Abstract:AIM:To explore the possible effects of genetic variant S18Y of ubiquitin carboxyl-terminal esterase L1(UCHL1)gene on age-related cataract formation.

METHODS:We have investigated the frequency of this variant among the Han-Chinese population in a case-control study. A total of 242 cortical cataract patients and 144 controls were genotyped using polymerase chain reaction(PCR)and genomic sequencing.

RESULTS:There is no statistical difference between cataract patients and healthy controls for the frequency of alleles(P=0.746)and genotypes(P=0.813). Since there was in our sample a significant difference between the groups in mean age(P<0.001), OR and CI for UCHL1 allele A positivity were computed by a binary Logistic regression model, no association was obtained for a positive UCHL1 allele A carrier status(P=0.818).

CONCLUSION:We did not find any difference between the cases and the controls at allelic and genotypic level. Our results do not support a role for this variant in cataracts.

Abstract:AIM: To evaluate the impact of active uveitis on refractive error changes.

METHODS: A prospective cohort study was conducted on 66 patients(88 eyes)with active uveitis. The subjects were classified based on the anatomical location of their disease activity as anterior, intermediate, posterior and pan-uveitis. Cycloplegic refraction was performed in both active and quiescent phases, and the results were compared.

RESULTS: Spherical changes in active anterior non-granulomatous uveitis resulted in an average of -0.25(0.77)D(95% CI: -0.5 to 0)shift toward myopia(P=0.039)and in active intermediate uveitis, an average of +0.39(0.8)D(95% CI: 0.09-0.69)shift toward hyperopia(P=0.003). Spherical equivalent changes in active intermediate uveitis resulted in hyperopic shift \〖+0.43(0.94)D, 95% CI: 0.08-0.79, P=0.005\〗. Cylinder had only significant changes in pan-uveitis \〖-0.3(0.39)D, 95% CI: -0.58 to -0.02, P=0.043\〗. In multivariate analysis, we noted that course of disease activity(acute versus recurrent)and anatomical location of disease activity had statistically significant effects on spherical equivalent changes(P=0.003 and P=0.004, respectively).

CONCLUSION: Active uveitis has a significant effect on the refractive status of the eye, the changes of which depend on the inflamed anatomical area.

Abstract:Photorefractive keratectomy(PRK), laser-assisted in situ keratomileusis(LASIK)and small-incision lenticule extraction(SMILE)are the most clinically effective and safe techniques, for refractive surgery. All three kinds of laser vision correction, while varying in technique, have roughly a similar high achievement rate. Which method is best for you to rely upon various components like the refractive error, habits and profession, for example, sports and lifestyle. LASIK is as of now the predominant strategy in refractive surgery but SMILE also spreads rapidly between surgeons. This increments comfort amid the early postoperative period, takes into account quick visual recovery, and diminishes the wound healing response. And additionally that there would be less postoperative dry eye after SMILE contrasted with LASIK because the anterior stroma is exasperates just by the small incision, implying that the anterior corneal nerves ought to be less influenced. SMILE likewise lower induction of higher order aberrations(HOA)contrasted with LASIK and PRK. No contrasts between SMILE, LASIK and PRK medicines in postoperative corneal hysteresis(CH)corneal resistance factor(CRF)or corneal hysteresis values. PRK, but, remains a supreme option for moderate to mild modifications, especially for cases involving thin corneas, frequent erosions.

Abstract:AIM: To discuss the protective effects of betaine-homocysteine methyl transferase(BHMT)on oxidative damaged human lens epithelial cells(HLEC)induced by homocysteine.

METHODS: HLEC were cultured in vitro and then randomly divided into 3 groups. Normal group:normal cultured HLEC; control group: normal cultured HLEC transfected with empty vector; BHMT gene overexpression group(OE): HLEC transfected with BHMT gene overexpression. All groups were cultured in 10% FCS DMEM +5mmol/L Hcy for 16h. After cultured, BHMT mRNA expression was measured by qRT-PCR and Western blot, the cell proliferation was detected by EdU Assay Kit,The level of ROS and GSH of HLEC were measured by Flow Cytometer and Visible Spectrophotometers. The expression level of of protein(GRP78, Nrf2, Caspase-12)was measured by western blotting.

RESULTS: After cultured 16h, cell proliferation ability in OE group was increased by 30.0% compared with NC group(P<0.05).The expression of ROS in normal group(89.2043±0.3511)% was obviously higher than OE group(49.5625±0.4502)%, P<0.05, GSH activity in OE group was obviously higher than control group and normal group,(P<0.05). The expression level of GRP78 in the normal group and the control group was significantly higher than overexpression group. The expression level of Nrf2 in the normal group and the control group was significantly lower than overexpression group. The expression level of Caspase-12 in the overexpression group was significantly lower than that in the control group.

CONCLUSION: BHMT in vitro can prevent the oxidative damage of HLEC by high homocysteine, clear the ROS and decrease the ER stress reaction. Apoptosis of lens epithelial cells was inhibited. BHMT plays an important protective role in oxidative damaged HLEC induced by Hcy.

Abstract:AIM: To investigate the mechanism of Delphinidin(Dp)in protecting retinal against light induced oxidative damage.

METHODS: All 661W photosensitive cells were treated with 2 000Lx light(48h)and/or different concentrations of Dp(5, 10, 20μmol/L, 24h). Cell activity, intracellular LDH activity, TBARS content and antioxidant enzymes(SOD, GSH-Px, GST)activity were determined respectively. After the healthy SD rats were treated with 3 000 Lx light(24h)and/or Dp \〖100mg/(kg·d)for 4wk\〗, then changes in retinal tissue structure were observed and fluctuations in oxidative stress index(SOD, GSH-Px, GST)were determined.

RESULTS: The results of in vitro experiments showed that the cell activity was significantly decreased after irradiation, the LDH activity and TBARS content were increased, and the activity of antioxidant enzyme system were decreased. However, Dp treatment could increase cell viability, decrease LDH activity and TBARS content, and increase the activity of antioxidant enzyme system. In vivo experiments showed that Dp can protect the structural integrity of retina, reduce the content of TBARS in retinal tissue, and increase the activity of SOD, GSH-Px and GST.

CONCLUSION: Dp may protect retinal against Photochemical factors -induced oxidative damage by regulating the oxidation-antioxidant system.

Abstract:AIM: To discuss the effect and mechanism of melatonin on diabetic retinopathy in rats and its mechanism.

METHODS:Totally 40 healthy male SD rats were choose and randomly divided into 4 groups, normal control group, diabetid group, low dose melatonin group and high dose melatonin group. The changes of retinal structure were observed by hematoxylin-eosin staining(HE staining), ultrastructure of retinal ganglion cells were observed by electron microscopy, superoxide dismutase(SOD)and malondialdehyde(MDA)level in the retina tissue were detected by xanthine oxidase method, and protein expression levels of B cell lymphoma/lewkmia-2(Bcl-2), Bcl-2 associated X protein(Bax)and P53 were detected by Western Blot.

RESULTS: HE staining results showed that the rat retina tissue structure of the normal control group was clear, the retinal tissue of diabetes group rats were not clear, the nerve fiber layer was edema, the retina cells of low dose melatonin group were probably distinct, the interlayer cells were arranged neatly, and the inner and outer nuclear layers were slightly disordered, rats retinal structure in high dose melatonin group were further improved than that in low dose melatonin group; Electron microscope results showed that compared with diabetes group, retinal ganglion cells form in melatonin group were improved in different extent; Xanthine oxidase method detected that SOD level in retinal tissue of melatonin group rats were higher than that in diabetic group, the MDA level were lower than that in diabetic group, compared with diabetes group the differences both have statistically significant(P<0.05); Western blot results showed that the protein expression of Bcl-2 in low dose and high dose melatonin group gradually decreased, Bax and P53 protein expressions increased significantly, compared with diabetic group the differences were statistically significant(P<0.05).

CONCLUSION: Melatonin could improve the morphological changes of retina in diabetic rats and inhibit diabetic retinopathy to some extent.

Abstract:AIM: To analyze the association between refractive status and refractive factors, and to explore the effectiveness of mean ocular axial length(AL), mean corneal radius of curvature(CR)and their ratio in the assessment of amitropia in children and adolescents.

METHODS: Cross sectional study, 816 cases(1632 eyes)aged 3-16 years old suspected ametropia were selected in the Affiliated Eye Hospital of Nanjing Medical University from December 2017 to December 2018. Uncorrected visual acuity(UCVA), mean AL and mean CR were tested. Autorefraction was performed after cycloplegia, which was measured as the spherical equivalent(SE).

RESULTS: Among 816 cases of children and adolescents aged 3-16, 773 were ametropia, accounting for 94.7%, with the highest proportion aged 7-14. The difference(one eye)in the mean AL, and AL/CR ratio of different refractive groups were statistically significant(P<0.05). In different refractive states, the mean AL and AL/CR ratio showed a low correlation with SE in emmetropes and low hyperopes but higher correlation in moderately hyperopic and myopic children. The mean AL, AL/CR ratio were higher correlation with SE increased with age. Sensitivity was 0.880, specificity was 0.916, and accuracy was 89.2%. The area under ROC curve was 0.954.

CONCLUSION: The proportion of myopia among children and adolescents gradually increases and shows a large increase after 7 years old. The AL and AL/CR ratio showed higher correlation in moderate hyperopes, myopes and older ages. The AL/CR ratio is highly accurate in the diagnosis of myopia in adolescents and children.

Abstract:AIM: To investigate the relationship among sleep apnea hypopnea syndrome(SAHS), nocturnal hypotension(NHP)and nonarteritic anterior ischmic optic neuropathy(NAION).

METHODS:The retrospective study participants included 31 patients with NAION and 31 age- and sex-matched controls. Twenty-four hour ambulatory blood pressure monitoring was used to evaluate the presence of NHP in NAION group and in control group. Berlin questionnaire was involved to evaluate the risk of SAHS. All participants underwent full-night respiratory polysomnography for monitoring apnea-hypopnea index(AHI), minimum oxygen saturation(MOS).

RESULTS: Totally 23 NAION patients(74%)presented with NHP, which was found in 14 control subjects(45%). The incidence of NHP was significantly higher among NAION patients compared to the controls(P=0.020). Of the 31 NAION patients, 22 patients(71%)had SAHS, compared to 13(42%)control subjects. Logistic regression analysis showed that NHP(OR=2.762, 95% CI: 1.275-3.746), AHI(OR=2.959, 95% CI: 1.478-6.432)and MOS(OR=3.058, 95% CI: 1.734-7.743)were risk factors for NAION.

CONCLUSION: SAHS and NHP were related with NAION. Taking precautions against SAHS and NHP may be crucial to the prevention and cure of NAION.

Abstract:The fluctuation of anterior chamber depth(ACD)is one of the main causes of refractive shift after cataract surgery. Currently, there are numerous studies on the changes of ACD after cataract surgery worldwide. This article reviews the trend of the change of ACD after cataract surgery, and the influence factors and accompanying refractive shift.

Abstract:Optic nerve sheath fenestration(ONSF), also known as optic nerve sheath decompression, was first proposed by Wecker. The procedure involves cutting incisions or windows in the retrabulbar optic nerve sheath to release the cerebral spinal fluid from the subarachnoid space of the optic nerve, reducing the pressure surrounding the optic nerve. With the development of surgical instruments and procedures, the safety of ONSF has been significantly improved with infrequent complications. Through the past three decades, more and more ophthalmologists realized that ONSF is an effective surgical treatment to stabilize or improve visual loss in idiopathic intracranial hypertension(IIH). Additionally, much progress in the use of ONSF has been made on secondary intracranial hypertension due to cerebral venous sinus occlusion, Cryptococcal meningitis, and intracranial mass or tumors. In this paper we review the application of ONSF in IIH, and secondary intracranial hypertension. From the review, it indicates ONSF is a good surgical alternative for ophthalmologists. It also indicates that ONSF can be used to prevent or halt progressive visual loss associated with intracranial hypertension, particularly when other treatment modalities fail to protect vision.

Abstract:Neovascular glaucoma(NVG)is a refractory blinding eye disease that adds a heavy burden to society. The incidence of neovascular glaucoma is related to a variety of factors, such as retinal ischemia and hypoxia, inflammation and trauma. There are more than 40 diseases that can cause it to occur, among which the most common in clinical is diabetic retinopathy and central retinal vein occlusion. Because of its complex etiology and the pathogenesis remains unclear, clinical treatment is extremely difficult. This paper summarizes some related researches in recent years. Finally, the onset and treatment of neovascular glaucoma are elaborated in order to be expected to help clinical work.

Abstract:Filtering channels carring and subsequent obstruction are the main cause of operation failure after glaucoma filtration surgery. During the process of scarring, human Tenon fibroblasts are transformed into myofibroblasts and secrete a large amount of extracellular matrixproteins. The derangement of the collagen fiber is also observed. A large number of studies have been carried out by domestic and foreign researchers on the treatment of postoperative filtering channel scarring. In this review we summarize the mechanisms of scar formation after glaucoma filtration surgery and corresponding research progress in recent years.

Abstract:Age-related macular degeneration is the main cause of blindness in middle-aged and elderly people, seriously affects the quality of life of patients, but there is no effective therapy. As the disease progresses, the retinal pigment epithelial cells gradually degenerate and eventually cause irreversible damage to vision. The emergence of induced pluripotent stem cells provides a source of transplantable retinal pigment epithelial cells, avoiding immune and ethical issues, but still needs to overcome many obstacles and difficulties.

Abstract:Blue light is an important part of natural light.The wavelength is mainly between 400nm and 500nm, which is a kind of short-wavelength light and a part of the high-energy visible spectrum. The damage of blue light refers to the photochemical action caused by radiation of this wavelength, resulting in damage to the retina. In the visible light, blue light has the highest sensitivity to the retina and the strongest penetrating power, so the photochemical damage is the strongest. The primary harm is to damage retinal pigment epithelium(RPE)and retinal photoreceptor cells. The research on the protection against the damage of blue light has been gradually carried out. In this paper, the research progress of its protective mechanism is discussed based on the currently study.

Abstract:Leber's congenital amaurosis(LCA)is a genetic eye disease that can cause blindness. Infants with LCA may have a severe low vision or loss of vision at the early stage. The LCA2 type of this disease is related to RPE65 mutation. According to previous studies, there is no effective treatment for genetic retinal diseases including LCA2. In recent years, with the advances in gene therapy technology, great progress in the treatment of genetic retinal diseases has been made, among which the most successful one is the gene therapy of LCA2. This paper briefly introduces the development of the gene therapy of LCA2, and reviews the correlation between age and injection type, dosage, injection method, measuring method as well as therapeutic effect and the stability of therapeutic effect in previous clinic trials, which provides reference and clinical treatment experience for the clinical application of the gene therapy of LCA2 in China.

Abstract:Calculating the intraocular lens(IOL)power in eyes with prior corneal refractive surgery(LASIK/PRK)is still a challenging task for all cataract ophthalmologists. The accuracy of the IOL power calculating is lower than virgin eyes, because the three generation formulae and traditional corneal instruments which measure central corneal radius of curvature in the paracentral 2.5-3.2mm zone are incorrect after myopic refractive surgery. There are three main sources of error in IOL calculation after refractive surgery: the radius measurement error, the keratometer index error and the IOL formula error. The purpose of the present paper is to describe the different available techniques to improve the accuracy of the IOL power calculation after refractive procedures.

Abstract:Topical ophthalmic nonsteroidal anti-inflammatory drugs(NSAIDs)are used to treat ocular surface and anterior segment inflammation as well as postoperative management of pain and inflammation. As a new generation of NSAIDs, because of its unique molecule structure, bromfenac is both a kind of potent anti-inflammatory drug and a lipophilic molecule that can penetrate ocular tissues and as a result increase the duration of action. Bromfenac has an extensive global safety record as an anti-inflammatory drug, as well as in the management of ocular pain and inflammation following cataract and refractive surgery. Apart from the functions mentioned above, nowadays researchers have also discovered other ophthalmic applications of bromfenac sodium, and therefore reach a conclusion that bromfenac sodium eye drops are safe, effective and convenient in terms of ophthalmic treatment.This review summarizes recent application progress of bromfenac sodium eye drops in ophthalmology, and then gives prospect about its future application, hoping to provide a new idea for the clinical treatment in ophthalmology in the future.

Abstract:Sjögren's syndrome(SS)is a complex connective tissue disease, with an incidence only secondary to rheumatoid arthritis. The initial record was case reports in the late 19th century. In 1930, Henrik Sjögren proposed the conception of “Keratoconjunctivitis Sicca”for the first time, and preliminarily realized that SS was a systemic disease. Subsequently, the discovery of specific autoantibodies and the application of labial biopsy technique significantly improved the accuracy for SS diagnosis. As the understanding the disease improving, different classification criteria were proposed to improve the diagnostic accuracy. However, there still no classification criteria that can be applied as diagnostic criteria so far due to uncovered pathological mechanism of the disease. Currently, comprehensive managements are required with the cooperation of rheumatology, ophthalmology, and stomatology department. Further exploration of the pathogenesis and development of new diagnostic tools are expected to improve the diagnosis of SS. The paper aims to review the development of the classification criteria and to propose new ophthalmic examinations in order to improve the diagnosis of SS.

Abstract:AIM: To evaluate the efficacy and safety of ripasudil in the treatment of glaucoma in recent years by Meta-analysis.

METHODS:According to the Cochrane systematic review method, we searched three databases(Pubmed, Web of Knowledge and CNKI). The change of intraocular pressure was used to assess the effect of ripasudil, WMD with 95% confidence intervals(CI)were used to report the outcome. Subgroup analysis was performed according to different types of glaucoma.

RESULTS:A total of 9 trials all in English, totally 3446 patients, Meta-analysis showed that compared with before-treated groups, after-treated groups have significant lower IOP(Test of WMD= -2.96 95% CI: -3.48 to -2.45, P<0.001), which indicates that ripasudil has great efficacy of curing glaucoma.

CONCLUSION:Ripasudil have significant efficacy in reducing IOP, which can be used as a treatment for glaucoma.

Abstract:AIM: To evaluate the clinical effects of using technetium-99 methylene diphosphonate(⁹⁹Tc-MDP)with methylprednisolone to treat thyroid-associated ophthalmopathy(TAO).

METHODS: We retrieved from 9 databases, from their foundation to March 2019, including Pubmed, the Cochrane Library, EMbase, ClinicalTrial.gov, Web of Science, CNKl, VIP database, China Biology Medicine disc, Wanfang database and collected the randomized controlled trail(RCT)of ⁹⁹Tc-MDP combined with methylprednisolone for treatment of TAO. According to inclusion and exclusion criteria, two researchers retrieved the literature independently, extracted data and evaluate methodological quality. Meta analysis was performed by Review Manager 5.3 software.

RESULTS: A total of 8 RCTs were identified with 644 patients. There was significant difference in the overall clinical effective rate between ⁹⁹Tc-MDP combined with methylprednisolone and methylprednisolone alone(RR=1.14, 95% CI: 1.03-1.26, P=0.01). Significant difierence was found in the effective rate of proptosis between intravenous injection of ⁹⁹Tc-MDP with methyprednisone and methyprednisone only(RR=1.28, 95% CI: 1.16-1.41, P<0.00001). Meanwhile, great improvement was seen in diplopia(RR=1.64, 95% CI: 1.04-2.58, P=0.03), but there was no significant difference in disturbance of ocular dyskinesia(P=0.37).

CONCLUSION: Applying ⁹⁹Tc-MDP combined with methylprednisolone is better than methylprednisolone alone for TAO with less adverse reaction, which appears to be an effective treatment for TAO.

Abstract:AIM: To observe the efficacy of bioengineered cornea in the lamellar keratoplasty treatment of infectious keratitis, and to evaluate the clinical value and significance.

METHODS: Totally 35 eyes in 35 patients with infectious keratitis requiring surgical treatment in our hospital were divided into three groups: the observation group(n=15)received lamellar keratoplasty with bioengineered cornea; the control group 1(n=10)received lamellar keratoplasty with conserved human cornea; the control group 2(n=10)received autogenous conjunctival flap covering for corneal ulcer. The vision, infection control and corneal transparency were observed lasting for 3-20mo.

RESULTS: In the observation group, corneal infection was controlled in 15 eyes after operation and except for 1 eye with cornea opacity during follow-up, the other 14 eyes remained basically transparent. In the control group 1, 9 corneal grafts were transparent, except for 1 eye of viral keratitis experienced corneal opacity because of virus recurrence. In the control group 2, corneal ulcer was scar recoveried in 9 eyes, except for 1 eye of aggravated fungal corneal ulcer infection with later removing of eye content.

CONCLUSION: Bioengineered cornea is a novel alternative material of human cornea, which plays a significant role in resolving the contradiction between the increasing keratopathy and donor cornea shortage.

Abstract:AIM: To assess corneal endothelial cells and corneal thickness in congenital cataract patients, which contributes to studying the characteristics and mechanism of the disease.

METHODS: From August 2014 to December 2018, 141 patients diagnosed with congenital cataract before surgery in our hospital were analyzed retrospectively. Their endothelial cell density(ECD), average size(AVE), standard deviation of size(SD), coefficient of variation(CV), Hexagonality(Hex)and central corneal thickness(CCT)were measured with non-contact specular microscope. The data were statistically analyzed using partial correlation analysis to detect the correlation among patients' ECD, AVE, SD, CV, Hex, CCT and age, and we conducted curve fitting with multiple stepwise regression. We compared male and female patients', bilateral and unilateral cataract's parameters above by covariance analysis.

RESULTS: The correlation between patients' ECD, AVE, SD and age was significant, and the fitting curve was obtained with equation ECD=3957.33-306.62×ln(age)、AVE=178.77+27.39×ln(age)and SD=77.13×e^0.013×age respectively. CV was significantly greater in female patients than that in male patients(P=0.044). SD and CV was significantly greater in right eyes of bilateral cataract than that in affected eyes(P=0.037, P=0.028 respectively)and healthy eyes(P=0.007, P=0.003 respectively)from unilateral cataract, Hex was significantly less in right eyes of bilateral cataract than that in affected eyes(P=0.006)and healthy eyes(P=0.009)from unilateral cataract, CCT was significantly greater in right eyes of bilateral cataract than that in healthy eyes(P=0.041)from unilateral cataract.

CONCLUSION: Congenital cataract may affect corneal endothelial cells and corneal thickness, especially SD, CV, Hex and CCT. Patients' ECD, AVE and SD changes with age. Female patients may have greater CV than male patients.

Abstract:AIM:To investigate the clinical value of serum amyloid A(SAA)in the diagnosis of infectious endophthalmitis.

METHODS:A total of 270 patients admitted to the Eye Hospital of Wenzhou Medical University from June 2016 to March 2019 were collected, including 116 patients with infectious endophthalmitis as the experimental group and 154 non-infectious patients as the control group. The levels of SAA was detected by colloidal gold immunochromatography. Variables were compared and diagnostic value was measured by using receiver operating characteristic(ROC)curve.

RESULTS:The median levels of SAA in experimental group and control group were 14.98mg/L and 2.56mg/L, respectively,the difference between the two groups was statistically significant(P<0.001); the median levels of CRP and WBC had statistic difference between two groups, respectively(P<0.001). The area under the ROC curve of SAA, CRP and WBC for diagnosis of infectious endophthalmitis were 0.772, 0.638 and 0.618 respectively. The optimal cut-off value corresponding to the maximum value of Youden index was 6.975mg/L by SAA, the sensitivity was 63.79% and the specificity was 84.42%.

CONCLUSION: SAA combined with CRP and WBC can improve the diagnostic efficacy of infective endophthalmitis. SAA can provide useful reference information for the assistant diagnosis of infectious endophthalmitis, which is worthy of clinical application.

Abstract:AIM: To observe the clinical value of Yiqihuoxuehuayu decoction combined with triamcinolone acetonide and 532nm argon laser in the treatment of macular edema(ME)secondary to branch retinal vein occlusion(BRVO).

METHODS: Totally 80 patients(80 eyes)with ME secondary to BRVO admitted to the hospital from January 2014 to August 2016 were randomly divided into control group and observation group, with 40 cases(40 eyes)in each group. Control group was given intravitreal injection of triamcinolone acetonide combined with 532nm argon laser photocoagulation, and observation group was additionally given Yiqihuoxuehuayu decoction. The best corrected visual acuity(BCVA), central foveal thickness(CMT)and intraocular pressure were measured before treatment and at 1wk, 1mo and 3mo of treatment. The visual acuity, improvement effects of ME and improvements of symptoms(metamorphopsia, hemorrhage, exudation, etc.)were compared between the two groups, and the incidence rate of complications and the recurrence rate at 3mo after treatment were statistically analyzed.

RESULTS: There were significant differences in the BCVA and CMT between the two groups at different time points of treatment(P<0.05), and the BCVA in observation group at different time points after treatment was higher than that in control group while the CMT was lower than that in control group(P<0.05). There was no significant difference in intraocular pressure between the two groups at different time points of treatment(P>0.05). The visual acuity and ME improvement effects in observation group were better than those in control group, and the metamorphopsia and hemorrhage exudation absorption were better than those in control group(P<0.05). There were no significant difference in the incidence rate of complications and the recurrence rate at 3mo after treatment between the two groups(P>0.05).

CONCLUSION: Yiqihuoxuehuayu decoction combined with triamcinolone acetonide and 532nm argon laser has definite efficacy in the treatment of ME secondary to BRVO, and it can improve visual acuity, reduce macular edema and promote fundus hemorrhage exudation absorption, and it has high safety.

Abstract:AIM: To investigate the relationship between serum homocysteine(Hcy)and anterior ischemic optic neuropathy(AION)in patients with type 2 diabetes mellitus.

METHODS: One hundred patients with type 2 diabetes mellitus who treated in Hebei Eye Hospital from January 2016 to April 2019 were divided into two groups: group A(n=53)without AION, group B(n=47)with AION. Thirty-eight healthy volunteers were used as control group(group C). The serum levels of Hcy, triglyceride cholesterol(TG), low density lipoprotein cholesterol(LDL-C), creatinine(Cr), gycosylated hemoglobin(HbA1c), blood pressure, best corrected visual acuity were detected. To analyze the correlation between serum Hcy level and the clinical indicators in AION in patients with type 2 diabetes mellitus.

RESULTS: The level of Hcy in group B was significantly higher than that in group A and group C \〖(13.87±5.02)μmol/L ratio(11.83±3.49)μmol/L, and(11.06±3.62)μmol/L, all P<0.05\〗.The group B HHcy incidence(36.2%)was significantly higher than that in group A(11.3%)and group C(10.5%).The level of Hcy was positively correlated with HbA1c(r=0.517, P=0.001)and negatively correlated with BCVA(r=-0.353, P=0.026)after adjustment for age, TG, LDL-C, Cr, systolic blood pressure, diastolic blood pressure and course of diabetes mellitus.

CONCLUSION: The level of Hcy in serum may be involved in the pathogenesis of AION in type 2 diabetic patients. Hcy may be a potential target for preventing and treating AION in type 2 diabetic patients.

Abstract:AIM:To study the effect of orthokeratology on accommodation function in myopic children.

METHODS: This was a retrospective clinical study. The clinical data of myopia children in our hospital from September 2015 to December 2018, who wore orthokeratology contact lens(Ortho-k)or single vision lens(SVL)to control myopia were analyzed. 27 cases(54 eyes)with Ortho-k were all selected as the study group, the control group was matched from 108 cases(216 eyes)of the SVL group with the Propensity Score-matching(PSM)function of SPSS software. After matching, 27 cases treated with Ortho-k were compared to 27 cases treated with SVL. Accommodation function were assessed by accommodative amplitude(AA), accommodative sensitivity(AS), accommodative lag(LAG), negative relative accommodation(NRA), and positive relative accommodation(PRA)before and 1, 3, 6 and 12mo after treatment.

RESULTS: There was no statistical significance in the differences of the accommodative parameters between groups(all P>0.05); Wearing time had a significant effect on AA, AS, LAG, NRA and PRA of myopic children in two groups(F_AA=4.7, F_AS=5.6, F_LAG=10.2,F_NRA=7.06, F_PRA=8.8, all P<0.05). Meanwhile, there was an significant interaction effect on the accommodative parameters between wearing time and wearing types of the two groups(F_AA=5.3, F_AS=4.6, F_LAG=11.4, F_NRA=3.4, F_PRA=11.1, all P<0.05).

CONCLUSION: Wearing orthokeratology can improve the accommodation function of myopic children, which may be one of the mechanisms by which they control myopia.

Abstract:AIM: To investigate the clinical effect of autologous penetrating keratoplasty in the treatment of corneal blindness.

METHODS: Totally 8 patients with corneal blindness were treated by autologous penetrating keratoplasty in our hospital from 2014-01 to 2018-03. Using retrospective analysis, the patients were followed up for one year. To observe the intraoperative complications and postoperative conditions such as visual acuity, corneal transparency, and other were observed.

RESULTS: The uncorrected visual acuity of all the 8 patients was greater than 0.02 1wk after operation, and the rate of restoration of visual acuity was 100%(8/8). The corrected visual acuity of 5 patients(5-8)was more than 0.3 1mo after operation. The corrected visual acuity of 3 patients(3-8)with severe cataract before operation was improved to 0.08-0.2. One year later, all the corneal grafts in the recipient eyes were transparency and no recurrence of infection or secondary infection occurred in all 8 patients.

CONCLUSION: Corneal graft is easy to grow and there are no exclusion reactions, fewer postoperative complications after autologous corneal transplantation. So, corneal implants can remain transparent for a long time, and the surgery cost is lower. Autologous corneal transplantation can not only provide long-term useful vision for patients with monocular blindness combined with corneal blindness, but also reduce their financial burden and bring great benefits to patients.

Abstract:AIM:To investigate the distribution of corneal spherical aberration in age-related cataract.

METHODS: Retrospective study. Totally 217 cases of age related cataract(217 eyes)were collected in the Central Hospital of Kaifeng from August 2017 to August 2018. Patients were divided into 3 groups according to age: 50-60 years(63 eyes)in group Ⅰ, 61-70 years(107 eyes)in group Ⅱ, 71-80 years(47 eyes)in group Ⅲ. Pentacam anterior segment analysis was used to measure the anterior and posterior corneal K-readings. The corneal spherical aberration of anterior, posterior and total were calculated on an area of 6mm diameter by Zernike analysis and a descriptive study was used.

RESULTS:The Mean±SD of total corneal spherical aberration was 0.311±0.098μm for all the patients. Statically significant were found for the anterior and total corneal spherical aberration(F=34.434, 32.896; P<0.05). The anterior, posterior corneal K-readings and posterior corneal spherical aberration had no correlation with age(r=0.040, 0.066, 0.097, P>0.05). The anterior and total corneal spherical aberration were positively correlated with age(r=0.506, 0.509, P<0.05).

CONCLUSION:The total corneal spherical aberration in age-related cataract was slightly higher than that before. The anterior and total corneal spherical aberration increased with age, and then the posterior corneal spherical aberration was not.

Abstract:AIM: To investigate the clinical effect of transscleral sutured fixation intraocular lens(IOL)implanted in the capsular bag combined with phacoemulsification for subluxated lens(SL).

METHODS: A prospective study of 18 consecutive cases(18 eyes)with SL(≤270°)was treated with phacoemulsification by Nagahara's chop method combined with the iris hook. Then according to the extent of SL, one or two IOL haptics were transscleral sutured suspension in the capsular bag. Moreover, two cases were performed 25G minimal invasive vitrectomy. The clinical efficacy was observed such as visual acuity, best corrected visual acuity(BCVA), intraocular pressure(IOP), the position of IOL and complications.

RESULTS: All cases were performed successfully. With following-up ranged from 6-12mo, the BCVA was improved obviously, which had significant difference contrasted to that of preoperation(t=7.30, P<0.01). All cases' IOP ≤21mmHg, the position of IOL were normal without dislocation. No several complications took pace in intraoperative or postoperative surgical process.

CONCLUSION: Without implanting capsular tension ring(CTR), IOL in the capsular bag sutured fixation by one or two haptics suspension is an alterative approach for SL. This method maintains the position of IOL and rehabilitates visual acuity, and obviates CTR dislocation. So this way is effective and economical to be accepted by some basic hospital.

Abstract:AIM:To explore the etiology, related factors and prevention of infectious endophthalmitis after age-related cataract surgery.

METHODS: A retrospective analysis of 1 365 age-related cataract patients admitted to our hospital from 2016-01/2018-01, statistics of the incidence of infectious endophthalmitis, and analysis of the pathogenic characteristics of infectious endophthalmitis and related risk factors.

RESULTS: Infective endophthalmitis occurred in 28 patients, and 36 pathogens were detected, including 9 strains of staphylococcus epidermidis(25.00%), 9 strains of pseudomonas aeruginosa(25.00%), and 8 strains of bacillus(22.22%). Pseudomonas aeruginosa and Bacillus have strong resistance to cefazolin, cefotaxime and amoxicillin; high sensitivity to cefoperazone-sulbactam and meropenem; staphylococcus to epidermidis erythromycin and azithromycin have strong drug resistance, and have high sensitivity to vancomycin, nitrofurantoin and minocycline. Multivariate regression analysis of Logistic, age(≥70 years), diabetes, operative time(≥15min), intraoperative vitreous spillover were independent risk factors for infectious endophthalmitis after age-related cataract surgery(P<0.05).

CONCLUSION: Infectious endophthalmitis pathogens after age-related cataract surgery are more common with Staphylococcus epidermidis, Pseudomonas aeruginosa, and Bacillus. Age(≥70 years), diabetes, operative time(≥15min), intraoperative vitreous spillover were independent risk factors for infectious endophthalmitis after age-related cataract surgery.

Abstract:AIM: To investigate the influence of high perfusion irrigation during phacoemulsification on the postoperative visual function of patients with acute angle-closure glaucoma(AACG).

METHODS: Totally 35 patients(37 eyes)with AACG with cataract were included to do the surgery of phacoemulsification with goniosynechialysis. They have been followed up for 6mo. The preoperative and postoperative(3mo and 6mo)best corrected visual acuity(BCVA), intraocular pressure, mean sensitivity(MS), mean defect(MD), and square root loss variance(sLV)were measured and compared.

RESULTS: Compared with preoperative results, 3mo and 6mo BCVA were significantly improved and intraocular pressure was significantly reduced after operation, with statistically significant differences(P<0.001). There was no statistically significant difference between groups after operation(P>0.05). After surgery, 3mo and 6mo MS increased significantly, MD and sLV decreased significantly, and the difference was statistically significant(P<0.001). There was no statistically significant difference between the groups after surgery(P>0.05).

CONCLUSION: The high perfusion irrigation during phacoemulsification does not damage the visual function of patients with AACG.

Abstract:AIM:To compare the efficacy of transscleral cyclophotocoagulation(TSCP)with two different laser parameters.

METHODS: A total of 46 cases with refractory glaucoma(46 eyes)who underwent TSCP from January 2014 to December 2018 were analyzed retrospectively. According to the laser parameters, all cases were divided into low-power group(treated by low-power TSCP)and conventional parameter group(treated by conventional parameter TSCP). Intraocular pressures(IOP), best-corrected visual acuity(BCVA), number of anti-glaucoma drugs and complications were observed and compared between the two groups.

RESULTS: There was no significant difference of IOP between the two groups at postoperative 1d, 1wk, 1mo and 3mo(all P>0.05). The total success rate was 87% in the low-power group while 83% in the conventional parameter group(P=1.000).The overall incidence of complications of the low-power group(39%)was lower than that of the conventional parameter group(78%)(P=0.007)at postoperative 3mo. The early postoperative pain score of the low-power group was significantly lower than that of the conventional parameter group(P=0.007).

CONCLUSION:Compared with conventional parameters, TSCP with lower power may reduce IOP similarly with less pain and fewer complications.

Abstract:AIM: To explore the clinical study of Fuming tablet combined with timolol maleate eye drops in the treatment of open angle glaucoma.

METHODS: Totally 82(147 eyes)patients with open angle glaucoma who were treated in our hospital from April 2017 to July 2018 were selected as the research objects. According to the treatment methods, they were divided into control group and observation group, 41 cases in each group. Patients in the control group(72 eyes)were treated with timolol lecitrate eye drops, while patients in the observation group(75 eyes)were treated with Fuming tablets on the basis of the control group. The clinical efficacy of the two groups was observed. The intraocular pressure and hemorheology of the patients in the two groups were compared and analyzed before and after treatment.

RESULTS: After 12wk treatment, there was a significant difference in the total clinical effective rate(94.7% vs 80.6%)between the observation group and the control group(P<0.05). And the intraocular pressure of both groups was significantly lower than that before and after 6wk of treatment(P<0.05), and the intraocular pressure of the observation group was significantly lower than that of the control group(P<0.05). The levels of PSV, EDV and RI in the control group were not significantly different from those before treatment(P>0.05); while the levels of PSV and EDV in the observation group were significantly higher than those before treatment(P<0.05), and the levels of RI were significantly lower than those before treatment(P<0.05). And there were significant differences in the levels of PSV, EDV and RI between two groups(P<0.05). There was no significant difference in the total incidence of adverse reactions between two groups during the treatment(P>0.05).

CONCLUSION:Fuming tablet combined with timolol maleate eye drops can effectively improve the clinical efficacy of patients with open angle glaucoma. The effect of lowering intraocular pressure is obvious. At the same time, it has a good effect on the ocular hemorheology of patients with open angle glaucoma. This is a safe and reliable clinical treatment of open angle glaucoma.

Abstract:AIM: To explore the correlation between vitamin D(Vit-D)deficiency and age-related macular degeneration(ARMD).

METHODS: A total of 423 cases of middle-aged and aged outpatients(age>45 years)who participated in the physical examination in ophthalmology clinic of Yuncheng First Hospital during February 2018 to February 2019 were included in the cross-sectional study. The clinical information(including sex, age, family history of ARMD, etc.)and biochemical indices(including 25-hydroxyvitamin D \〖25(OH)D\〗, etc.)were collected. The correlations between serum 25(OH)D level and clinical information, as well as biochemical indices, were analyzed. The outpatients were divided into ARMD group(231 cases)and non-ARMD group(192 cases)according to the ARMD situation in the study. The correlation between Vit-D deficiency and ARMD was analyzed.

RESULTS: Serum 25(OH)D level was positively correlated with the male, duration of outdoor light exposure(P<0.05), and negatively correlated with age, smoking and drinking(P<0.05). Binary Logistic regression analysis showed that Vit-D deficiency was a risk factor associated with ARMD(OR=1.980, 95% CI: 1.829-2.201, P<0.01). Other associated factors included age, sex, hypertension, diabetes, low-density lipoprotein cholesterol(LDL-C), and duration of outdoor light exposure >5h/d, which were also risk factors associated with ARMD.

CONCLUSION: Nutritional imbalance due to Vit-D deficiency might be associated with the occurrence of ARMD. Appropriate sun exposure or vit-D supplements could contribute to preventing the development of ARMD.

Abstract:AIM: To investigate the effect of cardiovascular risk factors on the occurrence of nonarteritic anterior ischemic optic neuropathy(NAION)and visual functions of the patients.

METHODS: Sixty-eight patients diagnosed as initial ipsilateral NAION(68 eyes)in NAION group and another 68 patients(68 eyes)matched in age, gender and systemic diseases in Control group were selected from June 2014 to June 2016 were enrolled in this study and evaluated for their levels of homocysteine(Hcy), blood lipids, folic acid and vitamin B₁₂, as well as carotid Doppler ultrasonography. The visual functions were also examined in patients with NAION.

RESULTS: The levels of Hcy(24.8±13.9μmol/L), total plasma cholesterol(4.5±1.0mmol/L), triglyceride(2.0±0.9 mmol/L)and low-density lipoprotein(2.9±0.8mmol/L)in NAION patients were significantly higher(P<0.05)than those in Control group(11.1±8.2μmol/L, 3.8±0.7mmol/L, 1.5±0.5mmol/L and 2.3±0.5mmol/L)while the level of vitamin B₁₂ decreased significantly(315.6 ±214.5pg/mL, P<0.05)in NAION group in comparison with those(467.9±198.2pg/mL)in Control group. However, no significant differences in the artery resistance and inner diameter of the internal carotid were detected between the two groups. The mean deviation(MD)of the visual field was 16.6±7.5dB in NAION group. The levels of Hcy, vitamin B₁₂, folic acid and blood lipid and the presence of systemic diseases were not the risk factors for the visual field damage in NAION patients. MD value was associated with the amplitude and peak latency of P₁₀₀ waves.

CONCLUSION: Hyperhomocysteinemia, hyperlipidemia and low vitamin B₁₂ are the risk factors of in NAION patients. These risk factors, however, are not related to the extent of visual field damage. To some extent, the amplitude and peak latency of visual evoked potentials can reflect the extent of visual field damage.

Abstract:AIM: To compare the clinical curative effects of meibomian gland dysfunction(MGD)caused by evaporative dry eye by utilizing levofloxacin eye gel and Tobramycin and Dexamethasone Ophthalmic Ointment, respectively.

METHODS: The 180 cases(360 eyes)with dry eye(evaporative type)caused by confirmed meibomian gland dysfunction were randomly divided into two groups(i.e. A and B): In group A, 90 individuals with 180 eyes were treated with levofloxacin eye gel+ sodium hyaluronate eye solution; The other 90 cases in group B took Tobramycin and Dexamethasone Ophthalmic Ointment+ sodium hyaluronate eye drops for curing the MGD. In addition, the same comprehensive therapy were used to the MGD patients in groups A and B, after surface anesthesia on binoculus, secretion, obstructing meibomian gland secretions, were discharged by utilizing cotton stick to extrusion mass weekly and four times consecutive treatments were regard as a course of treatment. To remove residual the thin oil soften lipid in meibomian gland, heat can be applied to the eyelids with hot water(around 45℃)on towel for 15min and do that three times a day. After each hot compress, we use levofloxacin eye gel to the patients in group A by dropping into the conjunctival sac and apply to the root of the eyelid lashes. The group B of 90 patients were applied Tobramycin and Dexamethasone Ophthalmic Ointment to the root of the eyelid lashes. All patients were dripped odium eye drops eye into their eyes four times a day.

RESULTS: After treatment(Z= -0.64, P=0.524), there were no significant differences in clinical symptoms(Z= -1.37, P=0.171), secretion characteristics(Z= -1.06, P=0.288), tear film rupture time and tear secretion time between groups A and B(P>0.05). Corneal fluorescence staining score: group A(cured 83.3%, improved 11.1%, ineffective 5.6%)and group B(cured 55.6%, improved 27.8%, ineffective 16.7%). The therapeutic effect of group A was better than that of group B, with statistical significance(Z= -4.02, P<0.001).

CONCLUSION: Physical therapy for meibomian gland dysfunction caused by evaporative dry eye is given priority, and medication is treated as adjunctive therapy. Generally, the patients can achieve totally anti-inflammatory, antibacterial, safe and stable, without side effects by using levofloxacin eye gel. However, the patients with worst condition and lingering illness should cured by Tobramycin and Dexamethasone Ophthalmic Ointment. In addition, statistical significant difference is not found between the two drugs on curative effects.

Abstract:AIM: To explore the clinical value of Tuiyi Mingmu decoction combined with autologous limbal stem cell transplantation in the treatment of pterygium.

METHODS: A retrospective analysis was performed to collect 80 patients(98 eyes)with pterygium admitted to the hospital from January 2016 to January 2018. The patients were divided into transplantation group(autologous limbal stem cell transplantation, n=34 cases, 39 eyes)and combined group(Tuiyi Mingmu decoction + autologous limbal stem cell transplantation, n=46 cases, 59 eyes). The uncorrected visual acuity(UCVA), corneal diopter, corneal astigmatism, tear break-up time(BUT)and Schirmer I test(S I t)tear secretion were compared between the two groups before operation and at 1mo after operation, and the corneal epithelial repair time, incidence rate of complications and recurrence rate at 12mo of follow-up were counted.

RESULTS: Before operation, there were no significant differences in the UCVA, corneal diopter and corneal astigmatism between the two groups(P>0.05). At 1mo after operation, the UCVA was increased while the corneal diopter and corneal astigmatism were decreased in the two groups, and the UCVA in combined group was higher than that in transplantation group while the corneal diopter and corneal astigmatism were lower than those in transplantation group(P<0.05). Before operation, there were no statistically significant differences in the BUT and S I t between the two groups(P>0.05). At 1mo after operation, the BUT and S I t were increased in the two groups, and the indexes in combined group were higher than those in transplantation group(P<0.05). The corneal epithelial repair time in combined group was shorter than that in transplantation group(P<0.05), and the incidence rate of postoperative complications and recurrence rate at 12mo of follow-up were lower than those in transplantation group(P<0.05).

CONCLUSION: Tuiyi Mingmu decoction combined with autologous limbal stem cell transplantation can improve the visual acuity of patients with pterygium, reduce corneal astigmatism, promote the repair of corneal epithelial cells, and reduce the recurrence rate, with few complications and definite safety.

Abstract:AIM: To investigate the clinic opathological features of orbital soft tissue tumors.

METHODS: A retrospective analysis of 455 cases of orbital soft tissue tumors in our hospital from 2003-11/2018-11 were performed to observe the clinical features, pathological classification and pathological features of rare tumors.

RESULTS:All 455 patients with orbital soft tissue tumors, 421(92.5%)were benign tumors. The top 5 were 258 cases of cavernous hemangioma, 58 cases of capillary hemangioma, 16 cases of neurofibroma, 15 cases of fibroid, and 14 cases of schwannoma; 27 cases(5.9%)of intermediate type, including 23 cases of solitary fibrous tumor(SFT), 2 cases of low-grade malignant fibrous histiocytoma, 2 cases of low-grade mucinous neurofibroma; 7 cases(1.5%)of malignant type, 2 cases of orbital malignant SFT, 2 cases of orbital myeloid sarcoma(MS), mucinous liposarcoma(MLS), spindle cell undifferentiated sarcoma and peripheral primitive neuroectodermal tumor(PNET)1 case. Immunohistochemistry and molecular detection of some cases revealed that the application of new antibodies such as STAT6 and molecular detection techniques can improve the diagnostic accuracy.

CONCLUSION:Benign tumors account for the majority of orbital soft tissue tumors. Cavernous hemangioma in vascular tumors is the first, and there are few soft tissue tumor pathological types such as Erdheim-Chester disease(ECD)and granulomatous ossifying fibers. Tumors(POF), leiomyomas and myxomas; intermediate and malignant tumors are rare; pathological types such as SFT, MLS, spindle cell undifferentiated sarcoma and MS are often difficult to diagnose, easy to miss diagnosis and misdiagnosis, new immunity histochemical antibodies and molecular detection techniques can improve the accuracy of the diagnosis.

Abstract:AIM: To investigate the incidence and risk factors of near vision impairment(NVI)in patients with asthenopia.

METHODS: Totally 51 patients(102 eyes)with visual fatigue in our hospital from May 2017 to May 2018 were enrolled. According to whether the near vision of daily life is damaged, it is divided into daily near vision impairment group(24 cases)and no near vision impairment group(27 cases). General information of all patients were collected, and routine eye examination, subjective optometry and binocular eye movement parameter detection were detected.

RESULTS: In the survey, 27 patients(53%)with near vision impairment in naked eye and 24 patients(47%)with impaired near vision in daily life, and all patients had a significant improvement in visual acuity after correct optometry, and there was no one who has best corrected near visual acuity impairment. The age of patients with daily near vision impairment was significantly higher than that of patients without near vision impairment. The proportion of patients aged ≥45 years was significantly higher than that without near vision impairment(P<0.01). NRA/PRA, vergence \〖BO(40cm)\〗, and amplitude of vergence(40cm)were significantly different between the two groups(P<0.05).

CONCLUSION: Nearly half of patients with asthenopia would suffer NVI. The increase of age and imbalance between NRA and PRA as the predominant risk factors for its development.

Abstract:AIM: To compare and observe the image characteristics of polypoidal choroidal vasculopathy(PCV)with frequency domain optical coherence tomography(OCT)andoptical coherence tomography angiographyoptical(OCTA).

METHODS: Totally 25 eyes of 25 patients diagnosed with PCV in our hospital from March 2018 to December 2018 were included in the study. All the patients were examined by fluorescein fundus angiography(FFA)and /or indocyanine green angiography(ICGA)and OCT and OCTA were performed at the same time. Their similarities and differences between OCT and OCTA were compared.

RESULTS: OCT examination showed 14 eyes with serous and hemorrhagic pigment epithelial detachment(PED)in 25 eyes. OCTA lesions were in dark areas with low signal and 9 eyes showed strong signal points beside. OCTA showed branch vascular network(BVN)of reticular structure in 11 eyes with double layer sign. In 12 eyes with polyps lensions, OCTA showed strong or low signal areas.

CONCLUSION: OCTA is more intuitive to BVN in eyes with PCV. Polyps show strong or weak signals. Serous and hemorrhagic PED, OCT and OCTA images all showed low reflection or low singial dark ares,without characteristic. The lesion location and morphology of the two showed similarities, but also differences.

Abstract:Intravitreal injection is one of the most commonly used treatment methods in ophthalmology at present. It is easy to operate and has a shorter operation time. However, there is no consensus on whether it is necessary to dilate pupils before intravitreal injection. For this reason, we conducted an online questionnaire survey. On the basis of relevant research, we discussed the above issues and put forward our proposals. It is not necessary to dilate pupils before intravitreal injection.