evaluate the effects of internal limiting membrane peeling and vitrectomy with triamcinolone acetonide and silicone oil tamponade for the treatment of retinal detachment with choroidal detachment attributable to macular hole in patients with high myopia.

METHODS: Totally 28 eyes of 28 patients with retinal detachment associated with choroidal detachment attributable to macular hole in patients with high myopia, were treated with pars plana vitrectomy(PPV)and indocyanine green(ICG)assisted internal limiting membrane peeling(ILMP)and silicone oil tamponade. All patients had been followed up for 6-24mo. The reset rate of retinal detachment and the vision recovery, complications were analyzed.

RESULTS: All patients had been followed up 6-24mo. The mean LogMAR CVA was 1.01±0.31 after surgery, which significantly improved compared to that before surgery(t=-39.28, P<0.01). Of these 28 eyes, macular hole closed in 19 eyes(68%), macular hole did not close in 9 eyes(32%), retinal reattached in 26 eyes(93%), high intraocular pressure appeared in 6 eyes.

CONCLUSION: For the treatment of retinal detachment associated with choroidal detachment attributable to macular hole in patients with high myopia, PPV combined with ILMP and silicone oil tamponade and triamcinolone acetonide show a high retinal reattachment rate, which can arrest the regeneration of proliferative vitreoretinopathy.

Abstract:AIM: To study the clinical characteristics and prognosis of laser pointer retinopathy.

METHODS: Eleven eyes from ten patients who came to our hospital diagnosed as laser pointer retinopathy from June 2014 to June 2016 were included. All the patients underwent routine eye examination and optical coherence tomography(OCT)examination.

RESULTS: The patients were suffering from either bilateral or unilateral visual loss, and their visual acuity ranged from 0.3 to 0.8. Fundus examinations revealed anisochromasia or a yellow spot at the fovea in some patients, while there were also some patients without obvious abnormity. OCT findings include disruption of inner retina, high reflective outer nuclear layer, detachment of retinal nerve epithelium and disruption of inner segment/outer segment line. Follow ups were done 1mo after initial treatment and 7 patients(7 eyes, 64%)experienced anatomic recovery. Visual acuity improved to 1.0 in two cases(18%).

CONCLUSION: Visual loss caused by laser pointer retinopathy could be either temporary or permanent. Long-term follow-ups are still needed to make a firm conclusion.

Abstract:AIM: To observe the efficacy of two combined surgical methods in treatment of chronic dacryocystitis with upper lacrimal duct obstruction.

METHODS: Totally 68 cases(68 eyes)of chronic dacryocystitis with upper lacrimal duct obstruction were enrolled. They were randomly divided into Group A and Group B through random number table method, each group of 34 cases, Group A was treated with nasal endoscopic dacryocystorhinostomy combined with silicone tube implantation. Group B was treated with traditional dacryocystorhinostomy combined with silicone tube implantation. All patients were followed up for 1a.

RESULTS: In Group A, the total success rate was 82%, that in Group B was 79%. There were no significant difference between two groups' total success rate(P>0.05). The incidence of postoperative facial swelling in Group A was 6%. The facial scar incidence rate was 0. Those of Group B were 47% and 100%. The incidence of complications in Group A was significantly lower than that in Group B with significantly difference(P<0.05). Rate of patients' satisfaction was 82% in Group A, and 59% in Group B, which of Group A was significantly better than group B(P<0.05).

CONCLUSION: Canalicular intubation combined dacryocystorhinostomy using endoscopy is an ideal method in treatment of chronic dacryocystitis with upper lacrimal duct obstruction. It is safe, effective with less injury and less complication.

Abstract:AIM: To observe the clinical effect of the neotype lacrimal drainage tube(RS model)for the treatment of lacrimal duct obstruction.

METHODS: It was a retrospective case series study. Totally 75 cases(93 eyes)of lacrimal duct obstruction were enrolled in the study and randomly divided into two groups: treatment group(50 eyes)and control group(43 eyes). The treatment group was implanted the neotype lacrimal drainage tube(RS model). The control group underwent the implantation of annular silicone tube and their efficacy were analyzed.

RESULTS: Followed up for 3-12mo after extubation, the cure rate and total effective rate of the treatment group were 90%, 96% respectively, and the control group of it were 72%, 84%.The difference between the two groups was statistically significant(P<0.05). The total rate of intraoperative and postoperative complications was 8% in treatment group, 35% in control group respectively, the rate of the control group was obviously higher than that of the treatment group, there was significant statistical difference between the two groups(P<0.05).

CONCLUSION: The implantation of the neotype lacrimal drainage tube(RS model)is safe,fast and simple, easy to operate and extubate easily with good clinical effect in the treatment of lacrimal duct occlusion.

Abstract:AIM: To study the effect of pterygium excision combined with amniotic membrane transplantation for tear film function.

METHODS: Totally 82 cases(122 eyes)with pterygium treated in our hospital from October 2013 to October 2015 were selected and divided into observation group 39 cases(61 eyes)and control group 43 cases(61 eyes)by the random number table method. The control group was treated with simple pterygium excision, the observation group was treated with pterygium excision combined with amniotic membrane transplantation. The comparison of tear break-up time(BUT)and Schirmer I test(SⅠt)at preoperatively, 1, 3mo postoperatively between the two groups, ocular surface temperature and dry eye symptoms at 2mo were taken.

RESULTS: There was no significant difference in BUT and SⅠt between the control group and the observation group before operation(P>0.05). At 1mo after operation, the BUT of the observation group was 5.79±1.53s, which was significantly higher than that of the control group(4.28±0.98s)(t=2.478, P=0.012); the SⅠt of the observation group was 4.39±1.69mm/5min, higher than that of the control group(3.51±0.89mm/5min)(t=1.529, P=0.079). At 3mo after operation, the BUT of the observation group was 7.49±1.79s, significantly higher than that of the control group(6.71±1.89s)(t=2.271, P=0.026); the SⅠt of observation group was 9.58±1.30mm/5min, higher than the control group(8.91±1.49mm/5min)(t=1.857, P=0.068). At 2mo after operation, the eye of the observation group showed that the temperature was 34.29℃±0.67℃, higher than that of the control group(34.18℃±1.58℃)(t=1.033, P=0.278); the dry eye symptom score in the observation group(3.87±0.14)was significantly lower than that in the control group(5.34±0.78)(t=14.463, P<0.01).

CONCLUSION: Pterygium excision combined with amniotic membrane transplantation can effectively improve the dry eye, which is conducive to the stability of tear film function.

Abstract:AIM:To compare the clinical effect of the lower eyelid retractor muscle transposition and eyelid orbicularis muscle folding shorten combined with lower eyelid retractor muscle transposition in the treatment of senile lower eyelid entropion.

METHODS: Sixty-four cases(85 eyes)with senile lower entropion were divided into Group A(31 cases 42 eyes)and Group B(33 cases 43 eyes)according to the different ways of operation from January 2013 to October 2014 in our hospital. Patients in Group A were treated by eyelid retractor muscle transposition while patients in Group B treated by eyelid orbicularis muscle folding shortening combined with lower eyelid retractor muscle transposition. The short-term and long-term therapeutic efficacy and two-year recurrence rates after operation were compared between the two groups.

RESULTS: The short-term effective rate of patients in Group B was higher than that of Group A while the difference was not statistically significant(98% vs 95%, P>0.05). The long-term effective rate of patients in Group B was higher than that of Group A and the difference was statistically significant(95% vs 83%)and two-year recurrence rate of patients in Group B was lower than that of Group A(5% vs 17%)and the difference was statistically significant(P<0.05).

CONCLUSION:The clinical curative effect of eyelid orbicularis muscle folding shortening combined with lower eyelid retractor muscle transposition is better than single retractor muscle transposition in the treatment of senile lower eyelid entropion.

Abstract:AIM: To explore a simple, flexible and effective approach for medial canthoplasty combined with upper eyelids blepharoplasty aiming to achieve the natural and ideal appearance of eyelid.

METHODS: From September 2011 to May 2015, 62 cases(124 eyes)had received canthoplasty combined with upper eyelids blepharoplasty for single-folding eyelids and epicanthus were enrolled. Following the common upper eyelid blepharoplasty, an incision was prolonged to the medial canthus and was subsequently embedded within the double eyelid line. To decrease the skin tension, the canthal ligament was decompressed. Depending on the ideal appearance of the canthus, the upper eyelid and canthus were reformed next to the removal of excess skin. Patients were followed up for 3mo to 1a. At 3, 6mo and 1a, patients were investigated for the appearance of the canthus and the cicatrices.

RESULTS: Totally 57 cases(114 eyes)had 1 to 12 months' follow-up. In these 57 cases, 51 patients satisfied with the permanent double eyelids and corrected epicanthus, 6 cases' eyelids(12 eyes)appearance were improved partly. No recurrent epicanthus or hyperplastic scar was found in our study.

CONCLUSION: This approach combines medial canthoplasty with upper eyelids blepharoplasty to expose the canthus widely, hide the incision and scar, decrease the skin tension efficiently and remove the excess skin flexibly, which is an ideal method to correct epicanthus and single upper eyelids.