Abstract:AIM: To evaluate intraocular lens power(IOL)calculation and biometry before and 3mo after implantation of Keraring 355° intrastromal corneal ring segment(ICRS; Mediphacos, Belo Horizonte, Brazil)in keratoconic eyes.

METHODS: In this cohort study, data of 19 keratoconus eyes of 18 patients which undergone ICRS implantations were gathered before and 3mo after surgery. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), manifest refraction, IOL power calculation formulas, axial lenght(AL)and keratometry were analayzed.

RESULTS: Mean age of participants was 29.58±0.6. UCVA improved from 0.84(0.35)logMAR to 0.43(0.31)logMAR significantly(P<0.001). BCVA and AL didn't change significantly after 3mo. All Sphere, cylinder and spherical equivalent(SE)were improved significantly(P<0.001). On the other hand, keratometry 1(K1)and keratometry 2(K2)decreased significantly. It was a considerable change in SRK/Ⅱ(P<0.001), Hoffer Q(P<0.001)and Holladay Ⅰ(P<0.001)after 3-month's follow-up. Among this formula SRK/II had the lowest change.

CONCLUSION: In addition to improvement in visual, refractive, and keratometry outcomes after Keraring implantation, there was a significantly changes in IOL calculation formulas values. However, ICRS procedure doesn't interfere considerably AL in eyes, but it seems reduced keratometric values lead to IOL power calculations more accurately and all formulas suggested same IOL power.

Abstract:AIM: To evaluate the anatomic and visual outcomes of 25-gauge vitrectomies combined with air tamponade for the treatment of idiopathic macular hole(IMH).

METHODS: Thirty eyes of 27 patients with IMH were included in this prospective interventional study. All patients underwent 25-gauge pars plana vitrectomy(PPV)combined with phacoemulsification and air tamponade. Best corrected visual acuity(BCVA, logMAR), perimetry and multifocal electroretinography(mfERG)were conducted before and after the operation. Anatomical changes were evaluated with optical coherence tomography(OCT).

RESULTS: The macular holes closed successfully in 28 eyes after the primary vitrectomy. The mean BCVA improved from 0.72±0.22 logMAR preoperatively to 0.29±0.18 logMAR postoperatively(P<0.001). In the visual field of central 10°, the average mean deviation(MD)decreased from -3.59±1.83 dB preoperatively to -2.51±1.36 dB postoperatively(P<0.001)and the average pattern standard deviation(PSD)decreased from 1.86±0.68 dB preoperatively to 1.33±0.32 dB postoperatively(P=0.001). The retinal response densities of mfERG in the foveal and perifoveal area increased significantly, and implicit times of rings 4-6 prolonged significantly(P<0.05). The symptom duration and baseline N1 amplitude densities at ring 1 had a significant impact on postoperative BCVA(P<0.001, P=0.001, respectively).

CONCLUSION: The 25-gauge PPV and air tamponade with 1 day prone positioning produce favorable anatomic and functional outcomes.

Abstract:AIM: To evaluate fundus findings in patients with intracranial aneurysm(ICA)to determine the relation between ICA and distinguishable retinal features.

METHODS: We analyzed the medical records and ocular images of 46 patients with previously diagnosed ICA referred from the Neurosurgical Department. All patients underwent ophthalmologic evaluation including fluorescein angiography(FAG). Furthermore, the presence of drusen, macular degeneration, cotton wool spot, hard exudates, retinal hemorrhage, arteriolar attenuation, A-V crossing signs, arm-to-retina time, and A-V transit time were evaluated. The results of ICA patients(Group 1)were compared with those of 22 idiopathic epiretinal membrane patients with unaffected eyes(Group 2).

RESULTS: Mean ages were 60.02y(Group 1)and 60.68y(Group 2)respectively(P=0.70). The prevalence of hypertension was similar in both groups. No case with retinal macroaneurysm was found in either group. The presence of drusen, macular degeneration, cotton wool spot, hard exudates, retinal hemorrhage, arteriolar attenuation, and A-V crossing sign was not significantly different between the two groups. Mean arm-to-retina time was not significantly different in two groups, either.

CONCLUSION: We cannot find any evidence that the patients with ICA shows specific changes in the FAG and fundus.

Abstract:AIM: To investigate the incidence of trachoma in children aged 1 to 9y in Hainan Province and determine high-risk trachoma endemic and non-endemic areas in Hainan, and thus provide evidence for developing trachoma control and prevention therapy.

METHODS:The areas of investigation were chosen on the basis of past literatures, expert interviews and survey on the spot. In 2013, Hainan Provincial Office of Blindness Prevention carried out the survey in 7 counties including Dongfang City, Wuzhishan City, Ledong County, Baisha County, Baoting County, Lingao County and Changjiang County. In these districts, 356 pupils including 192 boys and 164 girls were examined, their age ranging from 1 to 9 and their average age being 7 years old. The targeted students received the trachoma rapid assessment by the adoption of simplified trachoma classification system which was recommended by the World Health Organization.

RESULTS: No case of active trachoma was found among the 356 students.

CONCLUSION:The prevalence rate of trachoma in children under 9 years is less than 5% in Hainan Province. Active trachoma is not a public health issue in Hainan Province.

Abstract:AIM:To compare the pattern electroretinogram(PERG)and pattern visual evoked potential(PVEP)between obstructive sleep apnoea(OSA)patients and controls.

METHODS: This was a prospective cross-sectional study involving 40 OSA patients and 31 control subjects in Hospital Universiti Sains Malaysia. Patients with a confirmed diagnosis of OSA who had no ocular pathology were randomly selected to participate in the study. The apnoea-hypopnoea index(AHI)was obtained from their records and used for stratification of OSA severity. Electrophysiological tests(PVEP and PERG)were performed on each patient by a trained technician in the electrophysiology laboratory of the Department of Ophthalmology, USM. The results obtained were recorded as median values. Data analysis was done using IBM Statistics Version 21.0.

RESULTS: Among OSA patients, we observed a significant reduction of the PERG amplitude P50(P<0.001)and the PVEP amplitude P100(P<0.001)compared to the control group. OSA patients also had a significant increase in PVEP time to peak P100(P=0.003)and time to peak N75(P=0.004). However, no significant differences were detected in PERG time to peak between OSA patients and controls. There were likewise no significant differences in PVEP or PERG between OSA patients with different disease severity.

CONCLUSION: OSA patients have significant abnormalities in PVEP amplitude and time to peak, as well as PERG amplitude. This may reflect subclinical optic nerve dysfunction in OSA. Further research is needed to determine the association between the severity of OSA and the degree of optic nerve dysfunction.

Abstract:AIM: To conclude the characteristics of flash visual evoke potentials(FVEP), and pattern visual evoke potentials(PVEP)of the healthy school-age children. And to compare the two methods, in order to find the association of them, and to find the impact of sex, age, and the other biological variables.

METHODS: A total of 101 healthy children were recruited(age from 5 to 14.4y, mean 8.27y). Each of them was underwent FVEP and PVEP examinations. Then the results were statistically analyzed by SPSS 13.0.

RESULTS: The curves of PVEP are simple and stable, while FVEP waveforms are variable. The latency of P100 of females is shorter than males. However there was no significant difference for FVEP in sex control. To compare the parameters between the two hemispheres, the amplitude of P100 of left eyes were higher than the right side. FVEP showed no difference in the two hemispheres either. There was no significant difference for age-dependent decreased in neither PVEP nor FVEP. And in a regression analysis of the FVEP and PVEP, we could not find the inner connection of the two methods.

CONCLUSION: Based on our research, there were no significant differences in age level or sex control in the period of school-age children. And there is no inner connection of the two methods. The differences between the PVEP and FVEP results might be due to the origin of these two responses. And these two stimuli should be used in a complementary manner not as alternative examinations.

Abstract:AIM: To construct the recombined pLenti-CMV-PEDF-EYFP vector to be infected into human umbilical cord-derived mesenchymal stem cells(hUCMSCs), and then to identify the PEDF expression in hUCMSCs and the cell viability of hUCMSCs after infection with the recombined lentivirus.

METHODS: The recombinant pLenti-CMV-PEDF-EYFP vector was constructed with pLenti-CMV-hChR2-EYFP and PEDF gene, and then infected into hUCMSCs to obtain the PEDF-hUCMSCs. The expression of PEDF in hUCMSCs was identified by confocal microscopy and ELISA. The Cell Counting Kit(CCK8)was used to assess the cell viability of PEDF-hUCMSCs. The influences of pLenti-CMV-PEDF-EYFP infection on the passage and phenotypes of hUCMSCs were assessed by microscope and flow cytometry.

RESULTS: The recombinant pLenti-CMV-PEDF-EYFP was successfully constructed and efficiently infected into hUCMSCs. The expression of PEDF was positively detected in the PEDF-hUCMSCs. No significant difference was observed on cell viability between PEDF-modified hUCMSCs and hUCMSCs(P>0.05). The infection of pLenti-CMV-PEDF-EYFP had no obvious influences on the proliferation, morphology and phenotypes of hUCMSCs.

CONCLUSION: PEDF was expressed effectively in the hUCMSCs modified with the recombinant lentivirus. The preliminary results from this study provide more evidences for further study of using PEDF-hUCMSCs to treat retinitis pigmentosa.

Abstract:AIM:To investigate the effects of estrogen on the expression of matrix metalloproteinases-2(MMP-2), tissue inhibitor of metalloproteinases-2(TIMP-2)and transforming growth factor- β1(TGF-β1)in cultured human corneal stromal cells.

METHODS: Inflammatory environments of human corneal stromal cells were simulated by using 1.5ng/mL IL-1β. The cells were then treated with or without different concentrations of estrogen(0, 1×10^-4, 1×10^-6, 1×10^-8, 1×10^-10mol/L estradiol)in vitro. Cell viability was evaluated by MTT. Expression levels of MMP-2, TIMP-2 and TGF-β1 proteins were measured by enzyme-linked immunosorbent assay(ELISA).

RESULTS:Estrogen did not affect the viability of human corneal stromal cells. Compared with the control group, expression levels of MMP-2 and TGF- β1 proteins in E2 treatment group significantly decreased after being treated with estrogen, while the expression level of TIMP-2 significantly increased.

CONCLUSION: Estrogen could, to some extent, down-regulate the expression of MMP-2 and TGF- β1 and up-regulate the expression of TIMP-2, which might contribute to protecting human cornea.

Abstract:AIM:To evaluate the morphological and functional changes of retinas induced by treatment of tunicamycin with optical coherence tomography(OCT)in rats.

METHODS:Totally 60 SD rats were randomly divided into 3 groups(20 in each group), 0.5mg/kg(in low dose group), 1.5mg/kg(in high dose group)tunicamycin were injected into vitreous cavity and saline(9g/L NaCl)were injected in the same dose as a control group. Changes of retinas were observed by OCT on the 1,7 and 14d after treatment of tunicamycin. Then the rats were sacrificed, retinas were taken out and embedded by the paraffin, tissue sections and the HE staining were performed.

RESULTS:OCT results suggested that tunicamycin played damage effects on retinal morphology and structure which appeared a time- and dose- dependent. Fundus photography results suggested that 2wk after tunicamycin treatments, with the gradually changing of tunicamycin concentration, peripheral retinal and macular region became pale color gradually, edema occurred in optic disk, retinal vessels appeared thinner in the high dose group, optic nerve came out atrophy. Fluorescein angiography confirmed that tunicamycin injection in vitreous cavity 2wk later, retinal vessels injury occurred, resulted in leaking of intravascular contrast agent from peripheral to the central part of the retinas. Electrophysiological data showed that retinal electrogram occurred disorder induced by tunicamycin, such as the amplitude of a wave, b wave decreased gradually, even closed to zero, which was very different from control significantly(P<0.05). HE staining of paraffin sections showed that retina injuries induced by tunicamycin were in dose - time dependent, which was consistent with the results of OCT.

CONCLUSION: Clinical retinal diseases could be simulated by retinal damage animal model induced by tunicamycin treatment. OCT detection offered real-time images of the retinal cross-section, which provided a helpful non-invasive method for detecting and evaluating the retinal damages.

Abstract:AIM: To observe the changes of MMP-9 expression in rabbit retina after laser irradiation at different thresholds of 577nm.

METHODS: Twenty-six pigmentation rabbits were randomly divided into normal control group(n=2), conventional photocoagulation group(n=6)and subliminal micropulse laser photocoagulation group(n=18). The conventional photocoagulation group was treated with 577nm laser photocoagulation, subcutaneous micro-pulsed laser photocoagulation at a working loading rate of 9%, 12% and 15%, respectively. Eighteen rabbits were again divided into three subgroups according different powers of subthreshold working loading rate of 9%(n=6), 12%(n=6)and 15%(n=6)that undertook, respectively. The expression of MMP-9 on the retina of rabbit eyes was detected by immunohistochemistry.

RESULTS: In the conventional photocoagulation group, the expression of MMP-9 in the RPE layer and the visual cell layer was strongly positive, which was significantly higher than that in the sub-micro pulse group(P<0.05). Less MMP-9 positive expression of RPE layer and visual cell layer in the working loading rate of 9% subgroup, and more MMP-9 positive expression of RPE layer and visual cell layer in the working loading rate of 12% subgroup; little expression was also noted in the nucleus of RPE and visual cell layer. Moderate MMP-9 positive expression of RPE layer and visual cell layer was observed in the working loading rate of 15% subgroup. There were no significant differences between the three subgroups(P>0.05).

CONCLUSION: The 577nm subliminal micro-pulsed photocoagulation has high selectivity to retinal pigment epithelium at working load rate of 9%, 12% and 15%, and no damage to retinal nerve fiber layer, which is safer than conventional 577nm laser photocoagulation.

Abstract:AIM: To study the effect of intravitreal injection of anti- vascular endothelial growth factor(VEGF)on best corrected visual acuity(BCVA)and multifocal-electroretinogram(mfERG)before and after treatment for choroidal neovascular disease.

METHODS: A total of 264 patients(332 eyes)with macular neovascularization(MCNV)and idiopathic choroidal neovascular disease(ICNV)who underwent pathologic myopia from January 2015 to January 2017 were enrolled in this study. Intraocular pressure and BCVA, fundus using 90D front mirror and slit lamp detection, and the fundus photograph, OCT, ICGA and FFA angiography, mfERG detection were taken. One month after the drug, 1mo after the final treatment, we recorded BCVA, intraocular pressure and mfERG and so on.

RESULTS: Ranibizumab was injected into the 254 eyes, and 78 eyes were injected with conbercept. There were 37 eyes injected once, 147 eyes were injected twice, 72 eyes were injected 3 times, 57 eyes were injected 4 times, 19 eyes 5 times. There were no significant differences on intraocular pressure between the two groups(P>0.05). The BCVA before treatment was significantly different compared with those 1mo after treatment and 1mo after the final treatment(P>0.05). The amplitude of Ring1, Ring2 and Ring4 increased after treatment, the difference was statistically significant.(P<0.05). The amplitude of Ring3 and Ring5 increased at 1mo after final treatment(P<0.05).

CONCLUSION:Intravitreal injection of anti-VEGF drugs has a significant effect on BCVA and mf ERG in patients with choroidal neovascular disease and is safe.

Abstract:AIM: To compare the accuracy of intraocular lens(IOL)power calculations by using five formulas(Haigis, SRK-T, Hoffer Q, Holladay-1, SRK-Ⅱ)in eyes with long axial lengths in order to improve the accuracy of predicating IOL powers.

METHODS: Fifty-one eyes of 51 cases of age-related cataract and with mild long axial(24.5mm27mm)were collected who's optical biometry were performed by the Zeiss IOL Master500 before operation. They underwent regular phacoemulsification and posterior chamber IOL implantation. The actual postoperative refraction was measured with the methods of phoropter and subjective optometry 3mo after surgery. Then we compared the differences of the predicted and actual postoperative refraction of the five formulas in each group.

RESULTS: In the mild axial lengths cases, the differences between SRK Ⅱ formula and the other four formulas were statistically significant(P<0.05), and the difference between Hoffer Q and SRK-T formula was statistically significant(P<0.05); there was no difference among the other formulas(P>0.05). In the moderate and severe long axial lengths cases, the differences between SRK Ⅱ formula and the other four formulas were statistically significant(P<0.05), and the difference between Hoffer Q and SRK-T formula, Hoffer Q and Haigis formula were statistically significant(P<0.05); there was no difference among the other formulas(P>0.05). The differences of all the five formulas between the two groups were statistically significant(P<0.05).

CONCLUSION: In the mild axial lengths cases, Haigis, SRK-T, Hoffer Q, Holladay-1 performed well. In the moderate and severe long axial lengths cases, Haigis, SRK-T and Holladay-1 performed better than other formulas. The accuracy of all the five formulas decreases as the axial length getting longer.

Abstract:AIM: To explored the treatment effects of retinal laser photocoagulation and the applications of color Doppler flow imaging(CDFI)in the diabetic retinopathy.

METHODS: We collected 60 patients(120 eyes)with diabetic retinopathy(Ⅲ～Ⅳstage)from February 2013 to February 2014 in Anyang Eye Hospital admitted in fundus disease department. The health control(HC)group of 55 normal people was established simultaneously. Ocular blood flow velocity of the 55 normal people(110 eyes)and the 60 patients(120 eyes)was examined by CDFI of central retinal artery(CRA)and posterior ciliary artery(PCAs)using the PHILIPS HD6. Peak systolic velocity(PSV)was recorded. The examinations of CDFI, electroretinogram(ERG)and the vision were performed in pre-operation, 1,7d, 1, 3 and 6mo postoperatively.

RESULTS: Compared the PSV of CRA of the DR group before and after photocoagulation to the data of the HC group, there was a significant difference(P<0.05); compared the PSV of CRA of the DR group after photocoagulation with the data before, there was a significant difference(P<0.05). Compared the PSV of PCAs of the DR group before and after photocoagulation to the data of the HC group, there was a significant difference(P<0.05); compared the PSV of PCAs of the DR group after photocoagulation with the data before, there was a significant difference at 1d postoperatively(P<0.05), there was no significant difference at 7d, 1, 3 and 6mo(P>0.05). Compared the aA and bA of ERG of the DR group before and after photocoagulation to the data of the HC group, there was a significant difference(P<0.05). Compared the aA and bA of ERG of the DR group after photocoagulation with the data before, there was a significant difference(P<0.05). Compared the aT and bT of ERG of the DR group before and after photocoagulation to the data of the HC group, there was a significant difference(P<0.05); compared the aT and bT of ERG of the group DR after photocoagulation with the data before, there was no significant difference(P>0.05). The vision of 49 cases(98 eyes)was improved 1 to 3 rows, the effective rate was 82%.The vision of 11 cases(22 eyes)remained constant.

CONCLUSION: Retinal laser photocoagulation is an effective treatment to diabetic retinopathy patients, which can significantly reduce the peak systolic velocity of the central retinal artery, improve and stabilize the condition, protect visual function in long-term clinical effect. Color doppler flow imaging can observe the changes of ocular vessel flow velocity in diabetic' eyes noninvasively, repeatedly and in real time, providing a basis for clinical treatments.

Abstract:Corneal collagen cross-linking(CXL)is a photochemotherapy for keratoconus, keratectasias and infectious keratitis. Corneal collagen fiber infiltrated with riboflavin, a photosensitizer which generates reactive oxygen species when activated by UVA at 370nm, was induced to form the crosslinks in corneal stroma. Corneal collagen cross-linking alone or combined with medicine therapy could be used to treat fungal keratitis, improve the cure rates, and reduce the complications and the demands of corneal transplantation surgery. The purpose of this paper is to review the basic principle, procedure, laboratory researches, clinical applications and the safety about this treatment.

Abstract:Acute retinal necrosis syndrome(ARNS)is a group of eye syndrome. Acute uveitis, retinal artery occlusive vasculitis, fused necrotic retinitis and late stage of retinal detachment is the main clinical manifestation. A part of patients may be associated with increased intraocular pressure. The etiology and pathogenesis is still not clear completely and most people think that may be related to the virus infection, which mainly to reflected to be herpes simplex virus(HSV), varicella zoster virus(VZV), EB virus and giant cell virus(CMV)infection. Its diagnosis mainly depends on clinical manifestation, examination and etiological examination. Acute retinal necrosis syndrome is urgent and develops quickly, and it is lack of specific clinical symptoms in early times. By the way, it enjoys high misdiagnosis rate and poor prognosis. It is hard to cure, therefore, it is an important reason for the blindness. Once diagnosed, treatment should be adopted by carrying local and systemic antiviral, preventive laser photocoagulation in time. At the same time, it is essential that vitreous body resection combine with silicone oil tamponade treatment when necessary. The study shows that the effective measures of early treatment will be able to prevent disease progression and improve visual acuity. Therefore, early diagnosis and treatment of acute retinal necrosis syndrome is very important. In this paper, combination of the literature on the diagnosis and treatment of acute retinal necrosis syndrome were reviewed.

Abstract:Retinopathy of Prematurity is a retinal vascular proliferative disease. With the improvement of the medical care in China, retinopathy of prematurity(ROP)has become one of the main causes of child hood blindness in recent years. Several factors such as short gestational age, low birth weight and oxygen supplementation are the three major risk factors for the disease, however, the pathogenesis is still not clear. This review here aims to expand the etiology and pathogenesis of ROP and provide a theoretical basis for the prevention and control of the disease.

Abstract:Oncomodulin(OM)is known by us progressively as a Calcium binding protein. Recently, OM has been found that it is secreted by inflammatory cells(neutrophilic granulocyte), and a signal which can promote cell growth between innate immunity and neurons, and a key to regenerate the damaged optical nerves by activating inflammation. The function of promoting the regeneration progress of axons has become a hot issue in recent years. This article summarized the mechanism of OM and the relationship between inflammation-induced OM and optic nerve regeneration research and progress were reviewed.

Abstract:Infectious endophthalmitis refers to the acute suppurative inflammation of the uveal and retinal, with acute onset, severe symptoms, and poor prognosis. Early diagnosis and effective treatment is particularly important. Based on the way of intraocular infection, endophthalmitis can be divided into endogenous endophthalmitis and exogenous endophthalmitis. In the East Asian, liver abscess is the main source of endogenous endophthalmitis, and Klebsiella pneumoniae is the main pathogen. Liver abscess endophthalmitis is a serious cause of blindness caused by intraocular infection. A liver infection disseminated through hematogenous and the primary focus was hidden, which makes the disease was easy to be confused with immune related uveitis, causing high misdiagnosis rate, delaying the best time for diagnosis and treatment. In this article we reviewed the etiology, clinical features, diagnosis and treatment and prognosis of endogenous endophthalmitis caused by liver abscess. Clinicians should maintain a high index of suspicion to the endogenous endophthalmitis caused by liver abscess.

Abstract:To the cataract patient after corneal refractive surgery, if the intraocular lens power was determined by conventional formulas, different refractive errors may be produced after intraocular lens implantation. This inaccuracy of the lens power mainly came from 2 aspects-errors of corneal refractive power measurement and errors of formulas. Besides, imprecise of ocular axial length measurement and invalid lens position calculation also contributed to the inaccuracy of lens power. Therefore, in order to reduce refractive errors of cataractous surgery in patient underwent refractive surgery, appropriate method should be used to estimate the refractive power of corneal, and proper formula should be selected to calculate intraocular lens power.

Abstract:AIM: To evaluate visual acuity outcomes after phacoemulsification and intraocular lens implantation in patients with wet age-related macular degeneration(wAMD).

METHODS: We reviewed the medical documents of the patients who underwent phacoemulsification and intraocular lens implantation surgery during June 2013 and January 2016. Totally 61 eyes of 48 patients with wAMD in the stable stage were recruited. The pre- and post-operative vision of selected cases were recorded and compared.

RESULTS: After phacoemulsification and intralocular lens implantation, visual acuity changes were as follows: 49 eyes improved, 11 eyes retained, and 1 eye deteriorated. Visual acuity improvement after cataract surger were statistically significant(P<0.001). Visual acuity improvement was not related to age.

CONCLUSION: Visual acuity improved in patients with wet AMD after phacoemulcification and intraocular lens implantation.

Abstract:AIM:To investigate the effect of dexmedetomidine hydrochloride on hemodynamics, sedation and analgesia effect during cataract surgery for senile patients with hypertension.

METHODS: Totally 90 senile patients with hypertension receiving cataract surgery were randomly divided into two groups, 45 cases in study group during the surgery by intravenous infusion of dexmedetomidine hydrochloride, 45 cases in control group were given normal saline for intravenous infusion. Blood flow dynamics index level were detected in two groups at five time points of before surgery(T₀), beginning of the surgery(T₁), 10 min after beginning(T₂), 20 min after beginning(T₃), the end of surgery(T₄). Analgesia and sedation scores were compared in two groups, the incidence of adverse reactions and complications were recorded in two groups.

RESULTS: Heart rate(HR), diastolic blood pressure(DBP), systolic blood pressure(SBP)increased significantly at the time points of T₁, T₂, T₃, T₄ compared with T₀ time point in the control group(P<0.05). HR, DBP, SBP decreased significantly at the time points of T₁, T₂, T₃, T₄ compared with T₀ time point in the study group(P<0.05), which of the study group were significantly lower than the control group at the same time(P<0.05). Analgesia scores at the time points of T₁, T₂, T₃, T₄ were showed different degrees of decline in the two groups, and analgesia scores in the study group were significantly lower than that of the control group at the same time(P<0.05). Sedation scores at the time points of T₁, T₂, T₃, T₄ were showed different degrees of decline compared with T₀ time point in the control group(P<0.05). Sedation scores at the time points of T₁, T₂, T₃, T₄ were showed different degrees of rise compared with T₀ time point in the study group(P>0.05). Sedation scores in the study group were significantly higher than that of the control group at the same time(P<0.05). The incidence of adverse reactions and complications in the study group was significantly lower than that of the control group(P<0.05).

CONCLUSION: Application of dexmedetomidine hydrochloride to monitoring anesthesia during senile cataract patients with hypertension surgery, can stabilize the hemodynamics and has obvious sedation and analgesia effect.

Abstract:AIM: To compare the effects of different surgeries in the treatment of angle closure glaucoma with cataract and the improvement of quality of life.

METHODS: The clinical data of 60 cases(60 eyes)with angle closure glaucoma and cataract who were admitted to the hospital between January 2014 and October 2016 were collected. According to the surgical method, they were divided into the control group(simple trabeculectomy, n=28)and the observation group(trabeculectomy combined with phacoemulsification and intraocular lens implantation, n=32). The changes of visual acuity and intraocular pressure before and after surgery were compared between the two groups. The incidence of postoperative complications was statistically analyzed, and the quality of life was compared between the two groups.

RESULTS: Before surgery, there was no significant difference in visual acuity, intraocular pressure and anterior chamber depth between the two groups(P>0.05). At 4wk after surgery, the visual acuity of two groups increased and intraocular pressure decreased. The anterior chamber depth of observation group increased while that of the control group decreased(P<0.05). At 4wk after surgery, the visual acuity and anterior chamber depth of observation group were higher than that of the control group but intraocular pressure was lower than that of control group(P<0.05). The success rate of surgery and the opening rate of chamber angle after surgery in the observation group were higher than those in the control group(P>0.05). The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). Before surgery, there was no statistically significant difference in quality of life score between the two groups(P>0.05). At 4wk and 3mo after surgery, the scores of the two groups increased(P<0.05), and the quality of life scores of observation group were higher than those of the control group at different time(P< 0.05).

CONCLUSION: The success rate of trabeculectomy combined with phacoemulsification and intraocular lens implantation is high in the treatment of angle closure glaucoma with cataract. The regimen can improve the visual function, reduce the incidence of postoperative complications, and improve the quality of life of patients.

Abstract:AIM: To study the application of macular ganglion cell complex(mGCC)and peripapillary retinal nerve fiber layer thickness(pRNFL)measured by optical coherence tomography(OCT)in the early diagnosis of glaucoma.

METHODS: Case-control study. Eighty-six subjects, including 30 eyes in normal subjects, 27 eyes in suspected primary open angle glaucoma, 29 eyes in primary open angle glaucoma were enrolled in this study. The thickness of mGCC and pRNFL were measured by OCT. The area under the receiver operating characteristic(AROC)curve at fixed specificities were calculated for each parameter.

RESULTS: There were significant differences in mean pRNFL thickness, superior pRNFL thickness and inferior pRNFL thickness between normal group, suspected glaucoma group and early glaucoma group(P=0.001, 0.004, 0.011). The mean mGCC thickness, the thickness of the top mGCC, the thickness of the lower mGCC were statistically significant(P=0.008, 0.002, 0.003); the difference of general loss of volume(GLV)and focal loss of volume(FLV)between the three groups was statistically significant(P=0.002). Compared with the normal group, all the pRNFL and the mGCC parameters were higher in the suspected glaucoma group, and the FLV had the highest AROC(0.801), all the remaining AROC was >0.700 except above Prnlf(0.688). Compared with the normal group and the early glaucoma group, all the pRNFL and the mGCC had higher AROC, average mGCC was hightest(0.804), all parameters AROC were >0.700 except mean pRNFL(0.683). In suspected glaucoma group, 58% patients had abnormal mGCC thickness and 23% had abnormal pRNFL thickness; in early glaucoma group, 98%patients had abnormal mGCC thickness and 90% had abnormal pRNFL thickness; in normal group, 93%patients had abnormal mGCC thickness and 93%had abnormal pRNFL thickness, the correlation between the three groups was statistically significant(χ²=12.11, P<0.05).

CONCLUSION: OCT measurement of mGCC thickness and pRNFL thickness in early glaucoma have good diagnostic ability; mGCC thickness measurement can be used as an effective method for early diagnosis of glaucoma.

Abstract:AIM:To compare the clinical effects of 25G+ and 27G+ transconjunctival sutureless vitrectomy in treating idiopathic macular hole.

METHODS: We retrospectively reviewed the clinical outcomes of 56 eyes(56 patients)with idiopathic macular hole which were treated with micro-incision vitrectomy from June 2015 to September 2016. Patients were divided into two groups, 28 patients(28 eyes)were treated with 25G+ vitrectomy and the rest(28 eyes)were treated with 27G+ vitrectomy. The operative time and intraoperative complications were recorded and patients were followed up for 3-6mo. During the follow up period, best correct vision acuity(BCVA), intraocular pressure, macular hole healing and postoperative complications were documented and statistically analyzed.

RESULTS: BCVA in two groups were significantly improved after surgery(P<0.001)and there was no significant difference between the two groups(P=0.84). No serious complications occurred. No statistically significant difference was found between the two groups in surgical time and healing rate of macular hole(P=0.57, 0.64). The incidence of low intraocular pressure(IOP<10mmHg)in 27G+ group was lower than that in 25G+ group on the first day after surgery(P=0.31). There was no significant difference between preoperative and postoperative intraocular pressure at 1wk after operation in both groups(P=0.72, 0.92).

CONCLUSION: Both 25G+ and 27G+ vitrectomy are safe and effective technique in treating idiopathic macular hole. Besides, 27G+ showed better superiority on the maintenance of intraocular pressure and reduce the trauma.

Abstract:AIM: To observe the effect on visual quality by traditional Chinese medicine(TCM)warm-reinforcing method for early idiopathic macular epiretinal membrane(IMEM).

METHODS: Totally 21 patients(21 eyes)diagnosed as early IMEM with spleen-kidney yang deficiency were treated by Gubenmingmu powder for 2mo. The best corrected visual acuity(BCVA), the contrast sensitivity and the modified vision quality of questionnaire score were detected to compare the life influence of pretherapy with posttherapy in visual changes.

RESULTS: The BCVA were separately 0.24±0.07、0.22±0.06、0.27±0.08 in the treating time of 1, 2 and 5mo. Contrast sensitivity function in special frequencies of 6,12 and 18c/d increased than pretherapy(P<0.01), those of 3c/d were no statistically significant(P>0.05). Scales of night fixation difficulty, guidepost difficulty, TV font difficulty, satisfaction, annoyance, understanding, newspaper easiness had significant differences(P<0.01), while the rest of the scales had no significant differences(P>0.05).

CONCLUSION: The TCM warm-reinforcing method could improve the visual function of IMEM patients and improve patients' quality of life.

Abstract:AIM: To analyze the effects of two kinds of anti-vascular endothelial growth factor(VEGF)drugs, conbercept and ranibizumab, on proliferative diabetic retinopathy(PDR)patients as pre-treatment for pars plana vitrectomy(PPV).

METHODS: From June 2016 to December 2016, 62 patients(64 eyes)aged 41-59 years old diagnosed with PDR with nonclearing vitreous hemorrhage(VH)and/or tractional retinal detachment(TRD)requiring PPV were enrolled in our study. Patients were treated with intravitreal injection of anti-VEGF drugs 0.50mg(0.05mL)3d before PPV. Then the standard 23G minimally invasive sclera three-channel vitrectomy was performed where there were no significant complications after the injection of anti-VEGF drugs. The operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy and silicone oil, and postoperative complications were recorded and analyzed. We compared and analyzed the visual acuity and macular thickness before and 1mo after the surgery with the preoperative data.

RESULTS: Both conbercept and ranibizumab could improve the postoperative visual acuity and reduce the postoperative macular thickness of PPV. There was no significant difference between the impacts of two kinds of anti-VEGF drug pre-treatment on operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy, silicone oil filling and postoperative vitreous secondary hemorrhage.

CONCLUSION: The effects of conbercept and ranibizumab pre-treatment were similar. PPV combined with anti-VEGF pre-treatment could improve postoperative visual acuity and macular edema. The choice of conbercept or ranibizumab should be made flexibly according to the actual situation of patients.

Abstract:AIM: To analyzed the effect of keratoconjunctivitis sicca treated by different medicines after phacoemulsification in patients with diabetes.

METHODS: Totally 78 diabetic patients 78 eyes with keratoconjunctivitis sicca(KCS)after phacoemulsification from March 2015 to March 2016 were selected and divided into two groups using random number table. In Group A, 39 eyes were treated with pranoprofen eye drops + artificial tears + Qiming granules. In Group B, 39 eyes were treated with pranoprofen eye drops + artificial tears. the two groups were observed for clinical symptoms, tear film break up time(BUT), corneal fluorescein staining and adverse reaction and so on before and after treatment.

RESULTS: Total effective rate of Group A was 97%, significantly higher than that of Group B(64%)(P<0.05). After treatment, symptoms and signs scores of the two groups were significantly lower, BUT were significantly prolonged. At 1, 2wk and 1mo after treatment, symptoms and signs scores of Group A were significantly lower the BUT was longer than those of Group B(P<0.05). Corneal fluorescein staining of Group A at 2wk was lower than that of Group B(P<0.05).

CONCLUSION: The combined therapy, pranoprofen eye drops + artificial tears + Qiming granules, is able to quickly and effectively improve the clinical symptoms and signs, with no serious adverse reactions for keratoconjunctivitis sicca after phacoemulsification in patients with diabetes.

Abstract:AIM:To investigate peripapillary vessel density and its relationship with other ocular parameters in highly myopic eyes with peripapillary intrachoroidal cavitation(PICC), and to analyze risk factors for PICC.

METHODS:Cross-sectional study. A total of 35 highly myopic eyes with PICC, 40 highly myopic eyes without PICC and 35 normal eyes were included in this study. All participants underwent fundus photography and spectral-domain optical coherence tomography(SD-OCT). OCT angiography was also performed to image the retinal vasculature in the peripapillary areas of different sectors, including the radial peripapillary capillaries(RPC)and optic nerve head(ONH)layer. The difference of morphology changes in optic disc and peripapillary vessel density between these three groups were compared. Correlations between peripapillary vessel density and PICC and risk factors for the presence of PICC were analyzed.

RESULTS: Significant differences were found among the three groups in spherical equivalent refraction(SER), best-corrected visual acuity(BCVA), axial length, peripapillary atrophy β-zone(β-PPA)area, retinal nerve fiber layer(RNFL)thickness and the presence of tilted optic disc, posterior staphyloma and myopic maculopathy(MMD)(P<0.05). There were significant differences among the three groups in the peripapillary vessel density both in RPC(54.34±5.58, 57.54±7.44, 64.42±3.50)and ONH(51.24±7.43, 52.75±9.96, 61.25±4.15)layers(P<0.001). In highly myopic eyes, vessel density was significantly lower in eyes with PICC than in those without in inferotemporal area both in the RPC(56.76±6.62,63.84±6.02,67.52±4.78)and ONH(56.47±5.79,60.38±4.72,64.18±4.37)layers. The vessel density was significantly correlated with the presence of MMD, β-PPA area and RNFL thickness in the RPC layer, whereas correlated with the presence of MMD, PICC and RNFL thickness in the ONH layer(P<0.05). Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC(OR=8.007, 95%CI: 2.045-31.348; OR=7.558, 95%CI: 1.398-50.026).

CONCLUSION:Highly myopic eyes with PICC had relatively lower peripapillary vessel densities, especially in the temporal area, than those without. Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC.

Abstract:AIM: To investigate the efficacy and safety of low dose mitomycin C(MMC)to prevent haze in trans photorefractive keratectomy(TransPRK)with moderate and high myopia, and to observe the changes of corneal density.

METHODS: Sixty-one patients underwent TransPRK with moderate and high myopia. Eyes were divided into research group(0.1g/L MMC for 40s)and control group(0.2g/L MMC for 40s)randomly. There were 21 patients in research group and 40 patients in control group. Cornea epithelial healing time, pain score, visual acuity, manifest refraction, haze and cornea density were analyzed.

RESULTS: The epithelial healing time(0.1g/L group: 3.86±1.11d, 0.2g/L group: 4.23±1.27d)and pain score(0.1g/L group: 2.01±0.58, 0.2g/L group: 1.79±0.7)were no significant difference between two groups(P=0.667, P=0.582). It was similar in spherical equivalent at 1mo and 3mo post-operation(0.1g/L group: 0.28±0.25, 0.05±0.23D; 0.2g/L group: -0.13±0.17, 0.07±0.22D; P=0.178, P=0.490). The BCVA of control group decreased at 1mo and improved to the same level as pre-operation at 3mo(F=15.847, P<0.001); 0.1g/L group showed the same trend, but the changes were no significant difference(F=3.038, P=0.093). There were also no significant difference in Haze between two groups post-operation(z=-0.709, P=0.479; z=-0.478, P=0.633).The change of cornea density was matched with the BCVA(0.1g/L group F=27.399, P=0.001; 0.2g/L group F=8.313, P=0.001)and it was similar between two groups.

CONCLUSION: The using of low dose MMC to prevent haze in TransPRK with moderate and high myopia is safe and effective. It is therapeutic equivalence to regular dose(0.2g/L). Besides the slit lamp, we can use the corneal density to measure the corneal transparency.

Abstract:AIM:To study the efficacy and safety of Toric implantable contact lens(TICL)implantation in the treatment of patients with high myopia and astigmatism.

METHODS: Totally 90 patients(178 eyes)diagnosed as this disease were selected in our hospital during September 2012 to September 2016 by the method of random. The UCVA, BCVA, refraction, astigmatism coefficient, corneal endothelial cell, intraocular pressure, manifest refraction examination were accessed and compared before and after 3 and 9mo of surgery.

RESULTS: After 3 and 9mo of the surgery, the UCVA and BCVA were much higher than those before treatment, which the difference was statistically significant(P<0.05). We compared the refraction at 3mo(-0.52±0.23D)and 9mo(-0.54±0.16D), the astigmatism coefficient at 3mo(-0.39±0.23D)and 9mo(-0.33±0.56D)after treatment, and we found that the differences were not statistically significant(P>0.05). The corneal endothelial cells at 3 and 9mo after operation were compared with those of before treatment, and we found that the differences were statistically significant(P<0.05). The intraocular pressure of 3 and 9mo after operation was compared with that before operation, and we found that the differences were not statistically significant(P>0.05).

CONCLUSION: TICL implantation in the treatment of patients with high myopia and myopic astigmatism has a more obvious clinical efficacy and safety and reliability.

Abstract:AIM:To investigate the effect of different cutting centers on the visual acuity, refractive diopter and visual quality of patients undergoing laser assisted in situ keratomileusis(LASIK).

METHODS: A total of 80 patients(160 eyes)with myopia treated by elective LASIK were divided into two groups. Thirty-six cases(72 eyes)with visual axis corneal reflection point(VACRP)as the cutting center were included into the VACRP group while 44 cases(88 eyes)with pupil center(PC)as the cutting center were included into the PC group. The uncorrected visual acuity(UCVA), the best corrected visual acuity(BCVA), refractive diopter, corneal aberration \〖total corneal and anterior corneal surface higher-order aberrations(HOA), spherical aberration(Z₄₀), vertical coma(Z_3-1), horizontal coma(totZ₃₁)and offset of cutting centers were determined before surgery and 1mo after surgery.

RESULTS: There was no difference in the probability of UCVA ≥ 0.1, BCVA and refractive diopter between the two groups at 1mo after surgery(P>0.05). The astigmatism and cutting center deviation of VACRP group were lower than those of PC group(P<0.05). The totHOA, totZ₄₀, totZ_3-1, totZ₃₁, froHOA, froZ_3-1、froZ₃₁ and froZ₄₀ were lower in VACRP group than PC group at 1mo after surgery(P<0.05).

CONCLUSION: The UCVA of patients treated with both cutting centers for LASIK is good but VACRP has more advantages in reducing the offset of cutting center and improving postoperative visual quality.

Abstract:AIM:To investigate the safety and effect of femtosecond laser-assisted cataract surgery with Cionni modified capsular tension ring(MCTR)implantation in the management of traumatic lens subluxation.

METHODS: Totally 11 patients(11 eyes)with traumatic lens subluxation were divided into three groups according to the severity of lens dislocation, ranging from 90° to 120°(4 eyes), 120° to 180°(5 eyes)and 180° to 270°(2 eyes). The contact LenSx femtosecond laser cataract surgery platform was applied to create the capsulotomy, prepare nuclear fragmentation and make corneal wound creation. Anterior vitrectomy was performed in some patients during the surgery. After capsular retractors insertion and phacoemulsification, the MCTR was inserted to the capsular bag and fixed to the sclera. Finally, the IOL was implanted into the capsular bag. Postoperative visual acuity, intra- and post-operative complications, anterior capsular opening, IOL and MCTR position and intraocular pressure(IOP)were assessed.

RESULTS:The duration of follow-up was 2mo. All the operations were completed successfully. Five eyes underwent cataract surgery combined with anterior vitrectomy. Four eyes had been inserted with 2-eyelet MCTR and seven eyes with 1-eyelet MCTR. The best corrected visual acuity(BCVA)after operation was better than 0.5 in 4 eyes, between 0.3 and 0.5 in 3 eyes, between 0.1 and 0.3 in 3 eyes, and less than 0.1 in 1 eye. Compared with preoperative BCVA, the difference was statistically significant(P<0.05). All the IOLs were stably centered and the eyelet of MCTR was fixated steadily between the iris and the anterior capsule. The common intra- and post-operative complications were subconjunctival hemorrhage, incomplete capsulotomy, residual cortex, secondary glaucoma and posterior capsular opacification.

CONCLUSION:Femtosecond laser-assisted cataract surgery can improve the success rate of capsulorhexis, and reduce the difficulty of nuclear fragmentation. Femtosecond laser-assisted cataract surgery combined with MCTR implantation is an ideal surgical method for traumatic lens subluxation.

Abstract:AIM: To explore the effect of early posterior approach vitrectomy in the treatment of penetrating ocular trauma with intraocular foreign body.

METHODS: Totally 10 cases of penetrating ocular trauma with intraocular foreign bodies(IOFB)in the past two years were included. Emergency vitrectomy, intraocular foreign body removal and silicone oil tamponade were performed by the same surgeon. Antibiotics and steroids were given after surgeries. Retinal photocoagulation was done according to fundus conditions after surgeries.

RESULTS: One patient combined with preoperation endophthalmitis and severely damaged retina failed to recover, eventually came to phthisis bulbi. Vitrectomy and IOFB removal were all successfully performed in the other patients. The postoperation follow-up time was 3-18mo. Two of the patients received secondary vitrectomy and silicone replacement surgeries due to recurrent retinal detachment. The remaining patients had no further bleeding with intraoclar pressure(IOP)8-21mmHg. At the last follow-up, three of them gained best corrected visual acuity better than 0.1, two patients had visual acuity of 0.01 to 0.1 and four patients had poor visual acuity of light perception to FC/50cm because of macular damage. The patient with phthisis bulbi had no light perception.

CONCLUSION: Early vitrectomy, foreign body removal and silicone oil tamponade is an effective treatment for patients with penetrating eyeball injury with IOFB.

Abstract:AIM: To analyze the etiological and epidemiological characteristics of fungal keratitis in the Hainan Province of China with a warm and humid tropical climate.

METHODS: Eighty-one patients(81 eyes)with fungal keratitis who attended the Corneal Services of Hainan Province Eye Hospital from January 2014 to December 2016 were retrospectively reviewed. The characteristics of fungal population, the age distributions of patients, the seasonal distribution of disease and the risk factor were analyzed. The treatment of fungal keratitis was reviewed. The positive rates of KOH based smear and fungal culture were assessed and analyzed using the Chi-squared test.

RESULTS: Eighty-one patients of fungal keratitis(including 81 eyes)were involved. The ration of the male and female was 2:1. The median age was 51 years. Corneal trauma seems to be the most common risk factor. Of all cases, 45 patients(55%)were greater than or equal to 50 years old. Twenty-eight(35%)were between 30-50 years old. Eight(10%)were less than or eaqual to 30 years old. Twenty-nine cases(36%)appeared in the first quarter indicated that fungal keratitis was most popular in the winter in Hainan Province. Standard fungal cultures were performed in 81 cases. Seventy-one of the 81 samples(88%)grew fungi. Fungal smear tests were performed in 80 cases. Forty-one cases(51%)were confirmed to be fungal keratitis by 10% KOH count. Statistical differences were found in the positive rates between fungal culture and fungal smear test(χ²=23.730, P<0.01). The predominant fungal species isolated was Fusarium sp. in 34 cases(48%)followed by asporogenous strain in 11 cases(15%). Antifungal drugs were applied in all cases. Conjunctival flap transplantation was performed in 23 cases(28%), penetrating keratoplasty in 9 cases(11%), and evisceration in 7 cases(9%).

CONCLUSION: The predominant fungal species isolated is Fusarium sp. followed by asporogenous strain. The fungal keratitis is most popular in the first quarter in Hainan Island. Corneal trauma seems to be the most common risk factor. Multidisciplinary approach, including the combined application of surgery and antifungal drugs is the treatment strategy common used for the fungal keratitis. The positive rate of fungal culture is higher than fungal smear test.

Abstract:AIM: To evaluate the clinical results of capsular tension ring(CTR)implantation in phacoemulsification for eyes with congenital lens subluxation.

METHODS: This study comprised 18 patients(31 eyes)with congenital ectopia lentis. All patients received phacoemulsification with CTR and intraocular lens(IOL)implantation. Visual acuity before and after surgery were examined. IOL decentration were measured with Image-Pro Plus image processing software. The complications were also recorded preoperatively and postoperatively.

RESULTS: Uncorrected vision of all eyes increased after surgery, and all cases had different degree of IOL decentration after surgery. Two eyes received CTR scleral fixation 3mo after surgery because the IOL decentration aggravated during the follow-up period.

CONCLUSION: Phacoemulsification with CTR and IOL implantation is effective and safe for congenital lens subluxation. The implantation of CTR increase the stability of the capsular bag, improve the safety of surgery, and maintain the right position of IOL. CTR scleral fixation is a effective supplement for progressive cases.

Abstract:AIM:To investigate the effect and safety of modified small incision cataract surgery in patients with soft core cataract.

METHODS: Totally 80 cases(109 eyes)of soft cataract patients who underwent surgical treatment from January 2015 to May 2016 in ophthalmology center of our hospital, using random number table method were divided into improved group(improved manipulation of small incision cataract surgery), traditional group(traditional approach to small incision cataract surgery), 40 cases in each group. Comparison of the two groups of treatment, the incidence of complications were taken.

RESULTS: There were no significant differences on uncorrected visual acuity between the two groups before and at 1d, 1wk and 1mo after operations(P>0.05). The uncorrected visual acuity of the two groups improved significantly at 1d, 1wk and 1mo after operations compared with those before operations(P<0.05). There were no significant differences on intraocular pressure(IOP)between the two groups before and at 1d, 1wk and 1mo after operations(P>0.05). The IOP of the two groups increased significantly at 1d, 1wk and 1mo after operations compared with those before operations(P<0.05). The complication rate was 9%(5/54)in the modified group, significantly lower than that in the conventional group 25%(14/55)(P<0.05).

CONCLUSION: Improved small incision cataract surgery for soft cataract patients was with reliable results, less complications.

Abstract:AIM:To observe related biological parameters of 3 minutes dark-room provocative test in patients with laser peripheral iridectomy(LPI)in the fellow eyes of acute primary angle-closure(APAC)by ultrasound biomicroscopy(UBM). To explore the risk factors in primary angle closure suspect(PACS)patients with progressive angle closure after LPI.

METHODS: Seventy-eight eyes of APAC patients without peripheral anterior synechia were selected. Each eye underwent 3 minutes dark-room provocative test after LPI. Anterior segment parameters, including anterior chamber depth(ACD), anterior chamber angle open distance500(AOD₅₀₀), peripheral iris thickness(PIT), iris convex(IC), the position of iris insertion and trabecular-ciliary process distance(TCPD), and the number of positional angle closure(NPAC)were observed and analyzed by statistic methods.

RESULTS:Patients with APAC were examined by UBM after LPI and 26 eyes(33%)occurs at least one positional angle closure,19 eyes(24%)were positive in 3 minutes dark-room provocative test among them. It occurs a positive relationship between the elevation intraocular pressure and the number of positional angle closure in dark-room provocative test(r=0.84, P<0.01). AOD₅₀₀, IT and IC were significantly changed from normal light to darkroom between positional angle closure positive group and positional angle closure negative group(all P<0.01). In single factor analysis, AOD₅₀₀(P=0.003), IT(P=0.012), IC(P=0.043), TPCD(P=0.015), the position of iris insertion(P=0.024)were correlative factors of positive results. In multiple-factor analysis, only IT(P=0.011), TPCD(P=0.009), iris root attachment points(P=0.02)were independent risk factors of positive results.

CONCLUSION:A certain proportion of patients with PACS after LPI appeared positional angle closure in a dark room. Peripheral iris hypertrophy, anterior displacement of the ciliary body and iris root attachment points are vital risk factors. Long-term follow-up study and intervention treatment are required in these patients after LPI.

Abstract:AIM: Using optical coherence tomography angiography(OCTA)to observe the changes and clinical significance of macular blood flow density in patients with diabetic retinopathy(DR).

METHODS: Totally 47 eyes(28 patients)with diabetic retinopathy(DR)were enrolled in the DR group. According to the international clinical grading criteria of diabetic retinopathy, 30 eyes(19 patients)with non-proliferative diabetic retinopathy were classified as the NPDR group, and 17 eyes(11 patients)with proliferative diabetic retinopathy were classified as PDR group. A total of 46(27 subjects)healthy eyes with matched age were enrolled in the control group. All the subjects underwent the 3mm×3mm scanning of macular retina by optical coherence tomography angiography(OCTA), obtaining 4 levels of macular blood flow density map. The macular blood flow density at 3 levels, including superficial retinal layer, deep retinal layer and choroidal capillaries layer, were measured.

RESULTS: The macular blood flow density of superfical retinal layer, deep retinal layer and choroidal capillaries layer in DR group were 0.4963±0.0840, 0.4798±0.0801 and 0.5290±0.0528, respectively. Among them, the blood flow density of each layer were 0.5064±0.0843,0.4983±0.0766,0.5345±0.0529, respectively, for the NPDR group, and were 0.4786±0.0830, 0.4473±0.0778,0.5192±0.0526, respectively, for the PDR group. For the control group, the density of each layers were 0.5919±0.0704, 0.6301±0.0527, 0.5691±0.0169, respectively. The macular blood flow density was significantly different in the superficial retinal layer, deep retinal layer and choroidal capillary layer between the control group and the NPDR group, as well as the PDR group and the DR group(total P<0.001). Statistically significant difference was found between the NPDR group and the PDR group in the deep retina layer(P=0.029), but not in the superficial retina layer and choroid capillary layer(P=0.236, 0.268).

CONCLUSION: Compared with the control group, the macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillary layer in the patients with diabetic retinopathy decreased significantly. It indicated that the macular ischemia existed in both retina and choroid. By quantitatively measurement of the macular blood flow, OCTA may be used for monitoring the progression of diabetes, and early detection of diabetic retinopathy.

Abstract:AIM: To make a contrast and then analyze the difference of optical coherence tomography(OCT)before and after vitreomacular traction syndrome(VTS)was performed.

METHODS: The clinical date of 11 evaluable eyes of 11 patients with VTS who were diagnosed by OCT and underwent 25G vitreous surgery from January 2013 to January 2014 were retrospectively analyzed. Patients were followed up for an average of 6mo, to observe the visual acuity and OCT examination of the patient before and after operation. We compared the changes of retinal thickness and local morphology before and after operation.

RESULTS: After vitreous retraction, 6 eyes improved, 2 eyes do not improve. One eye received macular membrane traction, in the operation the macular epiretinal membrane peeling, retrial membrane stripping and the triamcinolone acetonide intravitreal injection were given, but after the operation, the vision does not improve. Two eyes received vitreous combined with retinal macular membrane traction. In the operation, macular epiretinal membrane stripping was given, after the operation, visual acuity improved. The proportion of those with visual acuity of 0.1 or more increased from 46% before to 73% after the operation. Before operations, the mean central macular thickness was 619.27±195.13μm, 239.12±143.84μm after, which decreased significantly(P<0.05).

CONCLUSION: Vitrectomy can effectively relieve the vitreous traction of the macula, and can prevent further decline in visual acuity and reduce macular edema as well as improve the visual acuity of some patients. So, OCT has important guiding significance on the diagnosis and prognosis of this group.

Abstract:AIM:By analyzing optical coherence tomography angiography(OCTA)characteristics of central serous chorioretinopathy(CSC)and comparing the differences of CSC between OCTA and indocyanine green angiography(ICGA), to explore if OCTA can substitute ICGA for diagnosis of CSC patients, and guide the treatment of photodynamic therapy(PDT).

METHODS: We reviewed 30 eyes of 30 patients with CSC, who were diagnosed by fluorescein angiography(FFA)and ICGA at Beijing Tongren Eye Center from November 2015 to March 2016. All patients underwent best-corrected visual acuity(BCVA)measurement, intraocular pressure, slit-lamp examination, indirect ophthalmoscope, color fundus photography, FFA, ICGA and OCTA. FFA and ICGA were captured by Spectralis HRA + OCT(Spectralis HRA + OCT^®; Heidelberg Engineering, Heidelberg, Germany). OCTA was performed by RTVue XR Avanti device(OptovueInc, Fremont, CA)with 6mm×6mm Angio Retina mode. The software(version 2017.100.0.1; OptovueInc)automatically segmented the tissue into four layers, the characteristics of choriocapillaris layer were analyzed. At the same time, the differences between OCTA and ICGA images were compared among CSC patients. The maximum diameters and areas of both choroidal hyperperfusion in ICGA and high flow signal in OCTA were measured. Then, the paired t test was used to analyze the differences between the maximum diameter and area of OCTA and ICGA measurement.

RESULTS: Among 30 cases, high blood flow signals of OCTA were clearly visible in 27 cases, namely the coarse grain region; the inner low flow signals surrounded by high blood flow signals were seen in 21 cases; the outer low flow signals surrounding high blood flow signals were seen in 7 cases. High blood flow signals of OCTA were corresponded with the choroidal hyperperfusion of ICGA images; among these 30 cases, there were low reflection shadows in choroidal hyperperfusion with ICGA for 22 cases, for 21 cases out of these 22 cases, low flow signals inside of high flow signals of OCTA could be seen; 9 out of 30 cases, there were low reflection halo outside of choroidal hyperperfusion of ICGA, and 7 out of these 9 cases, low flow signals outside of high flow signals of OCTA could be seen; still for those 30 cases, leakage point in late ICGA could be seen with 14 cases, however, special flow signals in OCTA could not be seen for them. For ICGA, the maximum diameter of choroidal hyperperfusion was 1.589±0.295mm, whose area was 0.705±0.131mm²; while for OCTA, the maximum diameter of high flow signal was 1.576±0.293mm, whose area was 0.745±0.138mm². By using paired t test, there was no statistical difference between the maximum diameter of choroidal hyperperfusion in ICGA and the maximum diameter of high flow signal in OCTA, nor difference between the area of ICGA and OCTA.

CONCLUSION: The high flow signals can be clearly visible in OCTA, which are corresponded with choroidal hyperperfusion in ICGA.OCTA can substitute ICGA for diagnosis of CSC patients, and guide the treatment of PDT.

Abstract:AIM: To analyze clinical observation and the efficiency of intravitreal conbercept combined with 532-laser on Coats disease in adulthood.

METHODS: This was an retrospective analysis. Six eyes from 6 patients(5 males and 1 female)with coats disease diagnosed by fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)were enrolled. Before the injection, best-corrected visual acuity(BCVA)of early treatment of diabetic retinopathy study(ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, FFA, and OCT were examined. The initial average visual acuity(ETDRS letters)were 51.17±15.15. The initial average central retina thickness(CRT)was 303.30±107.87μm. All affected eyes were treated with intravitreal conbercept 0.05mL(10mg/mL)combined with 532-laser. Patients were followed up for 6 to 12mo, with a mean duration of 7.33±1.26mo. Post-treatment BCVA were compared with baseline using repeat analysis.

RESULTS: The mean BCVA showed significant improvement during 1 wk, 1, 3mo post-treatment and the latest follow up(P<0.01). During the latest follow up, the mean BCVA was obviously improved in 3 eyes(50%), improved in 2 eyes(40%), stable in 1 eyes(10%). Likewise, the subretina fluid absorption of different levels. No adverse events such as secondary retinal detachment or endophthalmitis were found during the follow-up.

CONCLUSION: Coats disease in adulthood more likely to have lower symptom and have a better response on treatment. Intravitreal conbercept combined with 532-laser significantly improve visual acuity and absorb the subretina fluid.

Abstract:AIM:To evaluate the efficacy and safety of methazolamide in treating refractory uveitic macular edema.

METHODS: Retrospective self-controlled study was designed. A total of 15 patients(20 eyes)with refractory uveitic macular edema which used methazolamide as adjuvant therapy were enrolled in Shanghai First People's Hospital from January 2015 to June 2016. The changes of central macular thickness(CMT)and best corrected visual acuity(BCVA)were observed at baseline and 2, 4, 8wk after treatment. We also focused on the incidence of complications and relapse.

RESULTS: The CMT was 445.95±154.10μm, 338.83±138.34μm, 251.50±40.20μm, 244.90±35.68μm at baseline, 2, 4 and 8wk after treatment, respectively. The differences among them were statistically significant(F=15.467, P<0.05). The BCVA(log MAR)were 0.40±0.17, 0.28±0.21, 0.19±0.20, 0.18±0.21 at baseline, 2, 4 and 8wk respectively, with a significant difference among them(F=5.208, P<0.05). When the cumulative dose reached to 700mg and 1400mg, no one had methazolamide-related complications; and when it came to 2800mg, 5 patients(33%)had methazolamide-related complication. After the withdrawal of methazolamide 1wk, 1 and 3mo, 3 patients(20%), 5 patients(33%)and 8 patients(53%)relapsed, respectively.

CONCLUSION: Methazolamide is beneficial in improving macular edema and vision in 4wk. When the cumulative dose is more than 1400mg, we need pay attention to the complications. After discontinuing methazolamide for 1wk, macular edema relapsed in some patients, and more than half of patients recurred after 3mo. So the patients should be followed closely in 3mo after withdrawal of methazolamide.

Abstract:AIM: To observe of optical coherence tomography angiography(OCTA)and indocyanine green angiography(ICGA)image feature in polypoidal choroidal vasculopathy(PCV).

METHODS: Selected 21 patients 21 eyes with PCV in our hospital from January 2016 to December 2016. All the eyes were examined by ICGA, and was examined by OCTA after ICGA examination 1h. We observed the characteristics of OCTA and ICGA images.

RESULTS:ICGA examination showed that there were 8 cases of choroidal abnormal branch vascular network(BVN), polypoid lesions 10 eyes, BVN with polypoid lesions 2 eyes, no abnormal performance 1 eyes. OCTA examination showed 8 eyes of BVN, and the location, range and shape of BVN were similar to ICGA in OCTA examination. ICGA examination showed 10 cases of polypoid lesions. OCTA showed strong signal highlights. ICGA examination showed 2 cases of BVN complicated with polypoid lesions, and OCTA examination showed strong signal highlights of BVN and corresponding parts. ICGA examination showed no abnormal performance in 1 eyes, and no abnormal findings in OCTA examination.

CONCLUSION: OCTA and ICGA are similar in the location and morphology of PCV lesions, and OCTA may play a role in the diagnosis of PCV restricted ICGA.

Abstract:AIM: To investigate the feasibility and clinical effect of punctoplasty by using trabeculectomy punch combined with a novel RS tube for the treatment of punctal stenosis.

METHODS: Totally 39 patients(39 eyes)with punctual stenosis were selected from October 2013 to October 2015 in the Second People's Hospital of Foshan. All patients underwent punctoplasty by using trabeculectomy punch combined with a novel RS tube. These tubes were removed at 3mo after operation. A follow-up of 6mo was taken for final analysis. The fluorescein dye disappearance test score was recorded before the operation and at 1,3 and 6mo after the extubation. The curative effect of the operation at 6mo after the extubation was assess.

RESULTS: Fluorescein dye disappearance test: the scores at 1,3 and 6mo after the extubation all decreased compared with the preoperative ones. The difference was statistically significant(P<0.05). At the last following up, 35 eyes(90%)were cured completely, 4 eyes(10%)were improved significantly, no patients recurred. Effective rate was 100%. No serious intraoperative and postoperative complications happened.

CONCLUSION: Punctoplasty by using trabeculectomy punch combined with novel RS tubes is a safe and effective method for the punctul stenosis, which is easy to perform, with high success rate.

Abstract:AIM: To study and analyze the clinical efficacy of diclofenac sodium eye drops combined with sodium hyaluronate eye drops in treating dry eyes after ophthalmic surgery.

METHODS: Totally 94 eyes from 94 patients with dry eyes were slected, and they were randomly divided into orbervation group and control group. Fouty-seven patients in the control group using conventional treatment combined with sodium hyaluronate eye drops. Other 47 patients in orbervation group were treated with diclofenac sodium eye drops on the basis of control group. We compared symptoms, fluorescein station, tear film break time, Schirmer Ⅰ test between the two groups.

RESULTS: Compared with before treatment, patients of both groups with sympotom, fluorescein station score, BUT, and Schirmer Ⅰ test were significantly improved(P<0.05). At the same time, sympotom, fluorescein station score, BUT and Schirmer Ⅰ test of control group were better than observation group(P<0.05). The cure rates of the orbervation group(98%)were more significant than control group(74%)(P<0.05).

CONCLUSION: Diclofenac sodium eye drops combined with sodium hyaluronate eye drops have significant efficacy in treatment of dry eyes after ophthalmic surgery, which can effectively relieve clinical symptoms, improve BUT and Schirmer Ⅰ test.

Abstract:AIM: To evaluate the effect of He-Ne laser combined with TDP irradiation in the treatment of herpes zoster ophthalmicus.

METHODS: Totally 22 patients(22 eyes)with herpes zoster ophthalmicus were treated by He-Ne laser irradiation combined with TDP(Group A). Another 22 patients(22 eyes)with herpes zoster ophthalmicus(Group B)were treated by medication. The duration of the disease, the incidence of complications, and the time of pain relief were compared between the two groups.

RESULTS: The cure rate of Group A was 91%, that of Group B was 73%, there was no significant difference between the two groups(χ²=1.375, P>0.05). The average cure time of Group A was 8±2.22d, Group B was 12±1.88d, the difference between the two groups was statistically significant(t=5.22, P<0.05). The complication rate of Group A was 18%, Group B was 59%, the difference between the two groups was statistically significant(χ²=6.86, P<0.05). The average pain relief time of Group A was 5±1.23d, Group B was 10±1.34d, the difference between the two groups was statistically significant(t=11.17, P<0.05).

CONCLUSION: He-Ne laser combined with TDP irradiation can shorten the treatment time of herpes zoster ophthalmicus, shorten the course of disease, reduce the incidence of complications, relieve pain, with no significant effect on the cure rate of herpes zoster ophthalmicus.

Abstract:AIM:To analyze the influencing factors of the curative effect of cataract extraction in cataract patients with high myopia.

METHODS: A total of 86 patients(118 eyes)with high myopia and undergoing cataract extraction were enrolled in the retrospective study. All patients completed follow-up in 6mo after surgery and the clinical data were complete. The best corrected visual acuity(BCVA)was recorded in 6mo after surgery. With 0.3 as the dividing line, the patients were divided into the low visual acuity group(the visual acuity <0.3)and the normal visual acuity group(the visual acuity ≥0.3). The clinical data of the two groups were retrospectively analyzed. Age, gender, course of disease, BCVA, corneal diopter, axial length, corneal astigmatism, sclera, degree of fundus lesions, postoperative complications, vitreous detachment, maculopathy and other factors were statistically analyzed. Univariate and multivariate Logistic regression analyses were performed to screen the related factors influencing the curative effect in the treatment of patients with high myopia and undergoing cataract extraction.

RESULTS: Among all patients, there were 34 eyes(29%)with low visual acuity and 84 eyes(71%)with normal visual acuity. The axial length, corneal astigmatism, proportion of with macular lesions, proportion of with posterior sclerotic staphyloma, the hardness of the lens nucleus and degree of fundus lesions showed statistically significant differences between the low visual acuity group and the normal visual acuity group(P<0.05). The axial length(OR:1.567, 95%CI: 1.129-2.224), macular lesions(OR:8.054, 95%CI:1.741-37.541), the hardness of the lens nucleus(OR:3.642, 95%CI:2.512-18.787)and the degree of fundus lesions(OR:7.964, 95%CI:1.254-28.415)were associated with the curative effect in patients with cataract and high myopia(P<0.05). During 6mo of follow-up, there were 5 eyes with posterior capsular opacification, no secondary glaucoma, artificial lens shift, corneal decompensation and complications of retinal detachment.

CONCLUSION:The axial length, macular lesions, hardness of the lens nucleus and degree of fundus lesions are the independent risk factors for visual acuity recovery in cataract patients with high myopia after surgery. To improve the visual recovery after surgery, the risk factors must be controlled actively and attention should be paid to fine surgery.

Abstract:AIM:To investigate the safety and complications of femtosecond laser corneal small incision lenticule extraction(SMILE)procedure and discuss the prevention and treatment.

METHODS: We retrospectively studied the complications of 403 patients(799 eyes)with myopia and myopic astigmatism treated by SMILE.

RESULTS: All the patients underwent the operation successfully. Only 1 case(1 eye)suffered from dark spot and changed to femtosecond laser-assisted LASIK(FS-LASIK), 5 cases(5 eyes, 0.6%)suffered from the suction loss, 11 cases(17 eyes, 2.1%)developed opaque bubble layer. All patients gained perfect uncorrected visual acuity(UCVA)(20/20). The best corrected visual acuity(BCVA)did not decrease after operations. The incidence of haze and diffuse lamellar keratitis was low(0.3% and 0.4%, respectively)and no other complications were observed. There was 9 eyes in 6 patients(1.1%)found regression of refraction at 6mo after surgery, while the UCVA of rest patients reached 1.0 at 3mo after surgery.

CONCLUSION: The SMILE procedure has high safety for myopia and myopic astigmatism. Effective prevention and management of the complications is the key to achieve the satisfactory visual acuity.

Abstract:AIM: To investigate curative effects of excimer laser corneal refractive surgery for adults or older adolescent with hyperopic anisometropic amblyopia.

METHODS: From March 2014 to March 2016, we selected 26 cases 26 eyes of adults or older adolescent with hyperopic anisometropic amblyopia in our hospital. All eyes underwent laser in situ keratomileusis, observed for the uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), diopter and stereopsis.

RESULTS: At the end of the follow-up, the patient's spherical equivalent and anisometropia were 1.47±0.51D and 1.15±0.22D, were significantly lower than that before operation(P<0.05). At the end of the follow-up, the distance and near UCVA and BCVA were 0.26±0.13 and 0.23±0.09, 0.42±0.09 and 0.31±0.16, which were significantly higher than those before operation(P<0.05). At the end of follow-up, the visual function of the patients was significantly improved(P<0.05), the rate of postoperative visual function < 100" eyes was 23%.

CONCLUSION: In adult or older adolescent with hyperopic anisometropic amblyopia, excimer laser corneal refractive surgery has a certain effect.

Abstract:AIM:To explore the treatment methods and curative effect of amblyopia in children, and to analyze the effect of compliance on the treatment process.

METHODS:The children with amblyopia treatment since January 1^st 2010 in General Hospital of Jinan Military Area, were selected and completed follow-up for a total of 129 eyes of 78 patients, including 53 eyes of male in 31 cases and 76 eyes of female in 47 cases, the initial age of 3 to 12 years, the treatment were performed with accurate optometry, reasonable glasses and appropriate to cover the dominant eye based comprehensive therapy and compliance training of the parents and children. The treatment time was 12-36mo, followed up for 3a. The final therapeutic effect was observed and the difference of the stage curative effect between the children with different grade of compliance(good, moderate and poor grade)was compared.

RESULTS:In the treatment of 36mo, 106 eyes were cured, 21 eyes were essentially recovered and the total cure rate was 98.4%, which was improved in 2 eyes(1.6%)and was ineffective in 0 eyes(0%); the total effective rate were 100%. The total cure rate was 69% in the treatment of 6mo and there was a significant difference in the cure rate among children with different compliance(overall comparison P<0.001, each comparison P<0.017). In the treatment of 12mo, the total cure rate was 89.1% and the cure rate were significantly different between children with the moderate compliance and the children with good compliance(P<0.05).

CONCLUSION:Comprehensive treatment of children with amblyopia can achieve an ideal clinical efficacy. Compliance is an important factor influencing the treatment effect and the treatment process. The parents and children's compliance training can shorten the course of treatment and improve the curative effect.