Volume 6,Issue 2,2013 Table of Contents

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    • 1  Myopia induced by flickering light in guinea pigs:a detailed assessment on susceptibility of different frequencies
    Yue Di ,  Rui Liu ,  Ren-Yuan Chu ,  Xing-Tao Zhou ,  Xiao-Dong Zhou
    2013, 6(2):115-119. DOI: 10.3980/j.issn.2222-3959.2013.02.01
    [Abstract](3339) [HTML](0) [PDF 887.17 K](1058)
    Abstract:
    AIM:To investigate the effectiveness and feasibility of inducing myopia in guinea pigs by flickering light (FL) stimulation with different frequencies. METHODS: Seventy 2-week-old guinea pigs were randomly assigned to six groups:five FL groups and a control group (n=12 for each). Animals in the five FL groups were raised under 500lx illumination with a duty diurnal cycle of 50% at a flash rate of 5, 1, 0.5, 0.25 and 0.1Hz respectively. Those in the control group were reared under steady 250lx illumination. Refraction, axial length, and radius of curvature were measured before and at 2, 4, 6, 8, 10 and 12 weeks after treatment. At week 12, the eyeballs were taken out and three ocular dimensions and dry weight of sclera were measured. RESULTS: A myopic shift and axial eye length increase developed in the five FL groups. Stimulation at 0.5Hz caused greater changes in myopic shift, axial elongation, eyeball dimension, and dry weight of sclera than stimulation at other frequencies. Compared with controls, eyes in 0.5Hz group were approximately -5.5±1.5D more myopic with increase in horizontal, vertical, axial dimensions by 0.89±0.3mm, 0.69±0.2mm, 1.12±0.2mm respectively and with increase in dry weight of sclera by 0.44mg. CONCLUSION: Chronic exposure to periodic illumination at temporal frequency is attended by development of excessive ocular enlargement and myopic refractive error. Emmetropization could be disrupted differently by frequency alteration.
    2  Perineuronal nets increase inhibitory GABAergic currents during the critical period in rats
    Hui Liu ,  Peng-Fen Gao ,  Hai-Wei Xu ,  Ming-Ming Liu ,  Tao Yu ,  Jun-Ping Yao ,  Zheng-Qin Yin
    2013, 6(2):120-125. DOI: 10.3980/j.issn.2222-3959.2013.02.02
    [Abstract](2755) [HTML](0) [PDF 1.03 M](993)
    Abstract:
    AIM: To investigate inhibitory γ-aminobutyric acid (GABA) ergic postsynaptic currents (IPSCs) and postsynaptic currents (PSCs) in layer IV of the rat visual cortex during the critical period and when plasticity was extended through dissolution of the perineuronal nets (PNNs).METHODS:We employed 24 normal Long-Evans rats to study GABAA-PSC characteristics of neurons within layer IV of the visual cortex during development. The animals were divided into six groups of four rats according to ages at recording:PW3 (P21-23d), PW4 (P28-30d), PW5 (P35-37d), PW6 (P42-44d), PW7 (P49-51d), and PW8 (56-58d). An additional 24 chondroitin sulfate proteoglycan (CSPG) degradation rats (also Long-Evans) were generated by making a pattern of injections of chondroitinase ABC (chABC) into the visual cortex 1 week prior to recording at PW3, PW4, PW5, PW6, PW7, and PW8. Immunohistochemistry was used to identify the effect of chABC injection on CSPGs. PSCswere detected with whole-cell patch recordings, and GABAA receptor-mediated IPSCs were pharmacologically isolated.RESULTS:IPSC peak current showed a strong rise in the age-matched control group, peaked at PW5 and were maintained at a roughly constant value thereafter. Although there was a small increase in peak current for the chABC group with age, the peak currents continued to decrease with the delayed highest value at PW6, resulting in significantly different week-by-week comparison with normal development. IPSC decay time continued to increase until PW7 in the control group, while those in the chABC group were maintained at a stable level after an initial increase at PW4. Compared with normal rats, the decay times recorded in the chABC rats were always shorter, which differed significantly at each age. We did not observe any differences in IPSC properties between the age-matched control and penicillinase (P-ase) group.However, the change in IPSCs after chABC treatment was not reflected in the total PSCs or in basic membrane properties in layer IV of the rat visual cortex.CONCLUSION:Our results demonstrate that rather than rapidly increasing during the critical period for neuronal plasticity, IPSCs in layer IV of rat visual cortex are maintained at an immature level when PNNs are removed by chABC. This suggests that GABA receptor maturation involves the conformation of the CSPGs in PNNs.
    3  Microscopic characteristics of the inferior tarsal muscle and its surroundings in Korean
    Jung Min Park ,  Mee Sook Roh ,  Moo Hyun Kim ,  Woo Jin Jeung ,  Won Yeol Ryu ,  Yoon Hyung Kwon ,  Hee Bae Ahn
    2013, 6(2):126-130. DOI: 10.3980/j.issn.2222-3959.2013.02.03
    [Abstract](1952) [HTML](0) [PDF 1.56 M](1011)
    Abstract:
    AIM: To investigate the detailed microscopic anatomic structures of the lower eyelid in Korean cadavers.METHODS: Eight lower eyelids of 4 formalin-fixed Asian cadavers (4 males; age range, 48-69 years; mean age, 60.2 years) were examined. Three perpendicular dissected sections with a 2mm thickness were obtained from each eyelid to investigate anatomic shapes, size and relationship with surrounding structures. One section was obtained from the midline and 2 the other sections were obtained from a 3mm apart from the lateral and medial tarsus margins.RESULTS:The inferior tarsal muscle fibers were not directly attached to the tarsus but were only linked to the tarsus with enclosed fibrous fascia. The inferior tarsal muscles connected loosely with the capsulopalpebral fascia anteriorly and the conjunctiva posteriorly. The inferior tarsal muscle runs horizontally to the tarsus according to the shape of muscle fibers. The capsulopalpebral fascia consisted of an anterior and posterior layer. The anterior layer reached the orbital septum and subcutaneous fat but the posterior layer forwarded into the tarsus. Lockwood''s ligament was separated from the inferior tarsal muscle and capsulopalpebral fascia or fused into the capsulopalpebral fascia.CONCLUSION: This study suggests that the inferior tarsal muscle which runs horizontally and doesn’t insert directly into the tarsus, plays an important role in the movement and localization of the lower eyelid.
    4  Heparanase-1 activities in the development of laser induced choroidal neovascularization
    Wei-Qiang Tang ,  Bao-Ke Hou
    2013, 6(2):131-135. DOI: 10.3980/j.issn.2222-3959.2013.02.04
    [Abstract](1708) [HTML](0) [PDF 2.98 M](857)
    Abstract:
    AIM:To investigate the role of heparanase-1 in laser-induced choroidal neovascularization (CNV).METHODS:Experimental CNV was induced by krypton laser photocoagulation in 15 male Brown Norway rats. Fundus fluorescein angiography and histopathological examination were performed in observing the CNV development. The expression and distribution of heparanase-1 protein in the laser lesions were determined by immunohistochemistry and western blotting analysis.RESULTS:The success rate of laser induced CNV was approximately 75% on 3-4 weeks after laser photocoagulation. The protein levels of heparanase-1 increased significantly in the retina-choroidal complex of CNV models when compared to normal rat eyes (P<0.01). Immunostaining confirmed strong heparanase-1 expressions in all laser lesions, and it displayed to be highest at the newly formed blood vessels within the fibrovascular complex in the subretinal space.CONCLUSION:Heparanase-1 is closely involved in the development of laser induced CNV.
    5  Comparison of subconjunctivally injected bevacizumab, ranibizumab, and pegaptanib for inhibition of corneal neovascularization in a rat model
    Ebru Eren Akar ,  Veysi Öner ,  Cem Küçükerdönmez ,  Yonca Aydın Akova
    2013, 6(2):136-140. DOI: 10.3980/j.issn.2222-3959.2013.02.05
    [Abstract](2526) [HTML](0) [PDF 2.18 M](894)
    Abstract:
    AIM:To compare the efficacies of subconjunctival bevacizumab, ranibizumab, and pegaptanib sodium injections for the inhibition of corneal neovascularization in an experimental rat model.METHODS:Sixteen corneas of 16 rats were chemically cauterized and randomized into four groups:bevacizumab group that treated with 0.05mL/1.25mg bevacizumab, ranibizumab group that treated with 0.05mL/0.5mg ranibizumab, pegaptanib group that treated with 0.05mL/0.15mg pegaptanib sodium, and control group that treated with 0.05mL saline solution. Digital photographs of the corneas were taken and analyzed using an image analysis software program. All corneas were excised and examined histologically on the 15th day.RESULTS: Each treatment group had significantly less neovascularized corneal areas and fewer blood vessels than the control group (all P<0.05). In addition, bevacizumab group had significantly less neovascularized corneal areas and fewer blood vessels than ranibizumab and pegaptanib groups (both P<0.05). However, there was no significant difference between the ranibizumab and pegaptanib groups regarding percentage of neovascularized corneal areas and number of blood vessels (both P>0.05). CONCLUSION:Subconjunctival bevacizumab, ranibizumab, and pegaptanib sodium were effective with no corneal epitheliopathy for inhibiting corneal neovascularization after corneal burn in rats. Bevacizumab was more effective than ranibizumab and pegaptanib sodium.
    6  Effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes mellitus
    Cai-Hong Zhu ,  Shi-Sheng Zhang ,  Yan Kong ,  Yu-Fang Bi ,  Ling Wang ,  Qiong Zhang
    2013, 6(2):141-145. DOI: 10.3980/j.issn.2222-3959.2013.02.06
    [Abstract](2303) [HTML](0) [PDF 1.11 M](999)
    Abstract:
    AIM:To evaluate the effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes by comparing the therapeutic effects of intensive and standard treatment in patients with type II diabetes.METHODS: A total of 107 patients with type II diabetes were randomly assigned into intensive and standard treatment groups. Patients in the intensive treatment group received preterax (perindopril/ indapamide) to control blood pressure, and gliclazide (diamicron) MR to control blood glucose. Patients in the standard treatment group received routine medications or placebo. Urinary microalbumin (UMA), urinary creatinine (UCR), the UMA/UCR ratio, and visual acuity were monitored according to the study design of the ADVANCE trial. Direct ophthalmoscopy and seven-field stereoscopic retinal photography were used to examine the fundi at baseline, and repeated after 5 years of treatment.RESULTS: The characteristics of patients in both groups were well balanced at baseline. After 5 years of treatment, visual acuity was found to be decreased in the standard group (P=0.04), but remained stable in the intensive group. The severity of diabetic retinopathy had not progressed in patients in the intensive group, but had deteriorated in the standard group (P=0.0006). The UMA/UCR ratio was not obviously changed in patients in the intensive group, whereas it was significantly increased in the standard group (P=0.00).CONCLUSION: Intensive control of blood glucose and blood pressure can decrease the incidence or slow the progression of microvascular complications in patients with type II diabetes, and maintain stable vision.
    7  CT features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy
    Zhi-Jia Fang ,  Jenny Y. Zhang ,  Wei-Min He
    2013, 6(2):146-149. DOI: 10.3980/j.issn.2222-3959.2013.02.07
    [Abstract](2499) [HTML](0) [PDF 847.92 K](1067)
    Abstract:
    AIM:To investigate computed tomography (CT) features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy (TAO).METHODS:A total of605 eyes of 325 patients with exophthalmos due to TAO were classified as grade I (mild exophthalmos) or II (severe exophthalmos) based on orbital CT imaging. The increased orbital volume features, such as changes from extraocular muscles, orbital fat, or both, were analyzed.RESULTS: A total of 605 eyes were analyzed, among them 62.98% presented grade I exophthalmos, while 36.02% showed grade II exophthalmos.#$TAB In grade I, 56.69% showed orbital fat change, and in grade II, 89.29% exhibited extraocular muscle enlargement.CONCLUSION: Orbital fat and extraocular muscle enlargement are likely to be observed on CTs of subjects with mild and severe exophthalmos, respectively. Our results suggest that CT findings may guide TAO clinical therapy recommendations and prognosis.
    8  Optical biometry intraocular lens power calculation using different formulas in patients with different axial lengths
    Jia-Kang Wang ,  Shu-Wen Chang
    2013, 6(2):150-154. DOI: 10.3980/j.issn.2222-3959.2013.02.08
    [Abstract](3701) [HTML](0) [PDF 285.14 K](1358)
    Abstract:
    AIM:To investigate the predictability of intraocular lens (IOL) power calculation using the IOLMaster and different IOL power calculation formulas in eyes with various axial length (AL).METHODS:Patients were included who underwent uneventful phacoemulsification with IOL implantation in the Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan, Chinafrom February 2007 to January 2009. Preoperative AL and keratometric values (Ks) were measured by IOLMaster optical biometry. Patients were divided into 3 groups based on AL less than 22mm (Group 1), 22–26mm (Group 2), and more than 26mm (Group 3). The power of the implanted IOL was used to calculate the predicted postoperative spherical equivalence (SE) by various formulas:the Haigis, Hoffer Q, Holladay 1, and SRK/T. The predictive accuracy of each formula was analyzed by comparing the difference between the actual and predicted postoperative SE (MedAE, median absolute error). All the patients had follow-up periods exceeding 3 months.RESULTS:Totally, there were 200 eyes (33 eyes in Group 1, 92 eyes in Group 2, 75 eyes in Group 3). In all patients, the Haigis had the significantly lower MedAE generated by the other formulas (P<0.05). In Group 1 to 3, the MedAE calculated by the Haigis was either significantly lower or comparable to those calculated by the other formulas.CONCLUSION:Compared with other formulas using IOLMaster biometric data, the Haigis formula yields superior refractive results in eyes with various AL.
    9  Long-term cost and efficacy analysis of latanoprost versus timolol in glaucoma patients in Germany
    Ulrich Thelen ,  Dietmar Schnober ,  Sonja Schölzel ,  Michael S. Kristoffersen ,  Lindsay A. Nelson ,  Jeanette A. Stewart ,  William C. Stewart
    2013, 6(2):155-159. DOI: 10.3980/j.issn.2222-3959.2013.02.09
    [Abstract](2220) [HTML](0) [PDF 230.26 K](883)
    Abstract:
    AIM: To evaluate 5-year effectiveness and cost between latanoprost or timolol monotherapy in a pilot trial. METHODS: A retrospective, multi-center trial performed at 6 sites in Germany of patients who had a diagnosis of primary open-angle or pigmentary glaucoma, in at least one eye, initiated on monotherapy with latanoprost or timolol maleate. Qualified consecutive charts were reviewed in which 5-year efficacy, safety and cost data was abstracted. RESULTS: Seventy-seoen latanoprost and 49 timolol patients were included, at the final visit no difference existed between the two groups in disc parameters including:rim area, rim area/disc area ratio, cup volume or vertical cup/disc ratio (P>0.05). There was no difference in intraocular pressure (IOP) between the initial latanoprost (17.4±2.6) and timolol (16.3±2.8mmHg) groups. There was less change in medicines over the follow-up period (0.1 vs 0.8) and fewer medications at the final visit (1.2 vs 1.8) with latanoprost compared to timolol. No patient treated with latanoprost discontinued therapy during follow-up, while 12% discontinued timolol mostly due to inadequate IOP control. Cost/year was less with initial timolol ($458±236) as compared to latanoprost ($552±202).CONCLUSION:Patients begun on latanoprost or timolol and followed over 5 years may have similar clinical outcomes. However, timolol patients may require more medicines and medicine changes to control IOP for long-term, but at a lower cost.
    10  Pediatric traumatic cataract and surgery outcomes in eastern China:a hospital-based study
    Ying-Nan Xu ,  Yu-Sen Huang ,  Li-Xin Xie
    2013, 6(2):160-164. DOI: 10.3980/j.issn.2222-3959.2013.02.10
    [Abstract](3448) [HTML](0) [PDF 1.42 M](1059)
    Abstract:
    AIM: To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China.METHODS:Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis.RESULTS:A total of 117 eyes of 117 patients (96 boys and 21 girls) with unilateral injuries (66 right and 51 left eyes) were included in the study. The mean (SEM) age at diagnosis was (6.6±3.2) years (range, 1.3-13.8 years). Each cataract was categorized according to the type of trauma:closed-globe (n=26) or open-globe (n=91) injuries. The most common injuring objects were sharp metal objects (37.61%). The most common complication in open-globe injuries was corneal laceration, whereas traumatic mydriasis was most common in closed-globe injuries. Of 68 eyes in patients with open-globe injuries who received cataract extraction, intraocular lens (IOLs) were primarily implanted in 47 eyes (68.12%), whereas 18 eyes with closed-globe injuries received cataract extraction, and IOLs were primarily implanted in 17 eyes (94.4%). The surgical procedures included reconstruction of the anterior segment, synechiolysis, excision of the membrane, lensectomy, vitrectomy and related techniques. Postoperative vision was significantly improved compared with preoperative vision.CONCLUSION: Pediatric traumatic cataract should be treated in time to attenuate the complications, and education on pediatric traumatic cataract and improvements in pediatric health care are needed for the early detection of cataract in children.
    11  Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole
    Jiao Tian ,  Luo-Sheng Tang ,  Xiao-Jian Guo ,  Yong-Heng Luo
    2013, 6(2):165-168. DOI: 10.3980/j.issn.2222-3959.2013.02.11
    [Abstract](2564) [HTML](0) [PDF 636.41 K](1005)
    Abstract:
    AIM:To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole.METHODS: Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post-EMB. The duration of follow-up time after removal of silicone oil was more than 3 months.RESULTS: Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08.CONCLUSION: Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome.
    12  Bevacizumab vs ranibizumab for neovascular age-related macular degeneration in Chinese patients
    Jun Li ,  Han Zhang ,  Peng Sun ,  Feng Gu ,  Zhe-Li Liu
    2013, 6(2):169-173. DOI: 10.3980/j.issn.2222-3959.2013.02.12
    [Abstract](2149) [HTML](0) [PDF 558.06 K](950)
    Abstract:
    AIM:To compare the clinical efficacy of intravitreal injections of bevacizumab and ranibizumab for treating Chinese patients with neovascular age-related macular degeneration (AMD).METHODS: Among 60 Chinese patients with exudative AMD (60 eyes), 28 received intravitreal bevacizumab injections (1.25mg) and 32 received intravitreal ranibizumab injections (0.5mg), once a month for 3 months and were followed for a total of 6 months. Monthly optical coherence tomography (OCT) was used to determine whether the patients received additional treatments during the follow-up. We compared the baseline and 6-month follow-up values of mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in both groups of patients. We also compared the occurrence of adverse events.RESULTS:At the 6-month follow-up, the mean BCVA (logMAR) of the bevacizumab and ranibizumab treatment groups improved from the baseline measurements of 0.72±0.23 and 0.73±0.22 to 0.47±0.14 and 0.45±0.20, respectively (P<0.05 for both groups). However, the change was not significantly different between the two groups. As evaluated by OCT, CRT decreased from 366.71±34.72μm and 352±36.9μm at baseline to 250.86±41.51μm and 243.22±41.38μm in the bevacizumab and ranibizumab groups, respectively (P<0.05 for both groups). However, the change was not significantly different between the two groups. There were no severe local adverse reactions or systemic adverse events.CONCLUSION:Intravitreal bevacizumab and ranibizumab have equivalent effects on BCVA and CRT and appeare safe over the short-term.
    13  Endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation to manage primary angle-closure glaucoma
    Jing Chen ,  Yu-Ping Zou
    2013, 6(2):174-177. DOI: 10.3980/j.issn.2222-3959.2013.02.13
    [Abstract](1919) [HTML](0) [PDF 862.65 K](936)
    Abstract:
    AIM:To describe and evaluate a new ophthalmic endoscope surgical technique combined with phacoemulsification andintraocular lens (IOL) implantation to treat goniosynechialysis and manage primary angle-closure glaucoma (PACG).METHODS:Endoscope-assisted goniosynechialysis combined with phacoemulsification andIOL implantation was performed in 32 eyes of 29 patients with PACG. Regular follow-up was performed 1 week and 1 month, 3, and 6 months after surgery to assess complications, intraocular pressure (IOP), anterior chamber depth, visual acuity, and anterior chamber angle.RESULTS:Preoperative mean IOP was 24.88±7.22mmHg with pharmacological treatment, and was 13.70±4.02, 13.06±3.74, 14.29±4.70, and 14.33±5.01mmHg 1 week, 1 month, 3 months, and 6 months after surgery, respectively. The postoperative decrease in IOP was significant (P<0.05). The rate for all eyes with IOP of 21mmHg or less was 93.8% (30 eyes) at the final visit without ocular hypotensive agents. The average preoperative anterior chamber depth was 1.60±0.64mm, and this value significantly increased to 2.72±0.62, 2.76±0.70, 2.73±0.68, and 2.74±0.71mm at 1 week, 1 month, 3 months, and 6 months, respectively. Visual acuity was improved in 28 eyes (87.5%) at 6 months postoperatively. The anterior chamber angle had increased in 25 eyes (78.1%) at the final visit; it was adhesive 90°-180° in 6 eyes, 180°-270° in only 1 eye. Two eyes exhibited minimal hyphema in the early postoperative period, but it could gradually be absorbed. Fibrinous reaction was observed in five eyes and spontaneously disappeared within 7 days. No shallow anterior chamber, iridodialysis, choroidal detachment, or malignant glaucoma was found in any eyes.CONCLUSION:Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation to manage PACG has several advantages, including optimized visualization, greater accuracy, and improved safety. Our results suggest that it has certain curative effects and clinical application value.
    14  Aberration changes of the corneal anterior surface following discontinued use of rigid gas permeable contact lenses
    Qing Yu ,  Jiang-Xiu Wu ,  He-Ning Zhang ,  Sheng Ye ,  Shi-Qi Dong ,  Chen-Hao Zhang
    2013, 6(2):178-182. DOI: 10.3980/j.issn.2222-3959.2013.02.14
    [Abstract](1858) [HTML](0) [PDF 569.72 K](895)
    Abstract:
    AIM: To record aberrations with a corneal topographic device on the anterior surface of the cornea at different time-points prior to wearing and following discontinued use of rigid gas permeable (RGP) contact lenses. The effect of wearing RGP on the anterior surface of the cornea was discussed to provide guidance for clinical refractive error correction.METHODS: The study objects were 24 eyes from 24 patients. All patients underwent identical examination procedures prior to lens use, as well as afterwards, including slit-lamp examination, non-contact tonometer measurement, computer optometry and corneal curvature measurement, subjective refraction test, and corneal topography analysis. The patients wore contact lenses everyday for 1 month and then discontinued. Corneal topographies were recorded at certain time points of 30 minutes, 1 day, 3, 7 and 14 days following use.RESULTS: Total corneal aberration at each time point following discontinued use of RGP contact lenses was less than the time point prior to use. Detailed results were as follows:root mean square (RMS) (pre)=(1.438±0.328)μm, RMS (30 minutes)=(1.076±0.355)μm, RMS (1 day)=(1.362±0.402)μm, RMS (3 days)=(1.373±0.398)μm, RMS (7 days)=(1.387±0.415)μm, and RMS (14 days)=(1.430±0.423)μm. Results showed that at 30 minutes after discontinued use of RGP contact lenses, almost all 2nd- and 3rd-order aberrations change. Quadrafoil Z10 and spherical Z12 of the 4th-order were also changed. Alterations to Z5, Z6, and Z12 at 1 day after discontinued use were significant differences compared with the time period prior to RGP use:Z5 and Z6 decreased, and Z12 increased slightly. Z5 and Z6 remained decreased at 3 days after discontinued use, but Z9 and Z10 continued to increase and Z12 returned to levels prior to RGP use. At 14 days after discontinued use, all aberrations were not significantly different from the values prior to use.CONCLUSION: The use RGP contact lenses greatly reduced total aberration of the anterior surface of the cornea. Changes to 2nd- and 3rd-order aberrations (including Z3, Z4, Z5, Z6, Z7, and Z8) were more significant. Following discontinued use of RGP contact lenses, the majority of lower order aberrations returned to original levels in a short period of time. During this process, a transient higher order aberration appeared, but all changes disappeared within 14 days after discontinued use of RGP contact lenses.
    15  Black diaphragm intraocular lens implantation and penetrating keratoplasty in aphakic eyes with traumatic aniridia
    Jun Li ,  Xiao-Guang Dong
    2013, 6(2):183-186. DOI: 10.3980/j.issn.2222-3959.2013.02.15
    [Abstract](2004) [HTML](0) [PDF 1.08 M](1010)
    Abstract:
    AIM: To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage.METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored.RESULTS: The patients were followed up for an average of 24.3±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting >1 000/mm2, although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells.CONCLUSION: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long-term safety and efficacy are required. A larger study population and longer follow-up may be beneficial.
    16  Cyclopexy versus vitrectomy combined with intraocular tamponade for treatment of cyclodialysis
    Wei-Wei Xu ,  Yi-Fei Huang ,  Li-Qiang Wang ,  Mao-Nian Zhang
    2013, 6(2):187-192. DOI: 10.3980/j.issn.2222-3959.2013.02.16
    [Abstract](2200) [HTML](0) [PDF 684.82 K](974)
    Abstract:
    AIM: To compare the effects and complications of direct cyclopexy (DC) versus vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade (VEE) treatment in patients with cyclodialysis and persistent hypotony.METHODS: This is a prospective, comparative, nonrandomized clinical trial which includes 52 patients with cyclodialysis and persisting hypotony. Fifty-two patients suffering from cyclodialysis and persistent hypotony in one eye were divided into 2 groups (groups DC and VEE) and treated, respectively, with direct cyclopexy or vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade. The patients were followed up for 12 months. Assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV) and subjective rating of the pain caused by the treatments.RESULTS:After a follow-up of 12 months, significant improvement was seen in postoperative mean BCVA, IOP, ACD and ACV in both treatment groups (which were not significantly different from each other). The success rates for the treatments were not significantly different (DC:50.0% vs VEE:62.5%, P=0.383). Postoperative morbidity of cataract and subjective pain rating were significantly higher in the VEE group vs the DC group (P= 0.003 and P<0.001 respectively).CONCLUSION: DC and VEE were effective surgical procedures in treating patients with cyclodialysis and persistent hypotony. Patients had better tolerance to DC treatment and VEE was more likely lead to cataract complications. Taking into consideration the ease of the operation, success rate, and patient comfort, DC treatment seems preferable to VEE treatment in patients with simple cyclodialysis. While VEE has the advantage of treating patients with cyclodialysis combined with vitreous hemorrhage.
    17  Treatment of intractable orbital implant exposure with a large conjunctival defect by secondary insertion of the implant after preceding dermis fat graft
    Hyun Kyung Kim ,  Tae Yoon La
    2013, 6(2):193-197. DOI: 10.3980/j.issn.2222-3959.2013.02.17
    [Abstract](2541) [HTML](0) [PDF 2.96 M](966)
    Abstract:
    AIM:To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repeated graft necrosis.METHODS:A retrospective chart review of four patients who had extensive orbital implant exposures with large conjunctival defects and had past histories of repeated autologous or preserved dermis graft failures was done. As a first-stage operation, the problematic pre-existing orbital implants were removed and autologous dermis fat grafts alone were performed on the defect area. Four months later, new orbital implants were secondarily inserted after confirmation of graft survival. The size of the conjunctival defects and state of the extraocular muscles were checked preoperatively. Success of the operations and complications were investigated.RESULTS:The mean size of the conjuctival defects was 17.3mm×16.0mm, and the mean time from the initial diagnosis of orbital implant exposure to implant removal and autologous dermis fat graft was 20.8 months. After implant removal and autologous dermis fat graft, no graft necrosis was observed in any patients. Also, implant exposure or fornix shortening was not observed in any patients after new orbital implant insertion.CONCLUSION:The secondary insertion of a new orbital implant after pre-existing implant removal and preceding dermis fat graft is thought to be an another selective management of intractable orbital implant exposure in which dermis fat grafts persistently fail.
    18  Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception
    Shan-Shan Yang ,  Tao Jiang
    2013, 6(2):198-203. DOI: 10.3980/j.issn.2222-3959.2013.02.18
    [Abstract](2780) [HTML](0) [PDF 224.69 K](1046)
    Abstract:
    AIM: To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP).METHODS: This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months.RESULTS: After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects and severe PVR.CONCLUSION:The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.
    19  Ocular disorders in children with spastic subtype of cerebral palsy
    A.Taylan Ozturk ,  A.Tulin Berk ,  Aylin Yaman
    2013, 6(2):204-210. DOI: 10.3980/j.issn.2222-3959.2013.02.19
    [Abstract](2461) [HTML](0) [PDF 280.82 K](1045)
    Abstract:
    AIM: To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP) and to find out whether any correlation exists between their occurance and etiologic factors.METHODS: Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student’s t tests were used in the statistical analysis.RESULTS: The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4%) and tetraplegia (36.1%) were found to be higher than the frequency of hemiplegia (16.5%) in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000). Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6%) had nystagmus and 107 children (55.2%) had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively). Abnormal morphology of the optic disc was present in 152 eyes (39.2%). Severe periventricular leukomalacia (PVL) was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000).CONCLUSION: Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.
    20  Effects of multiple intravitreal anti-VEGF injections on retinal nerve fiber layer and intraocular pressure:a comparative clinical study
    Güngör Sobacı ,  Rıza Güngör ,  Gökhan Özge
    2013, 6(2):211-215. DOI: 10.3980/j.issn.2222-3959.2013.02.20
    [Abstract](2187) [HTML](0) [PDF 861.20 K](1016)
    Abstract:
    AIM: To determine the effect of multiple injections of ranibizumab or bevacizumab on retinal nerve fiber layer (RNFL) and intraocular pressure (IOP) in patients with age-related macular degeneration (AMD).METHODS:This retrospective study includes 35 eyes of 35 patients treated with intravitreal bevacizumab (IVB, 1.25mg/0.05mL) and 30 eyes of 30 patients with intravitreal ranibizumab (IVR, 0.5mg/0.05mL) who had Fast RNFL analysis (Stratus?); IOP measurements were taken 30 minutes and 24 hours after each injection.RESULTS:The mean ages were 68.0±7.5 and 69.1±7.7 years in the IVR and IVB groups, respectively (P=0.55). They underwent (6.3±1.9) and (5.1±1.3) injections (P=0.07) over (13.6±2.1) and (14.05±2.6) months (P=0.45) in the IVR and IVB groups, respectively. Changes in overall and temporal RNFL thickness in IVR-treated eyes (105.3±6.9μm and 74.4±11.2μm) were not different from those in untreated eyes in the IVR group (104.6± 8.4μm and 75.1±12.6μm) (P=0.57 and P=0.41, respectively). Similarly, overall and temporal RNFL thickness in IVB-treated eyes (105.8±8.1μm and 74.5±11.8μm) were not different from those in untreated eyes in the IVB group (104.6±8μm and 74.8±12.9μm) (P=0.42 and P=0.80, respectively). The frequencies of IOP rise (P=0.60) and changes in RNFL thickness from baseline (P=0.16) were comparable between groups.CONCLUSION:Repeated intravitreal injection of ranibizumab or bevacizumab does not seem have adverse effects on RNFL thickness or IOP in wet AMD patients.
    21  Secondary glaucoma after pediatric cataract surgery
    Alparslan Şahin ,  Ihsan Çaça ,  Abdullah Kürşat Cingü ,  Fatih Mehmet Türkcü ,  Harun Yüksel ,  Muhammed Şahin ,  Yasin Çinar ,  Şeyhmus Ari
    2013, 6(2):216-220. DOI: 10.3980/j.issn.2222-3959.2013.02.21
    [Abstract](2541) [HTML](0) [PDF 266.29 K](1094)
    Abstract:
    AIM:To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery.METHODS: Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011.The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes.RESULTS: The mean follow-up periods of group 1 and 2 were (60.86±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8%) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycin C surgery. One patient underwent a second trabeculectomy + mitomycin C operation for both of his eyes.CONCLUSION: The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.
    22  Potential therapeutic effects of pigment epithelium-derived factor for treatment of diabetic retinopathy
    Xiao Liu ,  Hui-Hui Chen ,  Li-Wei Zhang
    2013, 6(2):221-227. DOI: 10.3980/j.issn.2222-3959.2013.02.22
    [Abstract](2040) [HTML](0) [PDF 1.23 M](888)
    Abstract:
    Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among working adults in the worldwide. The pathobiology of DR involves multiple molecular pathways and is characterized chronic neurovascular degeneration. Current approaches to prevent or to treat DR are still far from satisfactory. Therefore, it is important to develop new therapeutic strategies for the prevention and treatment to DR. Pigment epithelium-derived factor (PEDF), a 50-kDa secreted glycoprotein, has been described as a multi-functional protein. Some emerging evidences indicate that PEDF are able to target multiple pathways exerting neurotropic, neuroprotective, anti-angiogenic, antivasopermeability, anti-inflammation, anti-thrombogenic and anti-oxidative effects in DR. In this review, we addressed the functions of PEDF in different pathways, which could lead to potential therapeutics on the treatment to DR.
    23  Treatment of retinopathy of prematurity:a review of conventional and promising new therapeutic options
    Fatih Mehmet Mutlu ,  Serdar Umit Sarici
    2013, 6(2):228-236. DOI: 10.3980/j.issn.2222-3959.2013.02.23
    [Abstract](3210) [HTML](0) [PDF 442.64 K](1251)
    Abstract:
    Retinopathy of prematurity (ROP), a retinal vascular disease of premature infants, continues to be a major cause of preventable childhood blindness all over the world. The incidence of ROP varies among countries, being influenced by the quality of the level of neonatal intensive care. Here, we discuss the potential treatments that are now available or will soon or probably be available for ROP. Although ablation of the avascular retina with laser photocoagulation remains the current gold standard and well established therapy for ROP, some new therapeutic options including angiostatic therapies are being explored based on our knowledge of the pathophysiology of the ROP and complications and efficacy of laser treatment. However, prevention of the development of severe ROP and screening for ROP seem to be the best strategy in avoiding visual impairment caused by ROP in premature infants. New therapeutic interventions including vascular endothelial growth factor antibody administration, gene therapy and supplemental therapies should be supported with evidence-based data for the treatment of ROP.
    24  Prevalence and risk factors for eye diseases, blindness, and low vision in Lhasa, Tibet
    Gui-Qin Wang ,  Zong-Xi Bai ,  Jing Shi ,  Sang Luo ,  Hong-Fa Chang ,  Xiao-Yong Sai
    2013, 6(2):237-241. DOI: 10.3980/j.issn.2222-3959.2013.02.24
    [Abstract](2785) [HTML](0) [PDF 265.76 K](993)
    Abstract:
    AIM:To determine the prevalence and risk factors for eye diseases, blindness, and low vision in Tibet, and to assist the development of eye disease prevention and treatment schemes.METHODS:We carried out a survey of eye diseases among a population living at high altitude. A total of 1 115 Tibetan permanent residents aged 40 years or older from the towns and villages of Qushui County, Lhasa Prefecture, Tibet Autonomous Region, participated in this study. All participants completed a detailed questionnaire, and underwent presenting and pinhole visual acuity tests, and a comprehensive ophthalmic examination.RESULTS:There were 187 blind eyes (8.43%), 231 eyes with low vision (10.41%). The leading cause of visual impairment was cataract of 55.0% (101/187) blindness and of 50.2% (116/231) low vision, followed by fundus lesions of 22.9% blindness and 23.8% low vision, while only a low prevalence of glaucoma of 9.6% blindness and 1.7% low vision was observed. The analysis of 2 219 eyes showed that the most common external eye disease was pterygium (27.2%) in Tibet.CONCLUSION:The high prevalence of blindness and low vision in the Tibetan population at high altitude is a serious public health issue. There is a need to establish and maintain an appropriate effective eye care program in Tibet.
    25  Combine intravitreal bevacizumab with Nd:YAG laser hyaloidotomy for valsalva pre-macular haemorrhage and observe the internal limiting membrane changes:a spectralis study
    Rui Hua ,  Li-Min Liu ,  Yue-Dong Hu ,  Yun Zhou ,  Lei Chen
    2013, 6(2):242-245. DOI: 10.3980/j.issn.2222-3959.2013.02.25
    [Abstract](1775) [HTML](0) [PDF 2.57 M](925)
    Abstract:
    Valsalva retinopathy was described as a particular form of retinopathy, pre-retinal and subinternal limiting membrane haemorrhages in nature that rarely may break through and become subhyloid or intravitreal, secondary to a sudden increase in intrathoracic pressure. We reported a new way that Nd:YAG laser for ILM hyaloidotomy in order to drain the sub-ILM blood into vitreous cavity combined with intravitreal bevacizumab to improve the absorption of blood. Therapeutic alliance make significant outcome, protecting vision in time. We used spectralis OCT to observe sub-ILM mix cells and special ILM structure in this lesion for the first time, as the spectralis OCT can reach histology level imagination.
    26  Iris microhaemangioma:a management strategy
    Aruna Dharmasena ,  Simon Wallis
    2013, 6(2):246-250. DOI: 10.3980/j.issn.2222-3959.2013.02.26
    [Abstract](2122) [HTML](0) [PDF 932.09 K](1166)
    Abstract:
    AIM:To analyse previous literature and to formulate a management strategy for iris microhaemangiomas (IMH).METHODS: A review of the literature in English language articles on IMH.RESULTS: Thirty five English language articles fulfilled the criteria for inclusion to the study and based on the contents on these articles a management strategy was formulated. Age at presentation ranged from 42 to 80 years with no sex or racial predisposition. Most patients with IMH have no systemic disease but a higher incidence had been reported in patients with diabetes mellitus, myotonic dystrophy, chronic obstructive pulmonary disease (COPD) and several other systemic and ophthalmic co-morbidities. Most patients remained asymptomatic until they experienced a sudden blurring of vision due to a hyphaema. Some patients only develop a self-limiting single episode of hyphaema and therefore the laser or surgical photocoagulation of iris should be reserved for the cases complicated with recurrent hyphaema. In some patients, several laser photocoagulation sessions may be needed and the recurrent iris vascular tufts may require more aggressive treatment. Iris fluorescein angiography (IFA) is useful in identifying the true extent of the disease and helps to improve the precision of the laser treatment. Surgical excision (iridectomy) should only be considered in patients who fail to respond to repeated laser treatment. In some cases IMHs has been initially misdiagnosed as amaurosis fugax, iritis and Posner-Schlossman syndrome.CONCLUSION: Owing to its scarcity, there is no good quality scientific evidence to support the management of IMH. The authors discuss the various treatment options and present a management strategy based on the previous literature for the management for this rare condition and its complications.
    27  Central corneal epithelium self-healing after ring-shaped glycerin-cryopreserved lamellar keratoplasty in Terrien marginal degeneration
    Yan-Long Bi ,  </b>Felix Bock ,  </b>Qi Zhou ,  Claus Cursiefen
    2013, 6(2):251-252. DOI: 10.3980/j.issn.2222-3959.2013.02.27
    [Abstract](1650) [HTML](0) [PDF 908.02 K](914)
    Abstract:
    28  Angiography reveals early hiding iris neovascularization after ischemic CRVO
    Zhi-Qing Li ,  Xiao-Xu Zhou ,  Song Lin ,  Jun-Ling Li ,  Jian-Guo Wu
    2013, 6(2):253-254. DOI: 10.3980/j.issn.2222-3959.2013.02.28
    [Abstract](1764) [HTML](0) [PDF 913.58 K](1004)
    Abstract:
    29  Retained wooden foreign body in the orbit
    Sagili Chandrasekhara Reddy
    2013, 6(2):255-258. DOI: 10.3980/j.issn.2222-3959.2013.02.29
    [Abstract](2120) [HTML](0) [PDF 1.63 M](995)
    Abstract:
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