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    Short-term efficacy comparison of intravitreal aflibercept and dexamethasone sustained-release implantin on macular edema secondary to central retinal vein occlusion
    Liu Yuhui, Wang Bei, Liu Gang
    Ophthalmology in China    2023, 32 (3): 197-201.  
    Abstract896)            Save
    Objective To compare and analyze the short-term clinical efficacy of intravitreal aflibercept and dexamethasone(DEX) sustained-releaseimplant on macular edema (ME) secondary to central retinal vein occlusion (CRVO). Design Retrospective case series. Participants Thirty-six patients diagnosed with CRVO-ME in Nanjing Lishui People's Hospital from October 2018 to June 2021. Methods According to different therapeutic drugs, two groups were divided: aflibercept group (intravitreal aflibercept 0.5 mg) 17 cases (17 eyes), and DEX group (intravitreal DEX sustained-releaseimplant 0.7 mg) 19 cases (19 eyes). Clinical data between the two groups before surgery and 1, 2, 3, and 6 months after surgery, including best corrected visual acuity (BCVA), serous retinal detachment height (SRDH), central retinal thickness (CRT), photoreceptor layer thickness (PLT), and intraocular pressure (IOP) were analyzed. Main Outcome Measures BCVA, SRDH, CRT, PLT, IOP. Results There was no statistically significant difference in preoperative BCVA, SRDH, CRT, PLT, and IOP between the two groups (all P>0.05). One month after surgery, the BCVA, SRDH, CRT, and PLT of the two groups were better than before surgery (all P<0.05), and there was no statistically significant difference between the two groups (all P>0.05). At 2 and 3 months after surgery, the SRDH in the DEX group was significantly lower than that of the aflibercept group (P=0.021, 0.017, respectively), however, there was no significant statistical difference in BCVA, CRT, and PLT between the two groups (all P>0.05). At 6 months after surgery, the CRT in the aflibercept group was lower than that of the DEX group, the PLT was significantly higher than that of the DEX group, and the BCVA was better than that of the DEX group (P=0.005, 0.029, 0.036, respectively). There was no statistically significant difference in SRDH between the two groups (P=0.054). Conclusion Intravitreal aflibercept and DEX were proven effective for the patients with CRVO-ME, which significantly improve SRDH and CRT, and achieve visual benefits. Intravitreal DEX has better short-term efficacy in reducing SRD, with longer treatment intervals, while intravitreal aflibercept can maintain better visual outcomes during the treatment period. (Ophthalmol CHN, 2023, 32: 197-201)
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    Surgical choice of retinal retinal detachment below PVR C1 in intraocular lens eyes
    Yu Yajie, Zheng Pengfei, Zhang Ke, Zhou Haiying, Liu Wu
    Ophthalmology in China    2023, 32 (3): 192-196.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.003
    Abstract874)            Save
    Objective To observe and compare the anatomical and functional outcome of scleral buckling (SB) and pars plana vitrectomy (PPV) to treat the rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C1 below in the intraocular lens (IOL) eyes. Design Retrospective case series. Participants 156 patients (156 eyes) with IOL diagnosed as RRD at the south district of Beijing Tongren Hospital were enrolled. Methods Review the patient records. According to the method of surgery, all patients included were divided into SB group (44 eyes) and PPV group (112 eyes). The general characteristics, left/right eyes, retinal detachment duration, number and shape of retinal holes, and the stage of PVR were recorded for both groups. The rate of retinal reattachment (after primary and final surgery), best corrected visual acuity (BCVA), and secondary surgery were observed and compared between the two groups at 6 months after surgery. We also analyzed the reasons for the second surgery. Main Outcome Measures The rate of retinal reattachment, BCVA, and secondary surgery at 6 months after primary surgery. Results There was no difference in gender, left/ right eyes, retinal detachment duration, number and shape of retinal holes, and the stage of (PVR) between SB group and PPV group (all P>0.05). The rate of retina reattachment after the initial surgery was 77.3% (34/44) in SB group, and 92.9% (104/112) in PPV group (χ2=7.52,P=0.006). The secondary PPV was underwent for the patients without retinal reattachment, and finally, all of them achieved anatomical success. In the cases with unattached retina after the primary surgery in SB group, except for one new retinal hole, the rest retinal holes were all located on the encircling ridge. The absence of retina reattachment was associated with the progression of PVR. In the PPV group, the unattached retina after the primary surgery was also associated with postoperative PVR. The BCVA (LogMAR) before and after surgery in the SB group were 1.1 (0.70, 1.80) and 0.75 (0.50, 1.00), respectively (P=0.003). And in PPV group, the BCVA (LogMAR) before and after surgery were 1.9 (1.53, 1.90) and 0.7 (0.50, 1.00), respectively (P<0.001). There was no statistically significant difference in postoperative BCVA between these two groups (P=0.35). Conclusion For RRD with PVR less severe than grade C1 in IOL eyes, postoperative PVR is an important factor that affects the success rate of surgery. Although SB can achieve good surgical efficiency, PPV is superior to SB surgery in terms of retinal reattachment rate. (Ophthalmol CHN, 2023, 32: 192-196)
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    Clinical and imaging characteristics analysis of toxoplasmic retinochoroiditis
    Mao Yu, Cao Xusheng, Mo Bin, Peng Xiaoyan
    Ophthalmology in China    2023, 32 (3): 202-207.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.005
    Abstract790)            Save
    Objective To investigate the clinical and imaging features of toxoplasmic retinochoroiditis. Design Retrospective case series. Participants Six cases (6 eyes) with toxoplasmic retinochoroiditis patients in Beijing Tongren Hospital from Aug. 2017 to Sep. 2022. Methods Best corrected visual acuity (BCVA), slit lamp ophthalmoscopy, indirect ophthalmoscopy, fundus fluorescein angiography (FFA), indocyanine green fundus angiography (ICGA) and optical coherence tomography (OCT) were undergone. Goldmann-witmer coefficient and PCR assay in the ocular fluid were also recorded. All patients were treated with systemic antibiotics and corticosteroids for 4~6 weeks and followed up for 2~24 months. Main Outcome Measures Features of the fundus, FFA, ICGA and OCT. Results All patients had unilateral onset. The fundus showed a single and active focus with yellow-white focal retinochoroiditis, accompanied by vitritis. Two of the 6 cases had retinal vascular white sheath and 1 had an old lesion. Lesions in 4 cases were located in the posterior pole, while 2 were in the nasal mid-periphery. Three of the 6 cases had inflammation in anterior chamber. Lesion sizes ranged from (0.5×0.5) PD to (3.0×4.0) PD. The BCVA of the affected eye ranged from counting fingers to 0.5. The lesion appears as hypofluorescent or slightly hyperfluorescent in the early phase and showed varying degrees of fluorescence leakage in the late phase on FFA. Five cases had retinal vascular leakage and 4 had hyperfluorescence leakage of the optic disc in late stage. The lesions were consistently hypofluorescent on ICGA. OCT showed that lesions in 4 cases involved the entire layer of the retina, which were thickened and hyperreflective. Meanwhiles, choroid was thickened and single hyporeflective choroidal nodule could be found. The remaining 2 cases showed localized retinal thinning, and the inner retinal layer was collapsed with cavities. All 6 patients had macular epiretinal membrane or epiretinal membrane, including 1 case with vitreomacular traction. All 6 patients showed reduced activity of lesions after treatment, and no recurrence was observed during the follow-up period. Conclusion The typical presentation of toxoplasmic retinochoroiditis is a unilateral, focal yellow-white lesion in posterior pole with vitritis. OCT shows involved the entire layer of the retina with the possibility of choroidal nodules. Clinical and imaging examinations can effectively diagnose the typical cases. (Ophthalmol CHN, 2023, 32: 202-207)
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    Study on the synergistic effect of 0.05 D precision full correction technique and defocus incorporated multiple segments technique in delaying the progress of myopia
    Zhen Yi, Cao Kai, Gao Jie, Wang Ningli
    Ophthalmology in China    2023, 32 (4): 282-286.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.003
    Abstract714)            Save
     Objective To observe whether there is a synergistic effect between 0.05 D precise full correction technology and defocus incorporated multiple segments technology in delaying myopia progression. Design Pretrospective comparative case series. Participants 241 children who underwent frame glasses fitting at Optometry Center of Beijing Tongren Hospital from 2020 to 2022. Method According to the lens chosen by the parents, 241 children were fitted with 0.05 D spherical interval single vision group (63 cases), 0.25 D spherical interval single vision group (57 cases), 0.25 D spherical interval defocus group (61 cases), and 0.05 D spherical interval defocus group(60 cases). The fitting data including age, gender, refractive error, interval time between the two refractions, lens type of the above children in the electronic medical record system was retrospective analyzed. The refraction methods and environment of the four groups of patients were consistent, and the only difference was whether 0.05 D precise full correction technology was used in the central area of the frame eyeglasses and whether defocus incorporated multiple segments technology was used in the periphery of the lens. The data of the right eye were analyzed statistically. Main Outcome Measures Equivalent spherical change. Results The ages of the 0.25 D spherical interval single vision group, the 0.05 D interval single vision lens group, the 0.25 D spherical interval defocus group, and the 0.05 D interval defocus group were not significantly different (F=0.996, P=0.320). The mean equivalent spherical degrees at the first visit were (-2.10±1.77) D, (-2.00±1.34) D, (-1.97±0.89) D, and (-2.03±0.88) D, respectively (F=0.118, P=0.949). After 6 months of wearing glasses, the equivalent spherical changes in the four groups of patients were (-0.51±0.52) D, (-0.31±0.35) D, (-0.31±0.27) D, and (-0.15±0.26) D, respectively (F=9.503, P<0.001). The equivalent spherical changes in the 0.05 D interval single vision group (P=0.003), the 0.25 D interval defocus group (P=0.004), and the 0.05 D interval defocus group (P<0.001) were significantly smaller than those in the 0.25 D spherical interval single vision group. There was no significant difference in equivalent spherical changes between the 0.05 D interval single vision group and the 0.25 D interval defocus group (P=0.932). The equivalent spherical change in the 0.05 D interval defocus group was significantly smaller than that in the 0.05 D interval single vision group (P=0.018) and the 0.25 D interval defocus group (P=0.015). Conclusion 0.05 D precise full correction technology and defocus incorporated multiple segments technology showed a synergistic effect in delaying myopia progression due to different mechanisms of action. (Ophthalmol CHN, 2023, 32: 282-286)
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    Vitreous-related spaces and its clinical associations
    Huang Houbin
    Ophthalmology in China    2023, 32 (3): 177-181.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.001
    Abstract704)      PDF(pc) (1404KB)(2290)       Save
    Several spaces and structures are formed in vitreous interface with adjacent tissues, including Hannover's canal, Petit's canal, Cloquet's canal, Wieger's ligament, Berger's space, Erggelet's space, Martegiani's space and premacular bursa. It is of much importance to make clear these spaces for elucidating the pathogenesis and pathophysiological processes of some entities or lesions, such as lens dislocation following acute episode of glaucoma, maligment glaucoma, posterior vitreous detachment, formation of macular hole, etc. (Ophthalmol CHN, 2023, 32: 177-181)
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    Prognosis of large avascular PED
    Mo Bin, Ji Haixia, Zhou Haiying, Liu Wu
    Ophthalmology in China    2023, 32 (3): 217-221.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.007
    Abstract688)            Save
    Objective To observe and analyze the changes and prognostic characteristics of large avascular retinal pigment detachment (aPED) associated with dry age-related macular degeneration (AMD). Design Retrospective case series. Participants 17 eyes of 15 cases diagnosed with large (the maximum horizontal diameter of PED is greater than 1500 μm, the height is greater than 165 μm) aPED in dry AMD at Beijing Tongren Eye Center from January 2013 to January 2023. Methods We retrospectively analyzed the patients’ medical records, and the average follow-up time was (19.76±17.39) months. The characteristics of OCT, including choroid thickness, PED height, PED width, RPE collapse, hyperplasia of RPE, inner retinal capsules, hyperreflective foci, subretinal fluid, RPE laceration, geograghic atrophy (GA), neovascularization, and the changes of best corrected visual acuity (BCVA) were evaluated. Main Outcome Measures The BCVA, the choroidal thickness and the height and width of PED measured by OCT. Results At baseline, LogMAR BCVA was 0.55±0.31, the mean choroidal thickness of the macular center was (237.29±77.39) μm, the mean height of PED was (476.67±313.83) μm, and the mean width of PED was (3268.17±1482.28) μm. At the last follow-up, LogMAR BCVA was 0.70±0.34, which was significant worse than that at baseline (t=-2.842, P=0.012). In 5 eyes with PED collapse at baseline, 4 eyes had GA, another 1 eye had the RPE proliferation aggravated and RPE collapse, and had inner retinal capsules during the follow-up. One eye with retinal inner capsule at baseline appeared GA during the follow-up. There were 6 eyes (35.29%) with increased height and width of PED, of which 5 eyes had increased proliferation of RPE and 1 eye had no significant change; there were 4 eyes (23.53%) with the width of PED bottom diameter increasing and the height decreasing, all of which had the collapse of PED; RPE laceration occurred in one eye (5.89%); There was no obvious change in 2 eyes (11.76%), and no neovascularization was seen. At the last follow-up, the mean choroidal thickness of the macular center was (223.12±67.53) μm, which was no significant difference with the baseline. There were 12 cases with PED at the last follow-up which the mean height of PED was (370.08±242.25) μm, and the mean width of PED was (3545.17±1313.10) μm.There was no significant difference with the baseline (t=1.409、-2.105, P=0.186、0.059). Conclusion For large aPED associated with dry AMD, its natural prognosis is mostly transformed into GA, which seriously affects the vision of patients. The collapse of RPE and the appearance of retinal inner capsule can be used as biomarkers for the progress of the disease. Clinicians should pay enough attention to the mand increase the number of follow-up visits so as to detect the changes of the disease as soon as possible. (Ophthalmol CHN, 2023, 32: 217-221)
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    Genotype and clinical characteristics of ocular albinism and oculocutaneous albinism in China
    Li Nien, Zhong Junwei, You Bing, Xu Ke, Zhang Xiaohui, Yan Weiyu, Xie Yue, Zhang Xin, Li Yang
    Ophthalmology in China    2023, 32 (3): 182-191.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.002
    Abstract680)      PDF(pc) (3172KB)(2274)       Save
    Objective To analyze the genetic and clinical characteristics of Chinese patients with albinism-related gene variants, and to compare the clinical manifestations between ocular albinism (OA1) and oculocutaneous albinism (OCA). Design Retrospective case series. Participants 32 patients (from 28 families) with pathogenic variants in albinism-related genes collected from Beijing Tongren Hospital. Methods All patients underwent detailed ophthalmic examinations, including best-corrected visual acuity (BCVA), anterior segment photography, color fundus photography and optical coherence tomography (OCT). The pigmentation of skin and hair was also recorded. Genomic DNA was extracted from peripheral venous blood samples of the proband, his immediate family members and affected family members. Sanger sequencing, targeted exome sequencing (TES) and real-time quantitative polymerase chain reaction (PCR) was used to identify pathogenic variants. Multiple bioinformatics analysis software was used to predict the pathogenicity of the variants and co-segregation verification was performed. Main Outcome Measures Pathogenic variants, BCVA, nystagmus, foveal hypoplasia (FH) grade, pigmentation of eye, skin and hair. Results A total of 33 pathogenic variants in 7 genes (GPR143, OCA2, TYR, LRMDA, HPS1, HPS6 and SLC45A2) were detected in 32 patients, of which 8 were novel variants. There were 18 OA1 patients with GPR143 gene variants and 14 OCA patients with the other 6 genes variants. These patients all had varying degrees of vision loss, fundus hypopigmentation and FH. All but two patients had congenital nystagmus. The iris color of OA1 patients was darker, the FH grade was mainly 1~2, and no skin or hair hypopigmentation was found. OCA patients had diverse iris and fundus pigmentation, and most of them had varying degrees of skin and hair hypopigmentation. Patients with syndromic OCA were also associated with blood or immune system abnormalities. The two patients without nystagmus had mild visual impairment and FH. There were significant differences in iris and fundus pigmentation between OA1 patients and OCA patients. Conclusion This study preliminarily described the pathogenic gene composition of Chinese patients with albinism and expanded the variant spectrum of each gene. It was found that the degree of iris hypopigmentation was mild in OA1 patients, while the ocular and systemic pigmentation was highly variable in OCA patients. No obvious genotype-phenotype relationship was found. Genetic testing is essential for definitive diagnosis of atypical patients. (Ophthalmol CHN, 2023, 32: 182-191)
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    Clinical efficacy after FS-LASIK myopia correction guided by 0.05 D optometry
    Jia Yong, Zhang Baike, Liao Sha, Shen Jiafan, Guo Lisha, Tian Xuemin, Li Qiaoyun
    Ophthalmology in China    2023, 32 (4): 289-293.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.004
    Abstract671)            Save
     Objective To evaluate clinical efficacy after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) myopia correction guided by 0.05 D optometry. Design Retrospective case series. Participants From July 2021 to March 2022, a total of 355 eyes of 178 myopic patients who underwent FS-LASIK surgery were collected in No.988 Hospital of Joint Logistic Support Force of PLA. Methods The medical records of patients were reviewed. The optometry test modality was determined by patients, and all patients were divided into the 0.05 D group (89 cases 177 eyes) and the 0.25 D group (89 cases 178 eyes) according to the method of optometry. The 0.05 D group used 0.05 D optometry method to measure preoperative diopter; meanwhile, the 0.25 D group used 0.25 D optometry method to measure preoperative diopter. All patients underwent FS-LASIK with Zeimer LDV-Z2 and Zeiss Mel-80. The actual corneal ablation depth of the both groups and the corneal ablation depth simulated by 0.25 D optometry of the 0.05 D group were recorded. The patients were followed up for 6 months. And the visual quality questionnaire was conducted at 6 months postoperatively. Main Outcome Measures Visual acuity (LogMAR), diopter, corneal ablation depth, central corneal thickness (CCT), and visual quality questionnaire score. Results The actual corneal ablation depth of the 0.05 D group was (84.98±15.60) μm, which was slightly higher than (78.14±17.68) μm simulated by 0.25 D optometry of the 0.05 D group and (75.42±17.14) μm of the 0.25 D group (all P<0.001). There was no significant difference in the corneal ablation depth between simulated by 0.25 D optometry of the 0.05 D group and the 0.25 D group (P=0.129). The CCT of the both groups after surgery was significantly lower than that preoperative (t=72.459, P<0.001, t=58.693, P<0.001), and there was no significant difference in the CCT between the both groups after surgery (t=-1.890, P=0.060). At 3 months and 6 months after surgery, the uncorrected visual acuity (UCVA) of the 0.05 D group were -0.056±0.498, -0.061±0.479, which were better than 0.003±0.566, -0.002±0.530 of the 0.25 D group (all P<0.001). At 6 months after surgery, the percentage of UCVA better than preoperative best corrected visual acuity (BCVA) of the 0.05 D group was 67.80%, which was higher than 17.42% of the 0.25 D group (P<0.001). Among the adverse visual symptoms, the incidence of glare was the highest and the incidence of distortion was the lowest in the both groups. The incidence of asthenopia of the 0.05 D group was 1.7%, which was less than 6.7% of the 0.25 D group (P=0.018). There was no significant difference in the incidence of other symptoms. The asthenopia and total score of the 0.05 D group were significantly lower than those of the 0.25 D group (U=-2.032, P=0.042, U=-2.247, P=0.025). There was no significant difference in the scores of the questionnaire of other symptoms. Conclusion Compared with 0.25 D optometry, 0.05 D optometry can significantly improve visual acuity and subjective visual quality after FS-LASIK, and has the same surgical safety. (Ophthalmol CHN, 2023, 32: 289-293)
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    Study on fixation stability of intermittent exotropia in children
    Huang Weidong, Yang Xubo
    Ophthalmology in China    2023, 32 (4): 310-315.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.008
    Abstract667)            Save
     Objective To compare the differences in fixative eye movements and saccadic eye movements between children with intermittent exotropia and normal children. Design Case-control study. Participants Children attending the strabismus and amblyopia outpatient clinic at West China Hospital, including 31 cases of intermittent exotropia and 22 normal children. Methods All subjects watched the screen at a distance of 80 cm from the computer display screen, and used the visual biological information stimulation technology-enhanced vision eye tracker software, and used its augmented reality technology to collect and analyze binocular fixation and saccadic eye movements. Tobii Eye Tracker 5 4C eye tracking device captures the orientation and trajectory of eyeball movement, and it was performed under corrected state for those with ametropia. Main Outcome Measures Corrected visual acuity, refractive error, prism diopters of strabismus, horizontal deviation of fixation point, vertical deviation of fixation point. Results In terms fixation eye movement, significant differences were observed between the intermittent exotropia group and the normal group in the directions of upper-right, straight-right, and lower-left gaze. The deviations of fixation points were significant in the horizontal direction for straight-right (Z=-2.764, P=0.006) and in the vertical direction for lower-left (Z=-2.112, P=0.035), while both horizontal (Z=-2.266, P=0.023) and vertical deviations (Z=-2.113, P=0.035) were significant for upper-right gaze points. In terms of saccadic eye movement, the intermittent exotropia group glanced at the beginning of the first line (Z=-2.140, P=0.032) and the end of the line (Z=-2.573, P=0.010), the beginning of the second line (Z=- 2.907, P=0.004) and the end of the line (Z=-2.365, P=0.018), the end of the third line (Z=-3.268, P=0.001), the beginning of the fourth line (Z=-2.022, P=0.043), there was an obvious offset in the horizontal direction; when scanning the first line (Z=-2.527, P=0.011) and the end of the line (Z=-2.031, P=0.042), the third line end (Z=-2.257, P=0.024), and the fourth row head (Z=-2.826, P=0.005), the intermittent exotropia group had a significant shift in the vertical direction. In the third row, there were significant differences in the vertical deviation of fixation positions at the beginning and end of the row (Z=-2.858, P=0.004). Conclusion Children with intermittent exotropia have different degrees of impairment in both fixation eye movement and saccadic eye movement compared to normal children. (Ophthalmol CHN, 2023, 32: 310-315)
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    Analysis of the prognosis of visual function in blinding neuromyelitis optica spectrum disorders associated with optic neuritis
    Yang Qinglin, Sun Houliang, Meng Chao, Wang Jiawei
    Ophthalmology in China    2023, 32 (5): 392-396.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.006
    Abstract662)            Save
     Objective To analyze the clinical and immunological features of blinding neuromyelitis optica spectrum disorders associated optic neuritis, and to explore the predictive factors of visual function prognosis. Design Retrospective case series. Participants Patients with blinding neuromyelitis optica spectrum disorders related optic neuritis admitted to our department from 2018 to 2022 were enrolled. Methods The patients were divided into poor prognosis group (27 cases) and good prognosis group (18 cases). The demographic characteristics, symptoms, laboratory and imaging examinations, treatment methods, and visual acuity improvement at 6 months after treatment were compared between the two groups. Main Outcome Measures Clinical features, visual acuity improvement. Results In the poor prognosis group, the proportion of patients with optic nerve involvement longer than half was higher (P=0.009), the positive rate of serum immune antibody was lower (P=0.028), and the time from onset to methylprednisolone pulse therapy was longer (P=0.032). Logistic regression showed that the length of optic nerve involvement greater than 1/2 (OR=16.247, 95%CI: 10.834-24.363, P<0.01), serological immune antibody negative (OR=13.965, 95%CI: 9.465-20.603, P<0.01), the time from onset of methylprednisolone pulse therapy (OR=1.107, 95%CI: 1.075-1.139, P<0.01) were the risk factors for poor prognosis. ROC curve analysis showed that the area under the ROC curve (AUC) for predicting poor prognosis was 0.794 (P=0.001, 95%CI: 0.659-0.928) when the time from onset was more than 7 days. Conclusions The prognosis of blinding neuromyelitis optica spectrum disorders associated with optic neuritis is poor, and the duration of methylprednisolone pulse therapy is closely related to the prognosis. (Ophthalmol CHN, 2023, 32: 392-396)
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    12 months efficacy of adalimumab for the treatment of refractory juvenile idiopathic arthritis associated uveitis
    Shen Zhijun, Shen Lin, Cao Xusheng, Li Lin, Wang Hong
    Ophthalmology in China    2023, 32 (4): 320-325.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.010
    Abstract648)            Save
     Objective To evaluate the efficacy and safety of adalimumab (ADA) for the treatment of juvenile idiopathic arthritis (JIA) associated uveitis. Design Retrospective case series. Participants 16 patients (28 eyes) with refractory JIA related uveitis who were treated with ADA in Beijing Tongren Hospital from June 2020 to September 2021. 10 cases (18 eyes) presented anterior uveitis, and 6 cases (10 eyes) presented panuveitis. Methods The outpatient medical records of patients were analyzed. All patients underwent ADA subcutaneous injection treatment. For individuals with weight ≥30 kg, the initial dose was 80 mg, and thereafter every 2 weeks, with a dose of 40 mg each time, and the dose was half for those with weight <30 kg. After inflammation was controlled, the dosage of glucocorticoids and immunosuppressants were gradually decreased. Main Outcome Measures Cells and flare in anterior chamber, and vitreous haze, visual acuity, changes of glucocorticoid and immunosuppressant dosage, and side effects of ADA. Results The inflammation of uveitis in all suffered eyes was controlled within 3~6 months after ADA treatment, and the inflammatory cells and flare in anterior chamber, and vitreous haze were all reduced from 2+~3+ to 0~1+. No recurrence was observed after follow-up for ≥12 months. After uveitis was controlled stably with ADA treatment, 8 of 10 patients with anterior uveitis completely stopped all medicines, and the other 2 patients stopped taking immunosuppressants. 4 of 6 patients with panuveitis stopped taking glucocorticoid, only taking immunosuppressants and ADA, and the other 2 patients had reduced the dosage of glucocorticoid and immunosuppressants. After ADA treatment, the visual acuity of 20/28 eyes improved by≥2 lines, and the visual acuity of 8/28 eyes improved by ≥1 line. No serious eye or systemic side effects were observed. Conclusion ADA is effective and safe for the treatment of refractory JIA associated uveitis and can reduce the dosage of systemic glucocorticoids and immunosuppressants. (Ophthalmol CHN, 2023, 32: 320-325)
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    Evaluation of orthokeratology fitting status using deep learning algorithm
    Song Hongxin, Cao Jingwen, Niu Kai, He Zhiqiang
    Ophthalmology in China    2023, 32 (4): 305-309.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.007
    Abstract647)            Save
     Objective To develop an automatic and objective quantification algorithm based on fluorescein patterns to evaluate the fitting status of orthokeratology. Design Diagnose test. Participants Ortho-k lens fitting video with fluorescein patterns from 360 subjects during 2022 from Beijing Tongren Hospital. Methods A deep learning algorithm based on an attention mechanism to analyze the fluorescein patterns video was used. The algorithm used key frames of the fluorescein patterns video to capture static morphological information of the ortho-K lens, while the video as a whole was considered comprehensively to obtain dynamic information such as ortho-K lens mobility. The algorithm adopted a two-stage structure, first classifying the tight fitting samples, and based on this result, further classifying the fit and loose fitting samples, the results were compared with the evaluation standard agreed by the 5 experienced optometrists. Main Outcome Measures Sensitivity, diagnosis accuracy, consistency with ophthalmologists’ results. Results In the validation set, our proposed algorithm achieved a classification accuracy of 82%, a sensitivity of 80%, and a specificity of 85% in the first stage of the classification task of fitting tight samples. In the second stage, the model can classify the remaining two types of samples with a correct rate of 88%, a sensitivity of 85% and a specificity of 93%. In the end, the correct rate of classification results for each category could reached more than 80%, which was highly consistent with the judgment given by optometrists. Compared with the results of human evaluation, the results of computer algorithms had a high degree of matching and better repeatability. Conclusions Using the deep learning algorithm based on the attention mechanism, we developed automatic algorithm for automatic analysis of the fluorescein patterns video of orthokeratology, which can make objective judgments about the fitting status of orthokeratology. (Ophthalmol CHN, 2023, 32: 305-309)
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    Study of myopic animal model induced by illuminance under constrained visual range
    Zhang Kaixue, Fang Wenqing, Chen Juan, Zhang Youming, Yang Chaopu, Jin Han, Chen Taiyang, Huang Sanxiao, Zhou Penghui
    Ophthalmology in China    2023, 32 (4): 294-298.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.005
    Abstract617)            Save
    Objective To study the effect of different illumination on the development of axial length in chicks with visual distance restriction. Design Experiment study.  Participants Sixty 10-day-old chicks.  Methods Chicks were randomly divided into 5 groups with 12 chicks in each group. One group was the control group and the others were the experimental groups. Using the greedy and phototaxis of the chicken to food, the visual distance of the chicken was more naturally restricted. Four groups of chickens were raised in four sets of self-made myopia induction devices, which could keep the visual distance within about 5 cm with the growth of chicks. The illuminances of the experimental groups were set at 0.5 Lx, 5 Lx, 50 Lx, and 500 Lx, respectively. The control group was reared in the natural light environment near the window without restricting the visual distance. When the chickens were 50 days old, the axial length of the eyes was measured by A-scan. The refraction was measured by retinoscope in the dark room and under non-local anesthesia. The weight was measured by electronic scale and the abnormal growth of axial length was calculated. The relationship between this value and diopter was analyzed. Main Outcome Measured Axial length, axial increase, diopter. Results There was a linear relationship between axial length and body weight in the control group (R2=0.89). When the chicken were 50 days old, the abnormal axial growth of 0.5 Lx, 5 Lx, 50 Lx and 500 Lx groups were 0.60 mm, 0.30 mm, 0.75 mm and 0.80 mm, respectively. There were significant differences in the increase of axial length among 5 Lx group and 0.5 Lx group, 50 Lx group, 500 Lx group (P=0.033, 0.001, 0.003). There was a linear proportional relationship between diopter and abnormal axial growth (R2=0.74). Conclusion The model can significantly induce axial myopia in chicks. Illumination had a significant effect on the increase of abnormal axial growth. The increase of abnormal axial growth was the smallest at 5 Lx and the largest at 500 Lx.  (Ophthalmol CHN, 2023, 32: 294-298)
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    The ocular manifestations of patients with neurofibromatosis type 1
    Liang Xiaofang, Wang Kaiyue, Yang Liu, Zhang Xuxiang
    Ophthalmology in China    2023, 32 (5): 421-424.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.011
    Abstract615)            Save
     Objective To investigate the ocular clinical manifestations of patients with neurofibromatosis type 1 (NF1). Design Retrospective case series. Participants 17 cases (34 eyes) of NF1 in Beijing Tiantan Hospital from October 2021 to February 2022. Methods Clinical data of 17 patients diagnosed with NF1 were retrospectively analyzed. All patients underwent detailed ophthalmic examination and related general check-up. Main outcome measures The incidence of iris hamartoma and ocular and systemic related clinical manifestations. Results 17 patients ranged in age from 10 to 52 years were enrolled in this study, including 9 males (18 eyes) and 8 females (16 eyes). The best corrected vision acuities were from no light perception to 1.2. The intraocular pressures of all patients were normal. 11 patients (64.7%) suffered iris hamartomatain of both eyes, presenting as light brown to dark brown slightly raised nodules with clear boundaries, and ranged in number from 3 to 25, with diameters ranging from 0.5 mm to 1.5 mm. Their positions ranged from close to the pupil margin to any part of the iris, 73.3% distributed on inferior part of the iris. One patient suffered eyelid and orbital plexiform neurofibroma and one patient suffered choroidal abnormalities. The systemic manifestations also included milk coffee spots and neurofibroma of multiple types, and 12 cases combined with axillary groin freckles. Conclusion We found that 65% of patients presented with iris hamartoma of both eyes, which was manifested as brown micro-raised nodules of varying size and number. Iris hamartoma is one of the most important clinical manifestations of NF1, and this study provides a reference for clinicians to fully understand NF1 and determine the disease condition and classification. (Ophthalmol CHN, 2023, 32: 421-424)
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    Measurement of tarsal plate width and characteristic analysis of tarsal development in Chinese Han children with epiblepharon#br#
    #br#
    Wang Yue, Du Baopu, Hou Zhijia, Li Lei, Zhang Zheng
    Ophthalmology in China    2023, 32 (4): 316-319.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.009
    Abstract610)            Save
     Objective To measure the width of the upper and lower tarsal plates of China Han children with epiblepharon, and analyze their growth and development characteristics. Design Prospective case series. Participants From 2018 to 2022, 258 cases (516 eyes) of children with lower epiblepharon aged 2~13 years in Beijing Tongren Hospital were included. Methods Before the general anesthesia operation, the width of the upper and lower tarsal plates was measured by a steel ruler with an accuracy of 0.5 mm under the operating microscope. Upper eyelid medial tarsal plate width, upper eyelid central tarsal plate width, upper eyelid pupil temporal margin tarsal plate width, upper eyelid lateral tarsal plate width, lower eyelid medial tarsal width, lower eyelid central tarsal width, lower eyelid lateral tarsal width were included. Main Outcome Measures  Tarsal plate width.  Results The average width of the upper tarsal plate of 258 children was (4.76±0.74) mm for the medial tarsal plate, (8.05±0.70) mm for the central tarsal plate, (8.47±0.74) mm for the pupil temporal margin tarsal plate and (7.07±0.78) mm for the lateral tarsal plate. The average width of the lower tarsal plate was (3.18±0.49) mm for the medial tarsal plate, (3.87±0.51) mm for the central tarsal plate and (3.84±0.54) mm for the lateral tarsal plate respectively. There was no significant difference between male and female in children's upper and lower tarsal plate width. The width of central tarsal plate of the upper eyelid was (7.71± 0.46) mm in the 0~3 years group (n=21), (7.95±0.65) mm in the 4~6 years group (n=147), (8.25±0.70) mm in the 7~9 years group (n=72) and (8.59±0.94) mm in the 10~13 years group (n=17). The width of the tarsal plate in the center of the lower eyelid was (3.74±0.44) mm in 0~3 years old group, (3.84±0.52) mm in 4~6 years old group, (3.94±0.52) mm in 7~9 years old group and (4.06±0.46) mm in 10~13 years old group. Conclusions The growth and development speed of the upper eyelid tarsal plate is faster in China Han children with epiblepharon, reaching the widest at the age of 10~13, while the development of the lower eyelid tarsal plate is relatively slow. The tarsal plate at the temporal edge of the pupil is the widest, followed by the central tarsal plate of the upper eyelid, and the medial tarsal plate of the upper eyelid is the narrowest. This difference should be taken into account during eyelid surgery in children. (Ophthalmol CHN, 2023, 32: 316-319)
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    Fundus characteristics in patients with acquired immune deficiency syndrome complicated with cytomegalovirus retinitis at different periods
    Ye Hongli, Jiao Kangwei, Yan Pingjing, Zhang Qihang, Zhao Jie, Feng Xiaoxiao, Liu Jun, Xiao Libo
    Ophthalmology in China    2023, 32 (4): 326-331.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.011
    Abstract599)            Save
    Objective To observe ultra-wide angle fundus photography and optical coherence tomography (OCT) characteristics in patients with acquired immune deficiency syndrome(AIDS) complicated with cytomegalovirus retinitis (CMVR) at different periods. Design Retrospective case series. Participants 14 patients (22 eyes) diagnosed with AIDS complicated with CMVR from the Affiliated Hospital of Yunnan University and the Third People's Hospital of Kunming from January 2019 to June 2022. Methods The patient's medical records were reviewed. The characteristics of fundus and OCT images at different stages of CMVR, as well as the CD4+T lymphocytes (CD4) and blood CMV-DNA levels at corresponding stages were analyzed. Follow up was for 6~30 months. Main Outcome Measures CD4 value, fundus photography and OCT image features. Results All patients were in the acute stage of CMVR at the time of initial diagnosis, including 2 cases (3 eyes) in the initial stage of CMVR and 12 cases (19 eyes) in the active stage. The mean CD4 value in acute stage was (32.26±25.7)/μL at first diagnosis, and the manifestations of CMVR in initial stage were <1 DD yellow-white granular lesions. OCT showed no thickening of retina but full layer destruction. During the active stage, the fundus showed large yellow and white cheesy exudation accompanied by bleeding, and OCT showed significant thickening of retina at all levels and high reflexes. In 12 cases (19 eyes), there were 9 cases (15 eyes) of interlayer punctuated strong reflexes, 4 cases (6 eyes) of outer layer punctuated strong reflexes, 12 cases (15 eyes) of lesions involved the macular region, and 3 cases (3 eyes) of macular edema. Epiretinal membrane in 12 cases (18 eyes), vitreous inflammatory cells in 11 cases (16 eyes). During follow-up, the mean CD4 in remission period was (380.4±85.2)/μL. Grey and white scars of fundus were in 13 cases (20 eyes). Retinal atrophy and thinning in the lesion area were observed on OCT, and retinal detachment was observed in 1 case (2 eyes). Conclusion The fundus of AIDS patients with CMVR showed different manifestations at different periods, such as yellow and white granular lesions, tomato and cheese lesions, and gray-white cicatricial lesions. OCT showed significant hyperreflective thickening, thinning and atrophy of retina. (Ophthalmol CHN, 2023, 32: 326-331)
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    Ocular metastatic carcinoma
    Zhu Yu, Li Yanyan
    Ophthalmology in China    2023, 32 (5): 381-386.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.004
    Abstract583)      PDF(pc) (1216KB)(1218)       Save
     With the aging of society and the improvement of medical level, the number of people with tumor in society is increasing, and the number of patients with ocular metastatic cancer is also increasing, and 30% to 50% of the patients have the primary tumor site detected after the first symptom of the eye. Therefore, for middle-aged and elderly people, the ocular space-occupying lesion should be analyzed whether it is the primary tumor or metastatic cancer, and the cause should be found as soon as possible for the corresponding treatment. This article introduces the common primary foci, clinical manifestations and imaging features of the choroidal and orbital metastases, the diagnostic procedures, treatment methods and prognosis of ocular metastases. (Ophthalmol CHN, 2023, 32: 381-386
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    Clinical study on the effects of posterior corneal astigmatism (PA) on Toric intraocular lens (IOLs) cylinder calculation 
    Jin Tianru, Li Jingjing, Yu Lan, Zhou Yanwen
    Ophthalmology in China    2023, 32 (5): 397-402.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.007
    Abstract572)            Save
     Objective To assess the effects of selecting keratometer astigmatism (KA) or total corneal astigmatism (TCA) as a reference on toric IOL calculation among subjects with age-related cataract and high posterior corneal astigmatism (PA). Design A retrospective comparative case series. Participants The present study included 77 eyes with against the role astigmatism (ATR) from age-related cataract patients and measured PA of more than 0.5 D in Aier Eye Hospital (Shenyang) from June 2017 to December 2021. Method The subjects were randomly divided into the KA and TCA groups and each group selected KA and TCA for toric IOL cylinder power calculations with Alcon Acrysoft Toric online calculator (https://www.acrysoftoriccalculator.com/). Holladay formula was choose to calculate the IOL cylinder power by using TCA and Barrett formula was choose to calculate the IOL cylinder power by using KA. Main Outcome Measures The uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), subjective refraction, magnitude of error (ME) and correction index (CI) and the centroid error in predicted residual astigmatism in two groups. Results The postoperative UCVA in the KA and TCA groups were 0.14±0.80 logMAR and 0.15±0.72 logMAR, respectively, whereas the difference between the two groups was not statistically significant(t=0.79, P=0.718). The subjective refraction stigmatism value in the KA group was similar to that noted in the TCA group (KA group: -0.27±0.92 D, TCA group: -0.40±0.64 D, t=-0.55, P=0.582). The ME value was 0.33±0.33 D in the KA group and -0.22±0.52 D in the TCA group, suggesting postoperative undercorrection in KA group and overcorrection in TCA group. The absolute ME values of the two groups were not statistically significant (t=-0.46, P=0.542). According to the double-angle plot, the postoperative refractive prediction errors were 0.49±0.56 at 175° and 0.13±0.71 at 10°. The postoperative refractive astigmatism prediction error in KA group (48%) was similar with TCA group (43%) in <0.5 D. Conclusions In the eyes of high PA, the choice of TCA for Toric IOL lens calculation will lead to mild overcorrection and postoperative with the role astigmatism, which is an ideal refractive state. (Ophthalmol CHN, 2023, 32: 397-402)
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    Ophthalmology in China    2023, 32 (4): 286-288.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.015
    Abstract562)            Save
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    Effect of blue-blocking display mode screen on digital eye fatigue
    Zhang Wei, Zhen Yi, Du Lihua, Wang Ningli
    Ophthalmology in China    2023, 32 (4): 299-304.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.006
    Abstract560)            Save
     Objective To compare the difference of digital eye strain between blue-blocking mode and normal mode screen when using for reading task. Design A two-stage cross-designed clinical trial. Participants 74 healthy subjects aged 18~36 years old. Methods The subjects were randomly divided into two groups. 38 subjects (group 1) used normal mode first, and then used blue-blocking mode (400-500 nm 33.9% attenuated) to perform a 40-minute text reading. The second group (36 subjects) performed the task in the reverse order. The corrected visual acuity of the subjects was examined using a standard visual acuity chart. An open-field auto refractor was used to measure the refraction and accommodative lag. The subject's critical flicker frequency (CFF) was measured using a flash fusion frequency meter. These data were recorded within 3 minutes before and after reading. Likert scale was used to record subjective eye strain scores before and after reading. Reading efficiency was defined as a product of reading accuracy and reading rate per minute. Main Outcome Measures Refraction, corrected visual acuity, accommodative lag, critical flicker frequency, eye strain scale score, reading efficiency. Results Using normal mode, the diopter before and after reading was (-0.26±0.47) D and (-0.26±0.49) D, respectively (P=0.742); The accommodative lag before and after reading was (0.94±0.36) D and (1.05±0.42) D, respectively (P=0.002); The corrected visual acuity was 1.04 (1.0, 1.2), 1.03 (1.0, 1.2), respectively (P=0.058); The CFF was (29.03±2.84) Hz and (29.07±3.03) Hz, respectively (P=0.731). The subjective score of eye strain before and after reading was 0.73 (0, 1.00) and 2.04(1.00, 3.00), respectively (P<0.001). The mean value of eye strain score increased after reading, and the difference was statistically significant. Using blue-blocking mode, the diopter before and after reading was (-0.21±0.49) D and (-0.25±0.48) D, respectively (P=0.144), the accommodative lag was (0.98±0.39) D and (1.03±0.43) D, respectively (P=0.109), and the corrected visual acuity was 1.05 (1.0, 1.2), 1.04 (1.0, 1.2), respectively (P=0.096). The critical flicker frequency was (29.06±2.91) Hz and (29.15±3.08) Hz, respectively (P=0.432). The subjective score of eye strain before and after reading was 0.81 (0, 1.00), 1.64 (1.00, 2.00), respectively (P<0.001). The mean value of eye strain score increased after reading, and the difference was statistically significant. Cross analysis were applied for comparing the variation of ocular parameters caused by these two modes and the reading efficiency difference. There were no significant differences in the variations of refraction variation (P=0.447), accommodative lag (P=0.124), corrected visual acuity (P=0.356), CFF (P=0.687), reading efficiency (P=0.817). There was a significant difference for eye strain score (P=0.015) between these two groups. Conclusion Compared with reading using normal mode screen,blue-blocking mode did not cause obvious changes in objective refractive parameters of the human eye, and the subjective digital eye strain is lower for 40 minutes intense concentration text reading. (Ophthalmol CHN, 2023, 32: 299-304)
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    A survey on distant visual acuity test performed by nurses in ophthalmic specialized training of China
    Xing Jingyu, Luo Mingyue, Zhang Dingding, Kang Weijuan, Zhao Jialiang
    Ophthalmology in China    2023, 32 (4): 275-280.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.002
    Abstract558)            Save
     Objective To investigate the current status of distance visual acuity testing among ophthalmic nurses in China, and to provide a reference for further standardization of distance visual acuity testing and training of clinical nurses. Design A cross-sectional questionnaire survey. Participants 34 directors and 781 ophthalmic clinical nurses from 34 ophthalmic nursing training bases nationwide. Methods A survey questionnaire was designed based on the Chinese National Standard for the Standard Logarithmic Visual Acuity Chart (GB11533-2011). The survey was conducted using the questionnaire Star App and the collected data was analyzed. Main Outcome Measures The training and assessment of distance visual acuity testing, the knowledge of ophthalmic nurses on the National Standard for the Standard Logarithmic Visual Acuity Chart, and the distance, height, and illumination for distance visual acuity measurement. Results 21 hospitals (61.8%) had training materials and qualification test, 5 hospitals (14.7%) had no training materials and test, 8 hospitals (23.5%) had qualification test, but no relevant training materials. 31 hospitals (91.2%) had operating standards for distant visual acuity test, and the remaining 3 hospitals (8.8%) had no operating standards. 24 hospitals (70.6%) departments were equipped with standard logarithmic vision charts, 8 hospitals (23.5%) departments did not have standard logarithmic vision charts, and 2 hospitals (5.9%) did not know the National Standard. 84.6% of the nurses knew the National Standard and 15.4% did not. Operation without certification (OR=3.93, 95%CI: 1.77~8.73, P=0.0022) and only one remote vision chart (OR=1.84, 95%CI: 1.18~2.87, P=0.0072) were independent risk factors for the nurses not knowing the National Standard. Conclusion The standardized management level of distant visual acuity test of nurses needs to be improved, and the standardized training of distant visual acuity test by nurses needs to be strengthened. At present, it is urgent to standardize the operation procedures of distant visual acuity test nationwide. (Ophthalmol CHN, 2023, 32: 275-280)
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    Establishment of immortalized human scleral fibroblast cell line
    Li Jiaying, Li Peng, Cheng Zhen, Wang Wenbin, Li Shiming, Tian Jiaxin, Qi Yue, Qian Yuyang, Liu Zihan, Wang Ningli
    Ophthalmology in China    2023, 32 (5): 387-391.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.005
    Abstract557)            Save
     Objective To establish an immortalized human scleral fibroblast cell line and analyze the effect of immortalization using transcriptome sequencing. Design Experimental study. Participants The experimental group was immortalized human scleral fibroblasts, and the control group was primary human scleral fibroblasts. Methods Lentiviral particles were obtained by transfection of HEK293T using calcium phosphate transfection method using plasmid carrying SV40 T gene and lenti-Mix lentivirus packaging plasmid. The obtained lentiviral particles were transfected with primary cells and exposed to puromycin containing 1 μg/ml for 2 days, and the surviving cells were continued to be cultured for 25 generations to obtain immortalized human scleral fibroblast cell lines. Afterward, total RNA of primary human scleral fibroblasts and immortalized human scleral fibroblasts were extracted and sequenced to analyze the transcript characteristics of immortalized cells and primary cells. Differential genes were analyzed using the DESeq package and gene ontology (GO) analysis was performed using Clusterprofiler.  Main Outcome Measures Cell morphology, collagen-related gene expression and transcript correlation. Results Immortalized human scleral fibroblasts maintained the morphology of the primary cells and showed significantly enhanced proliferation ability and were successfully cultured for more than 20 generations. The transcriptomes of the immortalized and primary cells were highly similar, and the correlation between the two was r2=0.995 obtained by RNA sequencing. The transcriptome yielded 22903 genes and 33691 isoforms, and the eifferential gene analysis based on DESeq package revealed that 2063 (3.6%) genes were up-regulated and 2776 (4.9%) genes were down-regulated. GO functional analysis showed that the up-regulated genes were mainly clustered in DNA replication, cell division and other basic cellular metabolic activities and interactions with viruses, while the down-regulated genes were mainly enriched in extracellular matrix regulation and intercellular junction pathways. As for the extracellular matrix-related gene pathways, transcription of genes encoding collagen and fibronectin was slightly downregulated (log2 fold change=-0.4~-3.1), and COL1A1 transcription was downregulated 3.34-fold. Conclusion In this study, an immortalized human scleral fibroblast cell line was constructed by introducing SV40T exogenous gene using lentiviral transfection method, with high similarity to primary cells and good stability, which can provide sufficient research material for sclera-related experiments. (Ophthalmol CHN, 2023, 32: 387-391)
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    Application of a new type crystal adjuster on viscoelastics free implantable collamer lens implantation
    Chu Huiying, Tong Fengfeng, Yuan Bin
    Ophthalmology in China    2023, 32 (3): 240-244.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.011
    Abstract555)            Save
    Objective To observe the clinical efficacy of viscoelastic free implantable collamer lens (ICL) implantation assisted with a new type crystal adjuster. Design Retrospective case series. Participants 142 eyes of eighty-one patients who have done ICL V4C lens implanted surgery in Huzhou Aier Eye Hospital. Methods 142 eyes were divided into two groups: group of applied with viscoelastic (viscoelastic group, 72 eyes), and group of applied without viscoelastic (viscoelastic free group, 70 eyes). Intraocular pressure was measured before operation, and 2, 4, 6 hours, 1 day, 1 week, 1 , 3 , 6 months after operation; corneal endothelial cell count, corneal endothelial hexagonal cell ratio, vault height, and uncorrected visual acuity (UCVA) were measured before operation, and 1 week, 1, 3, 6 months after operation. The operation time were recorded during the operation. The differences of the above indicators during and after the operation were compared between the two groups. Main Outcome Measures Operation time, corneal endothelial cell count, corneal endothelial cell hexagonal cell ratio, vault height, UCVA, and intraocular pressure. Results The operation time of the viscoelastic free group and the viscoelastic group was 9.91±1.75 minutes and 18.90±8.93 minutes, respectively (t=-7.658, P<0.01). There was no significant difference in postoperative UCVA and postoperative vault height between the two groups. At 2, 4 hours after operation, the intraocular pressures of the viscoelastic free group and the viscoelastic group was (15.61±3.24) mmHg, (14.41±3.38) mmHg and (20.68±5.33) mmHg, (18.26±4.71) mmHg, respectively (All P<0.001); at 6 hours after operation, the intraocular pressures of the viscoelastic free group and the viscoelastic group was (14.48±3.54) mmHg and (16.59±4.05) mmHg, respectively (P=0.003). There was no significant difference in corneal endothelial cell counts between the two groups postoperatively. Conclusion The ICL implantation without viscoelastic agent assisted by the new lens positioner is safe and effective. It simplifies the process of surgery and reduces the high intraocular pressure caused by viscoelastics. (Ophthalmol CHN, 2023, 32: 240-244)
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    Orbital solitary fibrous tumors: a single-institution study of 38 cases
    Zhao Hongshu, Shi Jitong
    Ophthalmology in China    2023, 32 (3): 208-214.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.006
    Abstract552)            Save
    Objective To analyze the clinical manifestations, surgical options and prognosis of primary solitary fibrous tumors (SFTs) of orbit. Design Retrospective cases series. Participants 38 cases of primary orbital SFTs confirmed by pathology from 2017 to 2022 in Beijing Tongren Hospital. Methods The course of the disease, symptoms, signs, imaging and histopathology, as well as follow-up and survival data were analyzed. And recurrence free survival (RFS) and overall survival (OS) were analyzed by Kaplan-Meier curve. Main Outcome Measures Visual acuity, clinical symptoms and signs, pathological features, recurrence, and survival. Results The median age of initial cases and recurrent cases was 37 years (5~65 years) and 64.5 years (41~81 years), respectively (P=0.000). The sensitivity of preoperative imaging examination for SFTs was 22.58%, and the misdiagnosis rate was 41.93%. Pathological examination showed that 97.37% of all SFTs tumors were CD34 positive, and all tumors were STAT6 positive (100%). The mean course of disease of 37 patients with follow-up data was 8.6±7.6 years (1.9~31.0 years), and the mean course of disease of 16 patients with recurrence was 15.1±7.8 years (3.9~31.0 years). The mean interval between the first operation and the last operation was 12.7±7.9 years (1.3~29.7 years). The 36 patients with survival data (excluding biopsy and one case of lost follow-up) had 91.67% OS and RFS after surgery (first operation for primary cases, last operation for recurrent cases), and the mean follow-up time was 2.3±1.4 years (0.1~5.8 years) and 2.4±1.9 years (0.0~5.8 years), respectively. Of the 10 cases of malignant SFTs, 4 cases received postoperative radiotherapy and no recurrence was reported. 6 cases did not receive radiotherapy, of which 1 case relapsed and died, and 5 cases had no relapse at present. 3 cases recurred, of which 1 was malignant and 2 benign. Three cases died, of which two were tumor-related. Conclusion Most primary cases of orbital SFTs occur in young adults. Both benign and malignant orbital SFTs can recurs and spread to the intracranial easily. Extensive intracranial spread of benign SFTs can also lead to death. Imaging examination may misdiagnose SFTs as other tumors. (Ophthalmol CHN, 2023, 32: 208-214)
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    Anomalous posterior vitreous detachment
    Huang Houbin
    Ophthalmology in China    2023, 32 (5): 369-375.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.002
    Abstract550)      PDF(pc) (1891KB)(1251)       Save
     Other than innocuous posterior vitreous detachment (PVD), anomalous PVD indicates partial adhesion of posterior vitreous cortex to retina inner limiting membrane, or remnants of posterior vitreous cortex on the surface of inner limiting membrane. Anomalous PVD can result in vitreoschisis, retinal breaks, etc. The residual vitreous cortex could be fibrous with few cells or cell-rich, which are highly associated with the pathogeneses of full-thickness macular hole, lamellar macular hole, pseudomacular hole and epimacular membrane. (Ophthalmol CHN, 2023, 32: 369-375)
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    Focal scleral nodules
    Ran Zhenlong, Peng Xiaoyan
    Ophthalmology in China    2023, 32 (5): 376-380.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.003
    Abstract536)      PDF(pc) (1141KB)(1572)       Save
    Solitary idiopathic choroiditis (SIC) has been renamed as focal scleral nodule (FSN) based on multimodal imaging findings. FSN presents as yellow-white elevated nodules located between the posterior pole and the equator of the fundus. It exhibits hyperautofluorescent and hyperechogeneic characteristics. On optical coherence tomography (OCT), FSN appears as a highly reflective mass protruding inward from the sclera, and OCT angiography confirms the absence of blood flow within the lesion. FSN can remain stable over a long period without requiring treatment. But it can be misdiagnosed as amelanotic choroidal lesions, especially when there is suspicion of choroidal metastasis. Accurate identification of FSN contributes to making correct clinical decisions for ophthalmologists. This article elucidates the nomenclature process, demographic distribution, multimodal imaging features, and differential diagnosis of FSN. (Ophthalmol CHN, 2023, 32: 376-380)
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    Clinical characteristics of central retinal artery occlusion in 35 patients with internal carotid artery stenosis
    Li Jiebin, Li Songfeng, Gui Yu, Zhang Jing, Ding Ning
    Ophthalmology in China    2023, 32 (4): 332-337.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.012
    Abstract535)            Save
    Objective To compare the clinical characteristics of central retinal artery occlusion (CRAO) in patients with or without internal carotid artery stenosis (ICAS). Design Retrospective case series. Participants 92 patients with CRAO treated in Beijing Tongren Hospital from 2014 to 2021. Methods Thirty five patients (35 eyes) who had CRAO with ICAS formed CRAO-ICAS group and the other 57 patients (57 eyes) who only had CRAO formed CRAO-NICAS group. Demographic factors, clinical symptoms, vascular risk factors, internal medicine comorbidities, laboratory parameters and imaging examinations, treatment, 1-week and 1-year visual acuity improvement after treatment, and 1-year follow-up vascular events (e.g., ischemic stroke, acute myocardial infarction, death) were analyzed by comparing the two groups. Main Outcome Measures Clinical features, visual acuity improvement, 1-year follow-up vascular events. Results There was no statistically difference between CRAO-ICAS group and CRAO-NICAS group in affected eye, visual field defect, increased intraocular pressure, history of smoking, history of family cardiovascular and cerebrovascular disease, history of coronary artery disease, diabetes and atrial fibrillation (all P>0.05). Male (OR=5.765, P=0.003), hyperlipidemia (OR=3.638, P=0.028), hypertension (OR=3.769, P=0.020) were the independent risk factors for CRAO with ICAS. Compared with the CRAO-NICAS group, the CRAO-ICAS group was characterized by the higher rates of transient amaurosis before the onset, and acute cerebral infarction, and the difference were statistically significant (?字2=5.845, P=0.016; ?字2=9.563, P=0.004). The visual acuity was significantly improved in 12 cases (44.4%) of the 27 patients with CRAO-ICAS at 1 week after thrombolysis via super-selective ophthalmic artery catheterization, partially improved in 5 cases above 0.1, 1 case above 0.5 at 1 year of follow-up, furthermore improved in 2 new cases. The visual acuity was significantly improved in 19 cases(47.5%) of the 40 patients with CRAO-NICAS at 1 week after thrombolysis, partially improved in 7 cases above 0.5 at 1 year of follow-up. The visual acuity was significantly improved by early thrombolytic therapy (<24 h) in patients with CRAO-ICAS (?字2=9.258, P=0.002) and CRAO-NICAS (?字2=10.639, P=0.001). One year follow-up after treatment, there were 9 cases (25.7%) of vascular events (8 cases of cerebral infarction and 1 case of myocardial infarction) in CRAO-ICAS group, and 5 cases (8.8%) of cerebral infarction in CRAO-NICAS group, and the difference were statistically significant (?字2=4.825, P=0.038). Conclusions The visual recovery is relatively better by the thrombolysis via super-selective ophthalmic cartery catheterization within 24 hours of symptom onset both CRAO with ICAS and CRAO without ICAS. The patients of CRAO-ICAS have the higher rates of acute cerebral infarction at symptom onset and cerebrovascular and cardiovascular events at 1 year of follow-up. (Ophthalmol CHN, 2023, 32: 332-337)
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    Effect of abnormal vertical fixation disparity on stereoacuity in intermittent exotropia
    Hong Jie, Fu Jing, Ma Nan, Meng Zhaojun, Zhao Bowen, Li Lei
    Ophthalmology in China    2023, 32 (3): 228-232.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.009
    Abstract532)            Save
    Objective To analyze the abnormal vertical fixation disparity which coexists with intermittent exotropia (IXT) and its influence on stereoacuity. Design Case control study. Participants 104 newly diagnosed IXT patients and 128 controls in Beijing Tongren Hospital from Jul 2016 to Feb 2017 were involved. Methods Perceptual eye position (PEP) test was performed on normal controls to get normal range (<x+1.64 s). The IXT patients were divided into two groups according to whether their vertical PEP exceeded normal range abnormal vertical PEP (group and normal vertical PEP group). Stereoacuity was measured for both near and medium distances. The differences of stereoacuity were compared between the two groups. Main Outcome Measures PEP test, stereoacuity measured for both near and medium distances. Results The near and medium distance stereopsis were better in normal vertical PEP group (2.21±0.34, 2.09±0.23) than abnormal vertical PEP group (2.40±0.44;2.25±0.31) (t=-2.43, P=0.02;t=-2.97, P<0.01, respectively). However, no statistic differences were found between the two groups in age (P=0.19), interocular difference in spherical equivalent (P=0.12), near and far horizontal deviation (P=0.53, 0.38), break point of fusional divergence (P=0.70) and fusional vergences (P=0.94), fusion range (P=0.70). Conclusion Abnormal vertical fixation disparity coexisting with IXT may aggravates the damage of stereoacuity. (Ophthalmol CHN, 2023, 32: 228-232)
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    Structures of vitreoretinal interface and their clinical significance
    Huang Houbin
    Ophthalmology in China    2023, 32 (4): 265-274.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.001
    Abstract527)            Save
     Vitreoretinal interface consists of posterior vitreous cortex, retina internal limiting membrane, and extracellular matrix. Basement membrane-like complex is formed in the interface, especially in some special locations, such as vitreous base, optic disc margin, retinal vessels, macular foveola, and some pathologic lesions. With aging, the posterior margin of vitreous base extends posteriorly, internal limiting membrane thickens and its elasticity decreases, the adhesion in vitreoretinal interface weakens, and posterior vitreous detachment develops. To fully recognize the interface and its age-related changes is of much importance for understanding the pathophysiology and treatment strategy of some diseases. (Ophthalmol CHN, 2023, 32: 265-274)
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    Surgical strategy of angle closure glaucoma secondary to lens subluxation 
    Yu Xiaowei, Fan Zhigang, Shi Yan
    Ophthalmology in China    2023, 32 (5): 363-368.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.001
    Abstract525)      PDF(pc) (1085KB)(1239)       Save
     Angle closure glaucoma (ACG) secondary to lens subluxation is a clinical problem with complex etiology. Its essential anatomic change in its pathogenesis is zonulopathies caused by various reasons. Based on the anatomical characteristics and pathophysiological functions of zonule, this article reconceptualizes the adjacent tissue complex of the zonule, and proposes that the change of pressure between the adjacent tissue complex caused by zonulopathies is the key to understand the physiological process of ACG secondary to lens subluxation. Based on the pathogenesis of various types of lens subluxation and the pathophysiological process of complex pressure change, we can understand the ocular phenotype of zonulopathy and predict its possible surgical risks. Further, we propose four modular treatment methods to make apersonalized treatment for ACG secondary to lens subluxation, including the treatment of aqueous humor countercurrent, lens extraction, maintenance of long-term stability of intraocular lens and reconstruction of angle filtration, which provides guidance for the scientific treatment strategy of this kind of refractory glaucoma. (Ophthalmol CHN, 2023, 32: 363-368)
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    Causes and management of reoperation after implantable collamer lens implantation
    Mu Yanxiao, Qiao Mingchao, Li Yan, Wang Kaifang, Wang Xiaoming
    Ophthalmology in China    2023, 32 (3): 245-250.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.012
    Abstract516)            Save
    Objective To observe the causes leading to reoperation after the implantation of phakic posterior chamber implantable collamer lens (PPC-ICL), also known as implantable collamer lens(ICL), and to explore the potential treatment options and preventive measures. Design Retrospective case series. Participants 8 patients (11 eyes) required reoperation due to a variety of reasons, whom out of 342 patients (669 eyes) who underwent PPC-ICL implantation at Jinan Mingshui Eye Hospital from July 2019 to April 2022. Methods The medical records were reviewed, and the examining general conditions and ocular data including refractive error, anterior chamber depth, corneal diameter, ciliary sulcus diameter, ICL data, vault hight, and reasons for reoperation were recorded. The time, management, and prognosis of these reoperations were also assessed. The reasons for reoperation, potential treatment options and preventive measures were discussed. Main Outcome Measures The reasons for reoperation, the time of reoperation, treatment methods, and prognosis. Results In the 11 reoperated eyes, five were implanted of regular ICLs and six were implanted of Toric ICLs (TICLs), which were all implanted horizontally. The reasons for the reoperation were the ICL rotation and the abnormal vault hight. Three TICLs experienced rotation and had to be repositioned. The mean vault hight measured before the reoperation was (1.28±0.14) mm, which subsequently decreased to (0.73±0.12) mm post-reoperation (P<0.05). In one particular case, a lower vault was executed and a larger size ICL was chosen in the reoperation. However, there was not a significant change in the vault after the operation. Conclusion The common reasons prompting reoperation after PPC-ICL implantation includes abnormal postoperative vault height and ICL rotation, for which alignment or replacement surgery proves effective. Preoperative accurate examination and measurement, combining multiple examination results, improving the predictability of vault height, selecting the appropriate ICL size, and avoiding accidental injury may be the possible countermeasures to prevent the reoperation. (Ophthalmol CHN, 2023, 32: 245-250)
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    Ophthalmology in China    2023, 32 (5): 430-430.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.013
    Abstract514)      PDF(pc) (218KB)(1192)       Save
    剥脱性青光眼;房角镜辅助360°小梁切开术 
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    Efficacy of improved pars plana vitreous drainage in the combined surgery of glaucoma and cataract for angle closure #br# glaucoma with abnormal lens suspensory ligament#br#
    Yin Ruimei, Chen Lin, Wang Tao
    Ophthalmology in China    2023, 32 (5): 403-408.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.008
    Abstract511)            Save
    Objective To analyze the therapeutic effect of improved pars plana vitreous drainage in the combined surgery of glaucoma and cataract for angle closure glaucoma with abnormal lens suspensory ligament. Design Retrospective case series. Participants 18 patients (18 eyes) with angle closure glaucoma with abnormal lens suspension ligament were reviewed from January 2021 to February 2023 in Beijing Tongren Hospital. Methods All patients were treated with improved pars plana vitreous drainage, phacoemulsification and cataract extraction. All patients were implanted with intraocular lens (IOL) in the bag at the first stage. All patients were treated with wide base peripheral iridectomy. 11 patients were implanted with capsular tension ring, 5 patients with trabeculectomy, and 3 patients with ciliary body photocoagulation under endoscope. The average postoperative follow-up was (8.3±3.6) months. Main Outcome Measures Anterior chamber depth (ACD), visual acuity (VA), intraocular pressure (IOP), number of anti glaucoma drugs used, and surgical complications. Result At the last follow-up, all patients' VA improved compared to before surgery, with an average improvement of (3.7±2.2) lines on the standard VA chart. 16/18 eyes maintained 7~21 mmHg without the use of IOP lowering drugs and 2/18 eyes maintained normal IOP 6 months after surgery with the addition of a local IOP lowering drug. After the improved pars plana vitreous drainage, all patients had a decrease in IOP during surgery, and the ACD deepened compared to before drainage. No serious complications occurred during or after the surgery in all patients. Conclusion The improved pars plana vitreous drainage is a safe and effective method for the combined surgery of glaucoma and cataract in the treatment of angle closure glaucoma with abnormal lens suspensory ligament. (Ophthalmol CHN, 2023, 32: 403-408)
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    Ophthalmology in China    2023, 32 (3): 232-.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.019
    Abstract510)      PDF(pc) (135KB)(2184)       Save
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    Efficacy of phototherapeutic keratectomy combined with ocular surface intervention for recurrent corneal erosion
    Luo Jiajing, Duan Hucheng, Chen Rui, Lv Yiyang, Lv Hongling, Yan Shigang, Kong Xiangbin
    Ophthalmology in China    2023, 32 (4): 339-343.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.04.013
    Abstract510)            Save
     Objective To observe the clinical efficacy of laser therapeutic keratectomy combined with ocular surface intervention in recurrent corneal epithelial erosion (RCE). Design  Retrospective case series. Participants 52 cases (52 eyes) with RCE diagnosed in the Second People's Hospital of Foshan from November 2018 to June 2021. Methods RCE patients were divided into two groups based on their treatment methods. 26 patients (26 eyes) were treated with phototherapeutic keratectomy alone as group A, and 26 patients (26 eyes) were treated with phototherapeutic keratectomy combined with perioperative dry eye treatment as group B. All patients completed 1 year follow-up. Corneal repair refers to complete and transparent corneal epithelium checked and negative fluorescein staining by slit lamp examination. On the 7th day after surgery, the stimulation score was questionnaired, and 3 months later, the tear lipid, meibomian gland, BUT, and tear river height were examined with ocular surface comprehensive analyzer. Main Outcome Measures Eye stimulation response score, subjective stimulation symptom score, repair duration, eye surface condition, and postoperative complication rate. Results Eye stimulation response score was 5.38±1.30 in group A and 4.35±1.23 in group B and the subjective stimulation symptom score was 5.77±1.42 in group A and 4.5±1.45 in group B at 7th day after surgery. The repair duration of group A was 8.19±1.86 days, and that of group B was 6.19±1.23 days (P=0.001). At 3 months after surgery, the lipid score of group A was 2.23±0.59, and that of group B was 1.46±0.51. BUT of group A was 7.50±2.29 s, and that of group B was 10.66±2.28 s. The tear river height of group A was 0.30±0.09 mm and that of group B was 0.47±0.08 mm (all P<0.05). The meibomian gland loss score was 2.08±0.48 in group A and 1.85±0.46 in group B (P=0.08). The incidence of postoperative complications was 34.6 % in group A and 7.7 % in group B (P=0.038). Conclusions Phototherapeutic keratectomy combined with ocular surface intervention is effective in the treatment of recurrent corneal erosion, improving ocular surface status and reducing postoperative complications. (Ophthalmol CHN, 2023, 32: 339-343)
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    Clinical features and etiological analysis of candida keratitis 
    Wang Zhiqun, Deng Shijing, Zhang Yang, Liang Qingfeng, Chen Kexin, Sun Xuguang
    Ophthalmology in China    2023, 32 (5): 416-420.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.010
    Abstract498)            Save
     Objective To analyze the clinical and etiological characteristics of candida keratitis. Design Retrospective case series. Participants 18 patients (18 eyes) diagnosed with candida keratitis in the Beijing Tongren Hospital from January 2016 to December 2018 were enrolled. Methods Patient's medical records were reviewed. Clinical data was collected and the characteristics were observed by stages according to the severity. Corneal scraping, fungal culture or in vivo confocal microscopy was performed. Main Outcome Measures Clinical characteristics by stages, corneal scraping, fungal culture and identification of isolated strains, drug sensitivity results and result of laser confocal microscopy. Results 11 of the 18 (61.11%) patients had history of viral keratitis with long-term antiviral treatment. Of all the 11patients, 8 cases were combined with corticosteroids therapy and 3 cases were diabetes mellitus. 7/18 cases(38.89%) were in early stage with epithelial defect and multiple localized grey colonies like infiltration in epithelium and superficial stroma. 5/18 cases(27.78%) were in advanced stage with progressed infiltration and stromal ulcer, some were accompanied with hypopyon. 6/18 cases(33.33%) were in late stage, corneal ulcer enlarged and infiltration intensified, the edge of the ulcer became thinner and sulcus dissolved, often accompanied by hypopyon. 14 of the 18 patients were examined by confocal microscopy. Fungal spores were found in 13 patients and pseudohypha was found in 6 patients. Yeast-like fungi and / or pseudohyphae were detected in 11 cases (61.11%). 17 cases underwent fungal culture, 10 cases (58.82%) were Candida albicans, and 3 cases (17.64%) were Candida glabrata. The drug sensitivity of the isolated strains was more than 88.24%, and 100% to the voriconazole and amphotericin B. Conclusion Candida keratitis is more common in chronic recurrent viral keratitis patients. Clinical characteristics are aggravated colony like infiltrates and ulcer with hypopyon in severe cases. Corneal scraping, fungal culture combined with laser confocal microscopy can improve the diagnosis,and the main pathogen is Candida albicans and sensitive to voriconazole and Amphotericin B. (Ophthalmol CHN, 2023, 32: 416-420)
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    Assessment of ocular torsion in patients with intermittent exotropia
    Liu Peipei, Dai Wei, Fu Jing
    Ophthalmology in China    2023, 32 (5): 425-429.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.05.012
    Abstract498)            Save
     Objective To evaluate the distribution of ocular torsion in intermittently exotropic patients. Design Retrospective case series. Participants 108 patients with intermittent exotropia aged 5~16 years presented from October 2021 to July 2022, and 108 patients without strabismus were collected as the control group in Beijing Tongren Hospital. Method All subjects underwent non-mydriatic fundus photography. The disc-foveal angle (DFA) was measured using Image J software. Photographs of the fundus were classified as normal (no torsion) when the fovea lay between the center and the inferior margin of the optic disc. There was an intorsion when the fovea was above the disc center. Extorsion when the fovea was situated below its inferior margin. The correlation between DFA and the Revised Newcastle Control Score (RNCS) and strabismus angle, stereoacuity was analyzed. Main Outcome Measures DFA, ocular torsion and correlation with RNCS, strabismus angle, and stereopsis. Results The mean DFA in the intermittent exotropia group was significantly greater than that in the normal control group (6.17°± 3.18 °; 5.36 °± 2.50°, respectively, P=0.003), and the incidence of ocular torsion (extorsion or intorsion) in the intermittent exotropia group was significantly higher than that in the control group (33 eyes, 15.28%; 14 eyes, 6.48%, P=0.003). DFA size has significant positive correlation with RNCS, strabismus angle and stereoacuity in patients with intermittent exotropia (r=0.634, P<0.001; r=0.353, P<0.001; r=0.370, P<0.001; r=0.271, P=0.005). Conclusion Intermittent exotropia patients exist more obvious the ocular torsion when their control scores were poor, their strabismus angles were larger, and their stereoacuities were poorer. (Ophthalmol CHN, 2023, 32: 425-429)
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    Associations between retinal vessel diameters and optic disk morphology in a rural Chinese population: the Handan Eye Study
    Zhang Qing, Zhang Ye, Xin Chen, Mao Yingyan, Wang Ningli
    Ophthalmology in China    2023, 32 (3): 233-239.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.010
    Abstract481)            Save
    Objective To study the associations between the retinal vessel diameters (RVD) and optic disc parameters (ODP) in adults aged 30 years and older in rural northern China. Design Population-based cross-sectional study. Participants Adults aged 30 years and older in rural Northern China. Eligible 4137 subjects (60.6%),include 4097 non-glaucoma and 40 subjects with primary open-angle glaucoma (POAG) were included from the baseline population of 6830 participants in the Handan Eye Study. Methods RVD parameters, including central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were measured by the IVAN software and ODP, including cup area (CA), disc rim area (RA), and maximum cup depth (MCD) were measured by Heidelberg retinal tomography (HRTII). Univariate and multivariate analysis were used to analyze the relationship between RVD and ODP. Main Outcome Measures CRAE, CRVE, CA, RA, and MCD. Results Univariable analysis showed narrower RVD were significantly associated with larger CA (P<0.001), smaller RA (P<0.001), deeper MCD (P<0.001). Multivariable linear regression analysis showed CRAE were significantly associated with CRVE (P<0.001, β=0.50), MCD (P=0.001, β=-3.7) , the presence of diabetes (P=0.043, β=-2.0), the presence of hypertension (P<0.001, β=-6.5); CRVE was significantly associated with female (P<0.001, β=3.9), CRAE (P<0.001, β=1.1), axial length (P<0.001, β=-4.7), RA (P<0.001, β=4.7), the presence of hypertension (P<0.001, β=6.0). In the final model, a unit increase in MCD was associated with an average reduction of 3.7 μm in CRAE, while a unit decrease in RA was associated with a reduction of 4.7 μm in CRVE. Conclusion The association between RVD and ODP reminds that smaller disk rim area is related to the thinner retinal vein, and the deeper optic cup is related to the thinner retinal artery. This may provide an epidemialogical basis for the ischemic mechanism of glaucoma. (Ophthalmol CHN, 2023, 32: 233-239)
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    Experimental study on efficacy of electrothermal capsulorhexis rings assisted anterior capsule membrane circular capsulorhexis of isolated porcine lenses
    Lu Mingfeng, Pei Yajing, Zhu Jianbo, Guo Tonglin, Ma Ke
    Ophthalmology in China    2023, 32 (3): 222-227.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.008
    Abstract470)            Save
    Objective To explore the efficacy of Nichrome electrothermal capsulorhexis rings assisted anterior capsule membrane circular capsulorhexis of isolated porcine lenses. Design Experimental studies. Participants Fifty solated porcine eyeballs. Methods Solated porcine eyeballs was divided into two groups randomly with 25 cases in each group: continuous curvilinear capsulorhexis group (traditional group) and electrothermal assisted capsulorhexis group (electrothermal group). The surgical procedure will be performed after corneal removal and the whole procedure was videotaped. Anterior capsule holes and corneoscleral limbus were photographed after the operation. PotPlayer, Digimizer and MATLAB were used to perform marker analysis and mathematical calculation of the edge of anterior capsule holes and corneoscleral limbus in the video and image, and then the main indicators were obtained. Main Outcome Measures Circularity (△Z), bias(B), diameter(D), error of diameter(△D), capsulorhexis-time (T). Results There was no radial tearing of the anterior capsule during the experimental process. The average values of the parameters for the traditonal group were: △Z=(17.57±6.10)px, B=(36.99±17.59)px, D=(5.51±0.95)mm, △D=(0.59±0.49)mm, T=(26.12±8.82)s. Those values of the electrothermal group were: △Z=(16.95±7.08)px, B=(25.54±15.78)px, D=(5.29±0.50)mm, △D=(0.21±0.23)mm, T=(43.48±12.31)s. There was no statistically significant difference between the two groups in terms of △Z (Z=-0.534, P=0.594) or D (t=1.055, P=0.298). The B value of the traditional group was significantly greater than that of the electrothermal group (t=2.423, P=0.019). The T value was significantly shorter in the traditional group than in the electrothermal group (t=-5.731, P<0.001). The △D in the traditional group was significantly greater than that in the electrothermal group (Z=-3.218, P=0.001). Conclusion The electrothermal assisted capsulorhexis is feasible and can achieve similar results to continuous curvilinear capsulorhexis in roundness, while achieving better centering, more controllable and ideal diameter of anterior capsule holes. However, it still increasing the surgical steps to extend the time of capsulorhexis. (Ophthalmol CHN, 2023, 32: 222-227)
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    Ophthalmology in China    2023, 32 (3): 251-253.   DOI: 10.13281/j.cnki.issn.1004-4469.2023.03.013
    Abstract468)            Save
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