Abstract:AIM:To establish the rat model of streptozotocin (STZ)-induced diabetic retinopathy (DR), which is the most common cause of visual loss and blindness in patients with diabetes, and observe the gene expression of vascular endothelial growth factor (VEGF) and its receptors during the development of DR.METHODS:A rat model of diabetes was established by intraperitoneal injection of STZ. The diabetic rats were housed for 2, 3 and 4 months after the development of diabetes. Retinal histopathological observation was performed. The retinal vessels were observed by immunofluorescence staining by CD31. The mRNA expression of VEGF, VEGF receptor 1 and 2 (VEGFR1/2) in rat retina was detected by reverse transcription-polymerase chain reaction (RT-PCR) analysis.RESULTS:Retinal histopathological observation showed the morphological changes of inner nuclear layer (INL) and outer nuclear layer (ONL) at any time-point, and also demonstrated the increased new vessels at both 3, 4 months after the development of diabetes. The CD31 staining results showed that the number of vessels was increased in the retinas of diabetic rats at both 3 and 4 months after the development of diabetes. As compared to the normal rats, the mRNA expression of VEGF was increased in retinas of diabetic rats at 3 months after the development of diabetes, while VEGFR1 and VEGFR2 mRNA expression was increased at 2, 3 and 4 months after the development of diabetes.CONCLUSION: Taken together, our results demonstrated that DR was occurred at 3 months after the development of diabetes, and the mRNA expression of VEGF, VEGFR1 and VEGFR2 were increased in the process of DR. The present study further evidenced the involvement of VEGF and its receptors in the process of DR.

Abstract:AIM: To investigate the characteristics and criterion of graft rejection in mice model.METHODS: C57BL/6 or BALB/c mice corneal grafts were grafted onto BALB/c hosts. Each group was divided into two subgroups according to the corneal opacity scores 12d after transplantation. The characteristics of opacity and neovascularization were observed. Mice of the 12^th, 50^th day after transplantation, the grafts biopsy of mice in allogeneic group 1, which opacity score exceed 3, were prepared for histological observation and those restore transparent were endothelial stained.RESULTS: There was no difference of corneal opacity score on the 7^th and 12^th day after operation; the histological results had no disparity between syngeneic group and allogeneic group. On the 12^th day after surgery, the turbidity curve was apparent in grafts with opacity score ＜2. Mononuclear cells were shown in grafts with opacity score reached 3 in allogeneic group 1. Different rejection performance was observed in tissue sections on the 50^th day after surgery.CONCLUSION:Grafts, opacity score exceeds 3 from the 7^th to the 12^th day after operation could not be judged as a rejection. We should pay more attention to the variation of grafts opacity since 12d after corneal transplantation.

Abstract:AIM:To measure central corneal thickness (CCT) and pre-corneal tear film thickness using the Galilei dual-Scheimpflug analyzer (GSA) in New Zealand white rabbits.METHODS:Ten normal New Zealand white rabbits (20 eyes) were included in this study. With the assistance of 0.1% fluorescein, the pre-corneal tear film can be well visualized. Both eyes of each rabbit were scanned once with the GSA pre- and post-instillation of 1μL 0.1% fluorescein. The difference between the two measurements of CCT (4-mm diameter) was recorded as the pachymetric values of the central tear film.RESULTS:The CCT of pre- and post-instillation was 388.8±9.5μm and 407.0±10.5μm, respectively. After a paired t-test analysis, the central pre-corneal tear film thickness of 4mm diameter was 18.2±5.31μm with a 95% confidence interval of (15.7, 20.6)μm (P<0.001).CONCLUSION:GSA can be used to measure CCT and analyze central tear film thickness of rabbits with the help of fluorescein.

Abstract:AIM: To compare the effect of topically administered and subconjunctivally injected bevacizumab on experimental corneal neovascularization in rats for two weeks after treatment.METHODS: Twenty-eight Sprague-Dawley rats were divided into four groups of 7 animals. Each corneal center of right eye was cauterized with silver/potassium nitrate for 8s. After corneal burning, bevacizumab (12.5mg/mL) was topically administered three times per day (TB group) for two weeks or subconjunctivally injected on days 2 and 4 after cauterization (0.02mL; SB group). As negative controls, rats received 0.9% saline topically three times per day (TS group) or subconjunctivally on days 2 and 4 (0.02mL; SS group). Digital photographs of the cornea were taken 1 and 2 weeks after treatment and analyzed to determine the area of cornea covered by neovascularization as the percentage of corneal neovascularization.RESULTS: One week after treatment, the percentage of corneal neovascularization was significantly lower in the TB and SB groups than in the TS and SS groups (all P<0.05). Two weeks after treatment, the percentage of corneal neovascularization was significantly lower in the TB group than in the TS group (P<0.05). In all groups, the percentage of neovascularization was decreasing as time passed (all P<0.05)CONCLUSION: Topically administered bevacizumab has longer standing anti-angiogenic effect than subconjunctivally injected bevacizumab in corneal neovascularization following chemical injury in rats.

Abstract:AIM:To define the ultrasonographic structure of normal lower eyelid anatomic compartments and their spacial relationship in dynamic motion.METHODS:High resolution ultrasound (15MHz) was performed on the lower eyelids of 7 normal subjects. Movements of the lower eyelid and its compartments were visualized with ultrasound. In addition, the maximal excursion area of the lower eyelid fat compartments and retractor motions was measured before and after motion.RESULTS:The orbicularis muscle could be seen as an echolucent structure between the dermis and the echodence fat pads. Lower eyelid fat pad seems to be divided into 2 compartments as range of motion and direction of movement of each of them varies. It seems that these compartments have also different behavior. The measured profile area of the visible normal lower eyelid fat pads during movement of globe from up-gaze to down-gaze decreased by 50%. Order of movement of lower eyelid structures seems to be as follows:after globe movement fist we see retractor movement, anterior orbital fat pad, then skin and septum, and finally movement of inferior fat pad.CONCLUSION: Ultrasound represents a noninvasive tool for the visualization of lower eyelid morphology. Expanding its application could help us understand the compartmental changes in physiological eyelid movement, in aging and diseased study populations, as well as assess operative outcomes.

Abstract:AIM: To determine the histopathological changes of rifampicin applied intravitreally on retinal ganglion cells by means of stereological and histopathological methods.METHODS: For this study twenty-four New Zealand adult rabbits were divided into four groups (n=6 for each group). 50μg/0.1mL (group 1), 100μg/0.1mL (group 2), 150μg/0.1mL (group 3) and 200μg/0.1mL (group 4), rifampicin were injected into the vitreous of the right eyes of animals, their left eyes were used as control (group 5). After the 28^th day of application, animals were anesthetised with xylazine (8mg/kg, IM) and then their eyes were enucleated immediately. Patterns were taken away and eyes were prepared for both stereological and electromicroscopic observation.RESULTS: Depending on the high dose of rifampicin, some histopathological changes such as cytoplasmic dilatation and damaged membrane were observed on the electromicroscopic level. Using quantitative examination, which was done at the light microscopic level, it was shown that the number of neurons decreased linearly as rifampicin dose increased when compared with the control group.CONCLUSION: Based on these findings, low-dose rifampicin (50μg/0.1mL) may be useful for treatment of the ocular diseases.

Abstract:AIM: To characterize temporal pattern of resolution and recurrence of naive choroidal neovascularization (CNV) secondary to wet age-related macular degeneration (AMD) treated with intravitreal bevacizumab on as needed regimen, and to analyze baseline risk factors for CNV resolution or recurrence.METHODS:Ninety-one eyes of 80 patients with newly diagnosed wet AMD were retrospectively studied. All eyes were treated with a round of three monthly intravitreal bevacizumab injections, followed by one additional ‘bonus’ injection after resolution of CNV activity. During follow-up, eyes were monitored with fluorescein angiography, optical coherence tomography, and best-corrected visual acuity (BCVA). In case of recurrences of CNV activity, eyes were retreated with other rounds of bevacizumab injections following the same treatment protocol.RESULTS:Over a median follow-up of 532d, the median resolution time of CNV activity in the first, second, and third treatment round was 98d, 126d, and 111d, respectively. The median recurrence time for the three rounds was 154d, 126d, and 151d, respectively. No significant difference in resolution time (P=0.09) or in recurrence time (P=0.11) was detected among treatment rounds. Age (P=0.0082) and lens status (P=0.035) were found to be associated with CNV resolution; for every 1-year increase in age there was 4% greater chance of CNV resolution; Phakic eyes demonstrated a 33% better chance to experience CNV resolution than pseudophakic eyes. For CNV recurrence, lens status (P=0.0009) and gender (P=0.0446) were found to be predictive; pseudophakic eyes had a 3.69-fold greater risk to experience recurrence of CNV activity compared to phakic eyes; males had a 2.19-fold greater risk to experience recurrence of CNV activity than females. No significant BCVA changes among three treatment rounds were noted (P=0.56).CONCLUSION:Resolution time and recurrence time of CNV activity were not significantly different among treatment rounds, suggesting absence of tachyphylaxis to bevacizumab. A cautious decision should be made upon discontinuing treatment in wet AMD eyes of younger or pseudophakic patients, which showed slower response to bevacizumab. In addition, wet AMD eyes of male or pseudophakic patients should be evaluated more carefully after stopping the treatment, because they may have early reactivation of the CNV. BCVA was preserved by bevacizumab treatment despite multiple recurrences.

Abstract:AIM:To assess the quantitative association between anisometropia magnitude and the losses of resolution and contrast sensitivity; and to exemplify how the function of fusion and stereopsis vary with anisometropia magnitude (AM) in previously untreated anisometropic amblyopes.METHODS:A total of 57 patients with previously untreated anisometropic amblyopia without strabismus (range:8-35 years), were measured refractive error, best corrected visual acuity (BCVA), fusion and stereopsis, and 48 patients have completed contrast sensitivity function test. AM was determined by dioptric vector addition model, and the amblyopia depth was determined by the difference of BCVA in logMAR units between the amblyopic and fellow eyes.RESULTS: AM was significantly correlated with both amblyopia depth (Pearson R=0.728, P<0.001) and the inter-ocular difference of the area under the log contrast sensitivity function (AULCSF) (R=0.505, P<0.001). Depth of amblyopia and the inter-ocular difference of AULCSF was also significantly correlated (R=0.761, P<0.001). The more severity of amblyopia, the poorer levels of contrast sensitivity. Most pure anisometropes with AM was less than 3.0D retain fusion and some stereopsis, but when AM were more than 3.0D, especially for the anisometropes whose AM was more than 6.0D, fusion and stereopsis function were seriously impaired.CONCLUSION: In the patients with previously untreated anisometropia amblyopia, higher degree of anisometropia is significantly associated with deeper amblyopia, worse contrast sensitivity, fusion and stereopsis functions.

Abstract:AIM: To compare the regularity and accuracy of laser in situ keratomileusis (LASIK) flaps created by the Ziemer FEMTO LDV “Classic” (Ziemer “Classic”) and Ziemer FEMTO LDV Crystal Line femtosecond laser (Ziemer Crystal Line).METHODS:Fourier-domain optical coherence tomography (RTVue OCT) was used tomeasure the morphology of 200 LASIK flaps of 100 consecutive patients created with the Ziemer Classic (100 flaps) or the Ziemer Crystal Line (100 flaps) at one week postoperatively. Flap thickness was evaluated at 36 specified measurement points on each flap. For all procedures with both lasers, the nominal flap thickness was 110μm.RESULTS:The mean flap thickness of the Ziemer Crystal Line group(102.49±2.68μm) was thinner than that of the Ziemer Classic group (107.65±5.09μm) (P<0.01). Average thickness of all flaps was uniform within 4μm at all measurement points. The flaps in the Ziemer Crystal Line group were more regular than those in the Ziemer Classic group when measured from the center to the periphery. The maximum deviation from the nominal 110μm of 36 measurements was 8μm in the Ziemer Classic group, while in the Ziemer Crystal Line group it was 9μm. Within the 3 600 measurements on the 100 eyes, differences greater than 20μm were observed 0.14% in the Ziemer Classic group, and 0.04% in the Ziemer Crystal Line group.CONCLUSION:The flaps created with the Ziemer FEMTO LDV Crystal Linefemtosecond laser are more uniform and thinner than those created by the Ziemer FEMTO LDV Classic femtosecond laser.

Abstract:AIM:To evaluate the accuracy of spherical equivalent (SE) estimates of a double-pass system and to compare it with retinoscopy, subjective refraction and a table-mounted autorefractor.METHODS: Non-cycloplegic refraction was performed on 125 eyes of 65 healthy adults (age 23.5±3.0 years) from October 2010 to January 2011 using retinoscopy, subjective refraction, autorefraction (Auto kerato-refractometerTOPCON KR-8100, Japan) and a double-pass system (Optical Quality Analysis System, OQAS, Visiometrics S.L., Spain). Nine consecutive measurements with the double-pass system were performed on a subgroup of 22 eyes to assess repeatability. To evaluate the trueness of the OQAS instrument, the SE laboratory bias between the double-pass system and the other techniques was calculated.RESULTS:The SE mean coefficient of repeatability obtained was 0.22D. Significant correlations could be established between the OQAS and the SE obtained with retinoscopy (r=0.956, P<0.001), subjective refraction (r=0.955, P<0.001) and autorefraction (r=0.957, P<0.001). The differences in SE between the double-pass system and the other techniques were significant (P<0.001), but lacked clinical relevance except for retinoscopy; Retinoscopy gave more hyperopic values than the double-pass system -0.51±0.50D as well as the subjective refraction -0.23±0.50D; More myopic values were achieved by means of autorefraction 0.24±0.49D.CONCLUSION: The double-pass system provides accurate and reliable estimates of the SE that can be used for clinical studies. This technique can determine the correct focus position to assess the ocular optical quality. However, it has a relatively small measuring range in comparison with autorefractors (-8.00 to +5.00D), and requires prior information on the refractive state of the patient.

Abstract:AIM:To assess the effect of myopia on the thickness of retinal nerve fiber layer (RNFL) measured by 3D optical coherence tomography (3D-OCT) in a group of nonglaucomatous Chinese subjects.METHODS:Two hundred and fifty-eight eyes of 258 healthy Chinese myopic individuals were recruited and four groups were classified according to their spherical equivalent (SE):low myopia (n=42, -0.5D<SE<-3.0D), moderate myopia (n=120, -3.0D≤SE<-6.0D), high myopia (n=58, -6.0D≤SE<-8.0D) and extreme high myopia (n=38, SE≥-8.0D). The RNFL thickness profile including superior, nasal, inferior and temporal quadrant and each of the 12 clock-hour thicknesses were measured by 3D-OCT. The RNFL thicknesses among four sample groups were performed by one-way analysis of variance (one-way ANOVA) and least significant difference test (LSD test). Correlations between RNFL thickness and axial length/spherical equivalent were performed by linear regression analysis.RESULTS: The overall RNFL parameters shown significant differences between groups excluding 7, 9, 10, 11 o’clock hour thickness. The RNFL thickness of superior, nasal, inferior, average and 1, 2, 3, 4, 5, 6, 12 o’clock sectors were decreased with the increasing axial length and higher degree of myopia. In contrast, as axial length and the degree of myopia increased, the temporal and 8, 9 o’clock sectors thicknesses were increased. A considerable proportion of myopic eyes were classified as outside the normal limits. Six o’clock was the most notable of the total, which 43.4% were outside the normal limits.CONCLUSION:On the measurement of RNFL, the characteristics of RNFL with the change of the degree of myopia were observed. As the degree of myopia increases, the RNFL thickness measured by 3D-OCT including the average and superior, nasal, inferior sectors decreases. And due to the change of RNFL thickness, it should be considered when using OCT to access for the damage of glaucoma especially people with myopia.

Abstract:AIM:To evaluate the frequency of bacterial flora of conjunctiva after death (cadaver eyes) which will give information about the bacterial contamination of donor eyes, and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice.METHODS: Conjunctival swabs were taken from the cadavers (motor vehicle accident deaths and patients who died in the hospital), within 6h after death, and sent for culture and sensitivity test. Conjunctival swabs, taken from the healthy conjunctiva of patients admitted for cataract surgery, were sent for culture and sensitivity as controls (eyes in those of living status). The bacterial isolates were tested against the commonly used antibiotics (chloramphenicol, gentamicin, ciprofloxacin) in ophthalmology practice.RESULTS: Bacteria were isolated in 41 out of 100 conjunctival swabs (41%), taken from 50 cadavers (study group). Coagulase negative staphylococcus was the most common bacteria isolated (15%), followed by pseudomonas aeruginosa (5%). Gentamicin was effective against majority of the bacterial isolates (82%). Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group (eyes in living state). Coagulase negative staphylococcus was the most common organism (5%) isolated in control group; the others were staphylococcus aureus (1%) and beta hemolyticus streptococci (1%).CONCLUSION: Bacteria were isolated from 41% of the cadaver eyes. High percentage sensitivity of the bacterial isolates to gentamicin (82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution, to prevent the bacterial contamination.

Abstract:AIM:To compare the accuracy of IOPen rebound tonometer with Goldmann applanation tonometer (GAT) in individuals with low, normal and high intraocular pressure (IOP) and to evaluate the effect of central corneal thickness (CCT) on IOP measurements.METHODS:This cross-sectional study consisted of 159 participants. IOP of one eye of each subject was measured consecutively with IOPen and GAT. Then CCT was measured using an ultrasonic pachymeter. Based on GAT IOP readings, participants were divided into low, normal and high IOP groups. Correlation between tonometers and CCT was calculated by spearman’s correlation coefficient. Agreement between tonometers was evaluated using Bland-Altman method.RESULTS: Non-significant underestimation of IOP by IOPen was observed in low IOP group (Mean difference:0.20mmHg; P=0.454) and also in normal IOP group (Mean difference:0.56mmHg; P=0.065). However, IOPen significantly overestimated IOP in high IOP group (Mean difference:1.06mmHg; P=0.038). The 95% limits of agreement (LoA) width between IOPen and GAT IOPs were 7.84, 8.57 and 14.27mmHg in low, normal and high IOP groups, respectively. Low IOP group had thinner corneas compared to high IOP group (P=0.034). IOP measurements taken by IOPen were not influenced by CCT (P=0.099) while poor correlation between CCT and GAT was found (R=0.17, P=0.032). Using receiver operating characteristic (ROC) curve, cutoff value of 18.75mmHg was determined for IOPen with sensitivity of 98.1 and specificity of 97.2%.CONCLUSION:Accuracy of IOPen is comparable to GAT in patients with low or normal IOP but IOPen overestimates IOP at high IOP levels. CCT does not affect IOP readings with IOPen.

Abstract:AIM: To study the effect of different flap sizes on visual acuity, refractive outcomes, and aberrations after femtosecond laser for laser in situ keratomileusis (LASIK).METHODS: In each of the forty patients enrolled, 1 eye was randomly assigned to receive treatment with a 8.1mm diameter corneal flap, defined as the small flap, while the other eye was treated with a 8.6mm diameter corneal flap, defined as the big flap. Refractive errors, visual acuity, and higher-order aberrations were compared between the two groups at week 1, month 1 and 3 postoperatively.RESULTS: The postoperative refractive errors and visual acuity all conformed to the intended goal. Postoperative higher-order aberrations were increased, especially in spherical aberration (Z12) and vertical coma (Z7). There were no statistically significant differences between the two groups in terms of postoperative refractive errors, visual acuity, root mean square of total HOAs (HO-RMS), trefoil 30° (Z6), vertical coma (Z7), horizontal coma (Z8), trefoil 0° (Z9), and spherical aberration (Z12) at any point during the postoperative follow-up.CONCLUSION: Both the small and big flaps are safe and effective procedures to correct myopia, provided the exposure stroma meets the excimer laser ablations. The personalized size corneal flap is feasible, as we can design the size of corneal flap based on the principle that the corneal flap diameter should be equal to or greater than the sum of the maximum ablation diameter and apparatus error.

Abstract:AIM: To compare the clinical effects of the modified and conventional secondary hydroxyapatite orbital implantations.METHODS:A total of 40 patients who had received eye enucleation were equally randomized into the modified and conventional groups. Twenty patients were treated by conventional method. The four rectus muscles were separated, and then an orbital implant wrapped with xenogenous sclera was implanted. Twenty patients were treated by modified method. An implant unwrapped with xenogenous sclera was directly implanted into the muscle pyramid. The operating time, costs, clinical effects, and complications of the two groups were compared.RESULTS:The average operating time of the modified group was 20.5±5.6min, whereas that of the conventional group was 56.8±14.6min (P<0.01). The average cost of the modified group was 7 800±340RMB (1 274±55.6USD), whereas that of the conventional group was 9 800±660RMB (1 601±107.8USD) (P<0.01). The two groups did not show significant difference in orbital implant mobility or postoperative complications.CONCLUSION:The modified secondary hydroxyapatite orbital implantation has advantages in operating time, surgery cost, and complication reducing. It is worthy for wide clinical application and further study.

Abstract:AIM: To assess the refractive outcome of clear lensectomy combined with piggyback intraocular lens implantation in highly hyperopic patients.METHODS: This case review included 19 eyes of 10 patients with high hyperopia and axial length less than 21mm. Intraocular lens power was calculated for emmetropia using the Holladay II formula in 17 eyes, and SRK/T formula in 2 eyes following clear lens extraction and piggyback intraocular lens implantation. Patients were examined periodically over 24 months for visual acuity and spherical equivalent (SE).RESULTS: The mean postoperative SE at 24 months was 0.20±1.39D (range, -3.00 to 2.50D), better than preoperative 9.81±2.62D (range, +6.00 to +14.50D) (P<0.001). Five eyes had SE within ±0.5D of emmetropia and 11 eyes within ±1.00D at postoperative 24 months. The mean postoperative uncorrected visual acuity (UCVA) at 24 months was 0.60±0.36, significantly improved compared to preoperative 1.39±0.33 (P<0.001). The mean best-corrected visual acuity (BCVA) at 24 months was 0.49±0.35, not statistically different compared to preoperative 0.38±0.30 (P=0.34). Twelve eyes maintained and 1 gained 1 or more Snellen line of BCVA, 4 eyes lost 1 line, and 2 eyes lost 2 lines at 24 postoperative months. Twelve eyes best-corrected near visual acuity (BCNVA) achieved J1 at postoperative 24 months compared to preoperative 7 eyes and the other 7 eyes better than J3.CONCLUSION: Clear lens extraction combined piggyback intraocular lens implantation appears to be an effective procedure to correct high hyperopia but mild overcorrection and intralenticular opacification may require secondary procedure.

Abstract:AIM: To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied. All the operations were performed under surgical microscope, 5-0 silk sutures were used and were with bicanalicular silicone tube (diameter was 8mm) intubation, for one lacerated canaliculi one-stitch anastomosis through the skin. The stents were left in place for 3 months postoperatively and then removed. The follow-up period was 3 - 36 months (average 14 months).RESULTS:In 15 patients, 13 patients were cured entirely, 1 patient was meliorated, 1 patient with no effects. All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus. Complication was seen in one case, for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7^th day after operation, when he came at the 15^th day, the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound, and the inside silicone tube was exposed, a promptly repair with 10-0 nylon suture was done, the wound healed in a week. There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye, the cut ends can be anastomosed directly, and with excellent cosmetic results, it is acceptable for the patients. For there is no suture remained in the wound permanently, so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi. It is simple, economical, effective and safe.

Abstract:AIM: To evaluate the characteristics of pupillo-accommodative functions in patients with idiopathic tonic pupil according to the time of onset, gender, and age.METHODS:Totally, 15 males and 19 females were divided into 2 groups depending on the time of disease onset:group Ⅰ (onset <2 months, n=20) and group Ⅱ (onset >2 months, n=14). A supersensivity test was conducted by applying diluted pilocarpine 0.125% to the eye and accommodative functions were evaluated using the near-point of accommodation (NPA) as the cutoff point, at which the patient experienced blurred vision. Pupil size and the ratio of decrease in the affected pupilafter instillation of 0.125% pilocarpine were investigated.RESULTS:There was no significant difference between the 2 groups regarding the various pupillary reflex results, including data on the affected pupil size before and after 0.125% pilocarpine, anisocoria, and ratio of pupil decrease. No significant difference in NPA was found between the 2 groups. However, female patients were noted to have greater anisocoria and a faster constriction ratio than those of the male patients (P=0.02 and P=0.04). On subgroup analysis, female patients from group Ⅱ had larger affected-pupil sizes before 0.125% pilocarpine instillation and longer NPAs than those of the male patients.CONCLUSION: No relationship was found between time of onset and dysfunction of pupillo-accommodative functions. Pupillo-accommodative functions and age were not related, except for the NPA.

Abstract:AIM:To determine peripapillary retinal fiber layer thickness (RNFL) measured with spectral domain optical coherence tomography (SD-OCT) in normal and glaucomatous eyes in a large sample of exclusively white population and compare results with other similarly constructed studies.METHODS:Average, maximum, minimum and per quadrant RNFL thickness were measured in normal and glaucomatous Greek patients with a scanning laser ophthalmoscope (SLO)/SD-OCT device. The effect of age in normal RNFL thickness was also determined.RESULTS: A total of 278 normal (278 patients) and 67 glaucomatous (67 patients) eyes were included in the study. Average RNFL thickness was 114.8±13.3μm in normal and 92.1±18.5μm in glaucomatous eyes (P<0.001). In normal discs, superior quadrant was the thickest, followed by the inferior, nasal and temporal. Decline of normal RNFL thickness with age was statistically significant for average RNFL thickness (1.92μm per decade of life) and for the superior and inferior quadrants of the disc.CONCLUSION:SD-OCT peripapillary RNFL measurements can be used to distinguish between normal and glaucomatous eyes and establish normative databases, since normal disc measurements differ between different ethnic groups and between different SD-OCT devices.

Abstract:AIM:To compare the effects of first and second generation silicone hydrogel (SiH) contact lens wear on tear film osmolarity.METHODS:The healthy subjects who have never used contact lenses before were enrolled in the study. Tear film osmolarity values of 16 eyes (group 1) who wore first generation SiH contact lenses were compared with those of 18 eyes (group 2) who wore second generation SiH contact lenses after three months follow-up.RESULTS: Before contact lens wear, tear film osmolarity of groups 1 and 2 were 305.02±49.08 milliosmole (mOsm) and 284.66±30.18mOsm, respectively. After three months of contact lens wear, osmolarity values were found 317.74±60.23mOsm in group 1 and 298.40±37.77mOsm in group 2. Although osmolarity values for both groups of SiH contact lens wear after three months periods were slightly higher than before the contact lens wear, the difference was not statistically significant.CONCLUSION: Contact lens wear may cause evaporation from the tear film and can increase tear film osmolarity leading to symptoms of dry eye disease. In the current study, there is a tendency to increase tear film osmolarity for both groups of SiH contact lens wear, but the difference is not statistically significant.

Abstract:AIM: To evaluate the outcomes of pars plana vitrectomy (PPV) without the use of an ocular tamponade in patients having tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR).METHODS: It was an interventional study conducted at the Department of Ophthalmology, B.V. Hospital, Bahawalpur, Pakistan, from July 2011 to July 2012. A total of 75 patients (84 eyes) having TRD secondary to PDR were treated by PPV without using an ocular tamponade. All patients included in the study had a tractional retinal detachment secondary to proliferative diabetic retinopathy but didn’t have or develop retinal breaks before or during the study period. The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina. The mean follow-up period was 12 months.RESULTS:Successful retinal reattachement was observed in 78 of the operated eyes (92.8%). In these patients, the retina remained attached till the end of the one year follow-up period. Improvement in best corrected visual acuity (BCVA) was seen in 63 eyes (75%). The visual acuity remained unchanged in 9 eyes (10.7%). Mean improvement in BCVA was 2.00+1.24 at baseline to 1.24+1.22 (P<0.05) at the end of the follow-up period.CONCLUSION: In the absence of the retinal breaks, a TRD secondary to PDR can be successfully treated by pars plana vitrectomy without the use of an ocular tamponade.

Abstract:AIM: To determine the relationship between proliferative diabetic retinopathy (PDRP) and plasma coenzyme Q10(CoQ10) concentration.METHODS: Patients with type 2 diabetes and PDRP were determined to be the case group (n=50). The control group was consist of healthy individuals (n=50). Plasma CoQ10 and malondialdehyde (MDA) levels were measured in both groups.RESULTS: Ubiquinone-10 (Coenzyme Q10) levels in PDRP and control subjects are 3.81±1.19μmol/L and 1.91±0.62μmol/L, respectively. Plasma MDA levels in PDRP and control subjects were 8.16±2μmol/L and 3.44±2.08μmol/L, respectively. Ratio of Ubiquinol-10/ubiquinone-10 in PDRP and control subjects were 0.26±0.16 and 1.41±0.68, respectively.CONCLUSION:The ratio of ubiquinol-10/ubiquinone-10 is found lower in patients with PDRP. High levels of plasma ubiquinol-10/ubiquinone-10 ratio indicate the protective effect on diabetic retinopathy.

Abstract:AIM: To evaluate the changes in the anterior segment parameters of the subjects with primary angle closure suspect (PACS) before and after laser iridotomy (LI) using the Pentacam and gonioscopy.METHODS: Forty-eight eyes of 48 PACS were included. Anterior chamber angle (ACA), central anterior chamber depth (ACD), anterior chamber volume (ACV) and central corneal thickness (CCT) were recorded from the Pentacam before and one month after LI. ACA was graded according to Shaffer classification using the Goldmann gonioscopy.RESULTS: ACA increased significantly from 25.59±4.41 to 26.46±4.33 degrees (P=0.009) and ACV changed from 85.97±16.07mm³ to 99.25±15.83mm³ (P=0.000). The changes in ACD, CCT and intraocular pressure were non-significant (P>0.05). Gonioscopy showed significant widening of the Shaffer angle in 4 quadrants (P<0.001).CONCLUSION:Pentacam can serve as the objective instrument in assessing the efficacy of LI.

Abstract:AIM:To investigate the role of fundus autofluorescence (FAF) both in the diagnosis and the preoperative and postoperative evaluation of patients with idiopathic macular hole (MH).METHODS: Forty eyes of 40 patients diagnosed as idiopathic MH between May 2010 and May 2011 were included in this retrospective study. All patients underwent full ophthalmologic examinations and imagings including fluorescein angiography, fundus autofluorescence (FAF) and optical coherence tomography. Thirty of these patients underwent MH surgery. FAF findings were associated with duration of symptoms, visual acuity at presentation, stage of MH, and postoperative anatomical correction.RESULTS:The mean duration of patients’ symptoms was 3.8±2.0 (1-9) months. The MH was stage 2 in 4 (10%), stage 3 in 24 (60%) and stage 4 in 12 (30%) eyes. The median preoperative best corrected visual acuity was 20/200 (between 20/800 and 20/100). Twenty-eight of cases (70%) showed a stellate appearance with dark radiating striae. Having a visual acuity ≥20/200 was significantly more common in eyes with stellate appearance (P<0.001). The mean duration of symptoms was significantly shorter in eyes with stellate appearance (2.75±0.8 vs 6.33±1.61 months) (P<0.001). The frequency of stage 4 MH was significantly higher in eyes with non-stellate appearance (P<0.001). Anatomical correction of MH was achieved in 91.3% (21/23) of eyes with stellate appearance and 71.4% (5/7) of eyes without this appearance (P=0.225).CONCLUSION: Stellate appearance in FAF is associated with earlier stages of macular hole, better visual acuity at presentation, shorter duration of symptoms, thus more favorable prognosis.

Abstract:AIM: To assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.METHODS:Potential prospective controlled trials that comparing aspheric multifocal IOL implantation with spherical multifocal IOL group were extracted from the computer database. The statistical analysis was carried out using Stata 10 software. Standardized mean differences with 95% confidence intervals (CIs) were calculated for continuous variables. The pooled estimates were computed in the use of a random-effects model.RESULTS:A systematic review identified five prospective nonrandomized controlled trials, including 178 aspheric multifocal IOL and 164 spherical multifocal IOL. There was no significant difference in uncorrected distance visual acuity (95%CI, -0.248 to 0.152;P=0.641) and uncorrected near visual acuity (95%CI, -0.210 to 0.428;P=0.504) between aspheric multifocal IOL and spherical multifocal IOL. Statistically significant differences were detected less spherical aberration in aspheric multifocal IOL (95%CI, -1.111 to -0.472; P＜0.001) when compared to spherical multifocal IOL. Spherical multifocal IOL showed a greater higher order aberration compared to the aspheric multifocal IOL (95%CI, -1.024 to-0.293; P＜0.001). Sensitivity analysis suggested that the results were relatively reliable.CONCLUSION:The overall findings indicated that aspheric multifocal IOL and spherical multifocal IOL provided similar visual acuity at near and distance. Patients implanted with aspheric multifocal IOL had less spherical aberration and higher order aberration than patients with spherical multifocal IOL. Further well-organized, prospective controlled trials involving larger patient numbers are needed.

Abstract:AIM:To investigate the association between lumican gene -1554 T/C polymorphism and high myopiasusceptibility.METHODS: We searched the published literature in the Medline, Embase, and CBM databases from inception to July 2013. A meta-analysis was performed by the programs RevMan 5.1 and Stata 12.0, and the odds ratio (OR) with 95% confidence interval (CI) was calculated in fixed or random effect model based on heterogeneity test among studies.RESLUTS:Seven case-control studies with a total of 1 233 cases and 936 controls were included. A statistical significant association with high myopia was observed in the recessive model (TT vs CT+CC:OR=1.92; 95%CI=1.14-3.23) and codominant model (TT vs CT:OR=1.81, 95%CI=1.19-2.75).CONCLUSION: The present meta-analysis suggested that lumican -1554 T/C polymorphism might be moderately associated with high myopia susceptibility. This conclusion warrants confirmation by further studies.

Abstract:Uveitis is one of the most important causes of blindness worldwide. Its etiology and pathogenesis are complicated and have not been well understood. The treatment for uveitis is predominantly based on steroids and immunosuppressants. However, systemic side effects limit their clinical application. With the advancement of molecular biology, some intravitreal implants and biologic agents have been used for the treatment of uveitis. Additionally, novel techniques such as gene therapy and RNA interference are being studied for using as uveitis therapy. This paper reviews recent advances in uveitis treatment.

Abstract:Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today’s world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician’s responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of optical coherence tomography, frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.

Abstract:AIM:To determine the prevalence of asthenopia and identify any associated risk factors in the college students in Xi’an, China.METHODS:From April to September 2012, 1 500 students from five universities in Xi’an were selected according to a multi-stage stratified cluster sampling method. Data on demographic features, lifestyle or dietary habits, health status, living environment conditions, sleep and mental status, and asthenopia symptoms were collected through a self-administered validated questionnaire. Univariate logistic regression and multivariate logistic regression analysis modified by the factor analysis were performed to evaluate risk factors for asthenopia.RESULTS:Fifty-seven percent of the college students complained of asthenopia. Statistically significant risk factors for asthenopia in the univariate analysis included 13 variables. Multivariate analysis revealed a significant relationship between the use of computer and asthenopia (OR 1.21, 95%CI:1.09 to 1.35). Good sleep and mental status (OR 0.86, 95%CI:0.76 to 0.97), good living environment conditions (OR 0.67, 95%CI:0.60 to 0.76), and high intake of green leafy vegetables (OR 0.89, 95%CI:0.80 to 0.98) were found to be strong predictors of decreasing the occurrence of asthenopia complaints.CONCLUSION:Asthenopia symptom appears to be common among college students; and it is strongly associated with computer use, psychosocial state, environment conditions and dietary habits, suggesting that additional studies are warranted to verify these risk factors and establish prevention guidelines, especially for college students.

Abstract:AIM:To study the normal aerobic conjunctival flora in lower to mid Himalayan region of Shimla Hills.METHODS:Samples from normal conjunctiva of 200 individuals above the age of 13 years who visited Indira Gandhi Medical College Hospital Shimla for refraction or cataract surgery were taken by anaesthetising the conjunctival sac with sterile 4% Xylocaine solution. Samples were obtained by gently rubbing lower fornix with a sterile cotton wool swab moistened with normal saline and keeping the eye lids wide apart to avoid contamination from lid margins. It was immediately inoculated in Brain Heart infusion and subjected to standard aerobic culture and identification techniques.RESULTS:Totally, 72 eyes (36%) conjunctival sacs were sterile. Predominant aerobes isolated were Staphylococcus spp. in 120 (60%) followed by Haemophilus in 16 (8%), diphtheroids in 10 (5%), and Escherichia.coli (E. coli) in 4 (2%). A single aerobe was isolated from 98 eyes (49%) while 30 eyes (15%) yielded more than 1 aerobe. Staphylococcus epidermidis (S.epidermidis) was the most common bacterium, found alone in 58 eyes (29%) and in combination with another aerobe in 30 eyes (15%), followed by Staphylococcus aureus (S. aureus) in 18 (9%) and 10 eyes (5%) respectively.CONCLUSION:S. epidermidis is the most common commensal organism followed by Haemophilus species. diphtheroids occupied the third position which otherwise are found more abundantly in literature. Pathogens like S. aureus, Staphylococcus citreus and E. coli were also found. Therefore, preoperative administration of topical broad spectrum antibiotics is extremely important in prophylaxis against ocular infection. The variation in microflora of normal conjunctiva in this part of world can be attributed to geographical, climatic and ethnic characteristics of the population under study.

Abstract:AIM:To determine the frequency and causes of blindness in diabetic Africans.METHODS:The study was a cross-sectional survey carried out among known black diabetics consecutively admitted at the Teaching Hospital, University of Kinshasa, between 2005 and 2007. Examination methods included interviewer-administered structured questionnaire, eye examinations (visual acuity, tonometry, funduscopy), and fasting plasma glycaemia test.RESULTS:Of the 227 patients examined, 15.9% had blindness. Univariate analyses showed significant association between female, severity of diabetic retinopathy, Mayombian ethnic group, use of insulin treatment, low intake of vegetables, diabetic nephropathy, open angle glaucoma and blindness in all diabetics. After logistic regression, only diabetic nephropathy, use of insulin treatment, macular oedema, Mayombian ethnic group and vegetables low intake were the independent risk factors of blindness in all diabetics. However, after logistic regression in the sub-group with diabetic retinopathy, only open angle glaucoma and proliferative diabetic retinopathy were the independent determinants of blindness.CONCLUSION:The majority of the causes of blindness in these diabetic Africans are avoidable. It is recommended that appropriate diabetes care, nutrition education, periodic eye examination and laser photocoagulation facilities should be provided for treating diabetics in sub-Saharan Africa.

Abstract:AIM: To evaluate the performance of dominant eye (DE) for color vision discrimination ability among the medical students with normal color vision.CONCLUSION: The color vision discrimination performance ability was found prominent for DE. This superiority was attributed to higher sensitivityof the r/g local color spectral region. We conclude that DE has priority in r/g color spectral region, probably including inhibition of NDE.