Abstract:AIM: To quantify the lacrimal punctum using anterior segment optical coherence tomography(AS-OCT)and analyze the correlation between the epiphora and primary punctal stenosis.

METHODS: A cross-sectional study. There were 43 healthy volunteers(57 eyes)and 44 patients(62 eyes)with primary lacrimal punctal stenosis and epiphora enrolled in the Lacrimal Center of the Third Medical Center of PLA General Hospital from September 2020 to January 2021. The inferior punctum of all subjects were scanned by AS-OCT, and the images were quantified in order to observe the AS-OCT image features. The outer punctal diameter, punctal depth, tear well diameter and tear well depth were all measured simultaneously. The inferior punctum's punctal reserve and punctal reserve ratio were estimated according to the available parameter data.

RESULTS: 1)The measured parameters conforming to normal distribution were expressed as mean±standard deviation. The observation group's outer punctal diameter, tear well diameter, tear well depth, and punctal reserve ratio were 458.19±63.58μm, 200.34±84.69μm, 188.95±87.50μm and 0.32±0.18, respectively, while the control group's outer punctal diameter, tear well diameter, tear well depth and punctal reserve ratio were 655.53±82.62μm, 230.26±107.02μm, 275.30±144.34μm, 0.46±0.23, respectively. The parameters in observation group were all lower than those of control group(P<0.05); 2)Parameter data that did not conform to normal distribution were expressed as medians and quartiles, and the results were as follows: the punctal depth in the observation group was 265.50μm(interquartile range 204.25-328.77)μm and the punctal reserve was 71.53μm(interquartile range 46.12-111.37)μm, respectively, while the punctal depth in the control group was 468.76μm(interquartile range 420.50-588.88)μm and the punctal reserve was 182.16μm(interquartile range 131.36-309.84)μm. This difference was statistically significant(P<0.05); 3)In the observation group, there was a negative correlation between the epiphora and the outer punctal diameter(r=-0.448, P<0.05), a positive correlation between the epiphora and tear well depth(r=0.335, P<0.05), and a negative correlation between the epiphora and the punctal reserve and punctal reserve ratio coefficient(r=-0.520, -0.566, P<0.05).

CONCLUSION: The AS-OCT can aid in enhancing punctal morphology cognition; The outer punctal diameter and tear well depth are related to the epiphora; The primary punctal stenosis patients with smaller outer punctal diameters are more likely to have the symptom of epiphora, and in patients with punctal stenosis, the greater the potential capacity of the punctum to hold tears, the lesser the degree of epiphora.

Abstract:AIM: To investigate the effect of lncRNA MALAT1 on the proliferation, migration and angiogenesis of retinal vascular endothelial cells and its molecular mechanism.

METHODS: The expression levels of lncRNA MALAT1 in plasma of normal control group, diabetic without retinopathy group and diabetic retinopathy group were detected by qPCR and the effect of glucose culture on the expression levels of lncRNA MALAT1 were detected by qPCR too. The expression level of miR-124-3p was detected by qRT-PCR; Western blotting was used to detect the expression level of SOX7; The targeting relationship between lncRNA MALAT1 and miR-124-3p, miR-124-3p and SOX7 were detected by the dual-luciferase reporter system; CCK-8 assay was used to detect cell proliferation activity; Transwell assay was used to detect the migration ability of cells; Angiogenesis of hRMECs cells was measured by in vitro tube formation assay.

RESULTS:The expression level of lncRNA MALAT1 in plasma of diabetic retinopathy patients was significantly higher than that of diabetic without retinopathy group and normal control group(P<0.001). In vitro glucose culture significantly promoted the expression of lncRNA MALAT1 in hRMECs cells, as well as the proliferation, migration and angiogenesis of hRMECs cells(all P<0.05). Knockdown of lncRNA MALAT1 significantly inhibited the proliferation, migration and tubule formation of hRMECs cells(all P<0.05). Dual-luciferase reporter gene assay showed that lncRNA MALAT1 targeted with miR-124-3p, and miR-124-3p targeted with SOX7. Overexpression of miR-124-3p significantly inhibited the proliferation, migration and tubule formation of hRMECs cells(all P<0.05). Overexpression of lncRNA MALAT1+miR-124-3p, miR-124-3p+SOX7, and knockdown of lncRNA MALAT1+overexpression of SOX7 all significantly eliminated the inhibitory effect of hRMECs cells(all P<0.05).

CONCLUSION: lncRNA MALAT1 promote the proliferation, migration and angiogenesis of retinal endothelial cells in diabetic retinopathy by down-regulating the negative regulation of miR-124-3p on SOX7. Therefore, abnormal upregulation of lncRNA MALAT1 in patients with diabetic retinopathy is a potential biomarker.

Abstract:AIM:To establish an immune tolerance model for allergic conjunctivitis in newborn mice with different methods and observe the impact of environmental factors on allergic conjunctivitis in early life.

METHOD: A total of 50 Balb/c newborn mice were randomly divided into blank control group, ovalbumin(OVA)+subcutaneous injection group, OVA+nebulized inhalation group, OVA+gastric group, ragweed pollen(RW)+subcutaneous injection group, RW+nebulized inhalation group, RW+gastric group, house dust mite(HDM)+subcutaneous injection group, HDM+nebulized inhalation group, HDM+intragastric group(n=5 animals/group). Except for the blank control group, mice in each group were individually exposed to the corresponding antigens to induce immune tolerance early in life and stimulated with the corresponding antigens in adulthood. The ocular surface was visualized by anterior segment photography. The relative expression level of conjunctival RANTES and IL-17 mRNA was measured by RT-qPCR and serum IL-17 concentration was measured by ELISA.

RESULTS: Compared with the blank control group, the relative expression level of conjunctiva IL-17 mRNA in RW+gastric group was the highest, and it was the lowest in RW+subcutaneous group(all P<0.05). The relative expression level of conjunctiva RANTES mRNA was the highest in RW+gastric group(P<0.001). Compared with the blank control group, the serum concentration of IL-17 was increased in all treatment groups except OVA+nebulizer group and RW+subcutaneous group(P<0.05).

CONCLUSION: The immune tolerance of allergic conjunctivitis induced by subcutaneous injection of antigen was the most suitable method in the early life of mice.

Abstract:AIM: To investigate the correlation between postoperative lens decentration and tilt and visual quality in eyes implanted with aspherical intraocular lens(IOL)by using a new anterior segment swept-source optical coherence tomography(OCT)CASIA2.

METHODS: An observational study. A total of 90 eyes of 62 participants who underwent age-related cataract surgery at 1mo were included. Using CASIA2 by an experienced examiner, IOL tilt and decentration were obtained three consecutive times after mydriasis and the vector mean values were calculated. Double-pass optical quality analysis system(OQAS)and wavefront aberration instrument KR-1W were used for the visual quality measurements, including the total high-order aberration(tHOA), spherical aberration(SA), Coma, objective scatter index(OSI), modulation transfer function cut off frequency(MTF cut off)and Strehl ratio(SR)at 4 and 6mm pupil diameter.

RESULTS: IOL decentration was positively correlated with SA(r=0.347, P=0.001)and OSI(r=0.343, P=0.002)at 4mm pupil diameter, and it was negatively correlated with MTF cut off(r=-0.244, P=0.032). There was no significant correlation between IOL decentration and tHOA, Coma and SR. IOL tilt was negatively correlated with MTF cut off(r=0.-345, P=0.002)and SR(r=-0.256, P=0.023)at 4mm pupil diameter, but it was not correlated with tHOA, SA, Coma and OSI. There were no significant correlations between the IOL decentration and tilt and tHOA, SA, Coma, MTF cut off and SR at 6mm pupil diameter.

CONCLUSION: After aspherical IOL implantation in age-related cataract patients, IOL decentration was weakly correlated with SA at 4mm pupil diameter, while decentration and tilt were not significantly correlated with other higher-order aberrations. The decentration and tilt were weakly correlated with OSI value and MTF cut off value of the visual quality parameters. The results suggest that clinicians should pay more attention to higher-order aberrations and visual quality during precise cataract surgery.

Abstract:AIM:To explore the effect of base curve aspheric orthokeratology lens in the treatment of adolescents with myopia and moderate to high astigmatism, and its influence on ocular surface morphology and tears.

METHODS:A total of 232 adolescents(464 eyes)with myopia and moderate to high astigmatism treated in the hospital from December 2018 to March 2020 were selected as the research subjects. They were randomly divided into control group(116 patients, 232 eyes)and observation group(116 patients, 232 eyes). The control group was treated with base curve spheric orthokeratology lens, while the observation group was treated with base curve aspheric orthokeratology lens. Comparison was made between the two groups in terms of the correction effect, objective visual quality, ocular surface morphology, tears related indicators before and after wearing the lenses, and the incidence of complications after wearing the lenses for 12mo.

RESULTS:After wearing the lenses, the uncorrected visual acuity(UCVA)and diopter of the two groups were significantly improved. The UCVA and diopter of the observation group were significantly better than those of the control group(all P<0.05). After wearing the lenses, the whole-eye and corneal coma, spherical aberrations and high-order aberrations were significantly increased, while Strehl ratio and modulation transfer function were decreased in the two groups. Trefoil aberrations was significantly increased(all P<0.05). These indicators in the observation group were better than those in the control group(all P<0.05). After wearing the lenses, the epithelium fluorescence staining scores, ocular surface disease index(OSDI)scores were significantly decreased in the two groups(P<0.05), but there was no statistically significant difference between the two groups(P>0.05); The noninvasive tear breakup time(NI-BUT)of the two groups were significantly decreased after wearing the lenses(P<0.05), but there was no statistically significant difference between the two groups(P>0.05). The Schirmer Ⅰ test and tear meniscus height of the two groups showed no statistically significant difference before and after wearing the lenses(P>0.05). The incidence rates of complications in the observation group and the control group after wearing the lenses were close(6.9% vs 6.0%, P >0.05).

CONCLUSION:Base curve aspheric orthokeratology lens is superior to base curve spheric orthokeratology lens in the treatment of adolescents with myopia and moderate to high astigmatism in terms of correction effect and objective visual quality. The two lenses have similar influence on ocular surface morphology and tears.

Abstract:Posterior cataract opacification(PCO)is the epithelial-mesenchymal transformation(EMT)of residual lens epithelial cells(LECs)after cataract surgery, resulting in opaque scar which is one of the main complications of cataract surgery. A large amount of fibronectin(FN)produced by LECs after cataract surgery binds to a variety of cell surface receptors, matrix components and growth factors to regulate cell behavior. The purpose of this article is to review the literatures on the treatment of PCO targeting fibronectin and provide references for clinical treatment of PCO. In this paper, the research status of fibronectin in PCO in recent years is reviewed.

Abstract:Diabetes retinopathy(DR)may continue to develop even if blood sugar is well controlled, which indicates that previous hyperglycemia will lead to long-term harmful vascular dysfunction, and this phenomenon is defined as “metabolic memory” of diabetes retinopathy. Because the onset of DR is insidious, clinical symptomatic treatment is mainly used. Effective means of early diagnosis, accurate treatment and prognosis are lacking and new diagnosis and treatment ideas need to be developed urgently. In recent years, many new studies have shown that epigenetic modification is involved in the pathogenesis of DR “metabolic memory” in DNA methylation, histone post-translational modification and microRNA(microRNAs,miRNAs)regulation, which provides a direction and strategy for the exploration of DR molecular mechanism. In this review, we discussed the role of epigenetic modification in the pathogenesis of DR and analyzed the challenges and prospects of its application in the treatment of DR, with a view to provide a reference for early diagnosis and treatment of DR in the future.

Abstract:DNA methylation, as an important form of epigenetic modification, plays vital roles in the occurrence and development of diseases by regulating gene expression. In recent years, with the rapid development of DNA methylation research and the continuous updates of the detection method,it is reported that DNA methylation has become an important way to explore the pathogenesis of various diseases and new treatment methods.Many breakthroughs have been made in the basic research of DNA methylation in different ophthalmological diseases, including corneal epithelium repair, cell adhesion and abnormal matrix remodeling of conjunctival epithelium, ocular fibrosis and glaucoma, oxidative stress, inflammatory response and cell damage, the relationship between different DNA methylation levels and ocular tumors, etc. This review aims to provide a new idea for the pathogenesis, examination, diagnosis and prevention of different ocular diseases by summarizing the relevant studies on the regulatory mechanisms of DNA methylation in ophthalmological diseases.

Abstract:Dry eye(DE)is a multi-factorial ocular surface disease. The mechanisms underlying the pathogenesis of DE is still unclear. Inflammation and immune response are considered to be one of the core mechanisms among the pathogenesis of DE. Neuropeptides are small molecular peptides generated after the sensory nerve endings damaged or stimulated. They play an important role in triggering and regulating inflammatory response. Thus, they are important mediums between the nervous system and immune system. Recent studies have revealed that neuropeptides secreted by ocular surface nerves are considered to be an important factor involved in the pathogenesis of DE. Therefore, this paper summarized the research progress on the roles of neuropeptides underlying the mechanisms of the pathogenesis of DE, analyzed the latest points of view and research hot spots, so as to provide references for the prevention and treatment of DE.

Abstract:Conventional eye treatment formulation such as eye drops has shortcomings including low drug utilization and poor patient compliance. The contact lens(CL), well-known as visual correction lens, is considered to be a more promising ophthalmic drug delivery vehicle owing to its good biocompatibility, long-term wearing comfort, prolonged drug residence time and improved bioavailability. In order to improve the drug loading efficiency and prolong the release time, researchers have developed a variety of strategies to modify traditional CL, including the introduction of vitamin E molecular barrier, application of molecular imprinting technology of CL, increasing interactions between the drug and polymer matrix by introducing special genes, and incorporation of nanocarriers or drug-loaded polymer films. In this paper, the preparation methods and pros and cons of drug-loaded CL are reviewed. At last, the existing problems and future developments of CL as ophthalmic drug delivery carrier are briefly discussed.

Abstract:The American Association of Cataract Surgeons issued the Consensus on Astigmatism Management in Cataract Surgery in 2019. To help Chinese ophthalmologists better comprehend the consensus, the main contents are explained: Toric intraocular lens(Toric IOL)implantation is the first choice for correcting corneal astigmatism. Three or more than three instruments should be used for preoperative measurement, and the values that are consistent with results should be taken. Then the Barrett Toric calculator can be used to calculate Toric IOL. When calculating toric IOL,the position of the surgical incision, surgically induced astigmatism(SIA), etc. should be considered. Then, the Toric IOL that makes resultant astigmatism close to 0 without flipping the astigmatism axis can be selected. The intraoperative automated image-guided systems can be used to guide the implantation. If residual astigmatism causes discomfort, laser in situ keratomileusis(LASIK)or IOL replacement can be used for correction. Toric IOL implantation is not recommended for patients with pseudoexfoliation(PXF)syndrome or macular lesions. There are many contraindications in dysfunctional lens syndrome(DLS)patients, which should be carried out by senior doctors. In the future, it is necessary to explore further the influence of haptic design and optic material on the rotational stability of IOL. Cataract surgery assisted by intraoperative aberrometers, automated image-guided systems or femtosecond laser still needs further development.

Abstract:Cataract is one of the most common causes of vision loss and even blindness in patients, and surgery is a proven and effective treatment option. Traditional cataract surgery for vision loss has increasingly given way to refractive cataract surgery as science and technology have progressed. There are also a variety of refractive intraocular lenses on the market place. Patients are increasingly accepting and recognizing multifocal intraocular lens(MIOL)as an alternative to traditional single focus intraocular lens(SIOL). Through classification and listing, the existing MIOL are discussed in this article, as well as the features of different types of MIOL and techniques for evaluating the clinical impacts of patients after surgery, so as to provide references for ophthalmologists.

Abstract:Correcting astigmatism safely and effectively has become a crucial part of modern cataract surgery due to the transformation of the surgery into a refractive procedure. The increased predictability and enhanced safety of Toric intraocular lens(IOL)implantation has made it the preferred method of correcting corneal regular astigmatism above 0.75D in cataract surgery. Toric IOL needs to be implanted in a precise axis position to achieve good astigmatism correction. A major cause of toric misalignment is postoperative rotation, which typically occurs soon after surgery. However, large axis misalignment will eliminate the astigmatism corrective effect of Toric IOL, even cause astigmatism in a new axis position. The factors responsible for IOL postoperative rotation are diverse. As a result, profound understanding of the factors is crucial for clinicians to minimize the rotation. Repositioning procedure is generally selected in case of significant rotation and the timing of the procedure is vital. This paper reviewed the influencing factors of IOL rotation postoperatively and its principle of treatment.

Abstract:As an in-bag filling device, capsular tension ring(CTR)has played an important role in cataract surgery. Maintaining the circular contour of the capsular bag and improving the safety of surgery is the original intention of CTR design, and then it was found to have better effects in inhibiting posterior capsular opacity and capsular bag shrinkage, and enhancing the stability of intraocular lenses. After nearly 30a of improvement and development, CTR has been derived into a variety of types, and its clinical application has gradually expanded. In particular, CTR can be used in complex cataract surgery to reduce intraoperative risk and improve postoperative outcomes. In the present paper, the implantation timing, indications and complications of CTR were summarized, and the progress in clinical application in recent years was briefly reviewed.

Abstract:AIM: To systematically evaluate the effects of 0.01%, 0.025% and 0.05% ophthalmic atropine on the change of spherical equivalent(SE)degree and axial length(AL)of myopic children.

METHODS: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Database, VIP and CBM were searched for all publications related to 0.01%, 0.025% and 0.05% atropine to control myopia simultaneously. The publication time is from the database construction to May 2022. The Cochrane handbook was used to evaluate the risk of bias and quality of the included literature, STATA12.0 was used to detect publication bias and Revman5.4 software was used for Meta-analysis.

RESULTS: A total of 6 literatures(1 239 eyes)were included, with 5 randomized controlled trials and 1 case-control study. Meta-analysis results showed that 0.025% atropine had better inhibitory effect on SE and AL than 0.01% atropine(SE: WMD=-0.15, 95%CI: -0.23--0.06, P<0.001; AL: WMD=0.07, 95%CI: 0.03-0.10, P<0.001). The inhibitory effect of 0.05% atropine on SE and AL was better than 0.01% atropine(SE: WMD=-0.35, 95%CI: -0.44--0.26, P<0.001; AL: WMD=0.16, 95%CI: 0.12-0.20, P<0.001). The inhibitory effect of 0.05% atropine on SE and AL increase was better than 0.025% atropine(SE: WMD=-0.20, 95%CI: -0.28--0.11, P<0.001; AL: WMD=0.09, 95%CI: 0.06-0.12, P<0.001).

CONCLUSION: The concentration of 0.05% atropine is superior to 0.01% and 0.025% atropine in the control of SE and AL. However, the side effects of long-term use remain to be observed.

Abstract:AIM:To analyze the diagnostic value of optical coherence tomography(OCT)for early primary open angle glaucoma(POAG)by measuring the thickness of macular ganglion cell complex(mGCC), peripapillary retinal nerve fiber layer(pRNFL), macular retinal nerve fiber layer(mRNFL)and retinal ganglion cell layer+inner plexiform layer(GCIP)in the macular region.

METHODS:A case-control study design was used to collect 82 patients(82 eyes)with early POAG who admitted to our hospital from January 2019 to January 2020. There were 40 healthy volunteers(40 eyes)in the same period selected as the control group(20 eyes for left and right eyes, respectively). All subjects underwent tests of uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA)and equivalent spherical power. The upper, lower, nasal, temporal and average pRNFL thickness, the upper, lower and average mGCC, mRNFL and GCIP thickness in the macular region were analyzed. Spearman was used to analyze the correlation among the average thickness of eachindices, and ROC curve was used to analyze the value of mGCC, pRNFL, mRNF and GCIP thickness parameters in diagnosing early POAG.

RESULTS:In the early POAG group, the thickness of upper, nasal, lower, temporal, average pRNFL and the thickness of upper, lower and average mGCC, mRNFL and GCIP were lower than those in the control group(all P<0.05). Average thickness of pRNFL was positively correlated with average thickness of mGCC, average mRNFL and average GCIP(r_s=0.582, 0.632, 0.456, all P<0.05); average thickness of mGCC was positively correlated with average thickness of mRNFL and average GCIP(r_s=0.583, 0.851, all P<0.05); Average thickness of mRNFL was positively correlated with average thickness of GCIP(r_s=0.528, all P<0.01). ROC curve analysis shows that the AUC value of mGCC thickness and average value in early diagnosis of POAG were all above 0.8, and the diagnostic efficiency was the highest.

CONCLUSION: OCT measurement of mGCC has certain value in diagnosing early POAG.

Abstract:AIM:To compare the choroidal parameters in children and adolescents with different refractive status, and to investigate the associations between ocular biometrics and choroidal parameters.

METHODS:A cross sectional study. A total of 121 healthy children and adolescents(121 right eyes)aged 3-18 years treated in the Second People's Hospital of Hefei were collected. The data were divided into three groups according to spherical equivalent refraction(SER): emmetropia(-0.50RESULTS:TCA, LA, SA and CT were all different among the three groups before age correction(all P<0.001), and CVI was not different(P >0.05). TCA, LA, SA, CT and CVI were found to be statistically different among the three groups after age correction(all P<0.001), and there were differences in pairwise comparisons of TCA, LA, SA and CT among the three groups(all P<0.001), which were the highest in emmetropic eyes and lowest in moderate-to-high myopic eyes, However, the CVI in pairwise comparisons among the three groups showed that only the moderate-to-high myopia group was significantly lower than the emmetropic group(P=0.014). Multiple regression analysis showed that the LA was significantly associated with SER(P=0.020), whereas CT were significantly associated with the axial length(AL)(P=0.028).

CONCLUSIONS: The choroidal LA and CVI tend to decrease in children and adolescents with higher myopia, indicating that the decrease of sub-foveal choroidal blood flow may be related to the progression of myopia.

Abstract:AIM: To comparatively analyze the efficacy of subthreshold laser photocoagulation with the NAVILAS^® Laser system and subthreshold micropulse laser for patients with chronic central serous chorioretinopathy(cCSC).

METHODS: A retrospective clinical study. A total of 36 patients(40 eyes)with cCSC were recruited from January 2020 to January 2021 diagnosed at the Affiliated Eye Hospital of Nanjing Medical University. There were 19 patients(23 eyes)treated with subthreshold navigated laser photocoagulation(the Navilas group), and 17 patients(17 eyes)treated with subthreshold micropulse laser(SML)(the SML group). There was no significant difference in baseline data between the two groups(P>0.05). The best corrected visual acuity(BCVA, LogMAR), central macular thickness(CMT), subretinal fluid(SRF)height, vessel densities of the superficial capillary plexus(SCP), the deep capillary plexus(DCP)and area of the foveal avascular zone(FAZ)were collected at 2wk, 1, 3 and 6mo before and after treatment.

RESULTS: The BCVA of the two groups were significantly higher than that before treatment at 3 and 6mo after surgery(P<0.05),which was significantly reduced at 2wk after treatment in the Navilas group and was reduced at 1mo after treatment in the SML group(P<0.05). In both groups, there was significant decrease compared with that before treatment at 3 and 6mo after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05). The difference in SRF absorption between the two groups was statistically significant(P<0.05), and the complete absorption rate of SRF in the Navilas group was higher than that in the SML group. SCP, DCP, the area of the FAZ were not significantly different from each time ofbaseline in the two groups(P >0.05).

CONCLUSION: Subthreshold laser photocoagulation with the NAVILAS^® Laser system can rapidly improve the retinal morphology and shorten the course of cCSC to improve the recovery of visual function with its rapid effect, high cost-effectiveness, non-invasiveness and high repeatability, which can be a new clinical method for patients with cCSC.

Abstract:AIM:To evaluate the therapeutic efficacy of intravitreal injections of ranibizumab for macular edema secondary to retinal vein occlusion(RVO)and the prognostic factors for this disorder.

METHODS:A retrospective case study. There were 61 patients(61 eyes)with macular edema secondary to RVO who treated in our hospital from April 2020 to February 2021, including 30 cases(30 eyes)of branch retinal vein occlusion(BRVO)patients and 31 cases(31 eyes)of central retinal vein occlusion(CRVO)patients. All patients received 3 times of intravitreal injections of ranibizumab(0.5mg), and some eyes underwent retinal laser therapy. The patients were followed up for 3mo after treatment(the first intravitreal injection)to observe the visual acuity, intraocular pressure, central retinal thickness(CRT)and record the occurrence of ocular and systemic complications.

RESULTS: The visual acuity of the included patients after treatment was significantly improved compared with that before treatment, and the CRT was significantly decreased compared with that before treatment(P<0.01), and after 3 times of intravitreal injections, the visual acuity of BRVO and CRVO patients with pre-treatment visual acuity≤1(LogMAR)was better than that of the patients with pre-treatment visual acuity>1(P<0.01), but there was no difference in CRT(all P >0.05). Among BRVO and CRVO patients, 12 and 8 eyes received retinal laser treatment during 3 times of intravitreal injections, respectively. The difference in visual acuity and CRT among the eyes treated with laser and those that were untreated was not significant(P>0.05). No ocular and systemic serious complications emerged during follow-up.

CONCLUSIONS: Ranibizumab has high efficacy and safety in the treatment of macular edema secondary to RVO, while visual acuity at baseline may help predict the prognosis.

Abstract:AIM: To explore the efficacy of Danshen injection iontophoresis in the treatment of retinal vein occlusion(RVO).

METHODS: The clinical data of 90 patients(90 eyes)with RVO treated in our hospital from January 2020 to December 2021 were analyzed retrospectively, and they were divided into control group and observation group according to treatment methods. A total of 38 patients(38 eyes)in the control group were treated with intravenous Xueshuantong+oral compound Xueshuantong capsule+enteric-coated aspirin, and 52 patients(52 eyes)in the observation group were treated with Danshen injection iontophoresis on this basis. The treatment time of the two groups was 3mo. The clinical efficacy, best corrected visual acuity, retinal condition and hemorheological indexes(whole blood low shear viscosity, fibrinogen)were compared between the two groups before and after treatment.

RESULTS: The total effective rate of the observation group was significantly higher than that in the control group(87% vs 58%,P<0.05)at 3mo after treatment. The best corrected visual acuity in both groups was better than that before treatment, and the observation group was better than the control group(all P<0.05).The circulation time of retinal vein, the relative diameter of retinal vein and the relative area of retinal hemorrhage in the observation group were lower than those before treatment,and the observation group was lower than the control group(all P<0.05). The whole blood low shear viscosity and fibrinogen levels in the two groups were lower than those before treatment, and the observation group was lower than those in the control group(all P<0.05).

CONCLUSION: Danshen injection iontophoresis is effective in the treatment of patients with RVO, which can effectively improve the visual acuity, treat fundus lesions and improve the abnormal blood flow.

Abstract:AIM: To analyze the stability of different concentrations of fluorescein sodium solution on the detection of tear break-up time(TBUT).

METHODS:A retrospective study. A total of 150 cases(150 eyes)who came to our dry eye clinic with good cooperation from August 2019 to September 2021 were selected for the study, and the subjects were randomly divided into five groups, which were fluorescein sodium(FLS, 0.5%), FLS(1.0%), FLS(1.5%), FLS(2.0%)and fluorescein sodium parallel(FLSP), with 30 patients in each group(all the right eyes were the subject eyes). Each group was dripped with the corresponding fluorescein sodium. The FLSP group was the fluorescent test strip detection group. The slit lamp image scores of different concentration groups were compared, the survival time of sodium fluorescein at the instant, 2, 5, 10, 15 and 30min points was observed in each group, and the mean value of TBUT in each group was recorded.

RESULTS: The image score of FLS(0.5%)group was significantly higher than that of the other four groups(t=7.746, 21.483, 116.190, 38.730, all P<0.01). The image score of FLS(1.0%)group was significantly higher than that of FLS(1.5%)and FLS(2.0%)group(t=10.742, 15.492, all P<0.01). The survival time of fluorescein in FLS(0.5%)group was significantly shorter than that of the other four groups(t=8.226, 7.458, 9.159, 12.347, all P<0.01). The survival time of fluorescein in FLS(1.5%)group was significantly longer than that of FLS(1.0%)and FLS(2.0%)group(t=15.428, 13.274, all P<0.05). TBUT in FLS(0.5%)group was significantly higher than that of the other four groups at 2min(t=22.767, 22.345, 15.494, 17.213, all P<0.01), and was significantly lower than that of the other four groups at 10min(t=23.266, 25.353, 10.183, 22.025, all P<0.01). The mean first TBUT of FLS(1.5%)group was significantly shorter than that of the other four groups(t=25.236, 21.374, 19.658, 72.341, all P<0.01), and the mean first TBUT of FLSP group was significantly longer than that of the other four groups(t=22.487, 30.267, 60.247, 40.857, all P<0.01). There was no significant correlation between TBUT and ocular surface disease index(OSDI)and tear river height(r_s=-0.072, 0.219, P=0.689, 0.112). TBUT was positively correlated with tear secretion(r_s=0.674, P<0.01).

CONCLUSION: FLS(0.5%)had higher image quality but it was only suitable for observing staining within 5min, and the FLSP group was more suitable for clinical observation of corneal fluorescence staining for a longer period; FLS(1.5%)was the most stable and reliable concentration and dose for the detection of TBUT.

Abstract:AIM: To investigate long-term efficacy and safety of patients after excimer laser in situ keratomileusis(LASIK)surgery in 20a.

METHODS: A retrospective study.Patients who underwent LASIK in our hospital from January 1998 to December 2001 were recruited. The patients were notified by telephone to the outpatient for follow-up. The collected data included demographic characteristics(gender and age), preoperative uncorrected distance visual acuity(UCVA)and best corrected visual acuity(BCVA), preoperative diopter, intraoperative corneal flap thickness and corneal stromal residual thickness(RST). The main indicators were long-term efficacy index, safety index, UCVA, BCVA, corneal thickness and axial length. The slit lamp, fundus and optical coherence tomography(OCT)examination were performed at the same time.

RESULTS: A total of 95 patients(190 eyes)were recruited. At the final postoperative visit, there were 71 patients(142 eyes, 74.7%)had UCVA≥1.0, and 82 patients(164 eyes, 86.3%)had BCVA≥1.0. There were 2 eyes among them had bad BCVA(≤0.6)due to macular retinoschisis and glaucoma, respectively, while other patients' BCVA was 0.8. There was no significant correlation between the UCVA and BCVA of patients after surgery in 20a and the factors such as age at surgery, preoperative diopter and corneal thickness(P>0.05), but there was a negative correlation with the increase of axis length(r_s=-0.32, -0.31, all P<0.05). UCVA and BCVA were positively correlated with corneal stromal residual thickness at the last postoperative follow-up(P<0.05). The safety and efficacy indexes of LASIK after surgery in 20a were 1.00±0.10 and 0.83±0.27, respectively. During the follow-up, no patients were found to have corneal ectasia and complications related to corneal flap, and no patients underwent secondary surgery. No patients with corneal dryness were found after silt lamp examination.

CONCLUSION: LASIK after surgery in 20a shows good safety and efficacy.

Abstract:AIM: To explore the curative effect of modified Parks incision combined with rectus linear tucking on adults with concomitant strabismus and its influences on postoperative recovery of visual function and ocular aesthetics.

METHODS: A total of 160 adults with concomitant strabismus were enrolled as the research subjects between June 2019 and June 2021. They were divided into observation group(modified Parks incision combined with rectus linear tucking, 89 cases)and control group(corneal limbal trapezoid conjunctival flap incision combined with rectus linear tucking, 71 cases)according to different surgical methods. The clinical curative effect and surgical related indexes between the two groups were compared. The changes in scores of corneal fluorescence staining, standard patient of eye dryness(SPEED), visual analogue scale(VAS)and Vancouver scar scale(VSS)before and after surgery in both groups were observed. The occurrence of complications such as poor conjunctival healing and astigmatism was statistically analyzed at 1mo after surgery.

RESULTS: The total response rate of surgery in observation group was higher than that in control group, and length of surgical incision was shorter than that in control group(all P<0.05). The scores of postoperative corneal fluorescence staining and dry eye in observation group were lower than those in control group, and VAS scores at 1wk after surgery were lower than that in control group(all P<0.05). Postoperative divergent fusion range, strabismus angles of short-sighted 33cm and far-sighted 5m in observation group were greater than those in control group. Convergent fusion range was smaller than that in control group, and stereopsis of short-sighted 33cm and far-sighted 5m was lower than that in control group(all P<0.05). Postoperative break-up time in observation group was longer than that in control group, lacrimal secretion was more than that in control group, and scores of corneal surface regularity index(SRI)and VSS scores were lower than those in control group(all P<0.05). The total incidence of complications in observation group was lower than that in control group(P<0.05).

CONCLUSION: The modified Parks incision combined with rectus linear tucking can not only improve surgical effect and promote the recovery of visual function and tear film function in adults with concomitant strabismus, but also relieve dry eye and postoperative pain, improve ocular aesthetics and reduce the incidence of postoperative complications.

Abstract:AIM: To compare the efficacy and safety of dexamethasone intravitreal implant combined with anti-VEGF drug and anti-VEGF drug monotherapy in the treatment of macular edema secondary to retinal vein occlusion(RVO-ME).

METHODS: A total of 133 patients(133 eyes)diagnosed with central retinal vein occlusion(CRVO)or branch vein occlusion(BRVO)secondary to macular edema in the Xiamen Eye Center of Xiamen University from June 2019 to December 2020, including 48 patients with CRVO-ME and 85 patients with BRVO-ME were analyzed. All patients were randomly assigned to monotherapy or combination therapy. The monotherapy group(66 eyes)received a monthly injection of conbercept for consecutive 3mo, followed by monthly follow-up visits; The combination therapy group(67 eyes)received once intravitreal dexamethasone implantation, and conbercept was injected once 1wk later, followed by monthly follow-up visits.All patients in the two treatment groups were evaluated at baseline and every subsequent visit until 6mo after treatment with the best corrected visual acuity(BCVA), macular central retinal thickness(CRT), and injection times of conbercept and ocular and systemic adverse events associated with intravitreal injection therapy were recorded.

RESULTS: At 1, 2, 3 and 6mo after treatment, the BCVA and CRT in both groups were significantly improved than before.But there was no significant difference in the improvement of BCVA and CRT(P >0.05). From the initial intravitreal injection to 6mo, the injection times of the monotherapy group and the combination therapy group were 3.56±0.12 and 2.96±0.17 times, respectively. The injection times of the combination therapy group were significantly lower than those of the monotherapy group(P=0.004). Both the incidences of intraocular hypertension and cataract in the combination therapy group were higher than those in the anti-VEGF monotherapy group.

CONCLUSION: dexamethasone intravitreal implant combined with anti-VEGF drugs is an effective method for the treatment of RVO-ME, with significantly improved visual acuity and significantly lower CRT; The combined treatment regimen can reduce the times of injections and achieve similar results to anti-VEGF drug monotherapy. However, monitoring of intraocular pressure and cataract progression is required.

Abstract:AIM: To explore the effect of flipped classroom combined with team-based learning(TBL)in ophthalmology practice teaching by applying directly observed procedural skills(DOPS).

METHODS: A total of 54 students of clinical medicine “5+3” integration and clinical medicine for five years, interned at the department of ophthalmology from June 15th to November 14th, 2021 were divided into traditional teaching group(group A)and flipped classroom combined with TBL group(group B). The teaching effects of slit lamp microscopy and direct ophthalmoscopy in group A and group B were compared by DOPS score, and Mann-Whitney U test was used for statistical analysis.

RESULTS: Total DOPS score for slit-lamp microscopy in group A was 59(58.00, 60.00)points,which was significantly lower than that of group B 63(61.00,65.00)points(P<0.001). The DOPS score for direct ophthalmoscopy in group A was 63(61.00, 63.75)points, which was significantly lower than that of group B, 66(63.75,66.25)points(P<0.001). In the two operations and especially in the aspects of “understanding of complications,relevant anatomical structure and proficiency in operation”“preparatory work” and “technical ability of operation”, the scores of group B was significantly higher than those of group A(P<0.05).

CONCLUSION: Flipped classroom combined with TBL has significant advantages in clinical practice teaching for interns in ophthalmology, which is worthy of promotion and application compared with traditional teaching.

Abstract:AIM: To analyze the effects of dual viscoelastic agents DisCoVisc and sodium hyaluronate on corneal endothelium of patients after phacoemulsification and foldable intraocular lens(IOL)implantation.

METHODS: A total of 247 patients(285 eyes)with cataract treated in Jingmen Aier Eye Hospital between June 2017 and December 2019 were selected, and they were divided into DisCoVisc group(123 cases, 141 eyes)and sodium hyaluronate group(124 cases, 144 eyes)by random number table method. Both groups were treated with phacoemulsification and foldable IOL implantation. DisCoVisc and 1.7% sodium hyaluronate were used as viscoelastic agents in DisCoVisc group and sodium hyaluronate group, respectively. The two groups were compared in terms of intraoperative ultrasound time(UST), cumulative dissipated energy(CDE), time for aspiration of viscoelastic agents after IOL implantation, corneal edema at 1d, 1wk, 1 and 3mo after operation, corneal endothelial cell density(ECD)and ECD loss rates before operation and at 3mo after operation, coefficient variation of corneal endothelial cell size(CV), percentage of corneal hexagonal endothelial cells(6A), intraocular pressure, the proportions of patients with uncorrected visual acuity ≥0.5 and central corneal thickness(CCT)values before and after operation at 1d, 1wk and 1mo.

RESULTS:There was no statistically significant difference between the two groups in UST, CDE, aspiration time of viscoelastic agents(P >0.05)or corneal edema both rate on day 1 after operation(P>0.05). Corneal edema disappeared at 1 wk after operation. The ECD loss rate in DisCoVisc group was significantly lower than that in sodium hyaluronate group at 3mo after operation(P<0.05). Intraocular pressure, the proportion of patients with uncorrected visual acuity ≥0.5 and CCT values showed no statistically significant differences between the two groups before and after operation at 1d, 1wk and 1mo(P >0.05).

CONCLUSION: DisCoVisc, as the viscoelastic agent in phacoemulsification and foldable IOL implantation for patients with Emery-Little grade Ⅱ-Ⅲ lens nucleus hardness, can better protect the patients' corneal endothelium.

Abstract:AIM:To observe the early variation trend of the vault after phakic posterior chamber implantable collamer lens/toric implantable collamer lens(ICL/TICL V4c)implantation and analyze the related influencing factors.

METHODS:In this retrospective study, a total of 49 patients(98 eyes)who underwent ICL/TICL V4c implantation in the Lanzhou Huaxia Eye Hospital from October 2020 to March 2021 were enrolled. Preoperative ocular biometric parameters were collected, including spherical equivalent(SE), intraocular pressure, axial length, anterior chamber depth(ACD), lens thickness(LT), central corneal thickness, anterior chamber angle(ACA), anterior chamber volume(ACV), white to white corneal diameter(WTW), mean keratometry K1 and K2, and intraoperative implantation size of ICL. The vault was measured by anterior segment optical coherence tomography(AS-OCT)at 1, 3d, 1wk and 1mo after surgery. The patients were divided into insufficient vault group(<250μm, 12 eyes), normal vault group(250-750μm, 62 eyes)and excessive vault group(>750μm, 24 eyes)according to the vault at 1mo after surgery. The factors affecting the postoperative vault were analyzed.

RESULTS:The mean vault values at 1 and 3d, 1wk and 1mo after surgery were 591.05±293.44, 599.62±309.78, 592.22±301.49 and 586.69±285.63μm, respectively. There were significant differences in WTW, ACA, ACV, ACD, ICL size and LT at 1mo after surgery(all P<0.05). The regression equation of vault at 1mo after surgery was as follows: vault(μm)=-3142.19+388.25×WTW+10.40×ACA-301.63×LT(R=0.674, R²=0.454, adjusted R²=0.436). WTW had the greatest influence on vault at 1mo after surgery(β=0.47, P<0.001), followed by LT(β=-0.34, P<0.001)and ACA(β=0.17, P=0.047).

CONCLUSION:WTW, ACA and LT were the main factors that affected and predicted the vault at 1mo after ICL/TICL V4c implantation.

Abstract:AIM: To evaluate the prevalence and potential risk factors of dry eye among residents in Hotan, Xinjiang, China.

METHODS: A cross-sectional study was conducted on 6 027 residents aged 18-98 from 105 villages in Hotan, Xinjiang, China from January 2019 to September 2019. The subjective symptoms of dry eye were collected by ocular surface disease index(OSDI)questionnaire, and the objective signs were collected by testing fluorescein breakup time(FBUT)and Schirmer Ⅰ test, so as to analyze the prevalence and risk factors of dry eye.

RESULTS: A total of 6 339 subjects aged 18-98 years were recruited from residents in Hotan, Xinjiang, China. Relevant eye examinations and questionnaires were conducted on the subjects, of which 6 027 were valid questionnaires, with an effective recovery rate of 95.08%. The dry eye detection rate of 6 027 residents was 40.37%(2 433/6 027), and the dry eye detection rates of male and female were 36.47%(846/2 320)and 42.81%(1 587/3 707)respectively. The dry eye detection rates of 18-24 years old, 25-34 years old, 35-44 years old, 45-54 years old, 55-64 years old, and ≥65 years old were 13.77%, 15.67%, 33.31%, 46.35%, 47.65%, 53.50%, respectively. According to the severity of dry eye, they were divided into mild dry eye, moderate dry eye and severe dry eye, and their constituent ratios were 80.11%, 19.03% and 0.86%, respectively.

CONCLUSION: The prevalence of dry eye in the study population was 40.37%. The prevalence of dry eye in female was higher than that in male, and the prevalence of dry eye increased with the increase of age. Older age and female are the risk factors for dry eye.

Abstract:AIM: To investigate the influencing factors of disequilibrium refractive development in children aged 6-12 years old.

METHODS: A total of 607 children with a mean age of 8.2±1.8 years old from two primary schools in Binhai New Area of Tianjin in December 2019 were selected by cluster sampling for optical biometry measurement(axial length and equivalent corneal power), cycloplegia refractive examination and questionnaire survey.

RESULTS: The childrens'spherical equivalent was -0.11±1.63D, binocular spherical equivalent difference was -0.08±0.64D and absolute value of spherical equivalent difference was 0.41±0.49D. There were 56 children with anisometropia and 551 children without anisometropia. There was no difference in the absolute value of binocular corneal power difference between anisometropia and non-anisometropia group(0.30±0.34D vs 0.27±0.24D, P=0.430). But the absolute value of axial difference was significantly different(0.67±0.39mm vs 0.13±0.13mm, P=0.005). Multivariate linear regression analysis showed that weekly usage time of phones/computers, weekly close work hours, weekly visual fatigue times and habitual reading distance were the influencing factors of refractive imbalance development(the absolute value of binocular spherical equivalent difference). Habitual reading distance and handedness in writing are the influencing factors of the developmental bias of refractive imbalance(binocular spherical equivalent difference).

CONCLUSION: Children aged 6-12 years old who spend more time on phones/computers, and have prolonged close work, more times of visual fatigue and close habitual reading distance may increase the degree of refractive imbalance. Children with right-handed handwriting and severe left or right head deviation have a deeper degree of myopia in the right eye than in the left eye.

Abstract:AIM:To investigate the myopia of junior high school students in Enshi, Hubei province with different selenium content, and analyze the correlation between the level of serum selenium, hair selenium and myopia.

METHODS:A cross-sectional study. A total of 600 students from grades 1-3 of junior high schools(100 students in each grade)in selenium-rich(selenium in soil ≥1.28mg/kg)and selenium-deficient(selenium in soil <1.28mg/kg)areas were randomly selected from September 2020 to September 2021, respectively. The level of serum selenium, hair selenium, glutathione peroxidase(GSH-Px)and myopia condition were determined.

RESULTS:The serum and hair selenium of myopic group(n=244, 40.7%)were 75.14±11.16μg/L and 0.51±0.01μg/g, respectively. Those in the non-myopic group(n=356, 59.3%)were 110.24±12.14μg/L and 0.68±0.02 μg/g, respectively. The serum selenium and hair selenium in the two groups were different(all P<0.01). The serum selenium of 300 students in the selenium-deficient area was 76.74±11.25μg/L, the hair selenium was 0.45±0.01 μg/g, and the number of myopia cases was 154(51.3%); The serum selenium of 300 students in selenium-rich areas was 102.31±10.26 μg/L, the hair selenium was 0.71±0.02 μg/g, and the number of myopia cases was 90(30.0%), the serum and hair selenium in the selenium-rich areas were significantly higher than those compared with the students in selenium-deficient areas, and the myopic incidence was significantly reduced(all P<0.01). The level of GSH-Px of the two areas was 114.65±12.12U/L vs 75.34±13.20U/L(Z=37.994, P<0.01). There is a negative correlation between serum and hair selenium and the myopic incidence(r=-0.542, -0.621, P<0.05).

CONCLUSION:Serum and hair selenium is significantly associated with myopia of junior high school students in Enshi, which may provide new ideas for the clinical prevention and treatment of myopia.

Abstract:AIM: To investigate the efficacy of the first follow-up visit after daily partial or full-day occlusion of the dominant eye in patients with unilateral amblyopia and assess the maximum efficacy produced by different amounts of occlusion.

METHODS: A retrospective clinical study was conducted on 135 cases of unilateral amblyopia cured in our hospital's outpatient clinic from January 2020 to December 2021. They were divided into 2h/d occlusion group, 6h/d occlusion group and all-day occlusion group according to the duration of occlusion, with fine sight training of amblyopic eyes. The effect of the first dose(baseline visual acuity-first review visual acuity), cured visual acuity, stereo vision at the first review and cure time of amblyopic eyes were recorded. The factors affecting the first dose effect in patients with unilateral amblyopia were also analyzed.

RESULTS: All patients had a baseline visual acuity of 0.4(0.22, 0.52), a first follow-up visual acuity of 0.22(0.15, 0.3), a first-dose effect of 0.1(0.08, 0.18), and a visual acuity of 0(-0.08, 0.05)when amblyopia cured. The first-dose effects were 0.08(0.07, 0.12)for patients in the 2h/d occlusion group, 0.18(0.08, 0.3)for the 6h/d occlusion group, and 0.10(0.08, 0.18)for the all-day occlusion group. The most significant first-dose effect was the 6h/d occlusion group(P<0.05); Analysis of different influencing factors showed that the highest values of the first-dose effect of 6h/d occlusion were in the 3-6 years group, 7-12 years group, female group, strabismic amblyopia group and mild to moderate group(P<0.05); Furthermore, the first dose effect of the 6h/d occlusion was positively correlated with cure time of amblyopic eyes(r_s=0.334, P=0.038). At the first follow-up, 21 cases(53.8%)had improved Titmus stereo visual acuity in the 6h/d occlusion group, which was higher than that in the 2h/d and all-day occlusion groups \〖16 cases(41.0%), 13 cases(22.8%), P<0.017\〗.

CONCLUSIONS: For monocular amblyopia, the first-dose effect of 6h/d occlusion treatment was the most significant, and the recovery of stereopsis was the best.

Abstract:AIM:To analyze the compliance and curative effect of comprehensive vision training in patients with amblyopia.

METHODS:A prospective study was conducted among 200 patients(294 eyes)with amblyopia who were treated in the hospital from July 2018 to August 2019. The patients were divided into a control group(98 patients, 140 eyes, traditional comprehensive vision training)and an experimental group(102 patients, 154 eyes, intelligent multi-dimensional comprehensive vision training)according to the random number table method. Curative effect, compliance, and the correlation between the two groups were observed.

RESULTS:The overall response rate and compliance rate in the experimental group(93.5%, 45.1%)were higher than those in the control group(80.0%, 35.7%, all P<0.05). The curative effect was different in patients of different age, with different types and severity of amblyopia, different nature of fixation, and different compliance(all P<0.001). Age and the severity of amblyopia were negatively correlated with the curative effect(r=-0.342, -0.459, P<0.001), while compliance was positively correlated with the curative effect(r=0.378, P<0.001). Patients aged 3-6 had significantly better compliance, followed by those aged 7-10(P<0.05). Age was negatively correlated with treatment compliance(r=-0.398, P<0.001).

CONCLUSION:Intelligent multi-dimensional comprehensive vision training can improve the compliance of patients with amblyopia, thereby achieving better curative effect. The curative effect is closely related to age, the type and severity of amblyopia, the nature of fixation and compliance. Compliance is related to age. Clinically, early treatment should be conducted bases on these features.

Abstract:AIM: To observe the efficacy and safety of modified four-point fixed intraocular lens suspension implantation in aphakic eyes.

METHODS:A prospective study. A total of 32 aphakic patients(32 eyes)with an average age of(44.56±8.48)years who underwent modified four-point fixed intraocular lens suspension implantation in our hospital from October 2020 to May 2021 were selected. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), corneal astigmatism, intraoperative and postoperative complications were observed before and after operation.

RESULTS:The mean follow-up of all patients was(4.84±0.64)mo. The preoperative UCVA(LogMAR)was 1.25±0.42 and the last follow-up was 0.5±0.25(P<0.001). The preoperative BCVA(LogMAR)was 0.41±0.19 and the last follow-up was 0.42±0.19,(P >0.05). The preoperative corneal astigmatism was(1.17±0.64)D and the last follow-up was(1.20±0.59)D(P>0.05). There were no intraoperative complications, but 2 eyes had low intraocular pressure, 1 eye had high intraocular pressure and 2 eyes had corneal edema occurred after operation. There were no complications of hyphema, vitreous hemorrhage, macular cystoid edema, corneal endothelial decompensation, inclination or eccentricity of intraocular lens and exposure of suture.

CONCLUSION:The modified four-point fixed intraocular lens suspension implantation can significantly improve the postoperative visual acuity of aphakic patients without additional corneal astigmatism,and with fewer complications.

Abstract:AIM: To investigate the effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end.

METHODS:A total of 13 patients(13 eyes)with traumatic single lacrimal canaliculus rupture were treated in our hospital. RS lacrimal duct drainage tube was inserted into the lacrimal duct from intact lacrimal canaliculus to fill the nasolacrimal duct, then sodium hyaluronate gel was injected to make sodium hyaluronate gel overflow from the nasal broken end of fractured lacrimal canaliculus, which was used to locate the nasal broken end which was difficult to find and completed the lacrimal anastomosis operation.

RESULTS: Among the patients with 13 eyes who were difficult to find the broken end, the nasolacrimal duct was filled with RS lacrimal duct drainage tube. After injection of sodium hyaluronate gel, the gel overflowed from the nasal broken end under direct vision of the microscope, and the lacrimal duct drainage tube was successfully inserted, and the success rate of finding the broken end was 100%. Thirteen eyes were extubated after being placed for 3mo, and then were followed up for 6mo. Among them, 9 eyes were cured, 3 eyes were markedly effective and 1 eye was ineffective. The cure rate was 69%, and the total effective rate was 92%.

CONCLUSION: A new technique for rapid location of nasal broken end is proposed for patients in which are difficult to find the broken end. This method is simple to operate and requires a relatively low clinical experience. It is suitable for patients with different degrees of single lacrimal canaliculus rupture and can complete complex lacrimal canaliculus rupture anastomosis in a short time.