Table of Content

22 December 2022, Volume 46 Issue 6

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Evaluation of clinical severity in intermittent exotropia

Luo Dan, Yu Xinping

2022, 46(6):  481-485.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.001

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Evaluation of the severity of intermittent exotropia is important to understand the progress of the disease and the determining of treatment. At present, it is mainly focus on three aspects: deviation amplitude, stereopsis and fusion control. The prism alternative cover test was routinely used to measure deviation amplitude, but sometimes the patient's maximum deviation amplitude not be obtained. By use of staring at 30 m visual markers, staring at outdoor visual markers, cover test and prism adaptation test, we tried to break the binocular fusion to get a greater degree of strabismus. Titmus stereopsis and Randot stereopsis were mainly used to measure stereopsis in clinic, but the results of the two methods were quite different, which was related to the design of stereopsis. In addition, binocular viewing glasses, measuring environment, viewing angle may affect the measurement results.Fusion control was assessed by Newcastle control score and Office control score,but both were significantly influenced by family subjectivity or patient compliance, the new LACTOSE control rating may be a more appropriate IXT control rating tool.In addition, the consistency of deviation amplitude, stereopsis and fusion control is poor, and the clinical judgment of the severity of patients also needs comprehensive consideration. Therefore, it is necessary to understand the characteristics and influencing factors of each evaluation method when interpreting the evaluation results of IXT. (Int Rev Ophthalmol, 2022,  46: 481-485)

Progress in detection and training of binocular stereovision

Zhao Yiyang, Fu Jing

2022, 46(6):  486-491.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.002

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Stereopsis detection has experienced the continuous evolution of depth gauge, pattern stereopsis and random dot examination. The traditional stereovision examination methods are represented by Titmus and synoptophore, but there are many problems such as high requirements for examination equipment and subjective factors. The combination of 3D display, mobile phone software and other technologies can reduce the examination requirements, increase patient compliance, and obtain a wide range of disparity and accurate examination values. Stereoscopic vision training has been developed from traditional synoptophore training to visual perception training and mixed training. Recently, virtual reality (VR) and other technologies have also been applied to visual perception training to improve patient compliance and obtain better training effects. There are many methods for detecting and training stereovision function, each of which has its own advantages and disadvantages. Clinicians should choose the appropriate method for patients and combine various methods to evaluate and train stereovision function of patients in a comprehensive way. (Int Rev Ophthalmol, 2022, 46: 486-491)

Biological measurement of anterior segment changes caused by accommodation

Zhao Jiawei, Qian Xuehan

2022, 46(6):  491-496.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.003

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Accommodation is the ability to see objects at various distances and decreases with age. Binocular vision abnormalities caused by accommodation can occur at different ages. Typical methods of measuring accommodation, such as accommodation amplitude and accommodation sensitivity, are influenced by the state of the eye at the testing time. They may have large fluctuations. With the gradual development of testing technology, different principle-based testing instruments can accurately measure various parameters of the ocular segment and obtain changes in intraocular morphology during accommodation. The study of changes in the anterior segment during accommodation or before and after ciliary muscle paralysis is significant for the occurrence and intervention of orthokeratology and presbyopia. (Int Rev Ophthalmol, 2022, 46:  491-496)

Refractive stability and the effectiveness of visual quality after corneal refractive surgery

Han Yu, Zhang Fengju

2022, 46(6):  497-501.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.004

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Femtosecond laser assisted laser in situkeratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) are becoming more spread and accepted. Abundant clinical data showed these two kinds of surgeries show satisfactory results. The short-term postoperative uncorrected and best corrected distance visual acuity show good results. In various studies, the safety and efficacy index and the predictability show slight differences in FS-LASIK and SMILE procedures. In terms of objective visual quality, SMILE induces less aberrations and presents better modulation transfer function and scattering index than FS-LASIK. More research about long-term postoperative stability and optical quality are required for clinical work. (Int Rev Ophthalmol, 2022, 46: 497-501)

Application of micro-monovision in phacoemulsification combined with intraocular lens implantation for  presbyopia corrections of cataract

Tang Tingting, Wan Xiuhua

2022, 46(6):  502-506.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.005

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Micro-monovision is a modified monovision method, which is gradually applied to the cataract surgery. The micro-monovision design can meet the near-distance vision needs of different patients which can correct presbyopia and obtain high-quality binocular full-distance visual acuity during cataract extraction. A    mong the varied types of cataract surgery combined with intraocular lens implantation, micro-monovision has the advantages of high postoperative satisfaction and spectacle independence rate, low surgical cost and safe clinical application. Different types of intraocular lenses can use micro micro-monovision design to provide patients with more satisfactory visual quality. (Int Rev Ophthalmol, 2022, 46:  502-506)

The causes of residual astigmatism after cataract surgery and the influence factors of making astigmatism corrected cataract incision

Wang Zhenyu, Liu Zhaochuan, Song Xudong

2022, 46(6):  507-511.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.006

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The formation of residual astigmatism after cataract surgery is mainly affected by preoperative corneal astigmatism and surgical induced astigmatism. Designing and making incision is one of the main ways to control residual astigmatism after cataract surgery. This method is affected by many factors, such as incision size (width), incision length and depth, incision position, incision structure, and incision healing. The effect of manual incision correction is limited. Femtosecond laserassisted incision making and corneal relaxing are more stable, effective, and clinically applicable. (Int Rev Ophthalmol, 2022, 46: 507-511)

Effects of decentration and tilt on visual quality of different types of functional intraocular lenses

Qian Jiulin, Liao Xuan, Lan Changjun

2022, 46(6):  512-516.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.007

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In the refractive cataract surgery, intraocular lens (IOL) has been developed from traditional spherical surface to aspherical design, and functional IOL with astigmatism correction and presbyopia correction met the different needs of cataract patients, but their tolerance to decentration and tilt is reduced. The IOL with 0 μm spherical aberration is well tolerant of displacement, and the influence of decentration and tilt on the visual quality of aspheric IOL is related to its spherical aberration correction ability and diopter. And the larger negative spherical aberration and the higher diopter of IOL, the greater impact is. Decentration and tilt are part of the sources of errors in the calculation of toric IOL degree, which will reduce its astigmatism correction ability and even cause new astigmatism, resulting in unpredictable visual functional results. Due to the more complex optical design and the division of near-sight and far-sight optical regions of presbyopia correction IOL, decentration and tilt have greater influence on its optical performance and are more prone to cause visual interference. In this article, the effects of decentration and tilt on the visual quality of different types of functional IOLs were reviewed to provide reference for clinical practice. (Int Rev Ophthalmol, 2022, 46:  512-516)

Charles Bonnet syndrome and its research advances

Xu Yilin, Yuan Fei

2022, 46(6):  516-522.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.008

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Charles Bonnet syndrome (CBS) is a kind of visual hallucination disease secondary to visual impairment. Patients generally have complete insight and no mental disorder. The prevalence of CBS is quite low, and it is more common among the elderly. Its pathogenesis remains unclear, but there are well-recognized theories, such as release phenomenon and deafferentation theory. At present, there is no unified diagnostic criteria for CBS, the diagnosis and differential diagnosis are mostly based on clinical features. The main goal of treatment is to restore vision. Ophthalmic treatment is the first choice. (Int Rev Ophthalmol, 2022, 46: 516-522)

Advance in the study of expulsive suprachoroidal hemorrhage

Huang Yi, Hu Haijian, Zhang Xu

2022, 46(6):  522-527. 

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Expulsive suprachoroidal hemorrhage (ESCH) is a rare,  but one of the most severe and frightening complication of intraocular surgery. It may involve the ciliary body,  vitreous,  and retina,  and can cause complete loss of vision. The pathogenesis of ESCH is unclear,  but it is related to choroid tissue composition and blood supply. Previous studies have shown that one of the most important triggers of ESCH is the sudden drop of intraocular pressure,  which often occurs during and after cataract surgery,  glaucoma surgery and vitrectomy.B-scan ultrasonography can diagnose ESCH and observe the degree of coagulation in the suprachoroidal space,  which helps to determine the timing of surgery. Surgery is the most important treatment for ESCH, early suprachoroidal drainage can save the remaining vision,  but the effectiveness of different drainage methods is controversial. ESCH can be effectively avoided by paying attention to the management of risk factors before surgery,  careful operation during surgery and timely detection of suprachoroidal hemorrhage (SCH). (Int Rev Ophthalmol, 2022, 46:  522-527)

Application of optical coherence tomography angiography in detecting diabetic retinopathy

Guo Kailu, He Shan, Hu Ailian

2022, 46(6):  528-534.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.010

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Diabetic retinopathy (DR) is a kind of irreversible blindness caused by diabetes， and the number of patients is increasing year by year.Optical coherence tomography angiography (OCTA) with wider field of view and longer wavelength can display the location and shape of retinal microaneurysms in the three-dimensional space of DR eyes, distinguish retinal microvascular abnormalities and neovascularization,evaluate the activity of neovascularization, and the percentage of chorio capillaris flow deficit can predict the progress of DR. It is beneficial to the early screening and choroidal evaluation of DR patients and is expected to replace FA as a diagnostic tool for DR.OCTA quantitative analysis has the potential to detect DR early and monitor the progress of DR. Moreover，OCTA quantitative data output provides a unique opportunity for artificial intelligence，which is expected to establish a new and more convenient workflow for DR screening, diagnosis, treatment and follow-up. (Int Rev Ophthalmol, 2022, 46: 528-534)

Research progress of the relationship between angiopoietin-like 4 and the pathogenesis of neovascular ocular fundus disease

Wu Dongting, Zheng Lei, Zhang Guoming

2022, 46(6):  535-540.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.011

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Angiopoietin-like 4 (ANGPTL4) is a recently discovered multifunctional protein involved in the regulation of glucose, lipid metabolism, angiogenesis, vascular permeability and other biological processes. ANGPTL4 is closely linked with the mechanism of neovascular ocular fundus disease such as diabetic retinopathy, retinal vascular occlusive disease, and age-related macular degeneration and so on. The expression of ANGPTL4 is up-regulated by high glucose and hypoxia, which induces a series of pathological events occurred including angiogenesis and increase vascular permeability. It is expected to become a diagnostic biomarker and potential therapeutic target for neovascular fundus diseases in the future. (Int Rev Ophthalmol, 2022, 46:  535-540)

Mechanisms of corneal endothelial cell injury related to glaucoma

Zhao Yin, Xu Lijuan, Zhang Xinyao, Liang Yuanbo

2022, 46(6):  541-546.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.012

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Corneal endothelial cell plays a key role in maintaining its transparency. Glaucoma and its treatment may cause damages to the corneal endothelial cells. Intraocular pressure, either too high or too low, could destroy the structure of corneal endothelial cells, as well as their pump function; the implantation and displacement of the drainage devices will damage the corneal endothelial cells; the imbalance of aqueous humor microenvironment will influence the nutrition supply to corneal endothelial cells; the toxicity of anti-glaucoma medicines may contribute to the dysfunction of corneal endothelial cells. This paper summarizes the relevant clinical and basic researches, and discusses the corneal injury mechanisms, aiming to provide guidances for the diagnosis and treatments of glaucoma, and reduce or avoid the visual function damages caused by corneal endothelial cell injury in glaucoma patients. (Int Rev Ophthalmol, 2022, 46:  541-546)

Research progress of transepithelial photorefractive keratectomy

Lin Min, Yao Haoying, Zhang Haorun, Wang Rui, Zhao Jingjing, Fu Mengjun

2022, 46(6):  547-554.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.013

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Transepithelial photorefractive keratectomy is a new corneal surface refractive surgery. It has the characteristics of zero incision, no contact and more accurate cutting. It can reduce apoptosis and postoperative pain, and improve postoperative comfort of patients.TPRK has good safety, efficacy, stability and predictability after correction of myopia and myopic astigmatism.Because there is no need to make corneal flap, the corneal biomechanics are more stable, and introduces less aberration, and acquires better visual quality. However, the prevention of postoperative dry eyes, delayed healing of corneal epithelium, decentered ablation and other related complications prevention still need to be studied and improved. (Int Rev Ophthalmol, 2022, 46: 547-554)

The role of outdoor activities in myopia prevention and control

Gao Yuting, Liu Heting

2022, 46(6):  554-559.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.014

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There are considerable researches to support that outdoor activity is an independent protective factor against myopia and  its protective effect is positively associated with time spent outdoors. Outdoor activity can prevent the onset of myopia, but it is controversial whether it can control the progression of myopia in children and adolescents who are already myopic.The "light-dopamine" hypothesis is the most likely potential biological mechanism for outdoor activities to prevent and control myopia, as outdoor sunlight exposure stimulates the retina to secrete more dopamine, thereby suppressing the elongation of the eye-axis. The large amount of short-wave length light in the outdoor spectrum is focused in front of the retina, which retards myopia progression after receiving this signal. The increased synthesis of vitamin D by the skin in response to sunlight exposure may also play an important role in the prevention and control of myopia by outdoor activities. (Int Rev Ophthalmol, 2022, 46: 554-559)

Tear osmolarity and dry eye disease

Fang Zijie, Zhang Chen, Zhao Shaozhen

2022, 46(6):  559-565.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.015

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Increased tear osmolarity is the prominent manifestation and core mechanism of dry eye disease. It can be measured by a variety of methods such as measurements upon electric impedance. Tear osmolarity fluctuates in a certain range which affected by self and environmental factors. The alteration of tear osmolarity is closely related to dry eye disease caused by multiple reasons. Increased tear osmolarity would cause inflammatory response, cell autophagy and oxidative stress.  Tear osmolarity provides more ideas for exploring the pathogenesis and treatment effect of dry eye. (Int Rev Ophthalmol, 2022, 46:  559-565)

Advances in basic research on gene therapy of corneal diseases mediated by adeno-associated virus

Wang Feng, Lai Jiangfeng, Shao Yi

2022, 46(6):  565-571.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.016

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Adeno Associated Virus (AAV) mediated gene therapy targets genetic material to corneal diseases through gene enhancement, gene deletion and/or gene editing. The accessibility of targeted drug delivery and high transduction efficiency enable AAV mediated gene therapy to effectively treat corneal diseases, including inhibiting corneal neovascularization and improving corneal opacity related to mucopolysaccharosis. To promote the healing of corneal mechanical and chemical injuries, treat infectious keratitis, and effectively transfect corneal endothelial cells to treat congenital hereditary corneal endothelial dystrophy, it provide a new way to treat corneal diseases. (Int Rev Ophthalmol, 2022, 46: 565-571)

Pilomatricoma of the eyelid

Ma Qiannan, Ma Jianmin, Ding Yi

2022, 46(6):  571-576.  doi:10.3760/ cma.j.issn.1673-5803.2022.06.017

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Eyelid pilomatricoma is a benign tumor originating from the stromal cells of the skin follicle and presents primarily as a painless, firm lump, typically composed of basophils cells, shadow cells and transitional cells. The clinical presentation is complex and variable, and the rate of misdiagnosis is relatively high. It is important to note that this disease needs to be distinguished from sebaceous cysts and eyelid hemangiomas from each other. Ultrasound examination is an important method for diagnosing this disease, and histopathology is the "gold standard" for diagnosing this disease. The treatment is mainly surgical resection with a good postoperative prognosis,and optimal treatment has not been found. (Int Rev Ophthalmol, 2022, 46:  571-576)