Abstract:AIM:To comprehensively investigate the relationship between outer retinal layer thickness and age in normal eyes.

METHODS: One hundred normal eyes of 100 subjects who underwent spectral-domain optical coherence tomography(SD-OCT)were included in this retrospective study. The distances between the external limiting membrane(ELM)line and the photoreceptor inner segment/outer segment(IS/OS)line(ELM-IS/OS), the IS/OS line and the cone outer segment tips(COST)line(IS/OS-COST), the COST line and the retinal pigment epithelium(RPE)complex(COST-RPE)and the full retinal thickness(RT)were measured at the fovea and on four quarters. The relationship between thickness and age or sex was then analysed.

RESULTS: A thinner RT was observed in women in a multiple regression analysis(men: 234.47±16.79 μm; women: 223.13±15.43 μm). The RT on the nasal quarter and the ELM-IS/OS thickness at the fovea and on the four quarters were significantly and negatively correlated with age. The IS/OS-COST and COST-RPE thicknesses at the fovea and on the four quarters were not significantly correlated with age or sex, respectively. The RT at the fovea was significantly thinner than on the four quarters. The ELM-IS/OS, IS/OS-COST and COST-RPE thicknesses at the fovea were significantly thicker than on the four quarters.

CONCLUSION: In normal eyes, the RT thickness on the nasal quarter and the ELM-IS/OS thickness were significantly and negatively correlated with age. The IS/OS-COST and COST-RPE thicknesses were not significantly correlated with age or sex.

Abstract:AIM:To investigate and analyse the prevalence and risk factors associated with diabetic retinopathy severity in Qingdao.

METHODS: This survey consisted of the 2 following parts: 2859 community residents aged >60 years old and 4275 patients with T2DM who were older than 30 years old in Qingdao. Ophthalmic examinations were performed on all patients. A questionnaire was used to obtain the patient's age and gender, the duration of diabetes mellitus(DM), glycaemic control and their knowledge of diabetic retinopathy(DR). Blood pressure and haemoglobin levels were recorded. All included patients underwent a comprehensive ophthalmic examination that included a fundus examination and retinal photographs and that assigned a grade for the severity of retinopathy according to the Early Treatment Diabetic Retinopathy Study(ETDRS)severity scale. Patients with severe non-proliferative or proliferative diabetic retinopathy and clinically significant macular edema(CSME)required ophthalmic therapy were assigned to the need-treatment group, while the remaining patients with DR were assigned to the need-observation group. Correlation and regression analyses were performed to determine the required-treatment rate and risk factors for DR. Logistic regression models were used to estimate odds ratios(OR)and 95% confidence intervals(CI)after adjustment for age, gender and the duration of diabetes.

RESULTS: DR was present in 334(11.68%)of the 2859 community residents aged >60 years old and 1097(25.66%)of the 4275 hospital patients with T2DM, and 48(14.81%)of the residents and 172(15.68%)of the hospital patients required ophthalmic therapy. In univariate and multivariate logistic analyses, factors including the age of the patients(51-60 years old: OR, 1.68; 95%CI, 1.21-1.72; 61-70 years old: OR, 1.55; 95%CI, 1.38-1.76), the duration of diabetes(11-15 years: OR, 2.61; 95%CI, 1.51-4.72; >15 years: OR, 4.15; 95%CI, 2.32-5.77), glycaemic control(medium: OR, 2.51; 95%CI, 1.98-3.92; poor: OR, 4.69; 95%CI, 3.39-6.95), and knowledge of DR(did not understand: OR, 1.45; 95%CI, 1.21-1.95)were significantly associated with the required-treatment rate in DR, while gender, low and advanced age(31-50 years old and >70 years old), duration of disease(<10y), hypertension, and insulin treatment did not.

CONCLUSION: The prevalence rate and the required-treatment rate in DR in Qingdao are relatively high. Being aged 51-70 years old and having a duration of diabetes >10y, poor glycaemic control and a lack of knowledge of DR were found to be potential risk factors that increased the rate of required ophthalmic therapy in patients with DR. In patients with T2DM who were aged 51-70 years old, we found that focusing on using science and education to strengthen the patients' knowledge of DR, establishing specifications for a community DR screening system, and effectively implementing early intervention in the community of DR-affected individuals were particularly important for preventing and controlling the high DR prevalence and the high rate of DR-associated blindness

Abstract:AIM: To determine the refractive and binocular vision status in clinical microscopists.

METHODS: It was an observational and cross sectional hospital based study. One hundred and three microscopists working at Tribhuvan University Teaching Hospital were recruited in the study. All subjects had a comprehensive eye examination including static retinoscopy, dynamic retinoscopy and orthoptic evaluation. Information about their visual symptoms associated with microscopy was also collected.

RESULTS: The prevalence of refractive error in this group of microscopists was 69.90%. Majority of the subjects were myopic(68.93% of total subjects)with the mean myopic error of -1.58±1.89 D. Convergence insufficiency was found in 61.20% of the study population. Prevalence of accommodative insufficiency and infacility were 41.30% and 40.06% respectively. Fusional vergence was also reduced in this study population. The outcomes of this study were expected to increase the awareness about the refractive and binocular vision anomalies among this population.

CONCLUSION: There was found to be increased prevalence of refractive error in clinical microscopists, especially myopia. Majority of them had vergence and accommodative anomalies. Most of the subjects reported asthenopic symptoms associated with their microscopy work, which may affect their work efficiency.

Abstract:AIM: To investigate the effect of Ghrelin on oxidative stress induced by high glucose in human retinal pigment epithelium(RPE)cells.

METHODS: RPE cells were cultured and divided into the negative control group, high sugar group, Ghrelin low dose group(10^-9 mol/L)and high dose group(10^-6 mol/L). Cells survival rate were detected by CCK-8 colorimetry, cells oxidative damage were observed by oxygen sensitive fluorescence probe H₂DCFDA staning, changes of intracellular reactive oxygen species(ROS)were detected by H₂DCFDA staining, super oxide dismutase(SOD)activity and malondialdehyde(MDA)content were detected by spectrophotometer colorimetry.

RESULTS: CCK-8 results showed that RPE cells survival rate increased to 54.79%±3.43% and 79.16%±3.29% after treated with 10^-9 mol/L, 10^-6 mol/L Ghrelin, the difference was statistically significant compared with high glucose group(41.65%±3.42%)(P<0.05). H₂DCFDA fluorescent probe dying showed that Ghrelin reduced ROS generation in RPE cells and decreased oxidative damage cells. Spectrophotometer colorimetric method showed that according to the high sugar group, SOD activity increased and MDA content decreased in Ghrelin group.

CONCLUSION: Ghrelin could inhibit high glucose-induced oxidative damage in human RPE cells, which has protective effect on the process of the occurrence and development of diabetic retinopathy.

Abstract:AIM: To research the morphological and fuctional change of human retinal pigment epithelium(RPE)induced by mobile phone screen light in vitro and the mRNA express of apoptotic inhibitor B-cell lymphoma(Bcl-2), Bcl2-Associated X(Bax)and apoptotic actuators Caspase-3 in different groups.

METHODS: Cultured human RPE cells were divided into different group in random. According to the time of exposing, the four groups were 3h group, 6h group, 12h group and no light-exposed group. Cells of different groups were exposed to the opening mobile phone that was kept high-light brightness and playing on the colorful picture on silent mode. The morphological and functional change of RPE was quantified after exposed by HE staining, TUNEL staining, MTT, and use the technology of polymerase chain reaction(PCR)to detect the mRNA express of apoptotic inhibitor Bcl-2, Bax and apoptotic actuators Caspase-3 in different groups.

RESULTS: The different was not statistically significant(P>0.05)in the way of HE staining, TUNEL staining and MTT. The expression of Bcl-2, Bax and Capase-3 intracellular was no difference statistically significant in 3h, 6h group to no exposure group on the way of PCR(P>0.05). But as the time of exposed increased to 12h, the expression of apoptotic inhibitor Bcl-2 decreased, at the same time the expression of apoptotic actuators Bax and Caspase-3 increased, and the different was statistically significant(P<0.05).

CONCLUSION: The human RPE would be injured under the constantly high-light brightness of mobile phone screen as the man-made light source.

Abstract:AIM: To study the mechanism and effect of Qingxuan decoction on evaporative dry eye in rabbit model.

METHODS: Totally 25 healthy male Japanese white rabbits were randomly divided into 5 groups: control group, model group, western medicine group, high dose of Qingxuan decoction group, low dose of Qingxuan decoction group. The blank control group did not do any treatment. The improved dry eye model of rabbit was prepared by the improved method of glandular burning of the eyelid plate. The high and low dose group were given daily 27.2mg/kg, 6.8mg/kg Qingxuan decoction by gavage. The model group was intragastric with the same amount of normal saline every day. The western medicine group with tobramycin and dexamethasone ophthalmic ointment 1 drops, once a day. The treatment were administered continuously for 28d. At 14d before the experiment, 7d before the experiment, 7d after the model, and 14d after the model, all the rabbits were tested by Schimer Ⅰ test(SⅠt)and break-up time(BUT). On the 15d after modeling, the animals were sacrificed by excessive anaesthesia. Rabbit ocular surface tissue sections were prepared. Hematoxylin-eosin staining method was used to observe the corneal morphological changes in each group. The concentrations of TNF-α, IL-1 and IL-6 in the ocular surface of rabbits were detected by ELISA.

RESULTS:(1)BUT, SⅠt: 7d after the model had been prepared, BUT and SⅠt of the model group and the western medicine group, high dose and low dose of Qingxuan decoction group was improved(P<0.05); Those of western medicine group, high dose and low dose of Qingxuan Decoction group compared with the model group, were significantly different(P<0.05).(2)TNF-α, IL-1, IL-6: The ELISA assay showed that TNF-α and IL-1, IL-6 concentration in the model group rabbits was significantly higher than those of the control group, TNF-α and IL-1, IL-6 concentration in western medicine group and high dose group of rabbits was significantly lower than those in the model group, the differences were statistically significant(P<0.05), and in high dose group the effect was better than that of Western medicine group.(3)Histopathological examination: on the 14d after the model, the corneal epithelium in the blank control group was stratified well. The cells in the base were columnar, near the surface, the cornea epithelium showed a squamous change. Conjunctiva showed complete epithelial layer and subconjunctival tissue layer, and goblet cells arranged closely. The number of corneal epithelial cells in model group was reduced or even stripped, and the matrix layer was disorder; Irregular loss of conjunctival epithelial cell layer and a large decrease in goblet cells. The corneal morphology of the rabbits in the western medicine group and the high dose group was close to the normal group, and the number of conjunctival goblet cells was not significantly different from that in the blank control group.

CONCLUSION: The expression of Qingxuan decoction can inhibit the inflammatory reaction through down-regulation of TNF-α and IL-1, IL-6 and in evaporative dry eye rabbit cornea and conjunctiva, so as to improve the ocular symptoms, increase tear secretion, prolong the time of BUT.

Abstract:AIM: To explore the effect of intravitreal injection of Conbercept combined with 23G minimally invasive vitrectomy on retinal hemorrhage, retinal proliferation and visual prognosis in patients with proliferative diabetic retinopathy(PDR).

METHODS: Totally 56 cases of PDR patients(56 eyes)admitted to our hospital were randomly divided into the conbercept group(n=28)and the pars plana vitrectomy(PPV)group(n=28). The conbercept group was given intravitreal injection of Conbercept and 23G minimally invasive vitrectomy, and the PPV group was given the 23G minimally invasive vitrectomy only. The operative time, retinal hemorrhage, retinal proliferation and visual acuity were compared between the two groups.

RESULTS: The operative time and intraoperative blood loss in the conbercept group were significantly lower than those in the PPV group(P<0.05). The visual acuity and macula thickness in the conbercept group were significantly better than those in the PPV group(P<0.05). The postoperative retinal hemorrhage score, retinal proliferative score, vitreous rebleeding rate and vascular endothelial growth factor(VEGF)level in the conbercept group were significantly lower than those in the PPV group(P<0.05).

CONCLUSION: Intravitreal injection conbercept combined with 23G minimally invasive vitrectomy for PDR can not only shorten the operative time, reduce the intraoperative retinal hemorrhage and postoperative rebleeding and the retinal proliferation, but also help patients with postoperative visual acuity recovery.

Abstract:AIM: To study the effect of panretinal photocoagulation(PRP)combined with calcium dobesilate on fundus microcirculation and the thickness of the retinal nerve fiber layer(RNFL)in patients with diabetic retinopathy(DR).

METHODS: Totally 166 cases of DR patients in the Department of Ophthalmology of our hospital in October 2015 to October 2017 were selected. According to the random number table method, 166 cases were divided into the control group(Group A)and the study group(Group B), with 83 cases in each group. Group A was treated with PRP, and Group B was given calcium dobesilate on the basis of Group A. Observation and comparison between the two groups on clinical curative effect, postoperative complication rate and the changes of best corrected visual acuity(BCVA), blood rheology index \〖hematocrit(Hct), erythrocyte sedimentation rate(ESR), deformation of erythrocyte(DE), plasma viscosity(PV), aggregation of erythrocyte(AE)\〗 and the changes of hemodynamic indexes \〖resistance index(RI), end diastolic velocity(EDV), peak systole velocity(PSV)of central retinal artery(CRA)\〗 before and after treatment. Besides, the RNFL thickness of the optic disc, the nasal side, the inferior and the superior side, and the average RNFL thickness of the optic disc center were observed and compared.

RESULTS: After treatment, BCVA in both groups decreased significantly compared with that before treatment(P<0.05), and there was no significant change between Group A and B(P>0.05), and the effective rate in Group B was significantly higher than that in Group A(P<0.05). There was no significant difference in the incidence of complications and the rate of loss of visits in the two groups of A and B(P>0.05). Compared with those before treatment, the EDV and PSV values of two groups increased after treatment(P<0.05), and RI value decreased(P<0.05). After treatment, the EDV and PSV values of CRA in Group B were significantly higher than those in Group A(P<0.05), and the values of RI and Hct, ESR, PV, DE and AE were significantly lower than those of Group A(P<0.05). After treatment, the average, inferior and superior RNFL of the two groups were all thinner than those before the treatment(P<0.05). The decrease of average, inferior, superior and nasal RNFL of Group A was more than those in the Group B(P<0.05).

CONCLUSION: Retinal photocoagulation combined with calcium dobesilate in the treatment of DR is effective and safe. It can effectively improve the fundus microcirculation and reduce the damage of PRP to DR patients' visual acuity and retinal nerve fiber layer thickness.

Abstract:AIM: To evaluate the efficacy and safety of ganciclovir combined with traditional Chinese medicine(TCM)in treatment of herpes simplex keratitis(HSK).

METHODS: All randomized controlled trials(RCTs)of ganciclovir combined with TCM for HSK were searched in CNKI, VIP, Wanfang, PubMed, Cochrane Library and EMbase database. The clinical endpoints of the total effective rate, relapse rate, heal time, and adverse reaction rate were collected to assess the drugs' efficacy and safety. The improved Jadad Scale was used to evaluate the methodological quality of included literatures. The RevMan5.3 software and Stata 12.0 were applied for meta-analysis.

RESULTS: We finally included 15 RCTs involving 1 285 patients. As for the total effective rate, relapse rate and heal time, significant differences were noted between ganciclovir combined with TCM group and ganciclovir alone group. For the total effective rate, RR and 95%CI were 1.23(1.15～1.31)according to the number of patients and 1.18(1.02-1.38)according to the number of diseased eyes. For relapse rate, RR and 95%CI were 0.25(0.17-0.36). For heal time, MD and 95%CI were -7.58(-10.89 to -4.26). No statistic difference of adverse reaction rate between the two groups was observed \〖RR=0.53, 95%CI(0.23-1.22)\〗. The side effects in the two groups were mild and could be relieved by themselves.

CONCLUSION: The ganciclovir combined with TCM can improve the total efficacy, reduce the relapse rate, and shorten the course of treatment for HSK with good safety.

Abstract:Age-related macular degeneration(AMD)is one of the major irreversible blinding disease affecting in nearly 50 million individuals globally. The pathogenesis and prevention of AMD has become research focus for several years. Amyloid β(Aβ), formed by hydrolysis of the precursor protein, is synthesized and secreted in retinal ganglion cells(RGCs)and retinal pigment epithelium(RPE)monolayer. Normally, the formation and degradation of Aβ maintain a dynamic equilibrium. When the balance was damaged, Aβ can deposit in retina which not only constitute the main components of drusen but activate complement system and induce inflammation in local tissue. Here, we review the most recent findings supporting the hypothesis that Aβ could be a key factor in AMD which may offer a better understanding of disease mechanism and develop new strategies affecting the pathogenesis.

Abstract:Diabetic retinopathy(DR)is a microvascular and neurological complication of diabetes mellitus. Oxidative stress is an important pathogenic mechanism for the occurrence of DR. Autophagy is a crucial regulatory mechanism of cells under both physiologic and pathologic conditions. It can maintain intracellular homeostasis by degrading redundant or damaged proteins and organelles in cells. Prior studies have documented that there is a strong connection between autophagy and oxidative stress of DR. This article reviewed previous findings regarding the specific relationship between autophagy and oxidative stress in DR, including early microvascular lesions, neuropathy and other pathological changes. The aim of this review is to provide new ideas to clarify the pathogenesis of DR.

Abstract:China has a large number of Hepatitis B virus carriers. Though hematogenous dissemination is the main transmission route, much remains unknown about the way the virus spreads. It is doubted that people may get the disease through various body fluids in daily activity. Some routine examinations in ophthalmology department such as Goldmann applanation tonometry could not avoid contact with patients' ocular surface and may cause virus spread due to the residual tears on the instrument. So it is quite necessary to inspect the tear infectiousness of Hepatitis B virus. This review summarized recent studies about hepatitis B virus transmission via tears.

Abstract:Accompanied with the rapid progress of materials technology and tissue engineering science, the increasing number of materials of organic polymer structure, especially nano-materials were highlighted by researchers in the field of biomedicine. Caused by some certain kinds of features, their excellent biocompatibility and security secondary to material size, surface modification, new materials were playing unique roles in drug delivery system, controlled release unit, disease detection etc. It provides a novel approach to diseases therapy. The application of new materials regarding organic polymer to ophthalmic drug therapy were focused in the review.

Abstract:Glaucoma filtration surgery is currently the preferred method for patients in whom anti-glaucoma medication and laser treatment can not control intraocular pressure, and its postoperative filtering bleb scar formation is the leading cause of surgical failure. At present, there are some progresses in the basic and clinical studies of postoperative anti-glaucoma scar. However, it is still a problem to seek for an effective, safe and stable treatment of scarring after glaucoma filtration surgery. Those articles published in the past three years on the glaucoma filtration after anti-scarring related drugs are reviewed.

Abstract:Glaucoma is a progressive optic neurodegenerative disease with specific characteristics of structural optic nerve head(ONH)and with changes in the inner retinal layer(ganglion cell complex)along with the presence of corresponding functional visual field(VF)changes that are irreversible. Obstructive sleep apnea hypopnea syndrome(OSAHS)is characterized by recurrent complete or partial interruption of normal breathing due to functional occlusion or collapse of upper airway during sleep that leads to apnea or hypopnea and hypoxia. This causes decrease in the arterial oxygen(O₂)saturation and a rise in the carbon dioxide saturation during sleep and results in transient hypoxia and increased vascular resistance in body tissues. OSAHS is an independent risk factor for cardiovascular and cerebrovascular, and many reports showed that OSAHS is one of the systemic risk factors for glaucoma which causes irreversible visual field damage, but lacks a systematic analysis of the relationship between the two. Comprehensive glaucoma evaluation should be recommended in patients with OSAHS.

Abstract:Delayed absorption of limited subretinal fluid occurs in some patients with rhegmatogenous retinal detachment(RRD)after scleral buckling. The macular-off patients may be effected more on visual function. The progress of recent researches on the epidemiology, diagnosis, pathogenesis and treatment of persistent subretinal fluid with rhegmatogenous retinal detachment has been summarized in this article.

Abstract:Diabetic Retinopathy(DR)has gradually worsening and lingering, which is the leading cause of global young people blindness. With the progression of the disease, patients with diabetes mellitus(DM)will have different degrees of DR. If you can not prevent and give acute early intervention, once the visual acuity decreased significantly, DR would be difficult to reverse. DR progressively has worsening, the treatment status has no optimistic. Therefore, DR in the early prevention and treatment will be indispensable. This article summarizes some of the early warning of the occurrence and development of biological markers and characteristic indicators in order to provide a basis for the early prevention of DR.

Abstract:Convergence insufficiency, basic exophoria and pseudo convergence insufficiency are three common reason for visual dysfunction. It's difficult for optometrist to differential diagnosis because of the similar signs and symptoms. Comprehensive analysis of distance & near eye position, accommodation, AC/A ratio and negative/positive relative accommodation(NRA/PRA)may help optometrist to make an accurate diagnosis and treatment strategy, which may relax asthenopia and maintain normal binocular vision.

Abstract:AIM: To quantitatively assess the influence of pars plana vitrectomy(PPV)on the length of lens zonules and anterior chamber depth(ACD).

METHODS: The medical records of 87 cataract patients(88 eyes)were retrospectively reviewed. Forty-three patients(44 eyes)with previous PPV were included in the study group, and 44 patients(44 eyes)without a history of PPV were served as control group. Length of zonules and anterior chamber depth(ACD)were quantitative analyzed based on the data from ultrasonic biomicroscopy(UBM)and IOL Master examinations respectively.

RESULTS: The average length of zonules in study and control group were 1.09±0.24mm and 0.78±0.22mm, respectively, and the difference was statistically significant(P<0.05). The ACD of the two groups were 3.25±0.39mm and 3.44±0.48mm, respectively, and a statistical difference was observed(P<0.05). The length of zonules in the control group was positively correlated with the ACD(r=0.468, P=0.001), however, this was not the case in the study group(r=0.173, P=0.263).

CONCLUSION: Previous vitrectomy may cause changes in zonular length, which may imply a possibly weakened zonules, especially for patients with the axial length less than 29mm. The change in anterior chamber depth in patients with previous PPV may not be correspondent to that in the length of zonules. The findings of our study suggest that preoperative conditions of zonules and anterior chamber should be fully understood to reduce the related complications and to improve the safety and efficiency of cataract surgery after pars plana vitrectomy.

Abstract:AIM:To compare the short-term surgical results of 27-gauge(27G)with 25-gauge(25G)microincision vitrectomy surgery(MIVS)for the treatment of vitreoretinal diseases and evaluate the feasibility, safety and effectiveness of 27G MIVS.

METHODS:Two hundred and seventeen eyes with various vitreoretinal diseases underwent 27G or 25G MIVS from April 2016 to October 2017 and were retrospectively reviewed. One hundred and thirty-five eyes underwent 27G vitrectomy and 82 eyes for 25G vitrectomy. The main outcome measurements of the study included surgical time, intraoperative complications, postoperative ocular inflammation reaction, short-term best corrected visual acuity(BCVA, LogMAR)recovery and intraocular pressure fluctuation.

RESULTS:All surgeries were completed successfully, and no eye in 27G group needed conversion to 25G vitrectomy. The mean surgical times in the 25G group was 56.4±38.9 min, which was significant longer than that of 27G group(45.5±26.1 min, t=2.422, P=0.016). However, when comparing the surgical time for each category of disease, there were no significant differences observed(P>0.05). Within the first week postoperatively, the mean cumulative score of conjunctival congestion, anterior chamber flare and aqueous cell in 25G group were 2.4±1.4, 0.7±1 and 0.5±1, which were higher than those in 27G group(2.1±1.6, 0.3±0.6, and 0.2±0.4), with significant differences(P=0.038, P=0.011, P=0.046 respectively). The improvement of BCVA was -0.4±0.9 in 25G group, and -0.2±0.9 in the 27G groups respectively(t=-1.636, P=0.103). The rate of transient ocular hypotony of the 25G vitrectomy was 19.5%(16 eyes), which was higher than that of the 27G group without significant difference(15.6%, 21 eyes; χ²=0.565, P=0.452). When the eyes injected with silicone oil were excluded, there was no significant difference in intraocular pressure fluctuation between the 25G group(3.59±0.69mmHg)and the 27G group(3.58±0.47mmHg; t=0.007, P=0.995).

CONCLUSION: The 27G microincision vitrectomy can be used to treat various vitreoretinal diseases. It is a safe and effective surgical procedure with small incision and mild anterior segment inflammatory reaction.

Abstract:AIM: To explore the effect of different incision phacoemulsification on corneal endothelial function and tear film function in senile cataract(SC)patients.

METHODS: Totally 90 SC patients(90 eyes)admitted to our hospital were randomly divided into the 2.2mm group(n=47, 47 eyes, 2.2mm corneal micro-incision phacoemulsification)and the 3.0mm group(n=43, 43 eyes, 3.0 mm clear corneal micro-incision phacoemulsification). The indexes of corneal endothelial function and tear film function were compared between the two groups before and after operation.

RESULTS: There was no statistical difference on the average phacoemulsification time(APT), mean effective phacoemulsification time(EPT), average phacoemulsification energy(AVE)and preoperative and postoperative intraocular pressure between the two groups(P>0.05). There were statistical differences on the tear break-up time(BUT), basal tear secretion test(ST-Ⅱ), corneal sodium fluorescein staining(SCSF)score, corneal endothelial cell count, central corneal thickness and the variation coefficient of corneal endothelial cells between the two groups(P<0.05). At 1wk and 1mo after operation, the BUT in the two groups was significantly lower than that before operation(P<0.05)while the ST-Ⅱ was significantly higher than that before operation(P<0.05), and the SCSF first increased and then decreased(P<0.05), and corneal endothelial cell count was significantly lower than that before operation(P<0.05), and the central corneal thickness and the variation coefficient of corneal endothelial cells significantly increased(P<0.05). The changed degrees of BUT, ST-Ⅱ, SCSF score, corneal endothelial cell count, central corneal thickness and corneal endothelial cell variation coefficient in the 2.2mm group were less than those in the 3.0mm group(P<0.05).

CONCLUSION: Phacoemulsification for SC patients can cause some damage in corneal endothelial function and tear film function, and 2.2mm corneal micro-incision have less damage and faster early recovery.

Abstract:AIM: To investigate the visual acuity after cataract extraction and vitrectomy with gas tamponade for idiopathic macular hole(IMH)at different stages.

METHODS: In this study, 75 IMH patients(75 eyes)treated in our hospital from August 2014 to August 2016 were enrolled and underwent cataract extraction, vitrectomy and C₃F₈ gas tamponade. Patients were divided into stage Ⅱ Group(18 cases), stage Ⅲ(36 cases)and stage Ⅳ(21 cases)according to Gass stages, and macular hole closure at 2 and 4wk postoperatively were compared. The routine visual acuity examination before and after surgery were performed, and the visual acuity in each group were compared. The optical coherence tomography(OCT)was used to measure the macular thickness before and after surgery.

RESULTS: The closure rate of macular hole in stage Ⅱ was significantly higher than that of stage III and IV at the 1mo after operation, that at the stage Ⅲ was significantly higher than that of stage Ⅳ group, and the difference was statistically significant(P<0.05). There was no significant difference in the rate of closure of macular hole between stage Ⅱ and stage Ⅲ at 3mo after operation(P>0.05). The proportion of eyes with visual acuity of finger counting, 0.02-0.08, 0.10-0.20, 0.25-0.40 and ≥0.50 was statistically significant different before and after surgery(P<0.05). The improvement rate of visual acuity was 94% in stage Ⅱ, which was significantly higher than that in stage Ⅲ(83%)and stage Ⅳ(67%). The macular thickness of the stage Ⅱ and Ⅲ was significantly lower after the surgery, but there was no significant difference in the stage Ⅳ before and after surgery(P>0.05), the decreasing range of the stage Ⅱ and Ⅲ was not statistically significantly different(P>0.05), which were significantly higher than that of the stage Ⅳ, the difference was statistically significant(P<0.05).

CONCLUSION: Cataract extraction, vitrectomy and C₃F₈ gas tamponade surgery is conducive to the vision recovery after idiopathic macular hole, but the effects with different Gass staging are different, surgery should be performed as early as possible to improve macular hole closure and eyesight recovery.

Abstract:AIM: To observe the efficacy of vitamin A palmitate eye gel and carboxymethylcellulose sodium eye drops on prevention of dry eye after phacoemulsification.

METHODS: Ninety patients(ninety eyes)with age-related cataract enrolled in our hospital from March 2016 to August 2017 were performed phacoemulsification with intraocular lens implantation. They were randomly divided into three groups as control group(n=30), treated group Ⅰ(n=30)and treated group Ⅱ(n=30). The control group was administered with tobramycin and dexamethasone eye drops for 15d as the basis therapy. In treated group Ⅰ, patients were administered with carboxymethylcellulose sodium eye drops for 30d based on the treatment of the control group. The treated groupⅡ was administered with vitamin A palmitate eye gel for 30d on the basis of the treated group Ⅰ. The dry eye symptom score, corneal fluorescence(FL)staining scores, breakup time of tear film(BUT)and Schirmer Ⅰ test(SⅠt)without topical anesthesia were examined in 1d before operation and 15d and 30d after operation.

RESULTS: There were no statistically significant differences in subjective symptom scores of dry eye, BUT values, FL scores, and SⅠt values among the three groups before treatment(P>0.05). After treatment, dry eye symptom scores, FL scores, and SⅠt values increased at first and then decreased with time. BUT values decreased at first and then increased. Fifteen and thirty days after surgery, dry eye symptom scores, FL scores, and SⅠt values were significantly lower in the treated group Ⅰ and the treated group Ⅱ than in the control group. While BUT values were significantly higher than that in the control group. The dry eye symptom scores and SⅠt value of treated group Ⅱ were significantly lower than the treated group Ⅰ, and the BUT value was significantly higher than that of the treated group Ⅰ(P<0.05).

CONCLUSION: Phacoemulsification combined with intraocular lens implantation has a certain damage of ocular surface tissue on the initial stage. The application of vitamin A palmitate eye gel combined carboxymethylcellulose sodium eye drops can improve the dry eye symptoms.

Abstract:AIM: To investigate the effect of calcium dobesilate on vitreous hemorrhage in patients with proliferative diabetic retinopathy(PDR)after pan retinal photocoagulation(PRP).

METHODS:Totally 62 patients(30 cases with binocular lesions, 32 cases with monocular lesions, a total of 92 eyes)with PDR who were treated in our hospital from January 2015 to July 2017 were selected as the subjects. They were divided into the control group(treated with pan retinal photocoagulation, n=30, 17 cases with monocular lesions, 13 cases with binocular lesions, a total of 43 eyes)and the study group(treated with calcium dobesilate on the basis of treatment for the control group, n=32, 15 cases with monocular lesions, 17 cases with binocular lesions, a total of 49 eyes). The recovery of visual acuity, blood rheology(plasma viscosity, hematocrit, erythrocyte deformation index)and the incidence of complications such as vitreous hemorrhage in the two groups after surgery were observed.

RESULTS: There was no significant difference between the two groups in the rate of excellent and good visual acuity, plasma viscosity, hematocrit or erythrocyte deformability index before treatment(P>0.05). After treatment, the rate of excellent and good visual acuity in the study group was significantly higher than that in the control group(P<0.05). After treatment, the plasma viscosity and hematocrit decreased significantly while the erythrocyte deformability index significantly increased only in the study group, and changes of above-mentioned indexes in the study group were more obvious than those in the control group after treatment(P<0.05). The incidence rate of vitreous hemorrhage and total incidence rate of complications in the study group were significantly lower than those in the control group(P<0.05).

CONCLUSION: The application of calcium dobesilate in patients with PDR after pan retinal photocoagulation can effectively improve the recovery of visual acuity and reduce the incidence of complications such as vitreous hemorrhage. The mechanism may be related to effectively improving the hemodynamics.

Abstract:AIM: To investigate the visual recovery factors in patients with complex traumatic and non-traumatic retinal detachment.

METHODS: According to the history of ocular trauma before admission, 135 patients with complex retinal detachment were divided into traumatic group(n=66, 66 eyes)and non-traumatic group(n=69, 69 eyes). The results of visual recovery and complications were compared between the two groups. Logistic regression was used to analyze the related factors of visual recovery in the two groups.

RESULTS: There was no significant difference in the recovery rate between the two groups within 24h after surgery(77.3% vs 78.3%, P>0.05), and there was no significant difference in the total incidence of complications at 3mo after surgery(18.2% vs 17.4%, P>0.05). Multifactorial Logistic regression analysis showed significant correlation between age, injury type, time since retinal detachment, rage of retinal detachment, preoperative vitreous blood, proliferative vitreoretinopathy(PVR)and postoperative visual recovery in patients with complex traumatic retinal detachment(P<0.05); age, time since retinal detachment, rage of retinal detachment and macular status were significantly associated with visual recovery in patients with complex non-traumatic retinal detachment(P<0.05).

CONCLUSION: Age, time since retinal detachment and rage of retinal detachment were significantly associated with traumatic and non-traumatic retinal detachment. The injury type, preoperative vitreous hemorrhage, PVR were significantly correlated with the visual recovery of traumatic retinal detachment patients. The condition of macular was significantly associated with the visual recovery of non-traumatic retinal detachment patients.

Abstract:AIM:To evaluate the efficacy of anti- vascular endothelial growth factor(VEGF)and photodynamic therapy(PDT)on pathological myopia(PM)combined with choroidal neovascularization(CNV)using ETDRS chart and multifocal electroretinogram(mfERG).

METHODS: Forty-three patients(45 eyes)diagnosed by fundus fluorescein angiography(FFA), indocyanine green angiograph(ICGA)and optical coherence tomography(OCT)with PM combined with macular CNV were recruited in this study. The patients were randomly divided into two groups for different treatments, intravitreal injection with Ranibizumab(20 patients, 22 eyes)and PDT(23 patients, 23 eyes). After treatment, all patients had been followed up monthly for 12mo. The further treatments were operated according to referral situations. The best corrected visual acuity(BCVA)was recorded with the ETDRS chart and mfERG. At the last follow-up, the therapy efficacy was determined by ETDRS numbers and mfERG and analyzed.

RESULTS:Before treatment, there was no significant difference on the baseline in ETDRS and mfERG latency of N1 wave, latency and the density values of P1 wave between ranibizumab group and PDT group. After 12mo treatment, the ETDRS number in ranibizumab group(39.23±20.06)significantly increased to the baseline by 5.88±9.03(P<0.05), and in PDT group(37.38±16.95)was not significantly improved by 0.33±6.94(P>0.05). There was no significant difference in latency of N1 wave, latency and the density values of P1 wave from treatment response of mfERG in the two groups(P>0.05).

CONCLUSION: In the treatment of macular CNV complicated by the PM, ranibizumab injection can improve visual function better than PDT, while similar on macular.

Abstract:AIM: To compare intervention effects on myopic children between three groups including orthokeratology combined with visual training(OCVT), orthokeratology(ortho-k), and single vision spectacle lense(SVL).

METHODS: A prospective, non-randomized, case-control study was performed from September to October 2016. One hundred and twenty myopic children were enrolled from the Shaanxi Eye Research Institute and divided into three groups, which consists of 37 in OCVT group, 43 in ortho-k group and 40 in SVL group. The changes of uncorrected visual acuity(UCVA), axial length(AL)and spherical equivalent refractive error(SER)before and after 1a intervention were compared between the three groups.

RESULTS: A total of 103 children completed the study, 31 in OCVT group, 37 in ortho-k group, 35 in SVL group. The changes before and after intervention of UCVA, AL, SER were significant differences between the three groups separately(P<0.01). Furthermore, the improvement effect of each parameter in the SVL group was worse than that in the OCVT group and the ortho-k group(P<0.05). Although the improvement effect in the OCVT group was slightly better than the ortho-k group, the difference was not statistically significant (P>0.05). After 1a intervention, UCVA was greatly improved(P<0.05), SER was reduced(P<0.05), but AL was not significantly changed(P>0.05)in the OCVT group. In ortho-k group, UCVA was improved, SER was reduced, and AL increased significantly(all P<0.05). UCVA decreased, as well as AL and SER increased significantly in the SVL group(all P<0.05).

CONCLUSION: Orthokeratology combined with visual training has a good control effect on myopic children, but the timing, method, time length and frequency of visual training still need further study.

Abstract:AIM: To research the quality of life(QOL)and influencing factors in patients with diabetic retinopathy(DR).

METHODS: A total of 103 diagnosed case of diabetic retinopathy from January 2017 to August 2017 in Daping Hospital of Chongqing were enrolled in this study. The questionnaire survey was conducted using Scale of Quality of Life in Patients with Visual Impairment(SQQL-VI)and social support revalued scale. The factors influencing their quality of life were also analyzed. The data were analyzed by SPSS 25.0 software. Proportions were compared by using the chi-square test and the means were compared by using the t-test. The factors of DR such as age, gender, education and social support were analyzed using stepwise multiple linear regression.

RESULTS: The scores in the patients with diabetic retinopathy included total quality of life 63.59±9.58, symptoms and visual function 53.13±8.51, body function 28.39±3.86, social activities 27.95±3.63, psychological aspects 27.78±3.85. The single factor analysis showed that there were significant differences in age, education level occupation, monthly income, the style of medical cost, course of disease, and social support(P<0.05). Multivariate linear regression indicated that age, education level, the style of medical cost, course of disease, and social support were statistically significantly associated with the quality of life(P<0.05).

CONCLUSION: To improve the quality of life of DR patients, it is essential to reduce the financial burden and increase the social support.

Abstract:AIM: To investigate the prevalence of myopia among primary and middle school students aged 7 to 18 in Longkou City, Shandong Province, and to provide a scientific basis for prevention and control of myopia.

METHODS: The students aged 7 to 18 were enrolled through the method of stratified random and cluster sampling by the unit of schools and were investigated in Longkou, Shandong Province in 2015. A total of 58 schools were selected and 61 036 students were effectively sampled. All the subjects were divided into three-tiers based on geographical location: urban, rural-urban continuum, and rural areas. All the subjects were examined with the visual acuity and non-cycloplegic objective fraction. Microsoft Excel worksheet was used to establish a database, and SPSS 21.0 software was used for statistical analysis.

RESULTS: The prevalence of total myopia in the sample population of students of Longkou in 2015 was 49.81% from 7 to 18 years old. The overall prevalence of myopia increased fastest from 11 to 12 years old. And the prevalence of mild myopia of students aged 13 was highest. The prevalence of total myopia were 46.41% for boys and 53.39% for girls, which showed the prevalence of girls was higher than the boys'. The prevalence of myopia in urban, rural-urban continuum, and rural areas were 55.18%, 49.75%, 44.47%, respectively, and the prevalence of myopia in urban areas was the higher than the rural-urban continuum and the rural areas. The prevalence of total myopia gradually increased with age(r_s=0.943, P<0.05).

CONCLUSION: The results of the investigation showed a high prevalence of myopia among primary and middle school students in the city of Longkou, and gradually increased with age. The overall myopia prevalence for girls was higher than boys, and the prevalence was highest in urban areas.

Abstract:AIM: To explore whether the drainage angle could be reopened by surgery in patients with severe acute angle-closure glaucoma at “the greatest degree” of angle closure, and to study the treatment methods, such as double-paracentesis, phacoemulsification combined with goniosychialysis, and the effectiveness.

METHODS: Retrospective observational case series. From November 2008, to November 2015, there were 33 patients with severe acute angle-closure glaucoma and 360° angle closure. Drug treatment showed no effect on them, so initial double-paracentesis(anterior chamber paracentesis combined with vitreous paracentesis)was applied. Then, either phacoemulsification combined with goniosychialysis or trabeculectomy surgery was performed after 7-14d, which was chosen based on the result of gonioscope during the surgery. The intraocular pressure, angle changes, and complications were observed. The follow-up period was 6mo to 3a.

RESULTS: Of 33 participants enrolled, 32 had normal intraocular pressure after “double-paracentesis”(2 had normal intraocular pressure after laser peripheral iridotomy). The mean intraocular pressure was significantly reduced from 53.4±10.7mmHg to 16.9±13.2mmHg(t=9.21,P<0.001)by applying “double-paracentesis”, and 1 still had higher intraocular pressure. The mean intraocular pressure(16.7±4.8mmHg)was 0.2mmHg lower after phacoemulsification than after “double-paracentesis” while there was no significant difference(t=0.38,P>0.05). One patient had abnormal intraocular pressure until 30d after phacoemulsification. Every participant had 360° angle closed before “double-paracentesis”, 32 patients had opened angle(mean 131.8°±111.3°)after “double-paracentesis” and mean(228.6°±108.3°)during phacoemulsification, and mean(234.6°±107.2°)at 3mo after phacoemulsification. There was a significant difference between the post-paracentesis and intraoperative values(t=4.52, P<0.001). There was no difference between the intraoperative and postoperative values(t=0.46, P>0.05). No patients had serious adverse events.

CONCLUSION: For the “maximum degree” angle closure of severe acute angle-closure glaucoma, “double-paracentesis” combined with phacoemulsification can be chosen to open the angle gradually, and reduce intraocular pressure in vast majority of patients.

Abstract:AIM: To observe the efficacy of 25G+ vitrectomy surgery for malignant glaucoma after cataract surgery.

METHODS: Totally 18 eyes of 18 patients with malignant glaucoma after cataract surgery were analyzed retrospectively from January 2013 to June 2016. The visual acuity was between hand moving to 0.5 before surgery, the intraocular pressure was between 18.3-56.8mmHg before surgery, an average of 35.21±10.43mmHg. The length eye axis was between 19.60-22.46mm, an average of 20.63±0.48mm. The depth of anterior chamber was between 0.98-1.86mm, an average of 1.31±0.22mm. All the patients were performed with 25G+ vitrectomy. The visual acuity, anterior chamber and intraocular pressure were studied after treatment.

RESULTS: The patients were followed up for 6-18mo with an average of 9mo. BCVA at the last follow up improved to 0.2-0.8, and there was significant difference compared to that before operation(P<0.01). IOP was from 12.3-19.8mmHg, an average of 16.05±2.46mmHg, there was significant difference compared to that before operation(t=7.59, P<0.01). The depth of anterior chamber was between 1.89-3.49mm, an average of 2.42±0.47mm, there was significant difference compared to that before operation(t=9.07, P<0.01). Only one case had IOP of 8mmHg, after treatment the IOP was 15mmHg. No complications such as corneal endothelium decompensation, intraocular lens(IOL)capture, intraocular hemorrhage, infection and uncontrolled IOP were observed.

CONCLUSION: The 25G+ vitrectomy is safe and effective for treating malignant glaucoma, controls IOP and reduces complications compared with traditional vitrectomy.

Abstract:AIM: To study the influence of Ahmed glaucoma valve implantation on eyesight, intraocular pressure and corneal endothelial cell density of patients with traumatic angle recession glaucoma.

METHODS: Totally 33 cases(35 eyes)of patients with traumatic angle recession glaucoma admitted to our hospital since June 2014 to June 2016 were selected and treated with Ahmed glaucoma valve implantation. The clinical data of all patients were retrospectively analyzed, so as to evaluated to success rate of surgery. Non-contact tonometer was applied to surveying intraocular pressure before treatment and at 1wk, 1,3,6mo and 1a post treatment. Specular microscope was adopted to examine and calculate the corneal endothelial cell density before treatment and at 1wk, 1,3,6mo and 1a post treatment. All affected eyes were compared for visual acuity before surgery and in 1a after surgery, moreover, patients were followed-up, received the further consultations and the complications were recorded.

RESULTS: As for 35 affected eyes, the absolute success rate of surgery was 54%, while the relative success rate was 40%, and the total successful rate and failure rate were 94% and 6% respectively. In terms of the number of people who had no light sensation before surgery, or who had light sensation, ≤0.01, 0.01-0.10 or >0.10-0.20, there was no significant difference(Z=-0.132, P=0.362). The intraocular pressure before treatment was 43.43±3.65mmHg, at 1wk after surgery was 13.50±2.54mmHg, at 1mo was 15.93±2.61mmHg,at 6mo was 16.00±2.18mmHg and at 1a was 16.45±2.21mmHg, and the difference among different time points had statistical significance(F=887.82, P<0.01). After treatment the intraocular press decreased compared to before treatment(P<0.05); those after treatment had no difference with each other(P>0.05). Before treatment, the corneal endothelial cell density was 2443.35±343.12 pieces/mm², in 1wk after the surgery was 2231.67±334.45 pieces /mm², in 1mo after the surgery was 2065.47±336.45 pieces /mm², in 3mo after surgery was 2031.47±345.76 pieces/mm², in 6mo was 2001.72±337.18 pieces /mm² and in 1a after the surgery was 1979.65±301.32 pieces /mm², and the difference among different time points had statistical significance(F=13.49, P<0.01). After treatment the corneal endothelial cell density decreased compared to before treatment(P<0.05); those after treatment had no difference with each other(P>0.05). After surgery, there were 4 cases(4 eyes)of ocular hypotension, 3 cases(3 eyes)of hyphema, 2 cases(2 eyes)of drainage tube plugging and 2 cases(2 eyes)of intraocular hypertension, which were all quickly relieved after basic intervention treatment.

CONCLUSION: Treating traumatic angle recession glaucoma with Ahmed glaucoma valve implantation can dramatically optimize the state of intraocular hypertension and protect the retaining visual acuity, and visual acuity can be optimized in some cases. It causes little complication that can be relieved with basic prognosis, but postoperative corneal endothelial cell loss exists in some cases.

Abstract:AIM:To compare the effectiveness of inverted internal limiting membrane flap(ILMF)coverage combined with sterile air tamponade or C₃F₈-filled surgery for idiopathic macular hole(IMH).

METHODS: In this retrospective study, 165 patients(175 eyes)who underwent pars plana vitrectomy(PPV)combined with inverted ILMF coverage were evaluated. The surgeries were performed by one surgeon at the Renmin Hospital, Wuhan University between January 2014 and June 2017. The patients were divided into sterile air(Group A)and C₃F₈-filled(Group B)groups, based on the technique used for intraocular tamponade. With a minimum 3-month follow-up, pre- and post-operative best corrected visual acuity(BCVA), macular hole closure rate, and major postoperative complications were analyzed.

RESULTS: Both groups showed significant improvement in visual acuity at 1 and 3mo postoperatively(P<0.05). There was no significant difference between the two groups 1mo postoperatively, but the average BCVA in Group A was better than that in Group B at 3mo, to a level of statistical significance(P<0.05). The closure rate of macular hole was 97.5% in Group A and 96.8% in Group B, a statistically non-significant difference. There were no statistically significant differences in defect diameters of the inner and outer junctions between the two groups at 1 and 3mo postoperatively(P<0.05), but significant differences compared to before surgery in both groups(P<0.05). The rate of IOP elevation was 9.5% in Group B, and zero(0)in Group A; this difference was statistically significant(P<0.05).

CONCLUSION: We postulate that PPV combined with inverted ILM flap is a safe and effective method for surgical management of IMH. Compared to C₃F₈-filling, sterile air tamponade can avoid IOP elevation; it may replace C₃F₈-filling in PPV for IMH.

Abstract:AIM: To evaluate the effect by optical coherence tomography angiography(OCTA)after intravitreal injection of Conbercept for wet age-related macular degeneration(wAMD)patients.

METHODS: The retrospective review included 18 patients(20 eyes)which were diagnosed with wAMD in Wuhu Ophthalmic Hospital from December 2016 to November 2017. All affected eyes were injected by conbercept, examined for the best corrected visual acuity(BCVA)and OCTA examine the foveal macular thickness(FMT), parafoveal macular thickness(PMT), choroidal neovascularization(CNV)flow area, foveal superficial vascular plexus flow density and parafoveal superficial vascular plexus flow density. The paired t test was used to compare those before and after treatment.

RESULTS: One months after treatment, the mean BCVA were improved with significant difference(P<0. 05). And the mean FMT, PMT, CNV flow area and foveal superficial vascular plexus flow density significantly decreased with significant difference(P<0.05), and the mean parafoveal superficial vascular plexus flow density decreased but with no statistical significance(P>0.05).

CONCLUSION: This study confirmed that the intravitreal injection of conbercept for treating wAMD is safe and effective. Intravitreal conbercept injections are associated with a significant change in native retinal and choroidal vasculature. OCTA could evaluate the effection of intravitreal injection of conbercept for wAMD more safely, objectively and conveniencely.

Abstract:AIM:To discuss the clinical efficacy of 27-gauge(27G)vitrectomy with proliferative membrane cutting in situ for late proliferative diabetic retinopathy(PDR).

METHODS: Collecting 10 cases(15 eyes)with late PDR from January 2017 to August 2017 which underwent 27G microincision vitrectomy with cutting proliferative membrane in situ, we observed the rate of intraoperative iatrogenic retinal hole(IRH), the rate of silicone oil tamponade, the best corrected visual acuity(BCVA)and intraocular pressure(IOP)before and after operation.

RESULTS: IRH occurred in 4 eyes(27%, 4/15); Silicone oil was tamponaded in 6 eyes(40%, 6/15); BCVA was improved in 13 eyes and only 2 eyes unchanged 3mo after operation. The best visual acuity(VA)was 0.6. There was significant difference on BCVA between preoperative and postoperative 7d(P<0.05). The same was found between preoperative and postoperative 1mo, even 3mo(P<0.05). The average preoperative IOP was 16.95±6.87mmHg and postoperative 3mo was 15.27±4.57mmHg. There was no significant difference between them(P>0.05).

CONCLUSION: The 27G vitrectomy with cutting proliferative membrane in situ method is markedly superior in the treatment of late PDR, and the curative effect is specific. It can be given preference to late PDR.

Abstract:AIM:To observe the therapeutic effect of the mild form disseminated photocoagulation treatment for moderate non-proliferative diabetic retinopathy(MNPDR).

METHODS: Prospective randomized controlled study. Totally 126 cases(209 eyes)with MNPDR were randomly assigned to two groups in ophthalmology department of Shanghai Shidong Hospital. There were 62 cases(103 eyes)were treated with the mild form disseminated photocoagulation as the therapy group, 64 cases(106 eyes)were treated with control of blood glucose as the control group. All cases were followed up for 24mo. The best corrected visual acuity(BCVA), fundus change and central visual field were observed and compared.

RESULTS: At 24mo after treatment, BCVA variety between two groups took on significant statistical difference which indicated that there were more eyes with improved or stable visual acuity in therapy group(H_c=5.942, P<0.05). There was significant difference in fundus examination between two groups which indicated that there were more eyes with improved or stable fundus change in therapy group(H_c=12.662, P<0.05). There was no significant difference in average mean sensitivity(MS)between before and after laser therapy for 12mo(t=3.1586, P>0.05). During our follow-up, there were no complications likewise infection, hemorrhage, retinal membrane, injury of the macular fovear occurred.

CONCLUSION: The mild form disseminated photocoagulation therapy for moderate non-proliferative diabetic retinopathy is safe and effective without obvious complications, which can effectively delay the progression of diabetic retinopathy.

Abstract:AIM: To observe the clinical effects of microincision vitrectomy combined with internal limiting membrane(ILM)peeling for high myopia patient with macular hole retinal detachment(MHRD).

METHODS: This was a retrospective non-randomized controlled clinical study. A total of 26 eyes of 26 patients with high myopic MHRD from January 2011 to December 2016 were included. All eyes underwent 23G pars plana microincision vitrectomy combined with ILM peeling. The preoperative and postoperative best corrected visual acuity(BCVA), intraocular pressure, ocular anterior segment and fundus examination were observed, and the anatomical closure of macular hole was checked by optical coherence tomography(OCT). The relationships between final BCVA and these parameters(age, GASS stage, onset time, OCT pattern of MH closure, initial vision)were examined by regression analysis.

RESULTS: The postoperative MH closure rate of high myopia MHRD was 58%. OCT images of the repaired MH in high myopia were categorized into 3 patterns: U-type(3 eyes)with relative normal foveal contour; V-type(4 eyes)with steep foveal contour; W-type(8 eyes)with foveal defect od neruosensory retina, but without warped hem of retinal hole or cystic formation. Multivariate Logistic regression analysis showed that postoperative BCVA was correlated with the OCT patternts of closed MH and initial vision(P<0.05). The postoperative visual acuity of U-type closed MH was 6.9 times higher than that of W-type.

CONCLUSION: Microincision vitrectomy combined with ILM peeling is a safe and effective surgical treatment for high myopia patient with macular hole retinal detachment. The postoperative visual acuity was correlated with the OCT patterns of closed MH and initial vision.

Abstract:AIM: To observe the efficacy of Bevacizumab intravitreal injection combined with compound trabeculectomy in the treatment of neovascular glaucoma(NVG).

METHODS: The 36 eyes were with bevacizumab intravitreal injection 1wk before surgery, and then were treated with trabeculectomy combined with mitomycin. The visual acuity, intraocular pressure, follicle, anterior chamber, regression of iris neovascularization, the number of anti-glaucoma drugs used and others were observed before injection, 1d after intravitreal injection, 1, 3, 6, and 12mo after surgery, respectively.

RESULTS: Total success was achieved in 26 eyes, partial success in 7 eyes and failure in 3 eyes at 1a after surgery. The IOP of 1mo(18.183±6.993mmHg), 3mo(19.586±6.198mmHg), 6mo(18.722±5.263mmHg)and 12mo(19.089±4.133mmHg)after surgery were significantly lower than those before injection(39.997±5.827mmHg)and 1d after injection(39.647±5.690mmHg; all P<0.05). The IOP of 1mo and 6mo after surgery was significantly lower than that of 3mo after surgery, and the difference was statistically significant(P<0.05). There was no statistically significant difference between the other two time points postoperatively(all P>0.05). The LogMAR visual acuity of 1mo(0.686±0.202), 3mo(0.622±0.157), 6mo(0.631±0.179)and 12mo(0.711±0.177)after surgery were significantly higher than that before injection(0.833±0.207)and 1d after injection(0.806±0.188), and the differences were statistically significant(all P<0.05). The LogMAR visual acuity of 3mo and 6mo after surgery were significantly higher than that of 1mo after surgery(all P<0.05). The LogMAR visual acuity of 12mo after surgery was significantly worse than that of 3mo and 6mo after surgery(all P<0.05). There was a significant difference in the number of anti-glaucoma drugs used before and after treatment with this method(t=11.131, P<0.05).

CONCLUSION: The bevacizumab intravitreal injection combined with compound trabeculectomy is effective in the treatment of NVG.

Abstract:AIM:To compare the efficacy and safety of LipiFlow pulsation system and traditional Meibomian warm compress treatment for patients with Meibomian gland dysfunction(MGD).

METHODS: Totally 50 patients with MGD were selected, whom were randomly divided into experimental group(25 cases)and control group(25 cases). The experimental group underwent a single treatment with the LipiFlow pulsation system. Subjects of the control group were subjected to a daily 15-minute warm compress treatment, lasting 2wk. Comparative analyses were made during moments before and 4, 8 and 12wk after treatments, according to the evaluation of eight indexes including subjective symptoms, tear film break-up time(TBUT), tear film lipid layer thickness(LLT), Meibomian deletions etc. Those analyses were made using LSD-t test, to analyze the effectiveness evaluation parameters at different time points. Independent samples t-test was employed to compare those statistic results between experimental group and control group.

RESULTS: Statistically significant differences were observed on Ocular Surface Disease Index(OSDI), the quality of Meibomian secretions and Schirmer test(P<0.05). There were also statistically significant differences on the difference in degree of improvements in OSDI, the Meibomian glands yielding liquid secretion, fluorescein staining score LLT, TBUT between the experimental group and control group(P<0.05). There were no differences on safety parameters between two groups.

CONCLUSION: A single treatment with the LipiFlow pulsation system and warm compress treatment are effective and safe for MGD, while the former is better.

Abstract:AIM: To investigate the significance of ocular surface interferometer in the diagnosis of Meibomian gland dysfunction(MGD).

METHODS: Prospective case-control studies. Totally 62 patients with MGD and 38 healthy volunteers were selected in Peking University Third Hospital from October to November in 2017. All subjects of both groups were examined respectively for Ocular Surface Disease Index Questionnaire(OSDI), slit-lamp anterior segment check, the eye surface interferometer inspection, and break up time. Independent sample t-test and chi-square test were used for comparison between the two groups. Spearman correlation analysis was used in the group of patients with MGD.

RESULTS: In both groups, there were changes on the morphology of the eyelid, and the lesions were different. The score of OSDI, the discharge ability and the loss score of the MGD group were significantly higher than those in the control group(P<0.05). However, the lipid layer thickness(LLT)was significantly lower than that in the control group(P<0.05). There was no significant difference in BUT, the proportion of incomplete blink time, the score of Meibomian gland orifice and the quality score of the Meibomian gland discharge ability between the two groups(P>0.05). The Spearman correlation analysis indicated that the negative correlation between LLT and the OSDI questionnaire score(r_s=-0.730, P<0.01), LLT and the Meibomian gland orifice(r_s=-0.639, P<0.01), LLT and the loss of Meibomian gland(r_s=-4.15, P=0.001); however, the positive correlation was shown between the loss of Meibomian gland and the OSDI questionnaire score(r_s=0.790, P<0.01).

CONCLUSION: Meibomian gland dysfunction symptoms and signs significantly correlates with LLT, loss of Meibomian gland detected by ocular surface interferometer, so ocular surface interferometer can be used for rapid, noninvasive and objective diagnosis of Meibomian gland dysfunction and assess the stage of disease progression.

Abstract:AIM:To analyze the difference in the level of fat-specific phospholipase A2(AdPLA)mRNA in the orbital adipose tissue between patients with thyroid-associated ophthalmopathy(TAO)and normal subjects.

METHODS:Thirty-seven patients(37 eyes)with TAO(stationary stage Ⅲ)who underwent orbital decompression surgery in our hospital from December 2016 to December 2017 were selected as the observation group; in the same period, 35 cases(35 eyes)of normal orbital adipose tissue were selected as the control group, which the source of the normal eyelid tissue was cosmetic surgery, pouch resection and ptosis correction. The eyeball protrusion was used to measure the degree of protrusion of the eye on the fat side of the observation group and the control group, and the BMI status of the two groups was calculated. A 16-slice spiral CT from Siemens motion was used to perform CT examination of the eyelids of both groups of subjects. Image J was used to detect the fat volume of the fat side and real time PCR was used to detect the expression of AdPLA mRNA in the adipose tissue of the eyelids.

RESULTS: There was no significant difference in mean age, BMI, and gender between the observation group and the control group(P>0.05); the intraocular fatty acid content, ocular outgrowth and intracellular AdPLA mRNA expression in the observation group were 32.21±1.85mL, 19.97±1.56mm, and 0.04±0.01, higher than those in the control group 24.05±1.64mL, 14.07±1.48mm, 0.01±0.003, respectively, and the difference was statistically significant(P<0.05).

CONCLUSION: The intraocular fatty acid content, ocular outgrowth and intracellular expression of AdPLA mRNA in TAO patients are all higher than those in normal subjects. The increase of AdPLA expression in the adipose tissue of eyes of TAO patients resulted in a decrease in the amount of fat hydrolysis and an increase in fat accumulation and increased emphasis.

Abstract:AIM: To investigate the incidence of neonatal eye disease, early intervention and follow-up observation.

METHODS: Totally 9 654 newborns born in our hospital from December 2015 to December 2017 were screened for ophthalmic diseases and symptomatic interventions, and the results were statistically analyzed.

RESULTS: There were 8 467 newborn infants(8 532 eyes)who were screened, accounting for 87.70% of the total; 7 047 of the normal group accounted for 89.94% for this group, and 1 420 of the high risk group accounted for 78.06% for this group. Screening found that some newborns had congenital and acquired ophthalmic diseases.

CONCLUSION: The screening of newborns for eye diseases can detect the abnormalities of newborns' eyes as soon as possible and intervene to improve the efficacy and accuracy of the treatment. Especially for high-risk neonates, eye screening is even more necessary.

Abstract:AIM:To investigate the distribution of serum specific IgE in children with allergic conjunctivitis and associated allergic diseases.

METHODS: Retrospective analysis of 708 cases of allergic conjunctivitis in children, according to age divided into the infant group(2 months to 1 years old)232 cases, the children group(>1 years to 3 years old)255 cases and the preschool group(>3 years to 6 years old)221 cases. A automatic in vitro detection system was used to detect serum inhaled allergens and food allergen specific IgE by immune capture method. A questionnaire survey was conducted to investigate the associated allergic diseases and consultation with relevant departments.

RESULTS: The sIgE positive rate was the lowest in the infant group(87.1%). There were significant differences in the number of sIgE positive species in the infant group compared with those in the other two groups(χ²=10.96, 21.78; P<0.01). The most common allergens in all three groups were milk, egg white and household dust mites, and the positive rate of SIgE in milk was higher in the infant group than in the other two groups. The positive rate of sIgE in dust mites, house dust, tree pollen, mulberry, dog fur, egg white, pineapple and mango were higher in the preschool group than in the other two groups. The positive rate of 3-6 grade sIgE in household dust mites and house dust were higher in preschool group than that in the other two groups(P<0.01). The infant group had the highest proportion of gastrointestinal allergy(28.9%). The preschool group had the highest proportion of allergic rhinitis. The proportion with more than three kinds of allergic diseases in children group was higher than that of the other two groups(P<0.01).

CONCLUSION: With the increase of age, the positive rate and types of allergen in children with allergic conjunctivitis increased gradually. House dust mites become the primary inhalation allergen from infancy. Allergic diseases associated with allergic conjunctivitis in children are consistent with allergic march.

Abstract:AIM: To investigate the relationship between retinal nerve fiber layer(RNFL)thickness and spherical equivalent(SE)refraction and axial length(AL)in juvenile myopic patients.

METHODS: Totally 100 cases(200 eyes)of juvenile myopia diagnosed in our hospital from December 2015 to December 2017 were selected. Patients were divided referring to the SE, in which 34 cases(68 eyes)with SE <-3.00D were divided into low myopia group, 36 cases(72 eyes)with -3.00D≤SE≤-6.00D were divided into moderate myopia group, 30 cases(60 eyes)with SE>-6.00D were divided into high myopia group. And 30 patients(60 eyes)with normal visual acuity were selected as the control group. The average RNFL of the whole visual field and the RNFL of upper visual field, inferior visual field, nasal visual field, and temporal visual field were measured by optical coherence tomography(OCT). AL was measured by A-scan. Pearson correlation analysis was used to analyze the correlation between the average RNFL thickness of whole visual field and the absolute value of SE and AL.

RESULTS: The average RNFL of the whole visual field and the RNFL of upper visual field, inferior visual field, nasal visual field, and temporal visual field in three myopia groups were significantly lower than those of the control group, the difference was statistically significant(P<0.05). The RNFL of four visual fields in three myopia groups decreased in turn(P<0.05). The SE of the three myopia groups increased in turn(P<0.05). And the SE of three myopia groups were significantly higher than those of control group, the difference was statistically significant(P<0.05). The AL of control group, low myopia group, moderate myopia group, and high myopia group increased in turn with significant differences(P<0.05). The average RNFL of the whole visual field was negatively correlated with the absolute value of SE(r=-0.564,P<0.001)and AL(r=-0.423, P<0.001).

CONCLUSION: RNFL thickness was negatively correlated with SE but positively correlated with AL, suggesting that juvenile with thinner RNFL thickness has more severe myopia.

Abstract:AIM: To observe the efficacy and safety of a new posterior chamber intraocular lens(ICMO V4c)implantation in patients with high myopia and low astigmatism and to provide reference for the clinical diagnosis and treatment of these patients.

METHODS: The study was to analyze the clinical data of patients with high myopia who underwent ICMO V4c implantation with low degree of astigmatism in our hospital from January 2015 to December 2016. The patients were followed up for 1, 3 and 6mo after operation. The items we analyzed including preoperative and postoperative uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA), diopter, spherical and cylinder equivalent, and manifest refraction spherical equivalent(MRSE), intraocular pressure(IOP), endothelial cell counting, anterior chamber depth(ACD), arch height and postoperative complications.

RESULTS: Postoperative UCVA and BCVA improved compared with preoperative, and the difference between preoperative and postoperative was statistically significant(P<0.05). All spherical and cylinder equivalent, and MRSE were reduced after surgery(t=38.510, 20.100, 34.300; P<0.01). The mean intraocular pressure increased at 1 and 3mo after operation(t=3.998, 2.837, all P<0.05), but it returned to normal at 6mo(t=0.383, P>0.05). The corneal endothelium counts in the patients at 3mo and 6mo after surgery were lower than those before surgery(t=2.119, 2.411; all P<0.05). The depth of anterior chamber was reduced to a certain extent within 6mo after operation, and recovered after surgery at 6mo after surgery, but it was still lower than the preoperative level(t=5.850, 5.260, 2.556; all P<0.05). The overall level of ocular arch after operation was stable and no significant fluctuations were observed. The incidence of postoperative complications in the surgical eye was low and significantly improved after active treatment.

CONCLUSION: The new posterior chamber intraocular lens implantation in the treatment of high myopia with low astigmatism reaches satisfaction with less complications, is a good supplement to corneal refractive surgery.

Abstract:AIM:To study the effects of orthokeratology, low concentration atropine and frame glasses on juvenile myopia prevention and control.

METHODS: A total of 120 juvenile patients(240 eyes)with mild to moderate myopia were chosen in our hospital from January 2016 to July 2016. They were divided into 3 groups voluntarily. Children in orthokeratology group(40 cases, 80 eyes)were treated with orthokeratology; children in low concentration atropine group(40 cases, 80 eyes)were treated with low concentration atropine; children in frame glasses group(40 cases, 80 eyes)were treated with frame glasses. After 18mo follow-up, refractive degree and ocular axial length of three groups were statistically analyzed.

RESULTS: After 18mo, diopters of children in orthokeratology group and atropine group were lower than those of children in frame glasses group(P<0.05). The diopter differences between before and after treatment of orthokeratology group and atropine group were lower than that of the frame glasses group(P<0.05), there was no significant differences between orthokeratology group and atropine group(P>0.05). The axial growth of children in orthokeratology group and atropine group were lower than those of children in frame glasses group(P<0.05). The axial length differences between before and after treatment of orthokeratology group and atropine group were lower than that of the frame glasses group(P<0.05); there was no significant differences between orthokeratology group and atropine group(P>0.05).

CONCLUSION: Both orthokeratology and low concentration atropine can effectively control the progress of diopter and axial length in juvenile myopia, and their curative effects were better than frame glasses. During the 18mo observation period, the curative effects of orthokeratology and atropine have no significant differences.

Abstract:AIM:To evaluate the effectiveness of visian implantable collamer lens with central hole(ICL V4c)implantation for the correction of high myopia using the double-pass visual quality analysis system.

METHODS: Totally 60 eyes of 30 high myopia patients who underwent ICL V4c implantation were enrolled into this prospective randomized control study. Myopic degree of selected patients was -6.0D to -12.0D, age 18 to 35 years old, best corrected visual acuity(BCVA)≥0.6, preoperative corneal astigmatism acuities ≤1.0D. All patients were taken the temporal side transparent corneal incision. The patients were evaluated postoperatively 1wk, 1 and 3mo respectively. The evaluating items included preoperative BCVA, postoperative uncorrected visual acuity(UCVA), objective scattering index(OSI), and modulation transfer function(MTF)cut off frequency, Strehl ratio(SR), and 100%, 20%, 9% Optical Quality Analysis System(OQAS)Value(OV, contrast visual acuity). All statistical analyses were performed with SPSS19.0 statistical software. Variance analysis of repeated measurement data was employed.

RESULTS: The UCVA gradually improved at 1wk, 1 and 3mo after surgery. There was statistical significance compared with the preoperative BCVA(P<0.01). The postoperative OSI, MTF cut off, SR, OV 100%, OV 20% and OV 9% at 1wk, 1 and 3mo showed statistically differences compared with the preoperative values(P<0.05).

CONCLUSION: ICL V4c implantation can effectively correct high myopia range from -6.0D to -12.0D. The postoperative OSI were smaller than the preoperative OSI. The postoperative UCVA were better than the preoperative BCVA. The value of postoperative MTF cut off, SR, and OV value of 100%, 20% and 9% improved.

Abstract:AIM: To investigate single step combined surgical treatments of Helveston syndrome.

METHODS: A retrospective clinical analysis of 7 cases(14 eyes)with Helveston syndrome in our hospital. There were 14 eyes underwent single step combined surgical treatments, according to the degree of patients with superior oblique overaction and strabismus. A-pattern, dissociated vertical deviation(DVD), function of superior oblique and binocular visual function were examined and analyzed preoperatively and postoperatively.

RESULTS: Bilateral superior oblique intrathecal tenectomy combined bilateral rectus recession were performed in 3 cases(6 eyes). Bilateral superior oblique tenectomy combined unilateral rectus recession were performed in 4 cases(4 eyes). The follow-up was 6mo; 14 eyes of 7 patients attained normal ocular alignment. A-pattern and DVD disappeared. Binocular vision and stereoscopic vision were recovered in 6 eyes of 3 children.

CONCLUSION: Helveston syndrome can be treated with single step combined surgery, and early surgical treatments can help the recovery of binocular visual function.