Ophthalmology in China

Pay attention to the value of medical imaging in etiology diagnosis of external ophthalmoplegia

YAN Fei, Li-Mei

2013, 22(5): 289-291.

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With the rapid development of modern medical imaging technology, magnetic resonance imaging(MRI) plays an increasingly important role in studing the etiology of congenital external opthalmoplegia and acquired extraocular muscles paralysis. Oculomotor nerves may be affected by the intracranial lesions, and develop external ophthalmoplegia. MRI could depict the relationship between the nerves and its adjacent lesions. 3D-FIESTA MRI could also directly demonstrate abnormality of cranial nerves（Ⅲ、Ⅵ、Ⅶ） in the cistern segment, and could be used for diagnosis and differential diagnosis of congenital neurogenic strabismus. Orbital 99mTc labeled octreotide SPECT/CT has a good prospect in evaluating activity and treatment effect of active thyroid associated ophthalmopathy. (Ophthalmol CHN, 2013, 22: 289-291)

The consciousness state and post-operative eye alignment of intermittent exotropia

ZHAO Guo-Hong, JIAO Yong-Hong

2013, 22(5): 292-294.

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The goal of surgical correction in patient with intermittent exotropia is to achieve stable alignment and satisfactory binocular vision. While the consecutive esotropia was appeared after surgery, especially for the visually immature children, the binocular vision would be damaged severely. By changing the different convergence components the early stage of consecutive esotropia after surgery, the incidence of consecutive esotropia may be reduced. (Ophthalmol CHN, 2013, 22: 292-294)

Several problems in treatment of amblyopia in children

WANG Hong-Feng, WANG En-Rong

2013, 22(5): 295-298.

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In the clinical treatment of amblyopia in children, many standards need to be defined. This article discussed the following problems in children amblyopia treatment. （1） Indicators of taking off the glasses are thought to be as follow: （a） uncorrected visual acuity ≥1.0 remained more than half a year, （b） normal position of eyes or residual angle ＜5° for strabismic amblyopia, （c） the refraction ≤+1.00 DS for hyperopia, （d） the refraction ≤+0.50 DC for hyperopic astigmatism. （2）The recurrence standard of amblyopia is that visual acuity reduces and cycloplegic refractive error increases obviously after corrected visual acuity≥0.9 or uncorrected visual acuity ≥1.0 through treatment of amblyopia. According to different stages of the treatment, the recurrence of amblyopia should be divided into 3 types: recurrence after basically cured, recurrence after wholly cured and recurrence after taking off the glasses. （3）The age for treatment. Treatment of amblyopia can begin as early as two and a half years old. The best time for treatment is from 2 to 6 years old with the highest rate of recovery. The appropriate age for treatment of amblyopia is from 7 to 12 years old. The treatment for children aged 13~18 should not be given up easily. （4）Treatment period. Patients should be followed up for 3 years after amblyopia basically cured. Finishing treatment after taking off the glasses would be the safest with the lowest rate of visual acuity reduction. (Ophthalmol CHN, 2013, 22: 295-298)

MRI study of the abnormality of cranial nerves and diagnosis of strabismus

MAN Feng-Yuan, YAN Fei, JIAO Yong-Hong, CHANG Qing-Lin, XIAN Jun-Fang, WANG Zhen-Chang

2013, 22(5): 299-303.

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Objective The abnormalities of cranial nerves in the cistern were displayed by MRI to explore their relationship with strabismus. Design Retrospective case series. Participants Fifty-five patients with strabismus. Methods Fifty-five patients were performed MRI examination, using three dimensional fast imaging employing steady state acquisition (FIESTA) sequence. Cranial nerves in the cistern were observed in oblique-axial and oblique-sagittal planes acquired by MRI. Main Outcome Measures The developmental conditions of the cranial nerves in the cistern. Results All the abnormal cranial nerves in the cistern in 55 cases on MRI were displayed as follow. In 21 cases of congenital fibrosis of extraocular muscles (CFEOM), 2 oculomotor nerves (CN3) were absent and 38 were thinner. In 16 cases of Duane syndrome (DS), 15 cases of CFEOM and 3 cases of Mobius syndrome, 41 abducens nerve were absent, 19 were thinner, 2 were chords-like signs, 1 was starting from the middle part of the brainstem, and 1 was substituted by an irregular chords-like signs. Other cranial nerves in the cisterns could not be traced including 6 facial nerves, 6 audible nerves and 3 hypoglosssal nerves in 3 cases of Mobius syndrome (MS) and 6 cases of DS. Conclusion MRI can clearly demonstrate abnormality of cranial nerves in the cistern, which can be used for the diagnosis and differential diagnosis of neurogenic strabismus. (Ophthalmol CHN, 2013, 22: 299-303)

MRI features of acquired abducens nerve palsy

LI Jing, Yan-Fei, XIAN Jun-Fang-

2013, 22(5): 305-308.

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Objective To explore MRI features of acquired abducens nerve palsy to provide reliable imaging basis for clinical diagnosis and treatment. Design Retrospective case series. Participants Forty-two patients with acquired abducens nerve palsy. Methods The MRI of 42 cases with acquired abducens nerve palsy were analyzed retrospectively. The MRI features of lesions were observed, including location, morphology, extent, signal intensity and the characteristics of contrast. Main Outcome Mearsures MRI findings. Results Sixteen cases were diagnosed with ischemic abducens nerve palsy, the main findings of MRI was multiple ischemic focus in brain. Tumor was found in 15 patients and the main locations were at prepontine cistern, tip of petrous bone or cavernous sinus, with corresponding segments of abducens nerve afflicted. Five patients got acquired abducens nerve palsy after head trauma, including 1 case of left abducens nerve palsy after multiple fractures of right skull and 4 cases with no fracture in skull bones. Four patients were diagnosed with nonspecific inflammation, in which 3 cases were manifested as cavernous sinus thickening. Other rare causes included 1 case of myasthenia gravis and 1 case who was after cerebellopontine cholesteatoma surgery. Conclusion The etiology of acquired abducens nerve palsy is quite diverse and MRI is useful to define the causes and original locations and help to guide specific treatment. (Ophthalmol CHN, 2013, 22: 305-308)

The evaluation of treatment effect of active thyroid associated ophthalmopathy with ^99mTc labeled octreotide SPECT/CT

LUO Sha, WANG Xue, LIU Li-Jie, LI Mei-

2013, 22(5): 309-312.

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Objective To explore the application of orbital 99mTc labeled octreotide SPECT/CT on the treatment effect evaluation of active thyroid associated ophthalmopathy(TAO). Design Retrospetive case series. Participants Twenty-one patients with active TAO were observed, with 37 afflicted eyes and 5 normal eyes. Methods Orbital 99mTc labeled octreotide SPECT/ CT and the clinical activity score (CAS) were separately performed before and after treatments in the patients with TAO. Main Outcome Measures An uptake ratio between the orbits and the occipital skull（O/OCC）, the numbers of involved extraocular muscles（N） and CAS. Results Before treatment,the average of N was 2.70±1.00 and its CAS was (5.49±2.04). Before treatments, the O/OCC of afflicted eyes(2.00±0.35) were higher than that in normal eyes(1.14±0.10)(P=0.000). After treatments, the O/OCC, CAS and N were (1.38±0.30), (1.78±1.18), (1.16±0.93) on average, respectively and significantly reduced compared to those before treatment in afflicted eyes（all P=0.000）. There was no statistical differences in normal eyes before and after treatments in the O/OCC(1.03±0.07) (P=0.242). A statistically significant correlation was found in the O/OCC versus CAS before and after treatments (r=0.574，P<0.01; r=0.555，P<0.01). A statistically significant correlation was also found in N versus CAS before treatments (r=0.445，P<0.01), but not found after treatments (r=0.235，P>0.01). Conclusion Orbital ^99mTc labeled octreotide SPECT/ CT is with good prospect in evaluating treatment effect of active TAO. (Ophthalmol CHN, 2013, 22: 309-312)

MRI features of adenoid cystic carcinoma of the lacrimal gland

GUO Jian, Xian-Jun-Fang, Zhang-Zheng-Yu, WANG Xin-Yan

2013, 22(5): 314-319.

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Objective To provide reliable basis for the diagnosis of adenoid cystic carcinoma (ACC) of lacrimal gland by characterizing the MRI manifestations. Design Retrospective case series. Participants Twenty-six cases of ACC confirmed by operation and pathology. All the patients performed MRI scan before the surgery. Methods The characteristics of the routine MRI were evaluated retrospectively for 26 cases, including location, morphology, margin, extent, signal intensity and the patterns of contrast. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging (DWI) were processed to get the quantitative indexes. Main Outcome Measures CIpeak，Tpeak, CImax, type of time-contrast index curve(typeⅠ, persistant enhancement type；type Ⅱ, platform type; tye Ⅲ, washout type) and ADC value. Results All the tumors of 26 cases originated from orbital lobes, with irregular shape in 20 cases, ill-defined margin in 14 cases and well-defined margin in 12 cases. Intracranial infiltration was shown in 6 cases and bone destruction in 9 cases. The masses showed isointensity or mild hypointensity on T1WI and isointensity or slight hyperintensity on T2WI, while hyperintensity on T1WI appeared in 3 cases. Inhomogeneous enhancement was shown in 25 cases, with cystic degeneration and necrosis in 16 cases. The CIpeak, Tpeak and CImax of the tumor were 0.9±0.41, 109.3±58.5 s and 0.95±0.45, respectively. The patterns of time-contrast index curves were type I in 2 cases, type II in 14 cases and type III in 6 cases. The mean ADC value for ACC of lacrimal gland was 1.25±0.30×10-3 mm2·s－1. Conclusion MRI can display clearly the location, orphology, extent, margin and bone destruction of lacrimal gland ACC. DCE and DWI can provide assistant quantitative features for diagnosis of lacrimal gland ACC. (Ophthalmol CHN, 2013, 22: 314-319)

Analysis of MRI features of lymphoma initiating in conjunctiva

GUO Peng-De, YAN Fei, XIAN Jun-Fang, LIANG Xi-Hong, CHEN Guang-Li, WANG Zhen-Chang

2013, 22(5): 320-323.

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Objective To deepen understanding the cognition of MRI features of conjunctival lymphoma. Design Retrospective cases series. Participants Twenty-one patients with conjunctival lymphoma first visiting the ophthalmology department of Beijing Tongren Hospital. Methods The clinical, MRI and histological features of 21 cases were reviewed. Main Outcome Measures The original locations, invasive extent， and MRI features of the tumor. Results In the 21 cases (25 eyes), the lesion located in the superior palpebrae conjunctiva in 4 eyes, the inferior palpebrae conjunctiva in 7 eyes, and both palpebrae conjunctiva in 14 eyes, respectively. Most of the lesions were limited to conjunctiva or eyelids (19 eyes, 76%) and others invaded the orbits (6 eyes, 24%; 2 eyes involving intraconal compartment, extraocular muscles and lacrimal gland; 3 eyes involving superior ocular muscles, 1 eye involving tenon follicle and optic nerve). There were well-defined margin in 15 eyes and ill-defined margin in 10 eyes. The lesions in 17 eyes circled the eye ball and in the other 8 eyes just located in the anterior eye segment. All the cases showed isointense on T1WI compared with ocular muscles. 18 eyes showed isointense and 7 eyes showed mild hyperintense on T2WI. Moreover, the signals were homogeneous in 18 eyes and heterogeneous in 7 eyes. 13 cases (15 eyes) had contrast-enhanced MRI. After injection of the Gd-DTPA, they showed mild to moderate enhancement. In 7 cases (8 eyes) for dynamic contrast-enhanced, 6 eyes showed plateau pattern and 2 eyes showed washout pattern in time-intensity curve. Conclusion Conjunctival lymphoma shows homogeneous isotense on T1WI and T2WI with mild to moderate enhancement in contrast-enhanced MRI， and plateau pattern in time-intensity curve. (Ophthalmol CHN, 2013, 22: 320-323)

Etiology and short-term efficacy of surgical treatment for consecutive exotropia

LI Li, LU Yan, JIAO Yong-Hong

2013, 22(5): 324-327.

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Objective To analyze the etiology of consecutive exotropia (XTc) and discuss the effects of different operation methods. Design Retrospective case series. Participants 17 XTc patients diagnosed and operated in Beijing Tongren Hospital. Methods The clinic information of 17 XTc patients was reviewed. The presence age and operative age of esotropia, refraction, corrected visual acuity, operation method for correcting esotropia, as well as the onset age and operative age of XTc, angle of deviation, eye movement, refraction, binocular vision, operation methods for correcting exotropia and their effects were analyzed. Main Outcome Measures Onset age, refraction, angle of deviation, eye movement, operation method and the effect of surgical treatment. Results In all the 17 cases, there were 11 cases who were diagnosed as esotropia at the age of less than one year. The average age of esotropia operation was 6.79±5.39 years old (2~19 years). The average onset age of XTc was 9.00±4.97 years old (3~21 years). The refraction was -1.0~+2.0 D in 9 cases (52.9%), larger than +2.0 D in 7 cases (41.2%), and 1 case (5.9%) was high myopia (-10.0 D). Four cases were combined with single-eye amblyopia. Thirteen cases had no binocular vision. The average exotropia angle was 45△ (15△~95△) for near view and 50△ (20△~ 105△) for distant view, respectively. Five cases (29.4%) had limited adversion. medial rectus reductions were underwent in 3 cases, and medial rectus reduction plus lateral rectus recessions were underwent in 14 cases. After exotropia sugery, 14 cases (82.4%) were orthophoria, 3 cases had residual exotropia, and 1case was found exotropia drift half a year after surgery. The binocular function was improved after surgery. Conclusion The development of XTc is associated with the younger age of esotropia onset and esotropia sugery, combined with amblyopia, and absence of binocular function, etc. Personalized designed XTc surgery can provide better effect for the correction of the XTc. (Ophthalmol CHN, 2013, 22: 324-327)

Short-term efficacy of surgical treatment for consecutive esotropia after exotropia surgery in children

LIU Li-Li, Yu-Gang, Wu-Qian, Cao-Wen-Hong, Fan-Yun-Wei, Cui-Yan-Hui

2013, 22(5): 327-331.

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Objective To investigate the clinical characteristic and causes of consecutive esotropia, and evaluate the surgical management of consecutive esotropia. Design Retrospective case series. Participants 17 patients who accepted surgical correction of consecutive esotropia after exotropia surgery. Methods The indexes of 17 patients as follow: the methods and characteristics of the first strabismus operation, onset time of consecutive esotropia and postoperative treatment after exotropia surgery, estropia operation mode and operative foundings were observed. 50 patients with intermittent exotropia were randomly choosed as control group, in order to analyze the causes of consecutive esotropia. Main Outcome Measures Types of exotropia, exotropia operation method and postoperative management, onset time of consecutive esotropia, estropia operation mode and operative foundings, the position of eyes after estropia operation. Results 9 of 17 cases(52.9%) were complicated with vertical strabismus, including 2 cases of V syndrome and 4 cases of DVD. In control group, 9 cases(18%) were complicated with vertical strabismus. There was significant difference between two groups ( χ2=6.33， P=0.01). Consecutive esotropia appeared 1~12 months after exotropia operation, the average of 2 months after surgery. In 17 cases, 16 cases were constant esotropia, 1 case was atypical periodic esotropia; 10 cases were complicated with the limitation of abduction, including 2 cases of muscle detachment, 3 cases of adherence syndrome, 3 case of suture adjusted; after the surgery, 14 cases(82.3%) were cured, 2 cases were overcorrected and 1 case was undercorrected. Conclusion Consecutive esotropia appears 2 months after exotropia surgery on average. Limitation of abduction, muscle detachment, adherence syndrome and vertical strabismus complicated may be the causes of consecutive esotropia. Compound strabismus combined with vertical strabismus is prone to consecutive esotropia after the surgery. (Ophthalmol CHN， 2013, 22： 327-331)

The effect of levobunolol on anterior corneal surface curvature after Laser in-situ keratomileusis

WU Gui-Ling, HU Qi, WU Qiong, YANG Fan, WANG Ke-Meng

2013, 22(5): 332-334.

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Objective To compare the effect of levobunolol hydrochloride eye drops on anterior corneal surface curvature applied in different stage after laser in-situ keratomileusis, to infer the effect of IOP-lowing medication on anterior corneal surface after laser in-situ keratomilersis. Design Case control study. Participants 111 cases (197 eyes) who were treated by laser in-situ keratomileusis and continuously followed up, the diopter of whom before operation was -6.00～-9.00 D. Methods 111 cases (197eyes) were randomly divided into 3 groups. Treatment group I （77 eyes） was treated by levobunolol hydrochloride eye drops from the first day after laser in-situ keratomileusis. Treatment group II (46 eyes) was treated by levobunolol hydrochloride eye drops from the fourteenth day after laser in-situ keratomileusis. Control group (74 eyes) was regularly treated. The anterior corneal surface curvatures were measured before and 3 months after operation and compared between groups. IOP were measured before operation and 1 month, 3 months after operation and compared between groups. Main Outcome Measures The anterior corneal surface curvature. Results The average of the differences between preoperative and postoperative anterior corneal surface curvatures were (6.51±0.91)D in the treatment group I, (6.24±0.96)D in the treatment group II and (6.19±1.02)D in the control group, respectively. The difference between the treatment group I and the control group was significant (F=4.04, P=0.045), the difference between the treatment group II and the control group was insignificant (F=0.02, P=0.760), the difference between the treatment group I and the treatment group II was insignificant (F=2.27, P=0.148). Conclusion Levobunolol hydrochloride eye drops applied in the early stage after laser in-situ keratomileusis is beneficial to the stability of anterior corneal surface. (Ophthalmology CHN, 2013, 22: 332-334)

Objective examination of accommodative function of computer vision syndrome

DENG Xiu-Jing, Zhao-Shi-Qiang, Wang-Xiao-Bing, Di-Ning

2013, 22(5): 335-339.

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Objective To examine the accommodative function of computer vision syndrome with an objective method. Design Retrospective case series. Participants 58 computer vision syndrome patients who were treated in optometry clinic of Beijing Tongren Hospital. Methods In addition to visual acuity, direct refraction, cycloplegic refraction, spectacles lenses test and subjective accommodative amplitude test, objective measurement of accommodative function was administered, using the Nidek AA-1 accommodative analyzer of human eyes. Main Outcome Measures Accommodative amplitude, the lag of accommodation and high frequency component (HFC) of accommodative microfluctuations. Results In the subjective accommodative amplitude test, the amplitude of accommodation in 24 out of 58 cases (41.38%) were reduced. In the objective accommodative function test, accommodative dysfunction happened in 41 cases (70.69%) in which, accommodative lag was detected in 10 cases (17.24%); HFC of accommodative microfluctuations increased in 14 cases (24.14%), including 11 cases (18.97%) with accommodative strain and 3 case (5.17%) with accommodative spasm; 17 cases (29.31%) was found with the accommodative lag combined with increasing HFC, including 14 cases (24.14%) with accommodative lag and accommodative strain and 3 cases (5.17%) with accommodative lag and accommodative spasm. Conclusion This small sample retrospective case series shows that most of computer vision syndrome patients have accommodative dysfunction, in which is the accommodative lag and accommodative strain is most common. (Ophthalmol CHN, 2013, 22: 335-339)

The change of tear composition with thin-wall bleb in glaucoma patients

XIN Chen, WANG Ning-Li, QIAO Li-Ya

2013, 22(5): 339-343.

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Objective To investigate the influence of thin-wall bleb on tear composition of glaucoma patients. Design Cross sectional observation. Participants 10 patients with thin-wall blebs，11 patients with thick-wall blebs, which were enrolled more than 6 months after filtering surgery, and 15 patients without filtering blebs were involved. Methods The concentration of ascorbic acid in tear was determined by ultraviolet spectrophotometer. Main Outcome Measures The concentration of ascorbic acid in tear. Results The concentration of ascorbic acid was (713.53±132.32)μg/ml in thin-wall bleb group, (502.52±93.90) μg/ml in thick-wall bleb group, and (470.95±86.85)μg/ml in without filtering blebs group, respectively. There was significant difference among the three groups(F=18.117，P=0.000). The concentration of ascorbic acid in thin-wall bleb group was significantly higher than that in thick-wall bleb group and without filtering blebs group (P=0.000, P=0.000). There was not significant difference between thick-wall bleb group and without filtering blebs group(P=0.446). Conclusion Aqueous humor can exude from the wall of thin-wall blebs to the eye surface under the pressure imposed by eyelid and as a result the composition of tear is changed. (Ophthalmol CHN, 2013, 22: 339-343)

Evaluation of rat retina by histopathological examination and spectral domain high-resolution optical coherence tomography

LIU Lu, MO Bin, JIAO Jian, LIU Wu

2013, 22(5): 344-348.

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Objective To investigate the characteristics, similarities and differences of the histopathological examination (paraffin and frozen sections) and the spectral domain high-resolution optical coherence tomography(HD-OCT) used for evaluation of rat retinal sublayers. Design Experimental study. Participants Twelve healthy Brown Norway (BN) rats. Methods The Cirrus HD-OCT was used to evaluate the thickness of the retinal sublayers of all the eyes in a peripapillary distribution at a distance about 2 disc diameters. The left eyes from the rats were made into paraffin sections and the right eyes were made into frozen sections after rats were sacrificed. The thickness of rat retinal sublayer approximately 2 optic disc diameters away from the optic disc were measured. The data were statistically analyzed. Main Outcome Measures The thickness and morphological characteristics of rat retinal sublayer. Results The thickness of BN rat retina was (166.98 ± 9.07）μm that measured in paraffin sections, (209.06 ± 10.41）μm in frozen sections, and (208.75 ± 11.19）μm in the OCT images, respectively. The thickness of the retina measured in the frozen sections was similar to that measured in the OCT images, and there was no significant difference statistically(P=0.425). The significant difference was found between paraffin sections and the other two groups (P <0.001). Except the thickness of inner nuclear layer, the thickness of other sublayers was significantly different among the three groups(P <0.05). The thickness of the rat retinal sublayer in paraffin sections was perceptibly less, but the organizational structure was more complete and clearer, and it showed more clearly at the cellular level. The rat retina images can be obtained by the spectral domain HD-OCT, but the boundaries between sublayers were not clear in some sublayers. The examination of frozen section was convenient and quickly, and the results were consistent with that measured in the OCT images. But it was likely to induce the incompletion of retinal nerve fiber layer caused by posterior detachment of vitreous. Conclusion Each method has its own unique characteristics on evaluation of rat retinal sublayer, but also some consistency. When conducting retinal quantitative study, frozen sections and OCT images are more accurate. When making qualitative research, the paraffin sections of tissue morphology is clearer and more complete, especially when focusing on cellular level. (Ophthalmol CHN, 2013, 22: 344-348)

The cultivation of the ability to get clinical problems concise under the guidance of the PICOT principle and modern medical graduate education

ZHANG Xin-Yuan-　

2013, 22(5): 348-350.

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The quality of medical postgraduate training concerns the construction of high-level medical echelon. Modern medical graduate education emphasizes student-centered and problem-centered culture mode. In order to maximize the benefits of patients, problems derived from clinical practice need to get concise under the guidance of evidence-based medicine, and the best evidence related to diseases need to be integrated. In this manuscript, considering the status quo of the medical graduate training system, the main problems of the system were analysed. It would play positive roles in promoting modern medical graduate education that understanding the PICOT(P: population, I: intervention, C: comparator, O: outcome, T: time) principle and paying attention to the cultivation of clinical research ability. (Ophthalmol CHN, 2013, 22: 348-350)

Postoperative analgesic effects of parecoxib sodium on the surgery of evisceration with implantation

YUAN Yi-Fei- Zhang-Rui, QIAN Jiang- Fu-Hai-Bin, WAN Ling-Guang

2013, 22(5): 351-353.

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Objective To investigate the postoperative analgesic effects of parecoxib sodium on the surgery of evisceration with implantation． Design Randomized controlled clinical trial. Participants Continuous 60 patients undergoing evisceration with implantation surgery under general anesthesia in department of ophthalmology, Eye and ENT Hospital, Fudan University. Methods Sixty patients undergoing evisceration with implantation surgery under general anesthesia were randomly divided into 2 groups of thirty: Group A received parecoxib sodium 40 mg by intravenous injection before anesthesia induction and before the end of surgery. Parecoxib sodium 40 mg was also administrated by muscle injection twice a day in the next two days postoperatively. Group B received 2 ml saline by intravenous injection or by muscle injection at the same time. Visual analog score (VAS) was recorded to evaluate postoperative pain at the time of analepsia (T1), 4 h(T2), 24 h(T3) and 48 h(T4) after the surgery. Side effects of parecoxib sodium were also recorded. Main Outcome Measures Visual analog score, side effects. Results The VAS scores at T1-T3 in Group A were 1.83±0.70, 1.17±0.65, 0.93±0.58. The VAS scores at T1-T3 in Group B were 2.87±1.04, 2.30±0.92, 1.40±0.62. The VAS scores in Group A were significantly lower as compared with those in Group B(all P<0.05). There was no significant difference of VAS score between Group A and Group B at T4(0.57±0.50 in Group A and 0.67±1.57 in Group B, P>0.05). No serious side effects were observed during the use of parecoxib sodium. Conclusion Administration of parecoxib sodium can provide good analgesia effects during early period after the surgery of evisceration with implantation. (Ophthalmol CHN, 2013, 22: 351-353)

Investigation of the questionnaires about implementation of pterygium surgery in Shandong Province Medical Institutions partly

HOU Yi-Yi- Zhang-Yi-Lin- Song-Peng, GAO Hua

2013, 22(5): 354-356.

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Objective To investigate the implementation of pterygium surgery among medical institutions partly in Shandong Province, and to promote the norms of pterygium surgery well cooperating with Shandong health strong foundation project. Design Cross-sectional survey. Participants 73 hospitals which attended the 2009 training courses about promoting clinical application of pterygium surgery. Method Questionnaires survey were conducted among 73 hospitals which attended the training courses. Main Outcome Measures Can carry out ophthalmic microsurgical or not, with or without separate departments or wards, amounts of pterygium surgery every year, surgical approachs performed, recurrence rate, best promoting strategy, best gains of training courses, etc. Result 75 questionnaires were sent out at the scene and 73 questionnaires were responded, including 10 provincial hospitals (13.70%), 43 municipal hospitals (58.90%) and 20 district hospitals (27.40%). 73 hospitals could carry out ophthalmic microsurgical, 68 hospitals own separate departments or wards. Less than 50 cases were performed in 10 hospitals every year, 50～100 cases in 34 hospitals, over 100 cases in 29 hospitals. 45 hospitals carried out pterygium excision combined with autologous stem cell transplantation, 14 hospitals carried out simple pterygium excision, 7 hospitals carried out pterygium excision combined with amniotic membrane transplantation, 7 hospitals carried out pterygium excision combined with antimetabolites therapy. The proportion of each grade hospitals whose recurrence rate of pterygium excision combined with autologous stem cell transplantation was less than 10% was as follow, 88.89% of provincial hospitals, 58.06% of municipal hospitals, 20% of district hospitals. 32 hospitals (43.84%) regarded the training courses as a good promoting method, 51 hospitals regarded the training course as an excellent opportunity to acquire surgical technique. Conclusions Pterygium excision combined with autologous stem cell transplantation is the main trend of surgical approach in Shandong Province Medical Institute partly, with lower recurrence rate. Training courses are beneficial to normalization of the pterygium surgery andimprovement on the level of operation. (Ophthalmol CHN, 2013, 22: 354-356)

Optimizing eye drop instillation technique

HU Ya-Bin, ZHEN Yi, LIU Sha, ZHAO Ya-Hui, WANG Wen-Xin, YU Jia, WAN Wei-Ning

2013, 22(5): 357-360.

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Objective To evaluate the effectiveness in regards to new treatment's substantial improvements in patients' instillation accuracy and avoid potential drug exposure infection. Design Prospective case-control study. Participants 27 numbers of patients receiving treatment from Ophthalmology Department ward of Beijing Tongren Hospital, between November 2007 and December 2007. Method Patients with single eye in trouble belong to “patient team”; patients without eye problem belong to “regular team”. For patients with problems in both eyes, the weaker-sighted eye should belong to “patient team”. Arrange the above chosen patients to test the whole process of new method of eyedrop instillation. Each patient shall repeat 5 times. It is recorded for the accuracy rate of instillation into the conjunctival sac within 5 times; It is recorded for the times needed to successfully instil into the conjunctival sac; It is recorded for the times needed to successfully instil into the conjunctival sac; it is recorded for the times without touching the skins around eye. Afterthat, our newly designed instillation process will be presented to patients, followed by a three-day-continuous recording for the patients' instillation process. Main Outcome Measures Counted times of instillation eyedrops into patients' conjunctival sac and eye skin areas touches by eyedrops bottle. Results Among 27 patients, the average year of using eyedrops was 1.70± 3.61. Within the 5 repeated tests, patients can successfully instil eyedrops into patients' conjunctival sac 3.00±1.82 times, with the cost of 7.15±1.97 drops on average. Within the 5 repeated tests, 0.37±1.33 tests had no eye skin areas touches by eyedrops bottles on average. After 3 days using our method, within the 5 repeated tests, patients can successfully instil eyedrops into patients' conjunctival sac 4.62±0.63 times, with the cost of 5.37±0.63 drops on average. Within the 5 repeated tests, none of eye skin areas touches caused by eyedrops bottles. The above mentioned indexes of comparison are statistically significant, with P indicator 0 for all. Conclusion It is observed that by using current instillation methodwould potentially cause several problems, including dropping the drug to the outer areas of conjunctival sac, so to cause a lot of pharmaceutical waste; potential infections caused by eye skin areas touches by eyedrops bottle, etc. By introducing the new instillation method, the above stated situation can be considerably improved, drug can be well treated to patients in higher efficiency, and the possibility of unnecessary infection by drug exposure to patients' eye skins can be avoided. (Ophthalmol CHN, 2013, 22: 357-360)

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