Abstract:AIM: To evaluate the efficacy of modified folding intraocular lens(IOL)suspension surgery in treatment of traumatic dislocation of lens surgery technique.

METHODS: Prospective randomized controlled study. A total of 15 patients underwent the modified folding IOL suspension surgery. Among them, 9 patients chose Akreos AO IOL, and polypropylene sutures were used to thread the haptics of IOL. After guided to puncture out through the sclera, the ends of sutures were thermal expanded and fixed in the sclera. And 6 patients chose Tecnis ZA9003 IOL and no sutures were used. After guided the haptics to puncture out through the sclera, the ends of haptics were thermal expanded and fixed in the sclera. The best corrected visual acuity(BCVA, LogMAR)of all patients and postoperative complication were observed.

RESULTS: This study included 15 patients, among them, 7 were male and 8 were female, the mean age was 64.00±9.85 years old, the mean course of diseases was 5.80±3.17 wk. There were no significant differences between the demographic and baseline clinical characteristics. After underwent the modified folding IOL suspension surgery, visual acuity of all patients were obviously improved. After 3mo of the surgery, the BCVA(LogMAR)of patients were improved from 1.28±0.56 to 0.52±0.30. More specifically, the BCVA(LogMAR)of patients who chose Akreos AO IOL were improved from 1.39±0.62 to 0.59±0.25, and those who chose Tecnis ZA9003 IOL of the BCVA(LogMAR)were improved from 1.12±0.45 to 0.42±0.35. Furthermore, there was no severe postoperative complication observed in our study. Only one patient suffered IOL dislocation and the IOL optical surface was mild oblique.

CONCLUSION: Modified folding IOL suspension surgery technique resulted in good visual and outcomes with no severe complication, making it an effective option for IOL suspension surgery.

Abstract:Myopia is an extremely common state of refractive error, and the incidence of myopia is increasing year by year and the age of onset is usually earlier. It has grown up to be a major public health problem that endangers people's visual health. Studies have demonstrated that myopia is a multi-factor complex disease which affected by genetic factors, environmental factors and gene-environment interaction. Genetics includes classical genetics and epigenetics. The emergence of epigenetic research has opened a new perspective of basic research on myopia. In recent years, the researchers have proposed that the occurrence of myopia may be related to epigenetics, and more and more experimental studies have also proved this view. The genetic study of myopia has identified several myopia genes and candidate genes for high myopia and myopia by using linkage and genome-wide association methods, which greatly deepened the understanding of the genetic basis of myopia. This article reviews the research on classical genetics and epigenetics of myopia in recent years.

Abstract:AIM: To investigate the effect of modified Zhujing pill on retinal autophagy in mice with form deprivation myopia.

METHODS: Thirty C57BL/6 mice were randomly divided into a negative control group, a myopia model group and a traditional Chinese medicine intervention group, with 10 mice in each group. Except for the negative control group, all mice in the myopia model group and the traditional Chinese medicine intervention group used translucent EP tubes to cover their right eyes to make a form deprivation myopia(FDM)model; The traditional Chinese medicine intervention group gavage Zhujing pill modified suspension 0.546g/(kg·d)(0.15mL/d), the negative control group and the myopia model group were given an equal amount of normal saline(0.15mL/d)for 4wk. At the beginning and the end of the experiment respectively, the right eye diopter of the mouse was measured with a strip retinoscope, measurement of the axial length of the right eye of mouse by A-ultrasound. At the end of the experiment, the right eyes of all mice were taken for detection, and immunofluorescence method was used to locate and detect the activity and migration of the retinal microglia marker(Iba1); Transmission electron microscope observation of autophagosome formation in retinal pigment epithelial cells; Western Blot, real-time fluorescent quantitative PCR(q-PCR)to detect the autophagy marker LC3Ⅱ and p62 protein quantitative and gene expression in retinal tissues.

RESULTS: At the end of the experiment, the refractive power of the right eyes of mice showed that the myopia model group and the traditional Chinese medicine intervention group formed relative myopia, the myopia model group and the traditional Chinese medicine intervention group were significantly lower than those of the negative control group(all P<0.01). At the end of the experiment, the axial length of the myopia model group and the Chinese medicine intervention group were significantly increased compared with the negative control group(P<0.01). Immunofluorescence method for locating and detecting Iba1 showed that the average optical density of Iba1 in the retina of the myopia model group increased the most obviously, followed by the increase in the negative control group, and the decrease in the traditional Chinese medicine intervention group. Compared with the negative control group, the myopia model group increased significantly(P<0.05), and the traditional Chinese medicine intervention group was significantly lower than the myopia model group(P<0.05). It was found that Iba1 migrated to the ganglion cell layer in the myopia model group and the traditional Chinese medicine intervention group. Transmission electron microscopy showed that autophagosomes were observed in the retinal pigment epithelial cells of the myopia model group and the Chinese medicine intervention group. The results of Western Blot and q-PCR showed that the expression of LC3Ⅱ and p62 increased most obviously in the traditional Chinese medicine intervention group, followed by the myopia model group, and the negative control group was the lowest.

CONCLUSION: The results of the study show that modified Zhujing pill may enhance retinal autophagy in mice with FDM by inhibiting the activation of microglia.

Abstract:AIM: To explore whether efferocytosis impacts ocular surface inflammation in high-iron environment by regulating macrophage polarization.

METHODS: A total of 50 healthy C57BL/6 male mice aged 6-8wk were randomly divided into normal control group, iron group, inhibitor group, enhancer group and solvent control group, with 10 mice in each group. The normal control group was injected intraperitoneally with 0.2mL of normal saline, and the other groups were injected intraperitoneally with 50mg/mL iron dextran of 0.2mL, once every 3d. From the 14d, the inhibitor group, the enhancer group and the solvent control group were injected intraperitoneally with the same volume(0.2mL)50mg/kg XMD8-92, 10mg/kg simvastatin and 50% DMSO solvent once a day, respectively. The anterior segment of the eyes was observed under slit lamp microscope on the 7, 14, 28d after intraperitoneal injection, and the ocular surface inflammation index and corneal fluorescein staining score were evaluated. The cornea, conjunctiva and lacrimal gland tissues were taken at 28d for the HE staining and immunofluorescence staining, and RT-PCR were used to detect the expression of macrophage polarization related indexes(CD86, CD206, iNOS, Arg-1); Western blot were used to detect the expression of efferocytosis related signal factors(Gas6, MerTK); ELISA was used to detect the expression of inflammatory factors(IL-1β, TNF-α, MMP-9).

RESULTS: After injection for 28d, compared with the normal control group, the ocular surface inflammatory index and corneal fluorescein staining score were increased in the iron group and the solvent control group. HE staining showed incomplete corneal epithelium, reduced conjunctival goblet cells, unclear lacrimal gland structure and relatively disordered arrangement of cells. In all tissues, the expressions of polarization related indexes of M1 macrophages such as CD86 and iNOS were up-regulated, while those of M2 macrophages such as CD206 and Arg-1 were down-regulated, and the expressions of inflammatory factors such as IL-1β, TNF-α and MMP-9 were up-regulated(all P<0.05). Compared with the iron group and the solvent control group, the ocular surface inflammation index and corneal fluorescein staining score of the inhibitor group were further increased. HE staining showed obvious exfoliation of corneal epithelium, further decrease or even disappearance of conjunctival goblet cells, disorder of lacrimal gland structure and irregular arrangement of cells. In all tissues, the expression of signal factors related to efferocytosis such as Gas6 and MerTK was down-regulated(all P<0.05), the expression of polarization related indexes of M1 macrophages such as CD86 and iNOS and the expression of inflammatory factors such as IL-1β, TNF-α and MMP-9 were further up-regulated(all P<0.05). But the ocular surface inflammation index and corneal fluorescein staining score decreased in the enhancer group. HE staining showed the integrity of corneal epithelial, the increase of conjunctival goblet cells and the improvement of lacrimal gland structure and morphology. In all tissues, the expression of signal factors related to efferocytosis such as Gas6 and MerTK was up-regulated(all P<0.05), and the expression of polarization related indexes of M2 macrophages such as CD206 and Arg-1 was up-regulated, while the expression of inflammatory factors such as IL-1β, TNF-α and MMP-9 was down-regulated(all P<0.05).

CONCLUSION: High-iron environment induces macrophages polarize to M1, which aggravates ocular surface inflammation and tissue damage. Efferocytosis by regulating the polarization of macrophages impact the occurrence of ocular surface inflammation in high-iron environment.

Abstract:AIM: To establish a dry eye mouse model of iron overload by intraperitoneal injection of iron dextran and preliminarily explore its possible mechanism.

METHODS: A total of 40 male C57BL/6 mice(taking the right eye as the experimental eye)were divided into 4 groups by random number table method: There were 10 mice in the control group, each time by intraperitoneal injection of 0.2mL of normal saline; Low-dose group, middle-dose group and high-dose iron group with 10 mice in each group were the model group. Each time, 0.2mL of iron dextran solution with concentrations of 12.5, 25, and 50 mg/mL was injected intraperitoneally. One injection 3d for a total of 28d. We observed the ocular surface inflammation index, corneal fluorescein staining, tear break-up time(BUT)and Schimer I test(SIt)on the 7, 14 and 28d after injection and evaluated the degree of dry eye and ocular surface inflammation. After 28d, the mice were sacrificed for cornea, conjunctiva and lacrimal glands tissue for HE staining, Prussian blue staining and tissue iron detection, to evaluate the inflammatory reaction and iron overload. The expression of inflammatory factors interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α)and matrix metallo proteinase-9(MMP-9)were detected by enzyme-linked immunosorbent assay(ELISA).

RESULTS: Compared with the control group, the mice in the model group showed a series of dry eye symptoms, the inflammation index of ocular surface in mice were increased, the score of corneal fluorescein staining increased, the BUT shortened and the amount of tear secretion decreased(all P<0.05). The cornea, conjunctiva and lacrimal gland tissues of the mice were damaged to varying degrees, the iron deposition on the eye surface of the model group was more serious than that of the control group, and the iron content of the tissue was significantly increased than the control group(all P<0.01). The contents of inflammatory factors(IL-1β, TNF-α, MMP-9)in the cornea, conjunctiva and lacrimal gland tissue of the mice in the model group were significantly higher than those of the control group(all P<0.01). With the increase of injection time and concentration of iron dextran, the degree of dry eye and ocular surface inflammation in mice gradually increased.

CONCLUSION: The mouse iron overload dry eye model was successfully established by intraperitoneal injection of iron dextran, the mechanism may be related to the ocular surface inflammation aggravated by iron overload.

Abstract:AIM: To evaluate the visual quality of patients after modified design aspheric balance curve(ABC)with intraocular lens(IOL)implantation, and to analyze the influencing factors of clinical IOL selection and guide the patient's IOL selection plan.

METHODS: A prospective case-control study was conducted in 67 patients(74 eyes)with simple cataract underwent phacoemulsification and foldable aspheric IOL implantation, and 23 eyes in the observation group were implanted with modified design IOL(HOYA Vivinex XY1 group), the control group was implanted with 51 eyes of traditional design IOL(Tecnis ZCB00 group with 27 eyes, IQ SN60WF group with 24 eyes). The uncorrected visual acuity, the best corrected visual acuity, total ocular spherical aberration(SA)and coma under different pupil diameters(3, 4, 5, 6mm), and different pupil diameters(3, 4, 5mm)were measured 1wk and 1mo after operation, the modulation transfer function(MTF)curve, objective scattering index(OSI), intraocular scattered light value Log(s)and contrast sensitivity were obtained. Statistical analysis was performed on the obtained data.

RESULTS: The uncorrected visual acuity and best corrected visual acuity at 1wk and 1mo after operation in the three groups were significantly improved compared with those before operation, there was no significant difference among groups(P>0.05). The difference of total ocular spherical aberration was statistically significant among the three groups with 5 and 6mm pupil diameter 1wk after operation(P=0.045, 0.037)and there were differences among three groups in pupil diameter of 6mm at 1mo after operation(P=0.042). Comparing the total ocular coma aberration, there were differences among the three groups at 1wk and 1mo after the operation at the pupil diameter of 5 and 6 mm(P<0.05). With the increase of pupil diameter at 1wk and 1mo after operation, the total ocular spherical aberration in the HOYA Vivinex XY1 group was lower than that in the other two groups. The MTF values of the Vivinex XY1 group were higher than those that of the control group at each spatial frequency, there was no significant difference among groups(P>0.05), and there were no statistical differences in objective scattering index, intraocular scattered light value Log(s)and contrast sensitivity among the three groups(P>0.05).

CONCLUSION:The improved design of the modified Vivinex IOL can reduce the total ocular spherical aberration and coma, improve the visual quality, and provide a new method for the selection of aspheric IOL.

Abstract:AIM: To investigate the expression and diagnostic value of long non-coding RNA(LncRNA)hypoxia-inducible factor 1 alpha antisense RNA 1(HIF1A-AS1)in serum of patients with proliferative diabetic retinopathy(PDR).

METHODS: A total of 160 patients with diabetic retinopathy(DR)admitted to our hospital from July 2019 to July 2021 were selected as the research objects. According to the degree of disease, they were divided into PDR group(80 cases)and nonproliferative diabetic retinopathy(NPDR)group(80 cases). At the same time, 100 healthy cases in our hospital were selected as the control group. Detect and compare serum triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), fasting blood glucose(FBG)and the level of glycosylated hemoglobin A1c(HbA1c); The expression level of LncRNA HIF1A-AS1 in serum was detected by real-time fluorescence quantitative PCR(qRT-PCR)method; Logistic regression was used to analyze the risk factors that affected the occurrence of PDR; Receiver operating characteristic curve(ROC)was used to analyze the clinical value of LncRNA HIF1A-AS1 level in the diagnosis of PDR.

RESULTS: The expression level of LncRNA HIF1A-AS1 in the serum of the patients in the PDR group was significantly higher than that in the NPDR group and the control group, and the NPDR group was higher than the control group(P<0.05); The course of disease, HbA1c, TC, TG, LDL-C, FBG levels in the PDR group and the NPDR group were significantly higher than those of the control group, the HDL-C level in the PDR group was significantly lower than that in the control group(P<0.05); The level of LncRNA HIF1A-AS1 was positively correlated with the course of disease, HbA1c, TC, TG, LDL-C and FBG(P<0.05), and negatively correlated with HDL-C(P<0.05); Logistic regression analysis showed that the LncRNA HIF1A-AS1, course of disease, FBG, HbA1c, TC, TG, LDL-C were all risk factors for PDR(P<0.05); ROC results showed that the area under the curve(AUC)of the LncRNA HIF1A-AS1 level predicting PDR was 0.766(95%CI: 0.692～0.829), the corresponding sensitivity was 66.25% and the specificity was 78.75%.

CONCLUSION: The level of LncRNA HIF1A-AS1 in the serum of PDR patients is up-regulated, it is a risk factor for the occurrence of PDR and it can be used as a potential serological indicator for predicting the occurrence of PDR.

Abstract:Myopia is the most common ametropia. High myopia, especially pathological high myopia, is often accompanied by a series of fundus pathological changes, such as Fuchs spot and choroidal neovascularization(CNV), etc, which can lead to serious damage of visual function. In recent years, it has been found that the changes of choroidal thickness and blood flow play a considerable role in the progression of high myopia. The change of choroidal thickness can directly reflect the abnormality of its structure and function. The choroidal thickness in high myopia is significantly thinner than that in normal people, and the thinning degree varies in different regions. At the same time, the choroid is the main source of blood supply to the eyes, and its blood flow directly determines whether the blood supply is sufficient to the eyes. Therefore, observing the changes of choroidal thickness and blood flow in high myopia is of great significance to explore the progress of myopia or observe its pathological changes. This review illustrates the choroidal structure, thickness and choroidal blood flow changes of high myopia. At the same time, it analyzes and discusses the new research progress and main existing problems in recent years, the new challenges and future research directions, hoping to provide help for clinical monitoring of the occurrence and progression in high myopia.

Abstract:Femtosecond laser small incision lenticule extraction(SMILE)is one of the most advanced corneal refractive operations at present. Different from other traditional corneal refractive operations, SMILE achieves minimally invasive and valveless operation. Therefore, the evaluation of postoperative visual quality of SMILE also has its own characteristics, at present, the latest research at home and abroad has confirmed that the naked eye vision can be significantly improved and the refractive status is stable after SMILE. However, there are different understandings of the objective visual quality indexes and their influencing factors, such as higher-order aberration, modulation transfer function cut off(MTF cut off)and objective scatter index(OSI)after SMILE. This paper reviews the postoperative visual quality and its influencing factors after SMILE to provide clinical help.

Abstract:Keratoconus is a corneal ectatic disease characterized by progressive corneal thinning and protrusion. Its pathogenesis remains unclear. In vitro experiments have shown that mechanical stimulation may damage corneal stromal cells by increasing oxidative stress level and inflammatory factor concentration, resulting in a series of changes such as degradation of corneal extracellular matrix. Numerous clinical studies have confirmed that mechanical factors, including eye rubbing and eyeball compression caused by sleeping position, may play an important role in the process of keratoconus occurrence and development. They may affect the cornea by increasing the level of inflammatory factors in tear, causing changes in intraocular pressure, changing the biomechanical properties of the cornea, directly damaging corneal tissue by mechanical friction, and increasing the temperature of corneal epithelium. The main aim of this review was to describe the efforts of mechanical factors on corneal stromal cells, corneal tissue, and the possible role of mechanical factors in the pathogenesis of keratoconus, so as to provide a reference for the prevention and management of keratoconus.

Abstract:With the rapidly improvement of people's living standard and diversification life style, obtaining better visual quality has become a new goal of cataract surgery. Corneal astigmatism directly affects the selection of functional intraocular lens(IOL)in cataract surgery and the recovery of postoperative visual function. The types of corneal astigmatism are no longer limited to a single astigmatism value, but subdivided into anterior corneal astigmatism, posterior corneal astigmatism, total corneal astigmatism and corneal higher order astigmatism. The corresponding examination equipment and technology are also updated. According to the characteristics and application of different equipment, clinicians can select appropriate examination equipments to evaluate the preoperative corneal astigmatism, so as to provide reference for formulating more accurate refractive cataract surgery planning. It is important for the axis and power calculation of Toric IOL and the selection of multifocal IOL. This paper reviews the recent progress of corneal astigmatism examination before cataract surgery.

Abstract:Central retinal vein occlusion(CRVO)is a common retinal vascular disease that severely affects visual acuity. Currently, ranibizumab, aflibercept and dexamethasone implant have been successful in treating macular edema associated with CRVO. However, there were still 1/3 patients with no significant improvement in vision after treatment, 30.7% patients with macular edema subsiding after treatment but recurring, and 28.1% patients with macular edema persisting after treatment. How to determine the prognosis of patients by their different clinical manifestations at the early stage of disease onset can help clinicians to better select treatment options for patients according to their specific disease conditions. Recent studies on the prognosis of CRVO treatment have focused on imaging markers including disorganization of retinal inner layers, retinal hyperreflective foci, subretinal fluid, ischemic index, leakage index, and biomarkers including VEGF, interleukin(IL)-6, IL-8, etc. This article reviews the progress of research on factors related to the prognosis of CRVO, with the aim of treating, managing and monitoring patients with CRVO more precisely and effectively.

Abstract:Pterygium is an ocular surface disease formed by many factors and associate with a series of changes caused by ultraviolet irradiation and radiation, its pathogenesis is still uncertain. Elevated vascular endothelial growth factor(VEGF), inflammatory infiltrates, angiogenesis, oxidative stress, epithelial-mesenchymal cell transition(EMT), and tumor suppressor gene inactivation are currently recognized causes of pterygium. The mechanism of this factor in pterygium deveopment is still not completely understood. This review aimed to investigate the role of these factors in pterygium formation and provide targeted therapy and effective preventive measures for clinical diagnosis and treatment.

Abstract:Thyroid-associated ophthalmopathy(TAO)is an organ-specific autoimmune disease, which will cause a series of symptoms to significantly reduce the health level and life quality of patients. The pathogenesis of TAO has not been fully clarified. At present, there is a lack of unified and mature treatment scheme of it. Indeed, T-helper 17 lymphocyte(Th17)cells, regulatory T(Treg)cells and their imbalance are closely related to the immunological pathogenesis of TAO. It is currently believed that the cytokines secreted by Th17 cells can not only promote the inflammatory response of TAO and the fibrosis of orbital connective tissue, but also inhibit the adipogenic differentiation of TAO orbital connective tissue. In addition, Treg cells mainly exert immunosuppressive effect on TAO and delay the disease progression. At the same time, there is a dynamic balance relationship between Th17 and Treg cells, the imbalance of Th17/Treg cells can trigger the occurrence and development of TAO. This paper mainly expounds the influence mechanism of Th17, Treg cells and their balance on TAO, and analyzes the reasons for the differences between different research results, so as to provide some reference for the study of the pathogenesis and clinical treatment of TAO.

Abstract:Thyroid-associated ophthalmopathy(TAO)is the most common orbital disease in adults, and its incidence is increasing year by year. The clinical manifestations include proptosis, eyelid retraction, ocular motility disturbance and visual impairment, which seriously damage the physical and mental health of patients. Treatment options for TAO mainly include glucocorticoids, radiotherapy and orbital decompression. Among them, the glucocorticoids are the mainstay of treatment for moderate-to-severe and active disease; Orbital decompression is mainly for patients with severe proptosis and increased orbital pressure leading to optic nerve compression injury; And radiotherapy is used for TAO patients who are intolerant of glucocorticoids and who refuse orbital decompression. Radiation therapy can effectively improve the clinical symptoms of patients by exerting a non-specific anti-inflammatory effect, and it is an important means of treating TAO. With the continuous update of computer technology and medical imaging, radiotherapy techniques have developed rapidly. The emergence of three-dimensional conformal radiotherapy technology and intensity-modulated radiotherapy technology has made it possible to locate the lesions accurately. Recently, a large number of clinical results show that radiotherapy for TAO has good curative effects and manageable adverse reactions. This article reviews the mechanism of action, technical characteristic, clinical protocol, radiation dose parameter selection and complications of radiotherapy for TAO, in order to provide clinical reference for peers and formulate personalized TAO treatment plans.

Abstract:Pituitary adenoma, the most common benign tumor in brain, its symptoms mainly include impaired visual function and endocrine hormone disorder. Visual acuity decline and visual field defect are the first symptoms, because of the special position of pituitary and optic chiasma, patients are often first seen in the ophthalmology department. Visual field examination and optical coherence tomography(OCT)can determine the degree of visual field defect and fundus condition. Electrophysiology examination can determine whether the optic nerve is damaged. All of them can be used as evaluation indexes of visual function in patients with pituitary adenoma. As an imaging tool, functional magnetic resonance, a derivative technique, has been used to study the texture of pituitary adenoma and optic nerve integrity in recent years. These comprehensive and detailed examinations can determine the best time for treatment and improve quality of life for patients. This article reviews the application of ophthalmic examination(visual field, OCT and electrophysiology)and functional magnetic resonance in pituitary adenoma.

Abstract:Cataract with high myopia is a kind of complicated cataract with highly blinding disease. Surgery has always been the only treatment, but there is always a difference between actual postoperative refraction and target refraction. The cataract patients with high myopia have increasing demands for postoperative refractive status and visual quality now. The intraocular lens(IOL)calculation formulas have been updating for higher predictive accuracy. A variety of alternative IOL calculation formulas can be applied to clinical practice. However, there is no consensus on the selection of a more suitable formula for cataract patients with high myopia. Based on the principles and clinical application of different formulas, this paper reviews the development of IOL calculation formulas and research progress of IOL calculation formulas for cataract patients with high myopia, in order to provide reference for clinical application.

Abstract:AIM: To compare the distribution characteristics of axial sagittal front power(ASF), true net power(TNP), total corneal refractive power(TCRP)and the difference in back-front corneal radius ratio(B/F ratio)after cataract surgery.

METHODS: A prospective study. A total of 156 patients(156 eyes)with age-related cataract who attend Weifang Eye Hospital for cataract surgery from December 2020 to May 2021 were collected. Pentacam was performed before operation and 3mo after operation to collect ASF, TNP and TCRP on 2, 4 and 6mm diameters rings and areas on the corneal apex and pupil-centered, as well as B/F ratio.

RESULTS: 3mo after operation, there was no statistical difference in ASF on the 2mm diameters ring and area centered on the corneal apex compared with preoperative values(all P>0.05), however, the ASF values on the 4 and 6mm diameters rings and areas were significantly different from those before surgery(all P<0.05); There was no statistical difference in ASF on the 2mm diameters rings and areas centered on the pupil compared with preoperative values(all P>0.05). The postoperative values of TNP and TCRP on the 2, 4 and 6mm diameters rings and areas centered on the corneal apex and centered on the pupil were statistically different before surgery(all P<0.05). Preoperative, TCRP values were different between 2mm and 6mm and between 4mm and 6mm on both corneal apex and pupil-centered rings(all P<0.0167), TCRP values were all different between 2mm and 6mm diameters areas on corneal apex and pupil-centered(all P<0.0167); 3mo after operation, TCRP values were different on corneal apex and pupil-centered rings between 2mm and 6mm and between 4mm and 6mm diameters(all P<0.0167). While TCRP values on the corneal apex and pupil-centered areas were only different between 2mm and 6mm diameters(all P<0.0167). The preoperative B/F ratio of patients was 81.79%±1.87%, and the postoperative B/ F ratio of patients was 80.68%±2.23%(P<0.001).

CONCLUSION: Corneal parameters of different diameters of rings and areas centered on the corneal apex and pupil before and after cataract surgery may change and differ, which should be taken into account when selecting the K value for intraocular lens calculation and individualizing the selection of IOLs based on corneal characteristics.

Abstract:AIM: To study the effects of the specific simulated luminous environment on the visual performance of people with different vision, so as to provide an experimental basis for revising pilots' vision standards.

METHODS: A controlled randomized trial was conducted. Twenty-four volunteers were recruited and divided into four groups(1.0/1.0, 0.8/0.8, 0.6/0.6 and 0.4/0.4, decimal vision)according to right/left eye visual acuity, with six subjects in each group. Each subject was tested for static distant vision, kinetic visual acuity, color vision, depth perception error and visual search time under the simulated luminous environments of sunlight, twilight, and on-cloud, respectively, to compare changes in the impact of distinctive luminous surroundings on the visual performance indicators of human beings with different vision.

RESULTS: There were main effect differences in static distant vision, kinetic visual acuity, color error, depth perception error and visual search time under different light environments(all P<0.01). The binocular static distant visual acuity, abilities of color discrimination, depth perception and visual search in simulated sunlight environment were higher than those in simulated twilight and on-cloud environments. In the 0.4/0.4 vision group, kinetic vision in simulated twilight and on-cloud environments were significantly lower than that in simulated sunlight environment(P<0.01). There were main effect differences in binocular static distant vision, kinetic visual acuity, depth perception error and visual search time among subjects with different vision(all P<0.05). Compared with 1.0/1.0 vision group, those with 0.6/0.6 and 0.4/0.4 vision had significant decrease in kinetic visual acuity, depth perception ability and visual search ability(all P<0.05).

CONCLUSION: Different luminous environments have a great impact on the visual performance of people with low vision, which poses a potential threat to flight safety.

Abstract:AIM: To observe the macular retina vascular density of patients with acute central retinal artery occlusion(CRAO)by optical coherence tomography angiography(OCTA)and to analyze the relationship with retinal circulation time of these patients on fundus fluorescein angiography(FFA).

METHODS: Retrospective case analysis. A total of 43 patients(43 eyes)from January 2019 to March 2021 admitted to Shaanxi Eye Hospital with clinical diagnosis of acute CRAO(course of disease ≤7d)were included. All patients underwent FFA, OCTA, best corrected visual acuity(BCVA)examination and thrombolytic therapy. The patients with enhanced or unchanged retinal blood flow signal in the affected eye showed on OCTA before treatment compared with the contralateral healthy eye were assigned to group A, and the patients with retinal blood flow signal of the affected eye was lower than that in the contralateral healthy eye by OCTA were assigned to group B. Image J software was used for OCTA image processing to evaluate the macular retina vascular density before treatment, and FFA examination was performed to record the affected retinal circulation time before treatment.

RESULTS: The retinal vascular density of patients in the affected eye and the contralateral healthy eye in group A was higher than that in group B(25.08%±4.40% vs 12.24%±3.41%, 25.72%±2.70% vs 17.89%±4.55%, all P<0.001), the filling time(FT)of retinal artery trunk to terminal in group B \〖96(20.50, 193.50)s\〗 was longer than that in group A \〖11(5.00, 19.50)s\〗(P<0.001). The course of disease, the retinal vascular density of contralateral healthy eye and FT were related factors of retinal vascular density of the affected eye(all P<0.05), and the influence strength order was FT, course of disease and the retinal vascular density of contralateral healthy eye, in which the course of disease and FT was negatively correlated with the retinal vascular density.

CONCLUSION: OCTA retinal vascular density was correlated with FFA retinal circulation time in CRAO patients.

Abstract:AIM: To investigate the image features of dynamic changes of tear film break-up after corneal fluorescein staining(FL)combined with tear film lipid layer(TFLL)dynamic changes in patients with dry eye and its value of diagnosis in dry eye.

METHODS: A prospective study. A total of 66 patients(132 eyes)with dry eye admitted to our hospital during September 2019 to December 2020 were divided area break-up group(17 cases, 28 eyes), circle break-up group(20 cases, 27 eyes), line break-up group(25 cases, 28 eyes), spot break-up group(21 cases, 24 eyes)and random break-up group(20 cases, 25 eyes)according to the different fluorescein tear film break-up patterns(BUPs). The image features of tear film break-up dynamic changes and the image features of TFLL dynamic changes were compared in each group, and the differences in the first non-invasive tear film break-up time(NIBUTf), average non-invasive tear film break-up time(NIBUTav), tear meniscus height(TMH)and fluorescein staining scores were compare,

RESULTS:A statistically significant differences were observed in NIBUTf among the groups of patients(P<0.001). Except that there was no difference between spot break-up group and random break-up group(7.56±1.54s vs 8.02±1.86s, P=0.881), other groups had significant differences in pairwise comparisons(P<0.05). There were statistically differences among the groups for NIBUTav(P<0.001). Except that there was no difference between spot break-up group and random break-up group(9.54±2.12s vs 9.73±1.94s, P=0.997), other groups had significant differences in pairwise comparisons(P<0.05). There was statistically difference among the groups for TMH(P<0.001). Except that there was no difference between circle break-up group and line break-up group(0.16±0.03mm vs 0.17±0.03mm, P=0.986), there was no difference between spot break-up group and random break-up group(0.22±0.03mm vs 0.21±0.05mm, P=0.993), other groups had significant differences in pairwise comparisons(P<0.05). There were statistically significant differences among the groups for FL scores and TFLL grading(P<0.001).

CONCLUSION:It is shown that different fluorescein BUPs intuitively reflects the tear film structure of the pathological changes according to evaluation and analysis of images feature of dynamic changes of FL tear film and TFLL combined with the results of static examination of tear film. It is helpful for clinicians to identify subtypes of dry eye, which has potential clinical value for the diagnosis and classification of dry eye.

Abstract:AIM: To evaluate the influence of slight eye movement during laser scanning on femtosecond laser precision of corneal ablation and postoperative refractive status in small incision lenticule extraction(SMILE).

METHODS: Totally 32 patients(62 eyes)who underwent SMILE surgery in our hospital from January 2019 to March 2021 were included and divided into the movement group and the fixation group according to whether the eyeballs were slightly moved during the operation, and select patients with slightly moved monocular eyeballs for binocular pairing. The actual difference of absolute value of corneal absolute cutting error(ACE), astigmatism error(AE), absolute refractive error(ARE)and absolute visual error(AVE)was compared between the movement group and the fixation group and the two eyes of the patients with slight ocular movement in one eye at 1mo after surgery, and the surgical images were quantified to analyze the correlation between the amplitude of ocular movement and AE, and to compare the effects of the area, layer and direction of slight eye movement on ACE.

RESULTS: There were no differences in all observed results between movement group and fixation group(P>0.05). Patients with slight movement of one eye had a difference in binocular AE(0.57±0.31D vs 0.33±0.27D, P<0.05), and the amplitude of movement was positively correlated with AE at 1mo after surgery(r=0.564, P<0.05). There was no statistical differences in ACE at 1mo after surgery in patients with slight ocular movement in different regions(central/peripheral), layers(upper/lower lens)and direction(nasal/temporal)(all P>0.05).

CONCLUSION:The slight eye movement during laser scanning in SMILE has no significant influence on precision of corneal ablation. It mainly causes decentered ablation and the changes of corneal astigmatism, which has little effect on the spherical equivalent and visual acuity.

Abstract:AIM: To compare the postoperative efficacy of corneal wavefront-guided femtosecond laser-assisted excimer in situ keratomileusis(FS-LASIK)in the treatment of myopia patients with different degrees of astigmatism and the changes of corneal higher order aberration.

METHODS: A total of 133 patients(265 eyes)with myopia and astigmatism were enrolled in this retrospective study. All of them underwent corneal wavefront-guided FS-LASIK surgery for the first time in Aier Eye Hospital(Kunming)from April to October 2020. The patients were divided into three groups according to the different astigmatism: Low astigmatism group: astigmatism ≤1.0D, 62 cases(124 eyes), medium astigmatism group: a total of 54 cases(107 eyes)with astigmatism was 1.25-2.0D, high astigmatism group: a total of 17 cases(34 eyes)with astigmatism ≥2.25D. Visual acuity and refraction were recorded before surgery and 3mo after the surgery and the cornea of the patients was measured by Pentacam three-dimensional corneal topography. Record total higher order aberrations(root mean square), spherical aberration, horizontal coma, vertical coma, horizontal clover and oblique clover in the 6mm diameter range of the cornea. The postoperative effects of the three groups of patients were observed and the changes of corneal high order aberration before and after surgery were compared.

RESULTS: The validity index of visual acuity in the three groups of patients was all greater than 1.1 and the residual diopter was all within ±0.30D. The residual diopter in the low astigmatism group was the least than that of the other two groups(P<0.05). At 3mo after surgery, the corneal total higher order aberration, spherical aberration and vertical coma of the three groups were all increased compared with those before surgery(P<0.05). The spherical aberration increase in the high astigmatism group was less than that in the other two groups(P<0.05).

CONCLUSION: Corneal wavefront-guided FS-LASIK surgery is safe and effective in the treatment of myopia with different degrees of astigmatism, and the effect is also accurate for patients with high astigmatism. The degree of of preoperative astigmatism is not responsible for increased corneal higher order aberration after the surgery.

Abstract:AIM: To investigate the visual fatigue of patients with accommodative asthenopia and the difference in scores before and after treatment by using the asthenopia survey scale(ASS), and to evaluate its reliability, validity and responsiveness in this population.

METHODS: A total of 112 patients with accommodative asthenopia were admitted to the department of ophthalmology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine and recruited online were investigated using the ASS questionnaire, and 48 subjects were randomly selected and retested 1wk later. A variety of reliability, validity and responsiveness indicators were used to evaluate the scale.

RESULTS: The overall Cronbach's α coefficients of the scale entries was 0.91; The split-half reliability coefficients was 0.86; Repeated measurement correlation coefficient of the scale total score was 0.74, there was no significant difference before and after(P>0.05); The results of confirmatory factor analysis showed that the absolute fit index of the three-factor structural model was χ²/df<2.0, RMSEA=0.08; The correlation coefficients of each dimension's total score and the scale's total score were 0.92, 0.90 and 0.83 respectively; The standard association validity analysis showed statistically significant differences between groups(P<0.01). Response analysis was statistically significant before and after treatment(P<0.01).

CONCLUSION: The ASS has high reliability, validity and responsiveness in the clinical evaluation of accommodative asthenopia, and it's an effective tool for clinical research and screening of asthenopia in this population.

Abstract:AIM: To explore the application value of deep learning technology in automatic meibomian glands segmentation.

METHODS:Infrared meibomian gland images were collected and 193 of them were picked out for establishing the database. The images were manually labeled by three clinicians. UNet++ network and automatic data expansion strategy were introduced to construct the automatic meibomian glands segmentation model. The feasibility and effectiveness of the proposed segmentation model were analyzed by precision, sensitivity, specificity, accuracy and intersection over union.

RESULTS: Taking manual labeling as the gold standard, the presented method segment the glands effectively and steadily with accuracy, sensitivity and specificity of 94.31%, 82.15% and 96.13% respectively. On the average, only 0.11s was taken for glands segmentation of single image.

CONCLUSIONS: In this paper, deep learning technology is introduced to realize automatic segmentation of meibomian glands, achieving high accuracy, good stability and efficiency. It would be quite useful for calculation of gland morphological parameters, the clinical diagnosis and screening of related diseases, improving the diagnostic efficiency.

Abstract:AIM: To measure the changes of ocular biological parameters before and after phacoemulsification, and compared the choice of intraocular lens(IOL)power calculation formulas based on the new optical biometric instrument IOL Master 700.

METHODS: A prospective study. Clinical data were collected from 52 patients(57 eyes)with cataract at the First Affiliated Hospital of Soochow University from January to June 2021. The axial length(AL), anterior chamber depth(ACD)and corneal curvature(Km)were measured and analyzed before and 3mo after phacoemulsification by IOL Master 700. The target refractive value reserved in the calculation of different IOL formulas and the actual refractive value of the automatic refractor 3mo after phacoemulsification were compared and statistically analyzed.

RESULTS: The average values of AL measured before and after phacoemulsification were 24.20±1.86, 24.09±1.86mm, the postoperative AL shortened by 0.11mm, and the ACD values were 3.08±0.44, 4.55±0.36mm(P<0.001), ACD deepened by 1.49mm after phacoemulsification. The Km values were 44.14±1.86, 44.14±1.82D(P>0.05). The refractive error of the results measured by the Barrett Universal Ⅱ formula was the smallest before operation, followed by Holladay Ⅱ and the SRK/T formula, the Holladay Ⅰ formula had the largest error and the difference was statistically significant(P<0.05).

CONCLUSION: The AL was shortened and the ACD was deepened after phacoemulsification. A correction factor of 0.1mm is suggested to add when calculating the degree. The Barrett Universal Ⅱ formula has the best predictability in the IOL power calculation formulas, follow by Holladay Ⅱ and SRK/T formula.

Abstract:AIM: To assess the astigmatism-correcting efficiency and clinical effects of cataract phacoemulsification combined with bifocal Toric intraocular lens(IOL)implantation.

METHODS: Retrospective analysis. The clinical data of 46 patients(46 eyes)with cataract complicated with regular corneal astigmatism by the treatment of cataract phacoemulsification and bifocal Toric IOL implantation in our hospital from August 2020 to September 2021 were included. The patients were followed up for 3mo after operation, and the changes of uncorrected distant visual acuity(UDVA), uncorrected near visual acuity(UNVA), best corrected distant visual acuity(BCDVA), best corrected near visual acuity(BCNVA)and astigmatism before and 1, 3mo after operation were evaluated. The IOL axial rotation was measured and calculated, and a questionnaire was conducted to investigate the necessity of using glasses at different distances and overall satisfaction.

RESULTS:After operation at 1 and 3mo, there were significant differences in UDVA, BCDVA, UNVA and BCNVA compared with those before operation(all P<0.001), and there was no significant difference in UDVA, BCDVA, UNVA and BCNVA at 1mo after operation and 3mo after operation(all P>0.0167). At 3mo after operation, 46 eyes(100%)of UDVA reached 0.20(LogMAR), 40 eyes(87.0%)of UNVA reached 0.20(LogMAR). Astigmatism vector analysis showed that the mean preoperative corneal astigmatism in this group was 1.88±0.70D, and the centroid value was 0.61D@177°±1.93D, the mean residual astigmatism at 3mo postoperatively was 0.33±0.30D, and the centroid value was 0.03D@34°±0.45D. After operation at 3mo, the axial rotation of IOL was 3°(0°, 5°). Only 5 eyes(11%)required some degree of refractive correction for near or intermediate distances. 83%(38 eyes)were satisfied or very satisfied with the surgical results

CONCLUSION: The implantation of bifocal Toric IOL during cataract surgery could effectively correct corneal regular astigmatism, improve uncorrected distance and near vision, and had high patient satisfaction.

Abstract:AIM: To observe the changes of the morphology and structure of macula, blood flow density of macula and optic disc, as well as retinal nerve fiber layer thickness by optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in patients with rhegmatogenous retinal detachment(RRD)under went sclera buckling(SB).

METHODS: As a cross-sectional case-controlled study, 25 patients(25 eyes)were diagnosed with RRD in the department of ophthalmology, Ganzhou People's Hospital from July 2014 to March 2021. The differences in the vascular density(VD)of superficial vessel cluster(SVC), the VD of deep vessel cluster(DVC)of macula, the SVC-VD of optic disc, retinal nerve fiber layer(RNFL), central macular thickness(CMT), subfoveal choroidal thickness(SFCT)and outer structure of macula between the affected eyes and healthy eyes at the last post-operative follow-up were compared, and the correlation indicators affecting best corrected visual acuity(BCVA, LogMAR)of the affected eyes at the last follow-up were analyzed.

RESULTS: There were no statistically significant in SVC-VD and DVC-VD of macula, SVC-VD of optic disc, RNFL, CMT, SFCT between the affected eyes and healthy eyes at the last post-operative follow-up(all P>0.05); At the last follow-up visit, the comparison of macular outer structure on OCT between the affected eyes and the healthy eyes showed that the light band integrity of the external limiting membrane(ELM), myoid zone(MZ), ellipsoid zone(EZ)and outer segment of photoreceptor(OS)had no statistically significant difference(all P>0.05), while the light band integrity of interdigitation zone(IZ)had significant difference(P=0.014); The difference of BCVA(LogMAR)between the affected eyes and the healthy eyes at the last follow-up was statistically significant(P=0.002). There was significant correlation between BCVA(LogMAR)of affected eyes at the last post-operative follow-up and the presence or absence of macular involvement, the correlated with SVC-VD of optic disc, the integrity of the light bands of ELM, MZ, EZ, OS and IZ on the outer structure of macula, it was positively correlated with the presence or absence of macular involvement(r_s=0.401, P=0.047)and it was negatively correlated with SVC-VD of optic disc, the integrity of the light bands of ELM, MZ, EZ, OS and IZ on the outer structure of macula(all P<0.05).

CONCLUSION: The OCT and OCTA can be used to observe fundus changes after SB surgery for RRD to obtain long-term follow-up information related to vision prognosis, and visual prognosis depends on the recovery of retinal outer structure, and the integrity of IZ structure is more important for visual recovery; The SVC-VD of optic disc is correlated with visual prognosis, and whether it was correlated with intraocular pressure require further observation and verification with postoperative continuous data.

Abstract:AIM: To investigate the correlation between meibomian gland dysfunction(MGD)and serum lipid in patients with type 2 diabetes mellitus(T2DM).

METHODS: A case-control study was performed which recruited 184 patients with T2DM admitted to hospital from July 2020 to October 2021. After completing the ocular surface examination, subjects were divided into MGD group(94 cases)and control group(90 cases)according to whether MGD was combined. The body mass index(BMI), fasting blood glucose(FBG), glycosylated hemoglobin A1c(HbA1c), total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)were examined for the condition of meibomian glands and collected between the two groups of patients. The relationship between MGD and blood lipid levels was compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of MGD.

RESULTS: The HbA1c, TC, TG, LDL-C in MGD group were 8.30%±1.95%, 5.72±1.21, 2.16±1.05, 3.42±1.10mmol/L, all significantly higher than control group(7.26%±1.18%, 4.82±1.19, 1.48±0.71, 2.75±1.00mmol/L, all P<0.001), there were no statistically significant in HDL-C between the two groups(P>0.05). Multivariate Logistic regression analysis revealed that the risk factors for the onset of MGD was significantly associated with higher blood levels of TC(OR: 5.846; 95%CI: 1.867-18.306; P<0.001)and the higher blood levels of TG(OR: 5.822; 95%CI: 2.654-12.774; P=0.002).

CONCLUSION: T2DM patients with MGD are related to a number of dyslipidemias, and the TC hyperlipidemia and TG hyperlipidemia are significantly associated with an increase risk of MGD in patients with T2DM.

Abstract:AIM: To analyze the risk factors related to pterygium in plateau area and establish a prediction model.

METHODS: Using the method of cluster random sampling, the long-term residents living in the plateau with an average altitude of 3 000m were selected to conduct a field survey of pterygium from June 2020 to June 2021. Single factor and multi-factor analysis were used to analyze the risk factors related to pterygium, and the R software was used to establish the prediction model.

RESULTS: The actual number of people investigated in this study was 1 514, and the number of patients with pterygium was 210, the overall prevalence rate was 13.87%. The age >43 years old, plateau area residence history, sunshine time, gender, smoking history, drinking history, hypertension, diabetes and hyperlipidemia are risk factors for pterygium. Among them, the long-term sunshine was the most dangerous factor for pterygium(OR: 6.215, 95%CI: 4.008-9.636, P<0.001), followed by >43 years old(OR: 5.348, 95%CI: 2.06-13.88, P=0.001). The decision curve analysis(DCA)showed that when the Nomo score system was applied, the predicted probability of pterygium was completely consistent with the actual probability of pterygium.

CONCLUSION: The risk factors of pterygium as follows, the age >43 years old, plateau area residence history, sunshine time, gender, smoking history, drinking history, hypertension, diabetes and hyperlipidemia. The Nomo scoring system prediction model can accurately predict pterygium and provide a theoretical basis for the intervention of pterygium in plateau areas.

Abstract:AIM: To investigate the safety and effectiveness of four-valve technique in the improved conjunctivo-dacryocystorhinostomy.

METHODS: Retrospective clinical study. A total of 28 patients(28 eyes)who were treated in our hospital from September 2017 to June 2020 with lacrimal disease were selected as the research subjects. These patients were treated with conjunctivo-dacryocystorhinostomy. Postoperative follow-up was performed for 6-12mo to observe the surgical effect, satisfaction and postoperative complications.

RESULTS: The positive rate of fluorescein sodium dye excretion test after surgery in this group of patients was 96%(27/28), the success rate of surgery was 96%(27/28), the cure rate was 68%(19/28), the improvement rate was 28%(8/28), the ineffective rate was 4%(1/28)and the overall satisfaction of patients was 93%(26/28). The postoperative complications included ocular foreign body sensation(28 eyes), conjunctival hyperemia(11 eyes), nasal cavity and conjunctival sac bleeding(8 eyes)and lacrimal passage tube out(1 eye).

CONCLUSION: The four-valve technique is used to improve the conjunctivo-dacryocystorhinostomy with high success rate, less complications, safety and effectiveness.

Abstract:AIM: To provide guidance for more accurate measurement of axial length(AL)of difficult measuring eyes by comparing the differences in the AL of the patient's difficult measuring eye with three methods of the sitting position, supine position A-scan and Lenstar 900(Lenstar, LS900).

METHODS: Clinical case-control study. We selected 102 cases(102 eyes)including cataract patients with combined silicone oil filled, vitreous hemorrhage or retinal detachment and patients with dislocation of the lens or IOL in Zhengzhou Second Hospital from May 2019 to September 2020. AL were measured using LS900 and A-scan on sitting position and supine position respectively, and the results of the three methods were statistically analyzed.

RESULTS: The detection rates of LS900 and A-scan axial measurement were 83% and 100% respectively. Three methods of A scan in sitting position, supine position and LS900 to measure the overall AL, silicone oil group, lens dislocation group and vitreous hemorrhage group, the differences were statistically significant(P<0.001), The mean values of AL measured by overall A-scan, supine positions of silicone oil group, supine position of lens dislocation group and vitreous hemorrhage group were statistically significant differences with LS900 measurement(all P<0.05), while there was no statistical difference between the results of the overall sitting position and the difficult measuring eye groups' sitting position compared with the LS900 measurement of AL. The three measurements showed good consistency within the 95% consistency range, but the result of A-scan on sitting position was closer to LS900.

CONCLUSION: Changing the conventional decubitus position to the sitting position can improve the accuracy of the measurement results and provide clinicians with more reliable guidance for the treatment of patients with difficult measuring eyes of A-scan axial measurement, especially in diseases with altered ocular structure.

Abstract:AIM: To investigate the choice of surgical approach, therapeutic effect and complications of orbital cavernous hemangioma(OCH)in different positions of orbit.

METHODS: The clinical data of 128 patients of 128 eyes with OCH whose were surgically removed and pathologically diagnosed in the department of ophthalmology of the Second Affiliated Hospital of Air Force Military Medical University from January 2016 to August 2021 were retrospectively analyzed. The position of OCH in the orbit was determined by preoperative imaging examination(CT/MRI), so as to select different surgical approaches and analyze the postoperative curative effect and the incidence of complications.

RESULTS: The location of OCH in the orbit: 82 eyes in the muscle cone and 46 eyes outside the muscle cone. According to the quadrant of the orbit where the tumor was located, there were 24 eyes in the upper-outer quadrant, 38 eyes in the lower-outer quadrant, 28 eyes in the upper-inner quadrant, 12 eyes in the lower-inner quadrant, and 26 eyes the intraconal central space. The selection of surgical approach: 1)OCH in the muscle cone: conjunctival approach surgery in 53 eyes, lateral orbital approach surgery in 22 eyes, lateral combined medial conjunctiva orbital approach surgery in 5 eyes, skin approach surgery in 1 eye, transnasal approach under nasal endoscope surgery in 1 eye; 2)OCH outside the muscle cone: skin approach in 29 eyes, conjunctival approach in 12 eyes and lateral orbital approach in 5 eyes. Postoperative efficacy: except for 1 eye of postoperative tumor residue, the other 127 eyes were completely removed. Postoperative complications: 1)Ocular motility disorder: 16 eyes, including conjunctival approach surgery in 11 eyes, lateral orbital approach surgery in 4 eyes, lateral combined medial conjunctiva orbital approach surgery in 1 eye; 2)Visual acuity decreased in 9 eyes: conjunctival approach surgery in 3 eyes, lateral orbital approach surgery in 6 eyes; 3)Mydriasis occurred in 9 eyes, including 4 eyes via conjunctival approach surgery and 5 eyes via lateral orbital approach surgery; 4)Intraorbital hemorrhage occurred in 3 eyes: all occurred through conjunctival approach surgery; 5)Visual acuity was lost in 2 eyes, including conjunctival approach surgery in 1 eye and lateral orbital opening approach surgery in 1 eye; 6)There were 2 eyes of ptosis, including conjunctival approach surgery in 1 case and skin approach surgery in 1 eye; 7)Tumor residue occurred in 1 eye: multiple intraorbital tumors were treated by lateral orbital approach surgery.

CONCLUSION: The accurate location of OCH combined with imaging examination and the selection of appropriate surgical approaches according to different locations can successfully remove the tumor and reduce the incidence of complications.

Abstract:AIM: To observe the changes of disease spectrum and characteristics of orbital disease distribution in orbital outpatients, introduce the procedures and methods of diagnosis and treatment of orbital diseases in our hospital and define the work focus and social needs in orbital disease.

METHODS: Prospective observational study. A registration form was designed to record the gender, age and diagnosis of orbital outpatients in our treatment group. The orbital diseases were divided into seven categories for statistical analysis. The composition ratio, male to female ratio, age of onset, subtypes of dominant diseases and the top three common diseases were analyzed. This paper introduces the diagnosis and treatment process of the orbital disease specialty clinic of our hospital.

RESULTS: A total of 1 059 patients with orbital diseases were registered from April 1 to December 31, 2021. The most common orbital diseases were thyroid-related ophthalmopathy(TAO)in 325 cases(30.7%), followed by orbital tumors in 282 cases(26.6%), orbital trauma in 213 cases(20.1%), orbital inflammation in 205 cases(19.4%). Orbital vascular malformation, congenital and genetic venereal diseases and other orbital diseases were 34 cases(3.2%). Pathological diagnosis: orbital tumors in 150 cases(72.8%)were benign, the first three benign tumors were hemolymphangioma, orbital cyst and neurogenic tumor. Orbital tumors in 56 cases were malignant(27.2%), the first three malignant tumors were orbital lymphoma, adenoid cystic carcinoma of the lacrimal gland and rhabdomyosarcoma. The most common orbital injury was orbital blowout fracture, followed by optic nerve injury and orbital soft tissue injury. Orbital non-infectious inflammation accounted for 89.8% and 10.2% with infectious inflammation.

CONCLUSION: The spectrum of orbital diseases has changed, and the most common and dominant diseases are TAO, orbital tumor, orbital trauma and orbital inflammation, accounting for 96.8% of the total, which are the main work content in orbital profession. Medical resources of orbital diseases should be rationally allocated according to the changes of disease spectrum to meet the needs of social development.