Abstract:AIM: To investigate the effect of conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation for neovascular glaucoma(NVG)with and without vitreous hemorrhage.

METHODS: In this retrospective study, 39 eyes in 37 patients who were diagnosed with NVG with and without vitreous hemorrhage(where iridotrabecular contact is more than 180°)in the ophthalmology department of Xi'an No.1 Hospital between January 2016 and December 2017 were enrolled in this study. Patients were divided into two groups, based on whether they had vitreous hemorrhage. All patients received 0.5 mg(0.05 mL)conbercept intravitreal injection. Twenty-one eyes in 20 patiants(Group 1)without vitreous hemorrhage received EX-PRESS(P50)glaucoma drainage device implantation on 4d after conbercept intravitreal injection and then received panretinal photocoagulation 2wk after implantation. Eighteen eyes in 17 patients(Group 2)with vitreous hemorrhage received vitrectomy combined with the EX-PRESS(P50)glaucoma drainage device implantation and panretinal photocoagulation on 4d after conbercept intravitreal injection. Air or silicone oil was selectively filled according to the situation during the operation. All patients were followed up for 6mo after operation.

RESULTS: No statistical difference was found between preoperative best corrected visual acuity(BCVA)and postoperative(6mo)BCVA in Group 1(P>0.05). There was statistical difference between preoperative BCVA and postoperative(6mo)BCVA in Group 2(P<0.05). The intraocular pressure( IOP)of Group 1 at postoperative 1d, 1wk, 1, 3 and 6mo was 20.5±4.3 mmHg, 19.6±3.8 mmHg, 20.1±3.7 mmHg, 19.9±4.2 mmHg, and 19.3±2.9 mmHg, respectively. The postoperative IOP of Group 2 was 22.3±3.7 mmHg, 20.6±2.8 mmHg, 20.4±3.8 mmHg, 18.9±4.1 mmHg, and 19.3±3.4 mmHg, respectively. The postoperative IOP of every time point was significantly lower than the preoperative IOP in Group 1 and Group 2(P<0.05). During the follow up, three eyes in three patients showed a recurrence of iris neovascularization and were given one more 0.05 mL conbercept intravitreal injection.

CONCLUSION: Conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation can effectively reduce IOP in NVG(where the iridotrabecular touch is more than 180°).

Abstract:AIM: To describe the distribution of the central fovea macula in different zones of the eye fundus and different posterior scleral morphologies in high myopia(HM).

METHODS: From May 2016 and February 2018, a total of 207 eyes(126 cases)with HM were selected and divided into three groups according to Curtin's posterior scleral staphyloma classifications: group A(Types Ⅰ and Ⅱ), group B(Type Ⅲ), and group C(Types Ⅶ, Ⅸ, and Ⅹ). The posterior zone of the fundus was divided into three zones: zones 1, 2 and 3. The horizontal distance between the central fovea and the vertical line pass of the optic nerve head(ONH)center(HDFCO), the vertical distance between the fovea and the horizontal line pass of the ONH center(VDFCO), and vision were tested. The fovea position in different posterior scleral morphologies groups were investigated.

RESULTS: In zone 1, 3 eyes were all from group A(1.5%). In zone 2, 117 eyes were from group A(56.5%), 15 eyes were from group B(7.2%), and 13 eyes were from group C(6.3%). The HDFCO was 5 037±507 μm, 4 771±509 μm, and 5 585±773 μm in groups A, B, and C, respectively(F=8.38, P<0.01). The VDFCO values were 615±297 μm, 643±322 μm, and 504±363 μm(F=0.87, P=0.41). In zone 3, 43 eyes were from group A(20.7%), 7 eyes were from group B(3.4%), and 9 eyes were from group C(4.4%). The HDFCO was 5 048±683 μm, 4 444±540 μm, and 5 293±840 μm in groups A, B, and C, respectively(F=3.13, P=0.05). The VDFCO values were 1 385±484 μm, 1 225±201 μm, and 1 664±318 μm(F=2.18, P=0.12). The mean best corrected visual acuity of HM group was LogMAR 4.87±0.22 and 4.77±0.27 in zone 2 and zone 3, respectively(t=-1.55, P=0.12).

CONCLUSION: The position of the central fovea changes slightly with different posterior scleral morphologies in HM and has no effects on best corrected visual acuity.

Abstract:AIM: To analyse and characterize the pattern of working and mobile phone usage distances(MPUD)for common users of electronic devices and computers.

METHODS: Transversal descriptive study consisting of a screening campaign evaluating the visual status of different professionals working with computers or electronic devices more than 2h per day. A total of 100 healthy patients with a mean age of 41.2(range: 20-62)years were revised and subdivided according to job subgroups. A battery of screening tests was performed to all participants in a single session at the working environment of each of them, including measurement of the working distance(WD), arm length, and MPUD.

RESULTS:The WD was significantly longer than MPUD(61.22±12.35 vs 32.22±6.35 cm; P<0.001). Likewise, MPUD was significantly shorter than the arm length(74.44±4.65 cm; P<0.001). A total of 4%(4/100)and 91%(91/100)of patients had a WD and MPUD of 40 cm or below, respectively. A weak although statistically significant correlation was found between WD and MPUD(r=0.387, P<0.001)as well as between WD and arm length(r=0.260, P=0.009). Statistically significant differences were detected among job subgroups in WD(P=0.021), being longer for militaries compared to university researchers and lecturers(P=0.025).

CONCLUSION:Working and mobile phone usage distances vary significantly among common users of computers and digital devices, although the use of mobile phones tends to be performed at significantly closer distances. This parameter should be considered when planning any type of optical correction, especially for presbyopia.

Abstract:AIM: To investigate the effects of doxycycline(DOX)on vasculogenic mimicry(VM)in human pterygium fibroblasts(HPFs)and its molecular mechanisms.

METHODS: Primary cultured HPFs were identified by Vimentin and CK through immunocytochemical staining. HPFs were divided into control group and DOX group including low, medium and high concentrations(50, 100, 200mg/L). The activity and migration of HPFs were detected by cell counting kit-8(CCK-8)and wound healing assay. The density of VM was observed by three-dimensional cell culture and periodic acid schiff(PAS)staining and compared the differences of VM formation in each group. Western blot was used to analyze the expression of matrix metalloproteinase-9(MMP-9)and vascular endothelial growth factor(VEGF).

RESULTS:Immunocytochemical staining results showed that the cells were spindle shaped, meanwhile, they were positive for Vimentin and negative for CK, which were consistent with the characteristics of fibroblasts. Compared with the control group, the cell activity, mobility, VM density and the expression of MMP-9 and VEGF proteins in the DOX group were significantly decreased(P<0.05). Compared among different concentrations of DOX groups, the differences were statistically significant(P<0.05). Correlation analysis indicated that VM density formed by HPFs was significantly positively correlated with the protein expression of MMP-9 and VEGF(r=0.949, 0.960, all P<0.05).

CONCLUSION: DOX can inhabit HPFs activity, migration, VM density by reducing the expression of MMP-9 and VEGF, suggesting that MMP-9 and VEGF may be the molecular mechanisms of VM formation in pterygium.

Abstract:AIM: To establish three-dimensional(3D)model of rat retinal angiogenesis in vitro based on retinal microvascular endothelial cells(ECs)and retinal microvascular pericytes(RMPs).

METHODS: The identified ECs and RMPs of third generation to seventh generation were used for research after isolated, purified and cultured. The cells were stained with cell tracer. Then, it were mixed and inoculated on Matrigel by the surface culture method for dynamic observation. The expression of VEGF-A was assessed during angiogenesis.

RESULTS: At 12h of co-culture, RMPs were recruited by ECs and gathered into cell masses with different sizes. At 24h, ECs/RMPs formed a complex 3D vascular spline network. At 48h, the reticular structure disintegrated obviously, and only a small amount of incomplete and simple reticular structure remained. At 72h, the vascular spline cable network disintegrated completely. In the development of 3D model, the expression of VEGF-A increased, but decreased when it degenerated.

CONCLUSION: This study successfully established a 3D model of rat retinal angiogenesis in vitro based on ECs and RMPs.

Abstract:AIM: To analyze the clinical value of phacoemulsification and intraocular lens implantation(Phaco+IOL)combined with endoscopic cyclophotocoagulation(ECP)in the treatment of patients with glaucoma and cataract.

METHODS: Between January and December 2019, 58 patients(64 eyes)with primary glaucoma and cataract diagnosed and treated in Ophthalmology Department of the hospital were enrolled in this study. According to the patients' and their family members' willingness, the study subjects were divided into ECP group(27 cases, 30 eyes, Phaco+IOL+ECP)and trabeculectomy(TRAB)group(31 cases, 34 eyes, Phaco+IOL+TRAB). Surgical results, changes in visual acuity, intraocular pressure, corneal endothelial cells, and optical coherence tomography(OCT)parameter were compared between the two groups.

RESULTS: The complete success rate of surgery in ECP group was 83%, higher than 59% in TRAB group(P<0.05). After surgery, visual acuity of the two groups was improved, and intraocular pressure was reduced(P<0.05), without statistical difference between groups(P>0.05). After surgery, the coefficient of variation of corneal endothelial area, proportion of hexagonal cells, average cellular area, and central corneal thickness of ECP group were lower and smaller than those of TRAB group, while corneal endothelial cell density was higher than TRAB group(P<0.05). After surgery, anterior chamber depth(ACD), angular opening distance 500(AOD₅₀₀), trabecular iris angle(TIA), and angular recess area(ARA)were increased in the two groups(P<0.05), without statistically significant differences between groups(P>0.05). The incidence of ocular hypertension requiring drug control and the total incidence of ocular hypertension were significantly lower in ECP group than in TRAB group(all P<0.05).

CONCLUSION: Compared with TRAB, ECP can achieve a higher complete success rate in the treatment of glaucoma with cataract, with less influence on corneal cells.

Abstract:AIM: To explore the effect of artificial tears combined with recombinant bovine basic fibroblast growth factor(rbFGF)on ocular surface function and inflammatory factors in patients with cataract complicated with xerophthalmia.

METHODS: A total of 118 cataract patients(118 eyes)with dry eyes treated in our hospital from February 2019 to February 2020 were randomly divided into control group(n=59)and observation group(n=59). The control group was treated with artificial tears before operation and the observation group was treated with artificial tears combined with rbFGF before operation. The clinical symptom score, ocular surface function index \〖ocular surface disease index(OSDI)questionnaire score, break up time(BUT), schirmer Ⅰ test(SⅠt), fluorescein stain test(FL)\〗, inflammatory factors in tears \〖interleukin-6(IL-6), tumor necrosis factor α(TNF-α)\〗 and oxidative stress indexes \〖malondialdehyde(MDA), lipid peroxide(LPO), superoxide dismutase(SOD), total antioxidant capacity(TAC)\〗 were compared between the two groups before and after treatment. The random walking model was used to evaluate the ocular surface function and the level of inflammatory factors in tears of the two groups.

RESULTS: Before treatment, there was no significant difference in clinical symptom score, OSDI, BUT, SⅠt, FL, IL-6, TNF-α, MDA, SOD, LPO and TAC between the two groups. Thirty days after treatment, the clinical symptom score, OSDI, FL, TNF-α, IL-6, MDA and LPO levels in two groups were significantly decreased, while the levels of BUT, SⅠt, SOD and TAC were significantly increased. The improvement of clinical symptom score, ocular surface function, inflammatory factors and oxidative stress in the observation group were significantly better than that in the control group.

CONCLUSION: Preoperative intervention with artificial tears combined with rbFGF can significantly improve the ocular surface function of cataract patients with xerophthalmia, reduce the level of inflammatory factors in tears, improve the symptoms of xerophthalmia, and provide reference for the clinical treatment of cataract with xerophthalmia.

Abstract:AIM: To explore the efficacy of phacoemulsification combined with capsular tension ring(CTR)implantation in the treatment of patients with high myopia complicated with cataract, and to analyze its safety.

METHODS: A retrospective analysis was performed on the clinical data of 186 patients(186 eyes)with high myopia and cataract who underwent phacoemulsification+ intraocular lens(IOL)implantation treatment in our hospital. Among them, 98 cases(98 eyes)were combined with CTR implantation(combined group)and 88 cases(88 eyes)were not combined with CTR implantation(control group). The best corrected visual acuity(BCVA, LogMAR), visual quality \〖root mean square value(RMS)of higher-order aberration(HOA)\〗 and corneal endothelial cell density were recorded in the two groups before surgery and at 1, 3 and 6mo after surgery, and the area of anterior capsular orifice and inclination angle of IOL were evaluated at 1, 3 and 6mo after surgery, and the occurrence of complications such as postoperative anterior capsule opacification, posterior capsule opacification and capsular contraction syndrome were compared between the two groups.

RESULTS: There were interaction effects in the BCVA between the two groups(P<0.05). The BCVA of the two groups after surgery was decreased compared with that before surgery(P<0.05), and the BCVA of combined group after surgery was lower than that of control group(P<0.05). There were interaction effects in the total HOA RMS(P<0.05), and the total HOA RMS of the two groups after surgery was increased compared with that before surgery(P<0.05), and the total HOA RMS after surgery in combined group was lower than that in control group(P<0.05). There were interaction effects in the anterior capsular orifice area after surgery between the two groups(P<0.05), and the area in the two groups was decreased with the prolongation of postoperative time(P<0.05), and the area in combined group at 3 and 6mo after surgery was higher than that in control group(P<0.05). The IOL inclination angle of the two groups had interaction effects between the two groups(P<0.05), and the angle of the two groups was increased with the prolongation of postoperative time(P<0.05), and the angle of combined group at 3 and 6mo after surgery was lower than that of control group(P<0.05). The corneal endothelial cell density in the two groups after surgery was lower than that before surgery(P<0.05), but there was no interaction effect(P >0.05).

CONCLUSION: Phacoemulsification+ IOL implantation + CTR implantation can improve the visual function of patients with high myopia complicated with cataract, with few postoperative complications and good efficacy and safety.

Abstract:Diabetic retinopathy(DR)is the most common complication of diabetes mellitus and remains the leading cause of blindness in working-age population. DR affects almost all the retinal cells, leading to the disruption and dysfunction of neurovascular unit and the neural-glial network. Erythropoietin(EPO), a glycoprotein hormone, plays a pivotal role in neuroprotection, neurotrophy, anti-inflammation, anti-apoptosis and anti-oxidation etc., in various central nervous system diseases. This review discussed the protective effect of EPO in DR so as to provide new options for DR treatment.

Abstract:Diabetic macular edema(DME)is the foremost cause of vision impairment and even blindness in patients with diabetes mellitus. Nowadays, the approach in the treatment of DME involves laser photocoagulation, intravitreal injections of anti-VEGF agents or triamcinolone acetonide. However, they still have some limitations. In recent years, dexamethasone intravitreal implant, as a new treatment option, has brought therapeutic hope to DME patients who have poor response to other methods. Meanwhile, it has the advantages of good clinical efficacy, long duration, acceptable safety and good patient tolerability. In this paper, the research advances in dexamethasone intravitreal implant for DME are described.

Abstract:With the development of refractive cataract surgery,Toric intraocular lens(Toric IOL)has been widely used in the treatment of cataract patients with regular astigmatism. And the rotational stability of Toric IOL has been paid more and more attention. This article reviewed the evaluation method of the rotation stability, and analyzed various related influencing factors.

Abstract:Glaucoma is a global blindness-causing disease characterized by visual function damage. Primary open angle glaucoma, also known as chronic open angle glaucoma, is not easily detected in the early stages of its occurrence and development, delaying treatment. Early diagnosis of the disease is helpful to reduce the rate of blindness. In recent years, new progress has been made in the diagnosis of primary open angle glaucoma, including optical coherence tomography, deep learning algorithms and biomarkers. This article will give an overview of these.

Abstract:Rheumatic immune disease, as a group of recurrent systemic diseases, involves the vascular system through inflammatory factors. Eye reaction can be used as a sign of rheumatic immune reactivation or disease aggravation, together with the first systemic manifestation of rheumatic immune disease. As a part of the most abundant blood flow in the eyes, choroid is an excellent evaluation index for ocular involvement, and it is greatly affected by systemic vascular diseases. And optical coherence tomography provides a scientific and accurate measuring tool for the observation of choroid thickness. However, whether changes in choroid thickness can be utilized as markers of disease activity, and progression, our results require further research. In this paper, the changes of choroid thickness in rheumatic immune diseases are analyzed.

Abstract:Uveitis is a clinically common refractory blinding eye disease with complicated etiology and pathogenesis that is difficult to treat and prone to recurrence. It is currently considered to be closely associated autoimmune inflammatory response. Tumor necrosis factor-α(TNF-α)acts as a key pro-inflammatory factor in development and progression of uveitis. Adalimumab(ADA)is a fully humanized recombinant anti-immunoglobulin monoclonal antibody targeting TNF-α, and exerts its biological effects by specifically binding to TNF-α and blocking its binding to tumor necrosis factor receptors(TNFR-1/TNFR-2). This paper reviews the clinical research progress on the mechanism, efficacy and safety of ADA in the treatment of non-infectious uveitis.

Abstract:Age-related macular degeneration(ARMD)is a progressive fundus disease which seriously damages the vision and visual function. It is one of the important causes of blindness in the elderly. With the development of aging population, ARMD has become a serious public health problem. With the continuous research of scholars at home and abroad, it is found that ARMD is often affected by a variety of risk factors, such as age, heredity, environment, diet and so on. Understanding the risk factors of ARMD and taking effective preventive measures are of great significance to reduce the incidence of ARMD and delay the disease progression. This article makes a brief review on the risk factors of ARMD.

Abstract:Rhegmatogenous retinal detachment(RRD)is the separation of the retinal nerve sensory layer and the pigment epithelium layer caused by retinal tears. It is a kind of ophthalmic emergency. If it is not treated in time, the blinding rate is close to 100%. Surgery is an important way to treat RRD. With the deepening of disease awareness and the improvement of retinal reattachment techniques, RRD reattachment has achieved a higher anatomical success rate, but in clinical, the postoperative visual experience of patients is still not ideal. This article mainly summarizes the influencing factors of RRD visual function prognosis and provides guidance for clinical treatment.

Abstract:Graves ophthalmopathy(GO)is the most common and relatively complicated orbital diseases, and the incidence rate is increasing year by year. Severe GO may present with exposure keratopathy, diplopia and compressive optic neuropathy, which seriously affects influences patients quality of life. At present, orbital decompression is an effective method in the treatment of moderate and severe GO, and with the continuous expansion of indications for orbital decompression, more and more patients with mild and moderate GO with exophthalmos require surgical treatment to improve the appearance. There are many different surgical techniques for orbital decompression, and which one can achieve patients' maximum benefit is a frequently encountered clinical problem for ophthalmologist. With the gradual increase of the amount of surgery, complications become increasingly prominent, which affect postoperative satisfaction of patients. In order to deepen the understanding of complications, avoid or reduce the occurrence of complications, and optimize the operation plan, this paper reviews the relevant literature at home and abroad in recent years, and summarizes the selection of operation methods and operation related complications of orbital decompression in GO patients.

Abstract:AIM:To systematically assess the efficacy and safety of femtosecond laser-assisted cataract surgery(FLACS)implanted with multifocal intraocular lens(MFIOL)with conventional cataract surgery.

METHODS: Electronic databases of PubMed, EMbase, Cochrane and OVID were searched for studies comparing FLACS-MFIOL and CP-MFIOL. Two independent reviewers performed the data extraction and analyzed. Visual acuity, spherical equivalent(SE), pseudophakic accommodation, cumulative dissipated energy(CDE)and endothelial cell density(ECD)were measured by Review Manager 5.4. Sensitivity and reporting bias were determined through the STATA 14 software.

RESULTS: From 106 screened articles, 1 045 eyes from 6 randomized controlled trials(RCTs)and 5 retrospective cohort studies were included(one of which contained two groups of comparative data). There was no evidence for any important differences in uncorrected distance visual acuity(UDVA)between FLACS-MFIOL and CP-MFIOL group after 1d, 1wk, 1, 3mo and 1a \〖s: -0.02, 95% Confidence Interval(CI)(-0.05, 0.01), P=0.13; s: -0.01, 95% CI(-0.03, 0.01), P=0.24; s: -0.03, 95% CI(-0.06, 0.00), P=0.05; s: -0.03, 95% CI(-0.14, 0.08), P=0.59; s: -0.03, 95% CI(-0.06, 0.00), P=0.10\〗. We found little evidence of any important difference in uncorrected near visual acuity(UNVA)between the two groups after 1d, 1wk, 3mo and 1a \〖s: 0.04, 95% CI(-0.04, 0.12), P=0.30; s: 0.04, 95% CI(-0.06, 0.13), P=0.47; s: 0.00, 95% CI(-0.04, 0.04), P=0.97; s: 0.03, 95% CI(-0.06, 0.12), P=0.54\〗. There was a small advantage in favor of FLACS-MFIOL over CP-MFIOL for UNVA after 1mo \〖s: 0.03, 95% CI(0.00, 0.06), P=0.04; s: 0.06, 95% CI(-0.02, 0.15), P=0.14\〗. In eyes treated with FLACS-MFIOL, SE showed no difference compared to CP-MFIOL \〖s: 0.06, 95% CI(-0.02, 0.15), P=0.14\〗, however, better than CP-MFIOL in distance and near pseudophakic accommodation \〖s: 0.57, 95% CI(0.42, 0.72), P<0.001; s: 1.32, 95% CI(0.99, 1.64), P<0.001\〗. Smaller CDE \〖s: -1.94, 95% CI(-2.59, -1.30), P<0.01; s: -3.81, 95% CI(-5.66, -1.96), P<0.01\〗 of Ⅱ and Ⅲ nucleus patients and increased ECD \〖s: 111.75, 95% CI(86.27, 137.23), P<0.01\〗 in FLACS-MFIOL group were analyzed. The sensitivity analysis indicated that the results were robust and no obvious reporting bias.

CONCLUSION: Compared to CP-MFIOL, FLACS-MFIOL makes a better visual quality and pseudophakic accommodation, as well as reducing endothelial cell loss and phacoemulsification energy.

Abstract:AIM: To analyze the efficacy of bevel-up phaco chop versus bevel-down phaco drill in the treatment of hard nuclear cataract and the influence on corneal endothelium.

METHODS: Between August 2018 and April 2020, 94 patients(104 eyes)with hard(grade Ⅳ-Ⅴ)nuclear cataract treated with phacoemulsification were enrolled in this retrospective study. Among them, 50 eyes treated by bevel-up phaco chop were included in the control group, while 54 eyes treated by phaco drill technique were included in the observation group. The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter in the two groups were recorded. The best corrected visual acuity(BCVA)in 7d, corneal endothelial cell count in 2mo, the proportions of normal hexagonal cells and the degree of corneal edema in 7d were compared between the two groups.

RESULTS: The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter of the observation group were shorter and lower than those of the control group(P<0.05). The BCVA of both groups increased after operation, and the observation group had higher BCVA than the control group at the same time(P<0.05). In 1 and 2mo, the corneal endothelial cell counts and the proportions of normal hexagonal cells in both groups were lower than those before operation. Meanwhile, the corneal endothelial cell count and the proportions of normal hexagonal cells in the observation group were higher than those in the control group(P<0.05). Besides, corneal edema was milder in the observation group than in the control group at 24h and 7d after operation(P<0.05).

CONCLUSION: Compared with bevel-up phaco chop, phaco drill can significantly shorten the time of using ultrasound, reduce ultrasound energy, promote visual recovery, and reduce corneal endothelial cell damage.

Abstract:AIM: To explore the application value of serum pigment epithelial derived factors(PEDF), fibroblast growth factor 19(FGF19)and β-endorphin(β-EP)in the diagnosis and severity assessment of primary glaucoma.

METHODS: A total of 102 patients with primary glaucoma in the hospital were enrolled as study group between February 2018 and February 2020, while other 102 healthy controls during the same period were enrolled as control group. The levels of peripheral serum PEDF, FGF19 and β-EP were compared between the two groups. And their diagnostic value for primary glaucoma was analyzed. The study group was divided into severe and non-severe groups according to the diagnostic criteria for severe primary glaucoma. The levels of peripheral serum PEDF, FGF19 and β-EP were compared between severe group and non-severe group. And their evaluation value for disease severity was analyzed. The risk factors of disease severity were analyzed by multivariate Logistic regression analysis.

RESULTS: The level of serum PEDF in study group was significantly lower than that in control group, while levels of FGF19 and β-EP were significantly higher than those in control group(P<0.001). AUC values of PEDF, FGF19 and β-EP levels in the diagnosis of primary glaucoma were 0.695, 0.754 and 0.768, respectively. The level of serum PEDF in severe group was significantly lower than that in non-severe group(P<0.001), while levels of FGF19 and β-EP were significantly higher than those in non-severe group(P<0.001). AUCvalues of PEDF, FGF19 and β-EP levels in assessing the severity of primary glaucoma were 0.731, 0.709 and 0.685, respectively. PEDF lower than 9.66pg/mL, FGF19 higher than 143.75ng/L and β-EP higher than 106.27ng/L were independent influencing factors of severe primary glaucoma(OR=2.280, 1.570, 1.413, all P<0.05).

CONCLUSION: FGF19 and β-EP are of auxiliary diagnostic value in primary glaucoma, while PEDF and FGF19 are of evaluation value in disease severity. PEDF lower than 9.66pg/mL, FGF19 higher than 143.75ng/L and β-EP higher than 106.27ng/L are independent influencing factors of severe primary glaucoma.

Abstract:AIM: To explore the effect and safety of pars plana vitrectomy(PPV)assisted by intravitreal injection of conbercept in the treatment of proliferative diabetic retinopathy(PDR)combined with vitreous hemorrhage(VH).

METHODS: In the prospective randomized controlled study, patients with PDR and VH who were admitted to ophthalmology department of the hospital from February 2017 to September 2019 were enrolled as the research objects. They were randomly divided into observation group(39 cases, 39 eyes)and control group(38 cases, 38 eyes). Both groups underwent standard 27G PPV. The observation group underwent intravitreal injection of conbercept within 6-7d before surgery. The perioperative indexes were collected. The best corrected visual acuity(BCVA), intraocular pressure and central macular thickness(CMT)were followed up. The occurrence of surgical related complications was statistically analyzed.

RESULTS: Operation time(74.18±15.26 vs 96.17±14.27min), number of bleeding eyes(8% vs 37%), ratio of silicone oil filling(18% vs 53%)and incidence of iatrogenic retinal breaks(15% vs 47%)were lower in observation than control group(P<0.05). BCVA at 1mo after surgery(0.33±0.10 vs 0.60±0.21), 3mo after surgery(0.29±0.08 vs 0.59±0.30)and 6mo after surgery(0.28±0.10 vs 0.66±0.25)were significantly better in observation than control group(P<0.05). CMT at 3mo after surgery(252.15±56.96 vs 278.41±57.48μm)and 6mo after surgery(239.65±41.52 vs 268.59±33.71μm)were significantly better in observation than control group(P<0.05). During follow up, the incidence rates of VH in observation group and control group were 5% and 21%, respectively(P<0.05). In control group, there were 3 eyes(8%)with tractional retinal detachment after surgery, while there was no tractional retinal detachment in observation group(P>0.05).

CONCLUSION: For patients with PDR and VH, intravitreal injection of conbercept before PPV can shorten operation time, reduce intraoperative blood loss and alleviate macular edema to obtain better visual acuity, with better curative effect and safety.

Abstract:AIM: To explore the risk factors that affect visual function recovery in patients with idiopathic macular epiretinal membrane(IMEM)undergoing internal limiting membrane peeling(ILMP).

METHODS: This study retrospectively reviewed 118 patients(118 eyes)with IMEM who underwent ILMP in the hospital between January 2016 and April 2020. The patients were followed up for 6mo after surgery to evaluate curative effect. Changes in visual acuity before surgery and at 1, 3 and 6mo after surgery, metamorphopsia degree, mean central foveal thickness and volume of macular area were observed. The correlation of mean central foveal thickness and volume of macular area before and after surgery with postoperative visual acuity and metamorphopsia scores was analyzed. The risk factors for poor visual function recovery after surgery were evaluated.

RESULTS: In this study, 96 eyes obtained good visual function recovery, and the improvement rate was 81.4%. At 1, 3 and 6mo after surgery, visual acuity was significantly improved(P<0.05), metamorphopsia score in horizontal direction, mean central foveal thickness and volume of macular area were significantly reduced(P<0.05). The mean central foveal thickness and volume of macular area before surgery and at 6mo after surgery were negatively correlated with visual acuity at 6mo after surgery(P<0.05), but positively correlated with metamorphopsia score in horizontal direction(P<0.05). The course of IMEM, preoperative corrected visual acuity, preoperative horizontal or vertical metamorphopsia, and preoperative macular edema were influencing factors of visual function recovery after surgery(all P<0.05). Poor preoperative corrected visual acuity(OR=3.062), horizontal metamorphopsia(OR=2.438)and preoperative macular edema(OR=2.000)were risk factors for poor visual function recovery.

CONCLUSION: The curative of ILMP is effect on IMEM, which can effectively improve visual acuity of operative eyes and reduce metamorphopsia. The longer the course of disease, the worse the preoperative corrected visual acuity, and the more severe the preoperative metamorphopsia, the worse the visual function recovery in patients with preoperative macular edema after ILMP.

Abstract:AIM: To explore the clinical value of oral administration of Tongmai Tangyanming Capsule after 23-gauge(23G)pars plana vitrectomy(PPV)in patients with proliferative diabetic retinopathy(PDR).

METHODS: This prospective study included 98 patients(109 eyes)with PDR admitted to the hospital between February 2018 and October 2019. The patients were randomly divided into control group(49 cases, 54 eyes, 23G PPV)and observation group(49 cases, 55 eyes, oral administration of Tongmai Tangyanming Capsule, 750 mg/time, 3 times/d, for 12wk). The best corrected visual acuity(BCVA), intraocular pressure, visual field sensitivity and central macular thickness(CMT)were measured before and 12wk after surgery. Changes in insulin-like growth factor-1(IGF-1)and vascular endothelial growth factor(VEGF)were determined, and insulin resistance index(HOMA-IR)was calculated. The surgical complications and recurrence rate during 12wk of follow-up were observed.

RESULTS: At 12wk after surgery, the BCVA(LogMAR)and visual field sensitivity of the two groups were improved(P<0.001), and CMT was decreased(P<0.001), but there was no significant change in intraocular pressure(P>0.05). Meanwhile, the BCVA and visual field sensitivity of the observation group were higher than those of the control group(P<0.05), and CMT was smaller than that of the control group(P<0.05). At 12wk after surgery, serum IGF-1, VEGF and HOMA-IR were decreased in the two groups(P<0.001), and these indicators in the observation group were lower than those in the control group(P<0.001). The incidence of complications and recurrence rate were similar in the two groups(P >0.05).

CONCLUSION: Oral administration of Tongmai Tangyanming Capsule after 23G PPV can better promote postoperative visual recovery, improve visual sensitivity, reduce insulin resistance and lower the levels of IGF-1 and VEGF, inhibit retinal neovascularization and proliferation, and reduce the risk of recurrence.

Abstract:AIM: To analyze the influence of limbal conjunctival autograft and amniotic membrane transplantation on vision, corneal astigmatism(CAD)and tear film function in patients undergo pterygium surgery.

METHODS: Totally 96 patients(96 eyes)who had undergone pterygium surgery in the Department of Ophthalmology at Pengzhou People's Hospital were enrolled in this retrospective study between August 2018 and March 2020. According to random number table method, the patients were divided into observation group(48 patients with 48 eyes treated with pterygium excision combined with limbal conjunctival autograft)and control group(48 patients with 48 eyes treated with pterygium excision combined with amniotic membrane transplantation). General surgical indicators, uncorrected visual acuity(UCVA), tear film function \〖break-up time(BUT), SⅠt\〗, CAD, ocular surface disease index(OSDI), recurrence rate and incidence of complications were compared between the two groups.

RESULTS: The surgical time of observation group was longer than that of the control group, and the corneal epithelial healing time was shorter than that of the control group(P<0.001). There was no significant difference in hospital stay or conjunctival hyperemia and edema remission time between the two groups(P >0.05). The UCVA of the two groups increased at 1, 3 and 6mo after surgery(P<0.05), without statistically significant difference between groups(P >0.05). Compared with pre-operation, the BUT and SⅠt of both groups also increased, while CAD and OSDI scores decreased at 1, 3 and 6mo after surgery(P<0.05). Besides, the BUT and SⅠt of observation group at 1mo after surgery were shorter/lower than control group, which were longer/higher than control group at 3 and 6mo after surgery(P<0.05). However, there was no significant difference in CAD between the two groups(P >0.05). OSDI scores of the observation group were lower than those of the control group at 1, 3 and 6mo after surgery(P<0.05). The recurrence rate of observation group within 6mo after surgery was lower than that of control group(P<0.05), but the difference in incidence of complications was not significant(P>0.05).

CONCLUSION: Compared with amniotic membrane transplantation, limbal conjunctival autograft combined with pterygium excision applied in treatment of patients with pterygium can significantly shorten the corneal epithelial healing time, and reduce the influence on tear film function and recurrence rate, without affecting vision and corneal astigmatism. It is also safe and reliable.

Abstract:AIM:To analyze satisfaction on night vision and its related factors after FS-LASIK in patients with high and low-to-moderate myopia.

METHODS:This was a retrospective study. Totally 75 patients(150 eyes)who underwent FS-LASIK in Xi'an No.1 Hospital from June 2018 to September 2019 were included. All subjects were divided into two groups based on spherical equivalent(SE): high myopia group(SE≥-6.00D)and low-to-moderate myopia group(<-6.00D). Six months after surgery, corneal topography and corneal higher-order aberrations(total HOAs, spherical aberrations, coma and trefoil)under 7mm pupil diameter was investigated by Sirius. Patients were required to complete a questionnaire to evaluate satisfaction and night vision symptoms.

RESULTS:For the high myopia group and low-to-moderate myopia group, preoperative SE was -7.85±1.27D and -4.57±1.01D respectively. There were significant differences in total HOAs, spherical aberrations and coma(all P<0.001)except for the trefoil(P>0.05)between the two groups. Overall satisfaction was 95.3% and 100.0% in high and low-to-moderate myopia group. 18.8% and 9.3% experienced worsen night vision, 51.2% and 40.6% experienced halo, 41.9% and 43.8% experienced starburst, and 18.6% and 15.6% experienced double vision, respectively. Except that there was significant differences in night vision between the two groups(P=0.010), the occurrence of other night vision symptoms were similar and there were no significant differences in any of them(all P>0.05). For all patients, the satisfaction was correlated with preoperative astigmatism and ablation zone(all P<0.05), night vision was correlated with preoperative SE, ablation depth, corneal curvature, total HOAs, spherical aberrations and coma postoperatively(all P<0.05), star burst was correlated with preoperative total HOAs, coma and postoperative trefoil(all P<0.05), double vision was correlated with preoperative astigmatism(P<0.05).

CONCLUSION: High myopic patient experienced worsen night vision mainly because of increased total HOAs, spherical aberration and coma. However, symptoms such as halo, starburst and double vision were similar in both groups and did not affect overall satisfaction.

Abstract:AIM: To analyze correlation of secondary glaucoma and postoperative visual acuity after infantile congenital cataract surgery.

METHODS: Retrospective case series. Totally 48 cases(86 eyes)were observed in our hospital from May 2006 to January 2018. All patients received intraocular lens(IOL)implantation with posterior continuous curvilinear capsulorhexies and anterior vitrectomy after cataract extraction. The best corrected visual acuity(BCVA)was determined, secondary glaucoma was evaluated during the 13a follow-up period. The independent samples t-test, Fisher exact test and multivariate Logistic regression were used to analyze the data.

RESULTS: Thirteen eyes(15%)with secondary glaucoma postoperative BCVA(LogMAR)were 0.63±0.20. And 73 eyes(85%)without secondary glaucoma postoperative BCVA were 0.44±0.27, there was statistically significant difference in BCVA between the two groups(t=2.417, P<0.05). Glaucoma occurred in 29%, 18% and 3% of patients with cataract extraction ≤3mo, 3-12mo and >12mo, respectively. Fisher analysis there was statistically significant difference between operation age ≤3mo and >12mo(P<0.05). The difference of axial length(AL)and refraction diopter between with and without secondary glaucoma were statistically significant(t=-2.92, P=0.004). Multivariate Logistic regression analysis showed surgery age ≤12mo was the risk factor(OR=8.372, 95%CI: 1.033-67.864, P=0.047). Cataract surgery age below 12mo is 8.372 times the probability of secondary glaucoma than surgery age above 12mo.

CONCLUSION: Most children can achieve good postoperative visual acuity and the secondary glaucoma occurred after surgery. The age of cataract surgery more than 12mo is a risk factor for postoperative secondary glaucoma, especially cataract surgery age below 3mo is much higher the probability of secondary glaucoma than above 12mo. Patients with secondary glaucoma have longer AL, smaller refraction diopter and more pronounced myopia drift than patients without secondary glaucoma.

Abstract:AIM:To investigate the effect of anti-VEGF combined with panretinal photocoagulation(PRP)in the treatment of severe non-proliferative diabetic retinopathy(sNPDR)with diabetic macular edema(DME)on the change of macular blood flow density.

METHODS: Data of 30 eyes in 30 patients at Guangxi Zhuang Autonomous Region People's Hospital from October 2018 to April 2019 were retrospectively reviewed, and they were randomly divided into group A and group B each with 15 cases. Group A was received PRP treatment after one initial intravitreal ranibizumab injection followed by pro re nata(PRN)at 7d, while group B was administered PRP alone. The blood flow density of superficial capillary plexus(SCP)and deep capillary plexus(DCP)in macular area(6mm×6mm), central macular thickness(CMT), and best corrected visual acuity \〖BCVA(LogMAR)\〗 were compared between the two groups before and after treatment.

RESULTS: Compared with before operation, the DCP blood flow density was significantly increased, CMT was obviously decreased, and BCVA was markedly improved in group A at 2wk and 1mo after surgery(all P<0.05), while CMT was decreased and BCVA was improved in group B at 1mo after operation(all P<0.05). Postoperative in group A at 2wk and 1mo, the DCP blood flow density was significantly higher than that in group B(43.37%±2.72% vs 41.03%±2.60%, 45.01%±2.28% vs 41.20%±2.43%, P<0.05), CMT was obviously lower than group B(303.4±30.36μm vs 329.60±31.47μm, 268.67±30.27μm vs 319.40±28.63μm, all P<0.05), and BCVA(LogMAR)was markedly improved compared with group B(0.28±0.11 vs 0.40±0.13, 0.23±0.14 vs 0.38±0.15, all P<0.05).

CONCLUSION: Anti-VEGF combined with PRP can effectively increase DCP blood flow density, reduce macular edema and improve visual acuity in the short term in patients with sNPDR with DME.

Abstract:AIM:To investigate the changes of microvascular diameter in non-proliferative diabetic retinopathy(NPDR)at different stages.

METHODS: Prospective case-control study. Patients with type 2 diabetes mellitus complicated with diabetic retinopathy(DR)who were hospitalized in the Endocrine Department of our hospital from September 2020 to March 2021 were selected and divided into diabetic non-retinopathy group(50 cases and 50 eyes), DR stage Ⅰ group(50 cases and 50 eyes), DR stage Ⅱ group(50 cases and 50 eyes), DR stage Ⅲ group(50 cases and 50 eyes)according to the “Clinical Diabetic Retinopathy Disease Severity Scale” formulated by the Chinese Medical Association in 1985. In addition, 50 cases and 50 eyes of a control group with normal physical examination were selected, totally 250 cases and 250 eyes. The fundus color photos were taken and entered into the ARIA1.0 automatic analysis software to record the diameters of arterio-venous and capillary vessels in different ranges, with 4 segments in each range and 200 segments in each group for statistical analysis.

RESULTS: There was no significant difference in the diameter of retinal artery between different stages of NPDR(P>0.05), and there was significant difference in the diameter of retinal vein and diameter of perimacular capillary amorg different stages of NPDR(P<0.05). The multiple comparison of retinal vein diameter and perimacular capillary diameter in different groups was statistically significant(P<0.01). The average score of retinal vein diameter in the range of 0-0.5PD was “stage Ⅲ course > stage Ⅱ course>stage Ⅰ course>normal group>control group”. The average score of retinal vein diameter group in the range of 0.5-1.0PD(including 0.5)was “stage Ⅲ course > stage Ⅱ course > stage Ⅰ course > normal group > control group”, the average score of perimacular capillary diameter group was “stage Ⅲ course > stage Ⅰ course > control group; Stage Ⅲ course > normal group; Stage Ⅱ course > stage Ⅰ course > control group; Stage Ⅱ course > normal group; The diseased normal group > the control group”, while there was no significant difference between the stage Ⅲ course and the stage Ⅱ course, the stage Ⅰ course and the diseased normal group(P>0.05).

CONCLUSION: Retinal artery diameter has no obvious change in NPDR stages. The retinal vein and perimacular capillary in diabetic patients are dilated. In different stages of NPDR, the diameter of the vein and perimacular capillary is gradually widened.

Abstract:AIM: To analyze the etiology and clinical characteristics of patients with vitreous hemorrhage, and to provide a scientific evidence for the clinical diagnosis, treatment and prevention of vitreous hemorrhage.

METHODS: We has collected and investigate 1 413 cases(1 437 eyes)from March 2013 to November 2019 in the Second Hospital of Lanzhou University, which had treated with vitreous hemorrhage as initial diagnosis and under-went pars plana vitrectomy(PPV)treatment.

RESULTS: Among 1 437 eyes with vitreous hemorrhage, the major causes of vitreous hemorrhage were proliferative diabetic retinopathy(PDR)(37.72%), retinal vein occlusion(RVO)(27.00%), and ocular trauma(13.15%). Analysis of the etiology of the age group, among 308 eyes in the youth group, the main causes were ocular trauma(35.06%), PDR(22.73%)and Ealse disease(11.69%); 590 eyes in the middle-aged group. Based on the affected eyes, the main causes were PDR(45.08%), RVO(28.98%)and ocular trauma(10.00%); From 539 eyes in the elderly group, the main cause was PDR(38.22%)and RVO(34.69%)and retinal tears and retinal detachment(RT/RD)(7.05%). There were significant differences in the etiology of each age group(P=0.003). Gender etiology analysis showed that among 859 males with vitreous hemorrhage, the top 3 pathogenic factors were PDR(36.32%), RVO(21.65%)and ocular trauma(18.98%); among 578 female eyes, the main causes were respectively for PDR(39.79%), RVO(34.95%)and RT/RD(6.92%), there was a significant difference in etiology between males and females(P<0.001).

CONCLUSION: PDR, RVO and ocular trauma were the main causes of vitreous hemorrhage in our study. Different age groups and genders caused different causes of vitreous hemorrhage. PDR and RVO were the primary causes of vitreous hemorrhage in middle-aged and elderly men and women; Ocular trauma was the primary cause of young male patients; PDR was the primary cause of young female patients.

Abstract:AIM: To analyze the anatomical characteristics of nasolacrimal duct development in children with congenital nasolacrimal duct obstruction by nasolacrimal duct CT scan combined with three-dimensional reconstruction technology.

METHODS: Prospective case control study. Totally 84 children(84 eyes)with unilateral congenital nasolacrimal duct obstruction were treated in the Department of Ophthalmology of Baoding Children's Hospital from September 2018 to September 2020. The nasolacrimal duct CT scan combined with three-dimensional reconstruction was performed. The transverse diameter and anterior posterior diameter of bilateral nasolacrimal duct were measured, and the anatomical characteristics of nasolacrimal duct development were observed and analyzed. Paired t-test was performed on the transverse diameter and anteroposterior diameter of bilateral nasolacrimal duct.

RESULTS: Nasolacrimal duct CT scan combined with three-dimensional reconstruction can clearly show the anatomical characteristics of nasolacrimal duct development in children with congenital nasolacrimal duct obstruction. The transverse diameter of bony nasolacrimal duct was 4.63±0.92mm, anterior posterior diameter was 6.03±1.08mm, the transverse diameter of middle bony nasolacrimal duct was 4.02±0.88mm, anterior posterior diameter was 5.42±1.10mm, the transverse diameter of final bony nasolacrimal duct was 4.26±0.93mm, anterior posterior diameter was 5.66±1.02mm. The transverse diameter of the bony nasolacrimal duct in the initial segment of the contralateral side was 4.12±0.78mm, the anteroposterior diameter was 5.60±1.02mm, the transverse diameter of the bony nasolacrimal duct in the middle segment was 3.92±0.86mm, the anteroposterior diameter was 5.24±1.04mm, the transverse diameter of the bony nasolacrimal duct in the final segment was 4.30±0.98mm, the anteroposterior diameter was 5.52±1.04mm. The transverse diameter and anteroposterior diameter of the affected side were larger than those of the healthy side and enlarged(P<0.01). There was no significant difference between the affected side and the healthy side(P>0.05).

CONCLUSION:The development of bony nasolacrimal duct in the affected side of congenital nasolacrimal duct obstruction is different from that in the healthy side. The initial segment of the affected side expanded obviously.

Abstract:AIM:To build prediction model of dry eye with data mining techniques.

METHODS: From March 2020 to January 2021, 218 patients(436 eyes)with dry eye were selected as dry eye group, and 212 patients(424 eyes)without dry eye were selected as control group. Schirmer Ⅰ test(SⅠt), fluorescein staining tear film break-up time(FBUT), non-contact tear film break-up time(NI-BUT), tear meniscus height(TMH), corneal fluorescein staining(FL)and meibomian gland function score(MG-SCORE)were performed in both groups. Totally 200 eyes of 100 samples were randomly selected from the dry eye group and the control group to form a test set of 400 eyes of 200 samples. The remaining 118 samples(236 eyes)in the dry eye group and 112 samples(224 eyes)in the control group were used as the training set. Correlation feature searching(CFS)feature selection algorithm was used to search the factors related to the detection of dry eye. C4.5, Random Forest, Rondom Tree, Naïve Bayes, KNN, SVM, Decision Stump and Bagging methods were used to construct the prediction model, respectively.

RESULTS:By using CFS feature selection algorithm, an optimal sub-feature set including SⅠt, NI-BUT, TMH and FL were obtained. Based on the four features, eight machine learning algorithms were employed to build the prediction model, respectively. The results show that the prediction accuracies were all higher than 75%. Among the eight prediction models, the prediction accuracy model by using Random Forest is the highest, which achieved 91.8% and 88.3%, respectively. And the total prediction accuracy reached 90.1%. In addition, through the analysis of single factor modeling, we found that FL and NI-BUT had the highest prediction accuracy, which exceeded 74%.

CONCLUSION: Random Forest could be considered as a stable and well generalization algorithm to build prediction model for dry eye with well generalization. NI-BUT and FL have a strong correlation with dry eye, which can be considered as the standard for clinical examination of dry eye.

Abstract:AIM: To compare the efficacy of two surgical approaches that microscopical Hotz combined with eyelid margin incision and flap translocation and pure Hotz method in correction of severe upper eyelid cicatricial entropion.

METHODS: Totally 84 eyes of 60 patients who underwent corrective surgery for upper eyelid trichiasis between July 2017 to July 2019 were retrospectively assessed. The patients in trial group(32 cases, 42 eyes)underwent the surgical procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope, the other group(28 cases, 42 eyes)were treated with Hotz method. The follow-up time was 12mo. Subjective symptoms, eyelid marginal position, eyelash eversion and patient satisfaction were recorded.

RESULTS: The surgery time of one eye in trial group was longer than that in control group(40.8±2.57min vs 28.5±2.64min, P<0.01). The cure rates of 1 and 12mo in trial group were 100% and 95%, respectively. And those in control group were 95% and 76%, respectively. The cure rate of 12mo in trial group was higher than that of the control group(P=0.013). There was no significant difference in patient satisfaction between the two groups at 1mo after surgery(Z=1.1825, P=0.2371). 12mo after surgery, patient satisfaction in the trial group was higher than that in the control group(Z=3.7346, P<0.01).

CONCLUSION: While it spents longer time, the procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope is reasonably successful and satisfactory in rectifying severe upper eyelid cicatricial entropion. It offers more higher cure rate than Hotz alone at long time after operation.

Abstract:AIM: To explore the characteristic changes of multifocal electroretinogram(mfERG)in strabismic amblyopia eyes with eccentric fixation.

METHODS: A total of 20 patients with strabismus amblyopia and eccentric fixation visited our hospital from January 2018 to December 2020 were collected as the study group(4 patients with exotropia and 16 patients with esotropia), while 20 patients with ametropic amblyopia were collected as the control group. The mfERG was examined under the state of mydriasis, and the amplitude density and incubation period of P1 wave were recorded.

RESULTS: Compared with the fellow eyes, the first ring(P=0.001), the second ring(P<0.001), the third ring(P=0.001), the fourth ring(P=0.009)and the fifth ring(P=0.026)of strabismus amblyopia eyes were reduced significantly. Compared with the control group, the first ring(P=0.033), the second ring(P=0.002), the third ring(P<0.001)and the fourth ring(P=0.014)of strabismus amblyopia eyes were reduced significantly. The incubation period of amblyopia eyes in the strabismus group showed significantly shortened in the first ring(P=0.017)and the second ring(P=0.001)compared with the fellow eyes, and in the second ring(P=0.007)compared with the control group.

CONCLUSION: The amplitude density of mfERG P1 wave in strabismic amblyopia eyes with eccentric fixation reduced more with the closer to macular fovea, and reduced more significantly than that in the ametropic amblyopia eyes.

Abstract:AIM: To investigate and analyze the status of visual fatigue of naval crew on continuous voyage, explore the risk factors related to visual fatigue, and build a decision tree model for visual fatigue prediction.

METHODS:A total of 373 naval fleet members were selected by stratified random sampling method from July to October 2016. By asking the medical history and basic personal information of the subjects, the naked eye visual acuity, the best corrected visual acuity, slit lamp examination including: eyelid, eyelid margin, meibomian gland changes, cornea and conjunctiva signs of ocular surface damage, and corneal fluorescein staining to determine the tear breakup time(BUT). The Ocular Surface Disease Analysis Scale(OSDI)and ocular fatigue questionnaire were filled in, the incidence and severity of ocular fatigue were counted, and the risk factors of ocular fatigue were analyzed.

RESULTS: Totally 63.0%(235)of the crew members had different degrees of visual fatigue. There was no correlation between asthenopia and gender, age and previous corneal refractive surgery(P>0.05); Dry eyes and exposure time of electronic screen were the risk factors(P<0.01). The overall prediction accuracy was 76.9%.

CONCLUSION: The exposure time of dry eye and electronic screen is the risk factor of visual fatigue in continuous navigation crew.

Abstract:AIM: To explore the mechanism of rejection of bioengineered keratoplasty by the laser confocal microscope and immunopathological studies.

METHODS: Retrospective case study. Five patients(5 eyes)who underwent bioengineered keratoplasty for infectious keratitis from Sep.2018 to Dec.2020 and were immunologically rejected included. All observers were monocular. Slit-lamp was used to examine corneal transparency and corneal neovascularization. The cornea was dynamically observed under laser confocal microscopy, the density of subepithelial langerhans cells and stromal inflammatory cells was recorded after graft rejection, and the contralateral eye was used as the control group for statistical analysis. The infiltration and distribution of CD4⁺ cells, CD8⁺ cells and inflammatory cells were observed after immunohistochemical staining of bioengineered corneas during corneal allograft.

RESULTS: Confocal laser microscopy showed that a large number of langerhans cells were activated under the corneal epithelium of the intraoperative eye, and the activation ratio was significantly different from that of the contralateral eye(χ²=38.29, P<0.001). The stromal layer was rich in inflammatory cells, which was significantly different from that of the contralateral eye(t=32.5, P<0.05). Immunohistochemical staining and HE staining were performed on the bioengineering corneal tissue. CD4⁺ and CD8⁺ cells were observed in all corneal stromal layers, and only one case had a large number of eosinophils.

CONCLUSION: Immunopathology of rejection after bioengineered keratoplasty confirmed that T-cell-mediated cellular immunity plays an important role in the pathogenesis, and hypersensitivity to xenoantigen may be involved in it.

Abstract:AIM: To investigate the application and therapeutic effect of allogeneic sclera transplantation combined with arbitrary flap plasty in the treatment of moderate and severe deep and full-thickness eyelid defect.

METHODS: Medical records of 103 patients(103 eyes)who underwent allogeneic scleral transplantation combined with random flap plasty in the treatment of moderate and severe deep and full-thickness eyelid defect from June 2017 to June 2020 were retrospectively reviewed. All patients were followed up for 1-6mo after operation was performed to evaluate the postoperative effects of the resorption and compatibility of allogeneic sclera, the survival situation of skin flaps, eyelid appearance, eyelid closure, eyelid scar.

RESULTS: Follow up observation from 1-6mo after operation, the allogeneic sclera was gradually replaced by the receptor tissue, allogeneic sclera in the inner layer of the eyelid was covered with conjunctival cells, allogeneic sclera and skin join closely together in the outer layer of the eyelid. There was no rejection in allogeneic sclera. All patients had survived skin flaps, good eyelid shape, natural eyelid closure, and no scars.

CONCLUSION: The allogeneic sclera transplantation combined with random flap plasty has curative effect in the repair of moderate and severe deep and full-thickness eyelid defect. It has both function and aesthetics result, and it is suitable for clinical promotion.