Table of Content

25 September 2024, Volume 33 Issue 5

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In vivo profile of microstructures of optic nerve head and clinical associations

Huang Houbin

2024, 33(5):  321-328.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.001

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 The complex microstructures of optic nerve head (ONH) can be observed in vivo with the development of optical coherence tomography, which deepens the acknowledgement of many clinical entities. This article elucidates the observable microstructures of ONH such as the marginal tissues of Elschnig and their clinical applications. The etiology, pathophysiological mechanism, nomination, differential diagnosis and prognosis of optovenous collateral is explored and analyzed in depth based on description of blood supply of ONH.  (Ophthalmol CHN, 2024, 33: 321-328)



Investigation on the diagnosis and treatment status and disease burden of glaucoma patients in Hunan Province

Zhang Xinyue, , , Chen Jiawei, , Luo Jun, Liao Sheng, Wu Ping, , Liao Li, , Duan Xuanchu, ,

2024, 33(5):  329-336.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.002

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 Objective To investigate the diagnosis and treatment status, compliance, quality of life and disease burden of glaucoma patients in Hunan Province. Design Questionnaire research. Participants A total of 243 glaucoma outpatients were recruited from the glaucoma clinic of Changsha Aier Eye Hospital, Hengyang Aier Eye Hospital, and Loudi Aier Eye Hospital in Hunan Province from December 25, 2023 to January 31, 2024. Methods The questionnaire from the Blue Book on Comprehensive Prevention and Treatment Management of Glaucoma was used to conduct a simple random sampling survey in the form of an online questionnaire. The questionnaire included the content of demographic information, comprehensive diagnosis and treatment management, patient adherence and quality of life, and disease burden. Main Outcome Measures Statistical description of the patient's diagnosis and treatment status, medication adherence score, quality of life score, and the proportion of visual acuity and visual field impairment. Results Totally, 85.2% of glaucoma patients were diagnosed with glaucoma in tertiary hospitals. 56.5%~57.1% of patients with late-stage visual field damage achieved their target intraocular pressure. 95.9% of glaucoma patients acquired glaucoma knowledge through face-to-face consultation with doctors during hospital visits. 79.4% of patients hoped to receive health education and 74.1% hoped to receive glaucoma screening services. 31.3% of glaucoma patients had a low medication adherence, with the possible factor of forgetting to use eye drops (89.5%). The average quality-of-life score of glaucoma patients was 58.4±9.3 (score ratio: 68.7%), and a significant difference was found inquality-of-life score of patients achieved different treatments (F=4.947, P<0.001). Among them, patients who only received laser treatment had the highest quality of life score, which was 70.2±10.6. Respectively, 72.0% and 67.5% of glaucoma patients had visual impairment and visual field damage on at least one of eyes. 27.2% of glaucoma patients had at least one blind eye, and there was significant difference in visual field damage among different types of glaucoma patients (χ2=11.099, P=0.011). Among them, patients with primary open-angle glaucoma had the highest proportion of visual field damage (78.6%). Conclusions In Hunan Province, glaucoma patients had low education level, medication compliance, and quality of life. They lacked knowledge about glaucoma and ways to acquire glaucoma knowledge. They had a high proportion of visual impairment and blindness. In order to reduce the rate of blindness caused by glaucoma, it is necessary to strengthen the management of glaucoma patients according to the characteristics of glaucoma patients in this region. (Ophthalmol CHN, 2024, 33: 329-336)



Clinical analysis of reoperation after phacoemulsification combined with goniosynechialysis for primary angle-closure glaucoma

Lin Haishuang, Wang Xiaojie, , Li Jiaqian, Ji Yiting, Ding Yutong, Zheng Xuanli, Wan Rui, Zhang Shaodan, Li Guoxing, Liang Yuanbo, Wang Ningli

2024, 33(5):  337-343.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.003

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 Objective To investigate the causes and clinical characteristics of reoperation after phacoemulsification combined with intraocular lens implantation plus goniosynechialysis (PEI-GSL) for primary angle-closure glaucoma (PACG). Design Retrospective case series. Participants 1241 patients (1461 eyes) with PACG who underwent PEI-GSL in the Eye Hospital of Wenzhou from January 1, 2018 to December 31, 2021. Methods The patients' medical records were reviewed to analyze their clinical characteristics, type of reoperation, and reasons for reoperation. Main Outcome Measures  Causes and clinical features of reoperation after PEI-GSL in patients with PACG. Results A total of 1241 PACG patients (1461 eyes) received PEI-GSL during the study period, including 17 patients (19 eyes) who received unplanned reoperation, with an incidence of 1.3%. Uncontrolled intraocular pressure was the main reason for reoperation, accounting for 73.7%. The complications such as residual lens cortex (5.3%), iris incarceration in corneal incision (5.3%), bag collapse (5.3%), deviation of intraocular lens (5.3%) and dilated pupil (5.3%) were the other reasons. The reason for uncontrolled intraocular pressure after PEI-GSL include early angle closure (9 eyes, 64.2%), late angle closure (3 eyes, 21.4%) and trabecular meshwork dysfunction (2 eyes, 14.3%). All patients with early angle closure were women. Among them, 6 eyes were CACG (66.7%), the median outset of uncontrolled intraocular pressure after PEI-GSL was 16 (1, 46.5) days (range: 1~60 days), the average range of anterior chamber angle synechiae before reoperation was (308.3±34.0) ° (range: 240°~360 °), the average central anterior chamber depth was (2.4±0.4) mm (range: 1.7~3.1 mm), and 71.4% of patients had myopia drift. Conclusion The main reason for reoperation after PEI-GSL was uncontrolled intraocular pressure. Patients with early angle closure after PEI-GSL surgery may have anterior displacement of intraocular lens. (Ophthalmol CHN, 2024, 33: 337-343)



Zhou Rongyao, Pu Liping, Qing Guoping

2024, 33(5):  345-349. 

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Objective To observe the clinical effect of Shengmaiyin on normal tension glaucoma (NTG) patients with hypotension. Design Non-randomized controlled trial. Participants Thirty patients with NTG with hypotension were divided into two groups, including 17 patients (33 eyes) in the study group and 13 patients (26 eyes) in the control group. Method The study group was treated with reducing intraocular pressure (IOP) eye drops and oral Shengmaiyin (10 ml, tid), while the control group was treated with reducing IOP eye drops only. IOP, blood pressure and visual field were evaluated at the third and sixth months after continuous treatment for 6 months. Visual field index (VFI) improvement or decline of ≥3% was defined as visual field improvement or decline. Main Outcome Measures  IOP, systolic blood pressure (SBP), diastolic blood pressure (DBP), ocular perfusion pressure (OPP) and visual field index (VFI). Results The average IOP of the study group and the control group was (13.94±2.23) mmHg and (16.80±2.65) mmHg, respectively. After 3 months and 6 months of treatment, the IOP of the study group was increased by (0.17±0.06) mmHg (P=0.744) and 0.22±0.03 mmHg (P=0.468), respectively. The control group decreased by (0.88±0.25) mmHg (P=0.177) and (1.94±0.81) mmHg (P=0.003), respectively. The values of SBP, DBP and OPP in the study group were higher than those before treatment (P=0.012, 0.006, <0.001, <0.001, <0.001, <0.001). There were significant differences compared with the control group (P=0.049, 0.045, <0.001, <0.001, 0.018, 0.033). After 6 months of treatment, the VFI of 21.21% (7 eyes) in the study group increased by≥3%, 78.79% (26 eyes) showed no change, and the VFI of 0 eyes decreased by≥3%, while that of 0 eyes in the control group increased by≥3%, 96.15% (25 eyes) showed no change, and 3.85% (1 eye) visual field VFI decreased by≥3%. After 6 months of treatment, VFI was significantly different from that before treatment (P=0.012). Conclusion Shengmaiyin can increase arterial blood pressure and ocular perfusion pressure in NTG patients with hypotension, as well as improve visual field index. (Ophthalmol CHN, 2024, 33: 345-349)

Clinical characteristics of Vogt-Koyanagi-Harada syndrome in children

Hu Ting, , Peng Xiaoyan, Huang Zhi, Wang Hong, Liu Jinghua, Ma Jing

2024, 33(5):  350-355.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.005

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 Objective To analyze the clinical features of Vogt-Koyanagi-Harada(VKH) syndrome in children. Design Retrospective case series. Participants 9 children (18 eyes) with VKH syndrome. Methods The medical records data were analyzed retrospectively. Main Outcome Measures symptoms, signs, and treatment effects. Results The mean age of onset was (10.8±2.4) years in 9 patients. The average follow-up was (8.1±6.1) months. 7 cases (77.8%) had prodromal symptoms before the onset of the disease, including 3 cases (42.8%) of cold-like symptoms, 2 cases (28.6%) of tinnitus headache, and 2 cases (28.6%) of headache. 2 cases were combined with joint symptoms and recurrent oral ulcers. 3 cases were infected with mycobacterium tuberculosis. One case occurred after measles vaccination. Two cases were treated with adalimumab (ADA), one of which was used in the early stage, and the other was used after 5 months of treatment because of the abnormal choroidal thickness. At the end of follow-up, the uncorrected visual acuity of 14 eyes (77.8%) was ≥0.6 and 4 eyes (22.22%) <0.3, mainly in children whose symptoms appeared more than 30 days after the first systemic corticosteroid treatment. Of the 9 patients, 3 had no complications, and one of them was observed in the early combination treatment with ADA. Conclusion Infection and vaccination may be the inducing factors of VKH syndrome in children. Attention should be paid to the screening of tuberculosis infection before treatment, and the combination of ADA can improve the treatment response. (Ophthalmol CHN, 2024, 33: 350-355)



The preliminary study on effects of progressive adjustment biofeedback training glasses with Alvarez zoom lens on accommodative function in adolescents

Zhen Yi, Huang Yan, An Wenzai, Gao Jie, Wang Ningli

2024, 33(5):  356-361.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.006

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 Objective To evaluate the effectiveness of Alvarez zoom lens-based biofeedback training glasses with progressive accommodation function as a tool for improving accommodative lag and accommodative amplitude in children and adolescents. Design Randomized controlled trial. Participants 32 adolescents aged between 8 and 16 years. Methods Participants were randomly divided into two groups. The training group wore biofeedback training glasses with accommodative function during daily close-up activities, training twice a day for 30 minutes each time. The control group maintained their daily close-up vision habits unchanged. Routine and accommodative function tests were performed before and 4 weeks after training. Accommodative function tests included accommodation response, AC/A, negative relative accommodation, positive relative accommodation, accommodative amplitude, and accommodative facility. Main Outcome Measures Accommodative amplitude and accommodative facility. Results A total of 32 participants were enrolled, including 9 females and 7 males in the training group with a mean age of 9.3±2.8 years and a diopter of -1.36±1.27 D, and 8 females and 8 males in the control group with a mean age of 10.3±2.6 years and a diopter of -0.95±2.18 D. Before training, there was no significant difference in accommodative function test results between the two groups. After four weeks of training, the training group showed significant improvements with an increase in accommodative amplitude by 4.95 D (95% CI: 2.60 to 7.30 D), an increase in accommodative facility by 2.6 cycles per minute (95% CI: 0.8 to 4.4 cycles per minute), a decrease in accommodative lag by 0.66D (95% CI: -1.20 to 0.12 D), and an increase in negative relative accommodation by 0.36 D (95% CI: 0.04 to 0.71 D). No significant changes were observed in the control group. At the end of the trial, the training group had significantly higher accommodative amplitude (t=3.147, P=0.004) and accommodative facility (t=2.527, P=0.017) compared to the control group. Conclusion Alvarez zoom lens-based biofeedback training glasses with progressive accommodation function can improve accommodative amplitude and accommodative response in adolescents. Further studies are warranted to evaluate its impact on the progression of myopia in adolescents. (Ophthalmol CHN, 2024, 33: 356-361)

Investigation of myopia prevalence and influencing factors in preschool children in Beijing Haidian District

Ma Zhangfang, Hou Jin, Mi Xuejing, Chen Wei, Pu Jianing, Jiao Yonghong, Zhang Wanxia

2024, 33(5):  362-366.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.007

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Objective To investigate the prevalence of myopia among 3~6 year old preschool children in Haidian District, Beijing and analyze its influencing factors. Design Cross-sectional study. Participants 1864 preschool children from 27 kindergartens in Haidian District, Beijing. Methods The visual acuity and diopter of the children were tested using LogMAR visual acuity chart and computer optometer which test after cycloplegia with 1.0% cyclopentate hydrochloride. Daily outdoor activity time, daily use time of electronic products, daily total sleep time, reading and writing posture, picky eating, and abnormal eye performance and parents' myopia were collected by questionnaire. Myopia is defined as equivalent spherical ≤-0.50 D. Multivariate logistic regression analysis was used to analyze the influencing factors of myopia.  Main Outcome Measures myopia prevalence, risk factors. Results The prevalence of myopia was 4.61% in the 1864 preschoolers, in which, 5.35% in boys and 3.81% in girls (P＞0.05). Multivariate analysis showed that at least one parent myopia (OR=1.60, P＜0.05), daily outdoor activity time <2 hours (OR=0.03, P＜0.05), daily use of electronic products(OR=1.07, P＜0.05), daily sleep time less than 10 hours (OR=1.89, P＜0.05) and abnormal eye appearance (OR=1.34, P＜0.01) were positively correlated with the prevalence of myopia. Conclusion The prevalence of myopia among preschool children in Beijing Haidian District is about 4.6%. Appropriately increasing outdoor activity time, ensuring sufficient sleep, controlling the use of electronic devices, showing abnormal eye symptoms, and paying more attention to children whose parents have a history of myopia can help prevent and control myopia in preschool children. (Ophthalmol CHN, 2024, 33: 362-366)

Meta-analysis of the effect of parental myopia on children's myopia

Zong Chenxi, Hu Jianping, Jia Hongyan, Jiao Yonghong

2024, 33(5):  368-376.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.008

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Objective To systematically evaluate the effect of parental myopia on children's myopia. Design Meta analysis. Participants 46 Cohort studies, case-control studies and cross-sectional studies which were conducted for the effects of parental myopia on children's myopia. Methods The literatures in Pubmed, Web of science, Embase, CNKI and Wanfang database VIP and Chinese Biomedical literature Database from the January 2000 to September 2023 were searched. The included literature data were analyzed using the STATA (12.0) software package. Main Outcome Measures OR value. Results A total of 46 literatures (273 376 participants) were included, with 13 cohort studies, 5 case-control studies and 28 cross-sectional studies. The OR of giving birth to a child with myopia, according to the prospective cohort, cross-sectional and case-control studies was 1.73(95%CI, 0.96~3.13),2.05(95%CI, 1.74~2.42),2.51(95%CI,2.28~2.76). When one parent had myopia, the OR was 2.00(95%CI, 1.84~2.18), respectively, when two parents had myopia, the OR was 2.90(95%CI, 2.46-3.42). Conclusion There is a significant positive correlation between parental myopia and the risk of myopia in children. Myopia in one or both parents significantly increases the risk of myopia in their children. Children with myopia in both parents have a higher risk of myopia compared to those with myopia in one parent. (Ophthalmol CHN, 2024, 33: 368-376)

Research on the accuracy of intraocular lens calculation formulas in short eyes based on IOLMaster700

Li Jiao, Wang Weiwei, Xu Qianqian, Guo Lin, Liu Jianrong

2024, 33(5):  377-381.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.009

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 Objective To investigate the accuracy of intraocular lens (IOL) power prediction formulas in patients with short eyes (axial length <22.00 mm). Design Prospective case series study. Participants 51 patients (56 eyes) with short axial length who underwent phacoemulsification and posterior chamber single-piece monofocal IOL implantation surgery at Xi'an People's Hospital from December 2021 to May 2023. Methods The axial length, corneal curvature, central anterior chamber depth, and lens thickness were measured with IOLMaster700. Postoperative refractive error was predicted using Holladay2, Haigis, and Barrett Universal II formulas. The best corrected visual acuity was converted into LogMAR visual acuity for statistical analysis. Subjective optometry examination was performed at 3 months postoperatively. The errors in predicting refraction using the Haigis, Holladay 2, and Barrett Universal II formulas were compared. Main Outcome Measures Refractive prediction error and absolute prediction error. Results The average central anterior chamber depth preoperatively was (2.2±0.2) mm, which significantly increased to (3.8±0.3) mm at 3 months postoperatively (t=25.7, P<0.001). There were no statistically significant differences in prediction error and absolute prediction error among the three formulas (all P>0.05). The Haigis formula showed 76.9% of prediction errors distributed within ±0.50 D, which was better than the Holladay 2 formula (50.0% within ±0.50 D) and the Barrett Universal II formula (57.6% within ±0.50 D). Conclusion The accuracy of IOL formulas (Haigis, Holladay 2, Barrett Universal II) based on IOLMaster700 is relatively high in patients with short axial length. (Ophthalmol CHN, 2024, 33: 377-381)


The establishment and initial application of the SMILE multi-level progressive teaching method

Lin Wen, Lu Yuehao, Wu Wenting

2024, 33(5):  387-390.  doi:10.13281/j.cnki.issn.1004-4469.2024.05.011

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Objective To establish the SMILE multi-level progressive teaching method and evaluate its preliminary application effect. Design Retrospective comparative teaching study. Participants A total of 7 surgeons received SMILE training in Fuzhou Southeast Eye Hospital. Among them, the training from 2019 to 2021 was organized and implemented by the clinical application specialist of SMILE equipment supplier, with a total of 5 surgeons (the first group), and 2 surgeons (the second group) received the SMILE multi-level progressive teaching training since April 2022. Methods The multi-level progressive teaching process of SMILE was divided into two parts: theoretical training and skill training. The skill training included two modules: femtosecond laser flap making skills and SMILE operating skills. The operating skills module was further divided into two stages: lens scanning and lens extraction. The whole training process is completed under the real-time guidance of the instructor, mainly clinical cases. Main Outcome Measures Surgical complications and their incidence, naked eye visual acuity and diopter the next day after surgery. Results Following training, the first group completed respective numbers of SMILE surgeries at their respective posts by June 2023: 60, 130, 224, 300, and 320 eyes, with complication rates of 6.67%, 3.85%, 16.1%, 2.3%, and 3.75%, respectively. The second group independently completed 45 and 143 SMILE surgeries, respectively, with complication rates of 0% and 1.39%. In the second group, the overall distribution of spherical and cylindrical mirrors on the next day after SMILE was similar to the early and recent results of the instructor, and the vision results of the next day after SMILE were better than those of the instructor (P=0.048), but there was no significant difference in visual acuity on the next day (P=0.086). Conclusions The SMILE multi-level progressive teaching training can effectively solve the teaching difficulty, shorten the learning curve, and fully guarantee the safety and effectiveness of SMILE. (Ophthalmol CHN, 2024, 33: 387-390)