Abstract:AIM: To investigate the application and effect of virtual-reality surgery exercise in minimally invasive cataract surgery training for ophthalmology residents.

METHODS:Twenty ophthalmology residents with equal seniority who had completed 3a standardized residency training in the Affiliated Eye Hospital of Nanjing Medical University from 2019 to 2021 were prospectively enrolled. After passing the theoretical examination, residents were randomly divided into virtual surgery exercise(Dry-lab)group(n=10)and real animal surgery exercise(Wet-lab)group(n=10). Dry-lab and Wet-lab group residents performed training using the Eye SI surgical simulator and pig eye respectively. At the end of the training, the overall training effects of the residents in both groups were rated using the Eye SI surgical simulator and the real pig eye operation, and the module training effects of the residents in both groups were rated using the virtual surgical simulator. Furthermore, a questionnaire survey was used to objectively evaluate the two training methods.

RESULTS:Residents in Dry-lab group had significantly higher total scores on both operation assessments,simulator assessment and real pig eye operation assessment than Wet-lab group(88.03±1.34 vs 80.35±2.87, 87.50±3.03 vs 77.60±5.62, 88.57±1.89 vs 83.10±3.22, all P<0.01). The simulator module assessment results showed that the residents in Dry-lab group scored significantly better than Wet-lab group in terms of scores and completion time on each module(P<0.01). The questionnaire results showed that Dry-lab group rated better than Wet-lab group in terms of the novelty of training, the proximity to the real surgical experience, the degree of help to the improvement of microsurgery skills, the confidence to perform real surgery, and the overall satisfaction of surgical training(P<0.05).

CONCLUSION:Applying virtual-reality surgery exercise to cataract surgery skills training for ophthalmology residents can significantly improve the cataract skills, increase overall training satisfaction, and help residents enhance their confidence, psychological quality, decision-making, and processing ability during real surgery at the initial stage of practice. This provides a new standard and model for establishing a formal and standardized cataract surgery training system for ophthalmology residents.

Abstract:Glaucoma is the first irreversible eye disease leading to blindness of the world. Due to its insidious and progressive nature, early diagnosis and monitoring of glaucoma progression is very important in clinical practice. Artificial intelligence(AI)is developing rapidly in the medical field. The research and application of AI and its subsets of machine learning(ML)and deep learning(DL)in glaucoma are becoming increasingly mature, which promotes human understanding of glaucoma, greatly improves the accuracy and efficiency of glaucoma screening and diagnosis, and greatly reduces the cost of examination. Using AI technology for early screening and diagnosis of glaucoma patients can reduce the risk of visual impairment of patients, and second, it can predict the progression of glaucoma and design personalized treatment plans, so as to improve the prognosis of patients. This paper summarizes the new progress of AI in glaucoma screening, diagnosis, and prognosis, the clinical difficulties and challenges, and prospects the advantages and future development trends of AI in glaucoma.

Abstract:AIM: To evaluate the application value of the automatic classification and diagnosis system of pterygium based on deep learning.

METHODS: A total of 750 images of normal, observational and operative anterior sections of pterygium were collected from the Affiliated Eye Hospital of Nanjing Medical University between May 2020 and April 2021. Seven triclassification models were respectively trained with original data set and enhanced data set. Totally 470 clinical images were tested, and the generalization ability of the model before and after data enhancement was compared to determine the best model for the automatic classification system of pterygium.

RESULTS:The average sensitivity, specificity and AUC of the best model trained on the original data set were 92.55%, 96.86% and 94.70% respectively. After data was enhanced, the sensitivity, specificity and AUC of different models were increased by 3.7%, 1.9% and 2.7% on average. The sensitivity, specificity and AUC of the EfficientNetB7 model trained on the enhanced data set were 93.63%, 97.34% and 95.47% respectively.

CONDLUSION: The EfficientNetB7 model, which was trained on the enhanced data set, achieves the best classification result and can be used in the automatic classification system of pterygium.This automatic classification system can diagnose diseases about pterygium better, and it is expected to be an effective screening tool for primary medical care. It also provides reference for the research on the refinement and grading of pterygium.

Abstract:With the formation of an aging society, cataract caused by age has become a public common concern about health problem all over the world. Surgery by intraocular lens replacement is the only effective mean to treat cataract. The most important thing to treat cataract is accurately calculating the intraocular lens diopter. However, some patients did not feel satisfied because the error of calculation of intraocular lens diopter. With big data analysis and self-learning, artificial intelligence can deeply analyze and autonomously decide on complex clinical data. Therefore, this technology is expected to improve the calculation accuracy of intraocular lens diopter, to reduce postoperative refractive error and to improve patients' satisfaction. By referring to relevant literature at domestic and abroad, this paper is aimed to introduce the basic principle of artificial intelligence in intraocular lens diopter calculation, analyze and compare the characteristics, advantages and limitations of artificial intelligence based on different principles.

Abstract:In recent years, the application of artificial intelligence(AI)has been greatly promoted in medical care, especially in the field of image recognition which has played an irreplaceable role in the diagnosis of ophthalmic diseases. AI has made remarkable achievements in the diagnosis and treatment of anterior segment diseases such as classification of infectious keratitis, screening of keratoconus, grading of lens opacity, automatic staging of cataract surgery videos, prediction of postoperative refraction status, and the diagnosis of primary angle-closure glaucoma. It is promising that AI could help solve many clinical problems and realize early diagnosis and treatment of diseases. However, there are still some challenges such as the ambiguity of black-box process, the absence of public data sets and the complexity of algorithms. In this paper, the current studies of AI applications in anterior segment diseases have been reviewed in detail. Also, the challenges and future directions of AI in ophthalmology have been proposed.

Abstract:In the past few years, with the valid development of computer science and the advancement of interdisciplinary integration, the application of artificial intelligence(AI)in the medical field has increased rapidly. Previously, most AI-related research in ophthalmology focused on posterior segment such as diabetic retinopathy and age-related macular degeneration. Recent years, with refinement of learning algorithms and availability of big data, there are more and more research about AI applied to ocular surface diseases. This article reviews the related research and application of AI in ocular surface diseases, which discussing the current challenges as well as the opportunities of AI-related application of ophthalmology.

Abstract:In recent years, with the continuous improvement of computer science and technology, artificial intelligence(AI)technology based on deep learning(DL)has developed rapidly and attracted wide attention all over the world. Great progress has been made in the research and application of AI in the medical field. In the field of optometry, AI can assist the diagnosis of myopia, strabismus, amblyopia and other diseases, and has achieved good results in the screening and early diagnosis of keratoconus as well as in the prevention and correction of myopia. Nevertheless, there are some limitations and great challenges in the application of AI in optometry, including clinical and technical challenges, interpretability of algorithmic results, medical legal issues and so on. This paper reviews the application, limitation and prospect of AI in the field of optometry.

Abstract:AIM: To construct and evaluate a diagnostic model based on transfer learning and data augmentation as a non-invasive tool for fusarium identification of fungal keratitis.

METHODS: A retrospective study. In this study, 2 157 images of fungal keratitis patients who underwent in vivo confocal microscopy examination in the Department of Ophthalmology of the people's Hospital of Guangxi Zhuang Autonomous Region from March 2017 to January 2020 were included as the dataset, which was classified according to the results of microbial culture. The dataset was subsequently randomly divided into training set(1 380 images), validation set(345 images)and test set(432 images). We used the transfer learning Inception-ResNet V2 network to construct a diagnostic model, and to compare the performance of the model trained on different datasets. The performance of the diagnostic model evaluated with specificity, sensitivity, accuracy, and area under the receiver operating characteristics curve(AUC).

RESULTS: The model trained with the original training set had a specificity rate of 71.6%, a sensitivity rate of 72.0%, an accuracy rate of 71.8% and AUC of 0.785(95%CI: 0.742-0.828, P<0.0001). And the model trained with the augmented training set had a specificity rate of 76.6%, a sensitivity rate of 83.1%, an accuracy rate of 79.9% and AUC of 0.876(95%CI: 0.843-0.909, P<0.0001), which made the model's prediction performance boost.

CONCLUSION: In this study, we constructed an intelligent diagnosis system for fungal keratitis fusarium through transfer learning, which has higher accuracy, and realized the intelligent diagnosis of fungal keratitis pathogen fusarium. Furthermore, we verified that the data augmentation strategy can improve the performance of the intelligent diagnosis system when the original dataset is limited, and this method can be used for intelligent diagnosis and identification of fungal keratitis pathogen fusarium.

Abstract:AIM: To investigate the feasibility of artificial intelligence(AI)in reading retinal optical coherence tomography(OCT)images of age-related macular degeneration(ARMD)in clinic.

METHODS: From November 2019 to November 2021, a total of 1 579 OCT images were collected in the outpatient department, and the imaging results of ophthalmologist and AI were collected. The Kappa consistency test of classification results without ARMD and with ARMD were analyzed.

RESULTS: The Kappa coefficients of the judgement of ophthalmologists about ARMD was 0.934. The Kappa coefficients between AI and ophthalmologists was 0.738. The sensitivity, specificity and area under curve(AUC)of AI to ARMD were 73.08%, 95.07% and 0.841 respectively.

CONCLUSION: AI has a high consistency with ophthalmologists in the recognition of ARMD based on OCT images, which is suitable for primary hospitals to complete the early screening and early referral of ARMD.

Abstract:AIM:To construct an artificial intelligence(AI)system based on convolutional neural network(CNN), which can automatically evaluate the morphological changes of meibomian gland(MG)in meibomian gland dysfunction(MGD)patients.

METHODS:The right eyes of 145 subjects who were treated at the Hangzhou Branch of the Eye Hospital of Wenzhou Medical University from January to November 2021 were selected for inclusion in the study. Meibography images of 60 of these subjects were randomly selected for AI training. The meibomian region and each MG in meibography were annotated and formed into datasets. The datasets were used for training and obtaining an AI system based on residual neural network(ResNet)combined with the U-Net model. The AI system was used to automatically analyze the MG morphological parameters in 85 subjects, including 53 patients with obstructive MGD and 32 volunteers with normal meibomian glands. The clinical indices including ocular surface disease index(OSDI), tear meniscus height, tear film break-up time(TBUT), corneal fluorescein staining, lid margin score, meiboscore, and meibomian gland expressibility score were also observed. The correlation between MG morphological parameters and clinical indices were analyzed.

RESULTS: After several iterations, we finally obtained an AI system with Intersection over Union of 92.0%. Using this AI system, we found that there was a significant correlation between the MG density in the upper eyelid with OSDI(r_s=-0.320), TBUT(r_s=0.484), lid margin score(r_s=-0.350), meiboscore(r_s=-0.749), and meibum expressibility score(r_s=0.425)(all P<0.05). The MG density in the lower eyelid was significantly correlated with OSDI(r_s=-0.420), TBUT(r_s= 0.598), lid margin score(r_s=-0.396), meiboscore(r_s=-0.720), and meibum expressibility score(r_s=0.438)(all P<0.05). The MG density in the total eyelid was significantly correlated with OSDI(r_s=-0.404), TBUT(r_s=0.601), lid margin score(r_s=-0.416), meiboscore(r_s=-0.805), and meibum expressibility score(r_s=0.480)(all P<0.05).

CONCLUSION:The AI system based on CNN in this study is an accurate and efficient MG morphological evaluation system, which can be conveniently used to evaluate the MG morphology of MGD patients quickly and accurately by using the MG density index established by us. MG density is a new quantitative index to evaluate meibomian gland atrophy, which is more accurate than meiboscore.

Abstract:AIM:To investigate the factors associated with short-term elevation of intraocular pressure(IOP)after conbercept intravitreal injection.

METHODS:This study was a clinical prospective observational study. It enrolled in 269 eyes of 269 patients who were diagnosed retinopathy, and all patients receive conbercept intravitreal injection. Among them, 143 were males and 126 were females. There were 201 cases of age-related macular degeneration(ARMD)and 68 cases of other retinopathy patients. The mean age was 62.86±11.74 years. Non-contact pneumatic tonometer was used to measure the IOP of the patients before, 10, 30min, 2 and 4h after injection. The group was divided according to the IOP elevation 10min after injection. The IOP elevation 10 mmHg and above was defined as the IOP elevation group, and the IOP elevation less than 10 mmHg was defined as the IOP stable group. Multivariate Logistic regression analysis was used to analyze the differences between the two groups.

RESULTS:The average IOP of patients at 10, 30min, 2 and 4h after injection was 24.1, 20.2, 19.5 and 16.9 mmHg, respectively. The average IOP at each time point after injection was 6.7, 3.1, 1.7 and 0.5 mmHg higher than that before injection. Among them, 56 cases of increased IOP, 213 cases of stable IOP. There were no significant differences in age, best corrected visual acuity(BCVA), gender, eye side and disease type between two groups(all P>0.05). There were statistically significant differences in the number of injection(Z=-4.389, P=0.012), IOP before injection and IOP at each time point after injection(t=-5.343, -10.467, -8.933, -6.124, -4.635, all P<0.01). Multivariate Logistic regression analysis showed that baseline IOP was positively correlated with IOP increase 10min after injection(B=-0.913, OR=0.521, 95%CI: 0.211-0.694, P=0.011).

CONCLUSION: The higher the baseline IOP, the higher risk of elevated IOP after injection. The factor associated with a short-term increase in IOP after intravitreal injection of conbercept was baseline IOP. The number of injection may be another risk factor.

Abstract:AIM: To study the cutting error of central corneal thickness(CCT)after small incision lenticule extraction(SMILE)in patients with different degrees of myopia.

METHODS: Myopic patients who had undergone SMILE surgery from May 2020 to September 2020 at the Jiangsu Province Hospital were included in the study. Data were organized by refractive status into low, moderate, and high myopia groups. The CCT was measured by the Pentacam anterior segment analysis system preoperatively and postoperatively at 1 and 3mo. Among different myopia groups, the cutting error(ΔCCT, defined as the difference between actual CCT and the predicted CCT)was calculated simultaneously during each visit. The difference ratio of ΔCCT and the relationship between ΔCCT, CCT, and cutting diameter were analyzed.

RESULTS: There were 221 patients(432 eyes)included in our study. At 3mo after operation, the ΔCCT in the high myopia group was larger than the low and moderate myopia group(χ²=225.74, 62.55; all P<0.01), and the moderate myopia group was larger than the low myopia group(χ²=132.77, P<0.01). The cutting deviation rate was also significantly different among three groups at 1 and 3mo after surgery. Pearson correlation analysis found that there was a linear regression relationship among preoperative refractive power, optical zone diameter and the central corneal cutting error at 3mo after operation(r=0.699, P<0.001; r=0.572, P<0.001).

CONCLUSION: The ΔCCT after SMILE increased with the increased of myopia, and the cutting error was positively correlated with preoperative equivalent spherical power and optical zone diameter.

Abstract:AIM: To observe the effects of different concentrations of curcumin on the proliferation and expression of VEGF and NF-κB p65 of human retinal capillary endothelial cells(HRCECs)induced by high glucose in vitro.

METHODS: The hyperglycemia model of HRCECs in vitro was established by simulating diabetic environment with high glucose medium. The cultured cells were divided into normal control group, high glucose control group, high glucose + 20, 40 and 80μmol/L curcumin groups. The proliferation of HRCECs was detected by CCK-8 assay, and the expression of VEGF and NF-κB p65 was detected by Western-blot and immunocytochemistry.

RESULTS: The results of CCK-8 assay showed that high glucose promoted the proliferation of HRCECs significantly compared with the normal control group(P<0.01). Curcumin at different concentrations could inhibit the proliferation of cells significantly in a concentration-dependent and time-dependent manner compared with the high glucose control group after being treated with curcumin at different concentrations for 12, 24 and 48h(P<0.01). The results of Western-blot showed that compared with the normal control group, the expression of VEGF-A and NF-κB p65 in the high glucose control group was increased significantly(P<0.01). Compared with the high glucose control group, the expression of VEGF-A and NF-κB p65 decreased significantly after being treated with curcumin at different concentrations for 12, 24 and 48h, and positively correlated with concentration and time(P<0.01). The results of immunocytochemistry showed that the expression of VEGF in the high glucose control group was significantly higher than that in the normal control group(P<0.01). After 24h of treatment with curcumin,the expression of VEGF was gradually decreased compared with the high glucose control group(P<0.01). There were significant differences in pairwise comparison between each group(P<0.01).

CONCLUSION: Curcumin can inhibit the proliferation and the expression of VEGF and NF-κB p65 of HRCECs induced by high glucose in a concentration-dependent and time-dependent manner, which may be related to its down-regulation of the expression of VEGF and NF-κB p65.

Abstract:AIM: To investigate the regulatory effect of miR-223-3p on the expression of transcription factor Rbpj and on the differentiation of Th1 and Th17 cells in experimental autoimmune uveitis(EAU)rats.

METHODS: The regulatory role of miR-223-3p in Rbpj gene expression was investigated by a dual luciferase expression reporter system. In the present study, 24 female Lewis rats were randomly divided into EAU model group, normal control(NC)group and blank control(BC)group, and each group included 8 rats. The EAU model group was injected with interphotoreceptor retinoid-binding protein(IRBP)emulsion containing Mycobacterium tuberculin H37RA and complete Freund's adjuvant to induce uveitis, while the NC group was injected with an equal volume of emulsion without IRBP peptide. The rats in the BC group received the same volume of sterile saline solution. At 12d after immunization, the spleen, lymph node and eye tissues in both groups were aseptically isolated, and the expression levels of miR-223-3p and Rbpj RNAs were detected by real-time quantitative PCR(Q-PCR); Meanwhile, the expression levels of Rbpj, IFN-γ and IL-17 proteins were detected by ELISA, and the levels of Th1 and Th17 cell lineages in each tissue from each groups were detected by flow cytometry.

RESULTS: The results of dual fluorescein assay indicated that Rbpj was the target gene which regulated by miR-223-3p. At 12d after immunization, compared with NC group, the relative expression levels of miR-223-3p in spleen, lymph node and eye tissues from EAU model rats were 0.33±0.29, 0.11±0.12 and 0.18±0.11, respectively, accompanied by the down-regulated expression, and the differences were statistically significant(all P<0.05); Rbpj mRNA levels were 3.00±0.06, 1.52±0.12 and 3.01±0.34, respectively, and were all up-regulated, while the differences were statistically significant(all P<0.05). Moreover, the differences in miR-223-3p and Rbpj mRNA levels in spleen, lymph node and eye tissues of rats in the blank control group were not statistically significant compared with those in the NC group(P>0.05); ELISA results revealed that the expression levels of RBPJ, IFN-γ and IL-17 proteins in all tissues from EAU rats at 12d after immunization were significantly higher than those in the NC group( all P<0.05), and there was no statistically significant difference in the expression levels of Rbpj, IFN-γ and IL-17 protein in all tissues of rats in the blank control group compared with the NC group(P>0.05); Meanwhile, flow cytometry results showed that the proportions of Th1 and Th17 cell lineages in all tissues from EAU model group were significantly higher than those from the NC group at 12d after immunization, and the differences were statistically significant(all P<0.05). Furthermore,there was no significant change in the proportion of Th1 and Th17 cells in each tissue in the BC and NC groups(all P >0.05).

CONCLUSION: The miR-223-3p can negatively regulate the expression of the transcription factor Rbpj of Notch signaling pathway. The down-regulated miR-223-3p expression in EAU rats can increase the expression levels of Rbpj gene and protein, and aggravate the differentiation of Th1 and Th17 cells and the expression levels of related molecules IFN-γ and IL-17, which in turn affect the development of uveitis.

Abstract:AIM: To study the biocompatibility of double-layer corneal stromal lens attactched by fibrin sealant(FS)in vivo, and to explore the feasibility of using this material for corneal transplantation.

METHODS: Fifteen healthy and clean New Zealand white rabbits were selected for a self-control study. The right eye of the rabbit was used as the experimental eye and the left eye was used as the control eye. The experimental eyes used FS adhesived double-layer corneal stromal lens as the material for lamellar keratoplasty, and the control eyes did not undergo manual intervention. At 7,14, and 28d after surgery, a hand-held slit lamp was used to observe the cornea of the rabbits and then score the biocompatibility. The corneas of both eyes were taken for histopathological examination by HE staining to observe the corneal recovery at the same time.

RESULTS: Slit lamp observation results showed that by 28d after the operation, the corneal epithelium of the experimental eyes grew well, the degree of corneal transparency was basically restored, the degree of edema was reduced, the growth of neovascularization to the corneal edge was not aggravated, and no rejection reaction such as epithelial and endothelial rejection lines were seen; The control eyes had clear corneas and smooth corneal epithelium. The results of biocompatibility score showed that the degree of corneal implant edema gradually decreased, the transparency gradually recovered, the rejection reaction was less, and the biocompatibility of corneal implants was better in the experimental eyes after corneal transplantation. There were no differences in the degree of corneal transparency, edema and neovascularization growth between the experimental and control eyes at 28d after surgery(P>0.01). The results of histopathological examination showed that by 28d after corneal transplantation, there were 4-5 layers of corneal epithelial cells covering the surface of the implant in the experimental eyes, the corneal collagen was neatly and regularly arranged, no obvious inflammatory cell infiltration was seen in the implant, the boundary between the two lenses disappeared, the interlayer FS was completely absorbed by the organism, the implant was fused with the implant bed, and no obvious demarcation was seen.

CONCLUSION:Using FS pasted double-layer corneal stroma lens as a graft for lamellar keratoplasty has better recovery, less rejection and better biocompatibility, and can be used for lamellar keratoplasty.

Abstract:AIM: To investigate the risk factors of neovascular glaucoma(NVG)after central retinal vein occlusion(CRVO), and to construct a predictive model.

METHODS: The clinical data of 483 patients(527 eyes)with CRVO admitted to the Department of Ophthalmology of our hospital from February 2016 to March 2020 were retrospectively selected and followed up until June 2021. CRVO combined with NVG were counted.The risk prediction model of NVG after CRVO was constructed according to the regression coefficient of risk factors, and the Hosmer-Lemeshow(H-L)test and receiver operating characteristic(ROC)curve method were used to evaluate the prediction model.

RESULTS: Fifteen patients(23 eyes)were followed up with 35(15-64)mo. NVG was happened in 70 patients(86 eyes)(NVG group)and no NVG was happened in 398 patients(418 eyes)(non-NVG group). Regression analysis showed that ischemic CRVO, IOP≥18mmHg at the first visit, hypertension,relative afferent pupillary defect(RAPD)≥0.75logU at the first visit, uncorrected visual acuity(UCVA)>0.30(LogMAR)at the first visit were risk factors for NVG after CRVO(P<0.01), and anti-vascular endothelial growth factor(VEGF)therapy were protective factors for NVG after CRVO(P<0.01). The risk prediction model for NVG after CRVO had good consistency(H-L test P>0.05)and discrimination(area under the curve was 0.877, 95%CI:0.830-0.924, sensitivity was 84.3%, specificity was 88.9%). The predictive scoring model was further constructed, and the critical value of NVG after CRVO was 5 points,the area under the curve was 0.844(95%CI:0.790-0.898), sensitivity was 78.6%, and specificity was 87.4%.

CONCLUSION: Ischemic CRVO, IOP≥18mmHg at the first visit,hypertension,RAPD≥0.75logU at the first visit, UCVA>0.30(LogMAR), and anti-VEGF therapy are closely related to NVG after CRVO, and the predictive model established on this basis has good predictive efficacy.

Abstract:AIM: To observe the efficacy of intravitreal anti-vascular endothelial growth factor(VEGF)injection treatment in chronic central serous chorioretinopathy(CCSC)combined with choroidal neovascularization(CNV)using multimodal imaging, to explore and evaluate the influence factors.

METHODS: In this retrospective study, 30 patients(30 eyes)were diagnosed as CCSC combined with CNV. Comprehensive ophthalmologic examinations were performed, including best corrected visual acuity(BCVA), enhanced-depth imaging(EDI)spectral domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), Indocyanine green angiography(ICGA), and optical coherence tomography angiography(OCTA). Patients were treated with intravitreal ranibizumab(IVR)parallel 1+PRN schem for subretinal fluid(SRF)secondary to CCSC combined with CNV. All the patients were followed up at 1wk, 1mo after treatment and 3mo after consecutive treatment. The BCVA, central macular thickness(CMT), subfoveal choroid thickness(SFCT)and CNV flow area were compared.

RESULTS: All the patients were observed at baseline, 1wk, 1mo after treatment and 3mo after consecutive treatment. The difference at various time points of CMT(μm)were statistically significant(F=62.06, P<0.01). CMT after treatment at each time point was compared with baseline, the difference among each time points was statistically significant(t=3.08, 6.57, 4.90; P=0.01, 0.02, <0.01). In which 46.7% of patients, SRF can be completely absorbed(14/30). The difference at various time points of BCVA(LogMAR)were statistically significant(F=87.21, P<0.01). BCVA after treatment at each time point was compared with baseline, the difference between each group was statistically significant(t=6.52, 4.71, 6.01; P=0.03, <0.01, <0.01). The difference at various time points of SFCT(μm)were statistically significant(F=57.98, P<0.01). SFCT after treatment at each time point was compared with baseline, the difference among each time points was statistically significant(t=5.11, 9.03, 4.2; P=0.03, <0.01, <0.01). The difference at various time points of CNV area(mm²)were statistically significant(F=70.78, P<0.01). CNV area at 1wk and 1mo after treatment was compared with baseline, the difference was no statistically significant(t=7.01, 6.54; P=0.07, 0.05). CNV area at 3mo after the last treatment was compared with baseline, the difference was statistically significant(t=4.51, P=0.02). The change of CMT was positively correlated with the baseline CMT, BCVA and CNV area(r=0.43, 0.41, 0.41; P=0.02, 0.03, 0.03). The change of BCVA was positively correlated with the baseline BCVA and CMT(r=0.89, 0.43; P<0.01, 0.02).

CONCLUSION: CCSC combined with CNV show different sensitivity to anti-VEGF therapy, the SRF can be completely absorbed after treatment in parts of patients. CNV may not be the only predictive factor leading to the SRF. The baseline BCVA, CMT and CNV area may be the factors that influence the final therapeutic effect of the intravitreal anti-VEGF injection therapy.

Abstract:The effect of cataract surgery is affected by various factors, such as the measurement of preoperative biological parameters, the formula for calculating refractive force of intraocular lens(IOL), surgical methods and surgical techniques. The axial length(AL)is an important parameter for calculating the refractive force of IOL. At present, the main methods of measuring AL are ultrasonic biometry and optical biometry, and these two methods have their own advantages and disadvantages and complement each other. The calculation formula of refractive force of IOL has been continuously updated in the past decades. In recent years, many new calculation formulas have appeared, such as the Barrett Universal Ⅱ formula(BUⅡ), the Kane formula, the Olsen formula, the Hill-radial basis function(Hill-RBF)formula, etc. This paper mainly summarizes the advantages and disadvantages of the two AL measurements, and compares the accuracy of the IOL refractive force calculation formula at different AL.

Abstract:Primary angle-closure glaucoma(PACG)is the most common type of glaucoma in clinical. It is characterized by progressive and irreversible development with high global incidence and high possibility of blindness. The pathogenesis of PACG is complicated. It is not only associated with the abnormality of the ocular anatomy, such as the small cornea, short eye axis and shallow anterior chamber, but also found that the abnormality of the lens, iris, ciliary body and choroid are related to the pathogenesis of PACG in recent years. Moreover, the occurrence of PACG is also closely related to genetic and psychological stress factors. Our study summarized some literatures and made a brief discussion on the pathogenesis of PACG from the three aspects of anatomical characteristics, genetic factors, and psychological stress. We hope to provide useful theoretical support for the early diagnosis and treatment of glaucoma.

Abstract:Anti-vascular endothelial growth factor(anti-VEGF)drugs have become the first choice for the treatment of intraocular neovascularization, but the inconvenience and possible complications caused by frequent intravitreal injection cannot be ignored. Therefore, it is necessary to seek new drugs with long-lasting effects, so as to reduce the number of injections. Brolucizumab, a novel small molecule anti-VEGF drug, has the advantages of stronger tissue penetration, higher drug concentration, smaller injection dose, long-lasting efficacy and longer injection interval. Registered clinical studies and real-world evidence showed that Brolucizumab is non-inferior to aflibercept in efficacy, while its ability to improve intraretinal/subretinal fluid is more significant, and it can maintain a longer dosing interval. In addition, Brolucizumab is safe and has a low incidence of serious adverse events, such as retinal vasculitis reported. Brolucizumab provides a new treatment option for neovascular age-related macular degeneration(nARMD). This article reviews the latest progress of Brolucizumab in the treatment of nARMD.

Abstract:Age-related macular degeneration(ARMD)is one of the main causes of irreversible visual impairment in the middle-aged and elderly people, which severely impacts the patient's life quality and poses a substantial health economic burden on society. There are two types of late ARMD in clinic: wet ARMD and dry ARMD. Anti-vascular endothelial growth factor drugs, as first-line clinical drugs for wet ARMD, achieved remarkable efficacy. For dry ARMD, however, effective therapies are in the air. This review focuses on the potential drugs, biological therapies and traditional Chinese medicines that made significant progresses in clinical trials for dry ARMD, including anti-inflammatory drugs(doxycycline and FHTR2163), anti-oxidants(risuteganib and elamipretide), complement inhibitors(APL-2 and zimura), visual cycle modulators(ALK-001), neuroprotective agents(brimonidine), stem cell transplantation(MA09-hRPE and BMMF), gene therapy(HMR59), and traditional Chinese medicine(saffron, curcumin, quercetin and resveratrol). The new drugs exhibited favorable clinical efficacy and broad application prospects, which would foster hope for improvement and treatment of ARMD.

Abstract:Diabetic macular edema(DME)is a severe ocular complication of diabetes and one of the leading causes of vision loss in diabetic patients. The pathogenesis of DME is complicated, and the key to treatment is controlling the systemic factors that cause the deterioration of DME. The existing studies have shown that the increased risk of DME is related to many factors. In this paper, the risk factors of DME were reviewed to provide theoretical support for the research and prevention of DME.

Abstract:MicroRNAs(miRNAs)are micromolecule non-coding RNA that play a key role in post-transcriptional regulation of gene expression and are involved in regulating various biological processes such as cell differentiation, proliferation and metabolism.The expression of miRNAs varies significantly in the process of the occurrence and development of diabetic retinopathy(DR), many domestic and foreign studies have shown that miRNAs are closely related to the physiological and pathological mechanism of DR by regulating gene expression. Partial miRNAs that specifically expressed can regulate the level of oxidative stress and inflammatory response in the retina and affect the occurrence and development of DR. Therefore, the progression of DR can be delayed by enhancing or inhibiting these miRNAs. The combination of single or multiple miRNAs can serve as novel transcriptome biomarkers for DR, and it is also a potential effective target for future treatment of DR. Current detection of specific miRNAs in blood or body fluids is helpful for early intervention and follow-up of DR. Therefore, this review focuses on the research progress of miRNAs and their molecular mechanisms, therapeutic prospects and biomarkers involved in DR regulation.

Abstract:With the continuous progress and development of modern surgical equipment, the types of intraocular lens and the continuous improvement of people's requirements for visual quality, cataract surgery has been transformed from traditional vision restoration surgery into a high-quality and high-demand refractive surgery. Piggyback intraocular lens implantation was originally a new surgical method for clinicians to implant two or more posterior chamber intraocular lenses in patients' eyes to correct hyperopia or secondary correction refractive errors after cataract surgery. With the birth and promotion of functional lenses in recent years, this surgical method has been applied to the field of refractive cataract surgery, which expanded the application of functional intraocular lens and achieved good postoperative effect. This review discusses the development and current clinical application of Piggyback intraocular lens implantation, and further expounds its development trend in the future.

Abstract:In clinical practice, many macular diseases in advanced stages such as age-related macular degeneration(ARMD)and Stargardt disease are manifested reduced visual acuity, unstable and even paracentral fixation resulting from the central scotoma followed by the scarring of neovascular fibres or the impairment of photoreceptors and retinal pigment epithelium, which cause great distress to patients' life, work and psychology. For a long time, there have been limited rehabilitation treatments for such patients. However, recent articles have indicated that biofeedback training by using microperimetry is expected to enhance neurosensory adaptation by achieving cortical plasticity, and makes better use of residual retinal function to help those with low vision associated with central scotoma consolidate or establish stable central or paracentral fixation, thereby improving visual function including visual acuity and reading speed. In order to improve the understanding of this rehabilitation therapy, this article will overview the mechanism and protocol of microperimetric biofeedback training(MBFT), the selection of the preferred retinal locus, the clinical application in macular diseases and its prospects.

Abstract:Meibomian gland dysfunction(MGD)is a chronic, diffuse blepharoplasty that is characterized by obstruction of the terminal ducts of the blepharoplasty gland and abnormal lid ester secretion, which is a common ocular surface disease as well as the major cause of hyper evaporation type dry eye. MGD can cause ocular surface lid ester abnormalities and bacterial proliferation, which in turn leads to associated ocular symptoms. Physical therapies and medicines are widely used to treat MGD in clinics. Through the topical or systemic use of antibiotics that are effective anti-bacteria medicine, ocular surface symptoms caused by MGD-induced bacterial proliferation and abnormal eyelid lipids can be alleviated. Currently, the effectiveness of various types of antibiotics in treating MGD has been demonstrated. In this review, the mechanism, modality, and efficacy of various antibiotics in the treatment of MGD were highlighted and summarized from the perspective of topical or systemic use of antibiotics, which can provide promising guidance for clinical treatments of MGD.

Abstract:Solitary fibrous tumor is a rare mesenchymal tumor originating from fibroblasts. It was first reported in the pleura. In recent years, more and more cases of solitary fibroma in the extra pleural area have been reported. It has been reported that the tumor can occur in almost all sites. The structure and function of the lacrimal drainage system has its particularity, and there are still few reports about solitary fibroma of the lacrimal drainage system. Therefore, this article summarizes the existing reports of solitary fibroma of the lacrimal drainage system to analyse its clinical characteristics and treatment.

Abstract:Sox2 gene is a member of sex determination region of Y chromosome(SRY)related gene family, and it is one of the key transcription factors to maintain the pluripotency and self-renewal characteristics of embryonic stem cells. Sox2 participates in a variety of biological processes, such as regulating cell proliferation and apoptosis, and participating in the formation and development of tumors. However, the review literature on the role of Sox2 gene in eye diseases has not been reported. This article reviews the expression level of Sox2 gene, related signal pathways and clinical application potential, so that readers can understand more comprehensive the role of Sox2 gene in eye diseases, and to carry out more in-depth research.

Abstract:AIM:To observe the effect of inferior oblique belly transposition(IOBT)in unilateral mild inferior oblique overaction with small angle vertical stabismus.

METHODS: The data of patients who underwent IOBT in our hospital from September 2019 to August 2021 were analyzed retrospectively. Inclusion criteria targeted patients with mild inferior oblique overaction(2+ and below)and small angle incomitant vertical strabismus(4-9PD). The horizontal deviation and vertical deviation in both primary and lateral gazes were measured, and the degree of inferior oblique overaction and fovea-disc angle(FDA)were also evaluated preoperatively and postoperatively.

RESULTS: A total of 16 cases(16 eyes)were included, aged 4-39 years. One case was 5a postoperative congenital esotropia with secondary unilateral inferior oblique overaction by mild superior oblique palsy, whereas 15 patients had monocular primary inferior oblique overaction with horizontal strabismus. The follow-up was 3-6mo. The mean improvement of inferior oblique overaction was 2.00(1.25, 2.00)grade from +2.00(2.00, 2.00)preoperatively to 0.00(0.00, 0.00)postoperatively, the difference was statistically significant(Z=-3.70, P<0.001). The horizontal strabismus decreased from 69.13±25.86PD preoperatively to 2.75±2.59PD postoperatively(t= 9.929, P<0.001). The vertical strabismus in the primary position decreased from preoperative 7.44±1.32PD to 1.00±1.21PD postoperatively(t=22.335, P<0.001), mean corrected hypertropia 6.44±1.15PD, and vertical strabismus in lateral gazes decreased from preoperative 12.44±2.73PD to 3.00±2.13PD postoperatively, mean corrected hypertropia 9.44±2.73PD, these differences were statistically significant(t=13.819, P<0.001). The FDA decreased from -8.85°±6.53° preoperatively to -6.49°±7.01° postoperatively, the difference was statistically significant(t=-2.384, P<0.001), with a mean reduction of 2.36°. No postoperative complications such as postoperative overcorrection or inferior oblique underaction were observed.

CONCLUSION:IOBT is safe and effective in correcting unilateral mild inferior oblique overaction with small angle vertical strabismus.

Abstract:AIM:To investigate the refractive status and axial length in patients with mild to moderate congenital ptosis coexisting concomitant exotropia.

METHODS:In this prospective observational study, we divided all patients between September 2011 and February 2021 into three groups: 18 patients with mild to moderate congenital ptosis coexisting concomitant exotropia(CPE), 19 patients with mild to moderate simple congenital ptosis(CP)and 30 patients with simple concomitant exotropia(CE). All subjects underwent ocular examinations, including axial length, and cycloplegic refraction. The prevalence of refractive errors, amblyopia, spherical power, astigmatism, spherical equivalent, and axial length were compared between CPE, CP and CE.

RESULTS:Ptosis occurred mostly in both eyes in CPE group about 17 cases(94%), but mostly in one eye in CP group about 13 cases(69%), with a significant difference between the two groups(χ²=15.531, P<0.001). There were significant differences in the prevalence of anisometropia(χ²=8.732, P=0.013)and myopia(χ²=6.047, P=0.049)among the three groups. The prevalence of anisometropia(χ²=8.072, P=0.004)and myopia(χ²=4.555, P=0.033)was higher in CPE than CP, while there was no significant difference in the prevalence of anisometropia(χ²=0.559, P=0.454)and myopia(χ²=0.055, P=0.815)between the CPE and CE. The spherical power(χ²=-31.143, P=0.002), myopic astigmatism(χ²=-23.434, P=0.028)and spherical equivalent(χ²=-30.137, P=0.003)of CPE were a higher refractive error and axial length(χ²=26.289, P=0.012)was longer than those in the CP, but there was no significant difference with the CE. In young group, the spherical power of the CPE was a higher refractive error than that of CE(χ²=-16.831, P=0.016), and the spherical equivalent of the CPE was a higher refractive error than that of CP(χ²=-18.391, P=0.020).

CONCLUSION:Mild to moderate congenital ptosis coexisting concomitant exotropia exacerbates the development of axial myopia, myopic astigmatism, and anisometropia, which is more severe than sample ptosis. Therefore, early ophthalmic evaluation and timely surgical treatment may prevent the visual acuity of damage caused by CPE.

Abstract:AIM: To investigate the clinical effect of posterior capsulotomy in diabetic retinopathy with silicone oil removal combined with cataract surgery.

METHODS: A retrospective analysis that collected clinical data of 83 cases(83 eyes)diagnosed as diabetic retinopathy and silicone oil filled eyes with cataract and treated in our hospitalfrom January 2019 to February 2020. They were randomly divided into two groups. The experimental group consisted 41 eyes received silicone oil removal and posterior capsulotomy combined with cataract surgery; The rest 42 eyes were in control group, who received silicone oil removal combined with cataract surgery. At 6mo after surgery, the best corrected visual acuity, posterior capsular opacification, and floaters were evaluated between the two groups to confirm the advantages of posterior capsulotomy in combined cataract surgery with silicone oil removal for diabetic retinopathy.

RESULTS: At 6mo after surgery, the best corrected visual acuity in experimental group was better than control group(P<0.05); There were significant differences between the two groups in the posterior capsular opacification, and floaters,experimental group is lower than control group(P<0.05). There was no significant difference in intraocular pressure compared to preoperative between the two groups, and no significant difference in retinal detachment, vitreous hemorrhage and intraocular lens deviationafter operation(P>0.05).

CONCLUSION: Posterior capsulotomy is safe and reliable in the application of silicone oil removal combined with cataract surgery for diabetic retinopathy, and can effectively avoid the occurrence of posterior capsular opacification.

Abstract:AIM:To explore the correlation between maternal iron deficiency anemia and retinopathy of prematurity(ROP)in premature infants or low birth weight infants so that to provide possible scientific basis for the prevention and control of ROP.

METHODS: This study was a case-control study. The clinical data of 317 premature or low birth weight infants who were diagnosed with ROP and their mothers in our hospital during January 2019 to July 2021 due to ROP screening for the first time(about 30d after birth)were analyzed. The relationship between maternal iron deficiency anemia and ROP and its stages were observed. And the relationship between Hb, blood value characteristics, mean gestational age, gestational weeks, infant birth weight of maternal iron deficiency anemia and ROP stage.

RESULTS: There were 235 mothers(74.1%)with iron deficiency anemia, 82 mothers(25.9%)without iron deficiency. Among them, there were 194 mothers(82.6%)with mild anemia according to anemia classification, 119 cases with stage Ⅰ ROP and 75 cases with stage Ⅱ ROP. There were 39 mothers(16.6%)with moderate anemia, 8 cases with stage Ⅱ ROP, 22 cases with stage Ⅲ ROP and 9 cases with stage Ⅳ ROP. There were 2 mothers(0.9%)of severe anemia, all of whom had stage Ⅳ ROP. No children with stage Ⅴ or threshold ROP and mothers with very severe anemia were found in this study. Compared with mothers with iron deficiency anemia, premature infants or low birth weight infants with normal iron levels were more likely to have stage Ⅰ ROP, but stage Ⅱ ROP was more pronounced in mothers with iron deficiency anemia, and the differences were statistically significant(all P<0.05). Stage Ⅲ and stage Ⅳ ROP was not observed in the mothers with normal serum iron, but was 9.4% and 4.7% in the mothers with iron deficiency anemia, respectively. The differences were statistically significant(P<0.05). Stage Ⅴ and threshold lesions ROP was not observed in preterm or low birth weight infants in mothers with normal serum iron values or iron deficiency anemia. Compared with mothers with normal iron levels, mothers with iron deficiency anemia had significantly lower hemoglobin, hematocrit, mean erythrocyte volume, serum iron and ferritin levels. At the same time, the higher mean gestational age, mean shorter gestational week and mean lower birth weight in the mothers with iron deficiency anemia, and the differences were statistically significant(all P<0.05).

CONCLUSION:Pregnant iron-deficiency anemia is associated with the occurrence and development of ROP in premature or low birth weight infants. The more severe maternal anemia, the higher maybe stage of ROP. Therefore, monitoring and supplementation of iron during pregnancy can effectively prevent and reduce the risk of ROP.

Abstract:AIM:To explore the relationship between the parameters of macular integrity assessment(MAIA), best corrected visual acuity(BCVA)and macular morphology in patients with diabetic macular edema.

METHODS: From March 2018 to January 2020, a total of 43 patients(74 eyes)with diabetic macular edema were randomly selected for treatment in the department of ophthalmology in our hospital.To compare the relationship between MAIA micro field meter parameters and the integrity of macular external membrane, junction of inner and outer photoreceptors(IS/OS)layer and hard exudation. Pearson correlation test was used to analyze the relationship between retinal thickness and retinal sensitivity. Pearson correlation test was used to analyze the correlation between retinal thickness, retinal sensitivity and BCVA in the intact and defect groups of IS/OS layer.

RESULTS: Compared with the IS/OS layer defect group, the levels of BCVA(LogMAR), central retinal thickness(CRT), elliptical area of binary contour 63(BCEA63), elliptical area of binary contour 95(BCEA95)and macular integrity index(MI)in the IS/OS layer intact group were lower, and the levels of average threshold(AT)and P2 were higher(all P<0.01), but there was no significant difference in the levels of central retinal volume(CRV)and P1 between the two groups(all P>0.05). Compared with the external membrane defect group, the levels of BCVA(LogMAR), CRT and MI in the external membrane intact group were lower(all P<0.05), but there was no significant difference in the levels of CRV, AT, P1, P2, BCEA63 and BCEA95 between the two groups(all P>0.05). Compare the group with and without hard exudation, there was no significant difference in eye parameters between the two groups(P>0.05).There was a significant negative correlation between retinal thickness and sensitivity in temporal, central and nasal sides of fovea(P<0.05), but no significant correlation in the upper and lower parts of fovea(P>0.05). In the complete group of IS/OS layer, AT was significantly negatively correlated with CRT and BCVA, while CRT was significantly positively correlated with BCVA(all P<0.05). In the IS/OS layer defect group, there was a significant negative correlation between AT and BCVA(P<0.05).

CONCLUSION:MAIA in the diabetic macular edema is closely related to the morphology and structure of macular area, especially the integrity of IS/OS layer and outer membrane. MAIA may be an important index to evaluate the visual function of patients with diabetic macular edema.

Abstract:AIM: To explore the multimodal imaging features of butterfly-like retinal pigment epithelial dystrophy(BPD)patients.

METHODS: Retrospective analysis of the multimodal imaging of 18 BPD patients(36 eyes)from January 2016 to July 2019, including fundus color photography, infrared photography, autofluorescence, fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography(OCT), and optical coherence tomography angiography(OCTA).

RESULTS: A typical fundus color photography showed the appearance of a butterfly-like lesion caused by abnormal pigmentation. The appearance of the butterfly was not obvious after the lesion progressed, and the corresponding region shrinks; Infrared photography showed the yellow lesions clearly in the BPD patients, which are white highlight images; Autofluorescence showed patchy, spotted butterfly wing performance. When the lesion progressed, autofluorescence did not show typical butterfly changes, but it showed the damage of pigment epithelial cells; Fundus fluorescein angiography and choroidal angiography, in addition to showed butterfly lesions, can more accurately display vascular lesions, especially choroidal neovascularization(CNV); OCT showed lesions located between the retinal pigment epithelial(RPE)layer and the photoreceptors. As the lesion progressed, the pigment epithelium showed enlarged lesions correspondingly. Secondary CNV patients can be seen to break RPE; OCTA showed that the lesions were not obvious at the deep and superficial layers of the retina. But the choroidal blood flow signals were lost in some degrees in OCTA, and the blood flow images of CNV can be detected sensitively.

CONCLUTION: Multimode imaging technology can provide imaging features of progression in BPD patients, which helps clinicians to understand the disease more deeply.

Abstract:AIM: To analyze the epidemiological characteristics of patients hospitalized for ocular trauma during the novel coronavirus(COVID-19)epidemic.

METHODS: A retrospective case analysis. Totally 876 cases(905 eyes)of ocular trauma were analyzed in this study, including 545 cases(565 eyes)from January to June 2019 were enrolled ascontrol group, and 331 cases(340 eyes)from January to June 2020 were enrolled in the research group. Information regarding age, sex, location of injury, cause of injury, place of residence, and type of injury were collected and analyzed.

RESULTS: The number of hospitalisation for ocular trauma in the research group decreased by 39.3% compared with the control group. The age distribution of patients showed a double peak, at 0-10 years(20.55%, 21.45%)and 41-50 years(17.98%, 19.03%)in the control group and research group, respectively. There was no statistically significant difference in the age distribution between the two groups(P=0.907). Men were predominantly injured in both the control and the research groups, accounting for 80.37% and 83.69%, respectively(P=0.219). The proportion of home injuries in the research group(28.40%)was higher than the control group(11.38%)(P<0.001). The proportion of mechanical eye injuries in the research group(98.19%)was higher than the control group(95.60%)(P=0.041), and the proportion of open globe injuries(85.54%)was also higher than the control group(76.58%)(P=0.001). The proportion of patients with no light perception in the research group(18.86%)was higher than that of the control group(9.53%)(P<0.001).

CONCLUSION: During the COVID-19 epidemic period, the total number of ocular trauma cases was significantly reduced. Mechanical eye injuries are still the main type for hospitalisation of patients with eye injuries. The awareness of eye injury prevention should be strengthened during the period of epidemic.

Abstract:AIM:To compare the accuracy of Toric intraocular lens(IOL)alignment using the Verion image guided system and conventional manual marker.

METHODS:Prospective randomized controlled study. A total of 56 eyes of 47 age-related cataract patients who underwent phacoemulsification combined with Toric IOL implantation in our hospital from June 2016 to December 2019 were randomly divided into two groups:In the image-guided group, Verion navigation system collected anterior segmental images before surgery, and Toric target was set to 27 eyes in axial direction. In the marker group, Toric target was marked at 0° and 180° levels before surgery, and Toric target was marked in 29 eyes in axial direction according to the labeling ring. At 1h, 1wk, 1 and 3mo postoperatively, the anterior segment of patients with dilated pupil was photographed. Photoshop software was used to analyze the deviation between the actual axial direction and the target axial direction of the two groups, and the patients' naked eye visual acuity(UCDVA), best corrected visual acuity(BCDVA)and residual astigmatism were recorded.

RESULTS: At 1h and 3mo postoperatively, the deviation between the actual axis and the target axis of IOL in the navigation group was less than that in the marker group(1.5°±1.8° vs 3.1°±2.1°; 1.9°±1.6° vs 3.3°±2.4°, all P<0.05). There was no difference in UCDVA(LogMAR)between the navigation group and the marker group(0.04±0.08 vs 0.06±0.07, P=0.338)and there was no difference in residual divergence(-0.39±0.32 vs -0.45±0.31D, P=0.491)between two groups at 3mo after operation.

CONCLUSION:Verion digital marking and manual marking showed high accuracy in marking Toric IOL axial direction. Although the navigation group showed no advantage in UCDVA and residual astigmatism, the IOL misalignment in navigation group was significantly smaller than the marker group, and Toric IOL axial direction was implanted more accurately under Verion digital marking.

Abstract:AIM: To investigate the therapeutic effect of conbercept injection combined with Ahmed valve implantation and phacoemulsification in the treatment of neovascular glaucoma(NVG).

METHODS: Retrospective analysis. Totally 18 patients(18 eyes)with NVG complicated combined with cataract in our hospital from June 2018 to January 2020. All patients received intraocular injection of conbercept at 3-7d before surgery, Ahmed valve implantation and phacoemulsification were performed after meeting the surgical indications. Best corrected visual acuity(BCVA), intraocular pressure(IOP), resolution of iris neovascularization and postoperative complications were followed up after the surgery, and all the cases were followed up 12mo.

RESULTS: Compared with preoperation(51.44±8.18 mmHg), IOP was significant decreased at 1, 7d, 1, 3, 6mo, 1a after surgery(25.94±11.82, 15.39±4.97, 15.94±2.69, 15.33±4.54, 18.89±7.95, 16.27±5.22 mmHg)(P<0.05). Last follow up after surgery, BCVA was improved in 12 eyes(67%), unchanged in 5 eyes(28%)and decreased in one eye. At 1a after operation, the complete success rate was 83%(15 eyes), conditional success rate was 11%(2 eyes), one eye of losing control of IOP was failed.

CONCLUSION: Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification can not only effectively control postoperative IOP, but also improve the visual acuity of the patients as much as possible. It is an effective method for the treatment of NVG with cataract.

Abstract:AIM: To investigate the value of conjunctival impression cytology(CIC)in the diagnosis of allergic conjunctivitis(AC).

METHODS: A case-control study. Forty patients(80 eyes)who were clinically diagnosed with AC in our department from January to February 2021 were included in the study,and 40 normal controls(80 eyes)were enrolled too. All subjects underwent double upper palpebral CIC examinations. Observed the morphology and number of conjunctival eosinophils and carried out Tseng classification in each group. To Compare the differences between the results of the two groups and analyze the effects of gender, age and course of disease on the results of CIC eosinophil examination in AC group.

RESULTS: The positive rate of eosinophils in the upper palpebral CIC examination of AC patients was significantly higher than that of the normal control group(χ²=57.744, P<0.001); The Tseng grade of AC patients was also higher than that of the normal control group(Z=-2.453, P<0.05). Gender, age and course of disease had no significant effect on the results of CIC eosinophils in AC group(all P >0.05).

CONCLUSION: CIC examination is simple, and the result is objective and accurate. It has good application value in the diagnosis of AC.