Table of Content

25 January 2014, Volume 23 Issue 1

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To meet the arrival of the era of minimally invasive glaucoma surgery

WANG Ning-Li

2014, 23(1):  1-3.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.001

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【Abstract】 Surgery is a crucial treatment for glaucoma. Combined trabeculectomy is the most common choice. Even though the newly developed combined trabeculectomy is on the verge of the perfection, the potential complications and the various complications associated with filtering blebs arise sometimes. The minimally invasive glaucoma surgery (MIGS), a much safer and more up to physical standard way, is the one on the rise and has a great impact on the therapy for glaucoma. The emerging, the development and the prospect of the minimally invasive glaucoma surgery are summarized in this article. (Ophthalmol CHN, 2014, 23: 1-3)


Reasonable evaluation for integrated imaging in glaucoma

GE Jian

2014, 23(1):  4-5.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.002

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 Integrated eye imaging is initiated by International Society Imaging in the Eye (ISIE). It is combined optical coherence tomography (OCT) and automated perimetry with ultrasound biomicroscopy (UBM), Heidelberg retinal tomography (HRT), fundus photograph/fluorescein fundus angiography (FFA), tonometry, and visual electrophysiology testing. It is necessary to establish platform of integrated imaging, Forum software, morphology and function and then to make an overall evaluation of glaucoma damage. On the other hand, it is important to reduce data bias by reasonable standardized methods, rather than only by database of instruments. It cannot be over emphasized that to analyze the specificity, sensitivity and repeatability of measurements especially in early diagnosis and prognosis. (Ophthalmol CHN, 2014, 23: 4-5)

Significance of glaucoma damage staging diagnosis

LI Jian-Jun, XU Liang

2014, 23(1):  6-8.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.003

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Primary glaucoma as chronic disease need to accept eye care services lifelong. American Glaucoma Association according to the standard automated perimetry results recently drafted ICD-9 staging diagnosis criterion of glaucoma. In this criterion, glaucoma  is divided into mild, moderate, severe based on coding. In the PACS system of some eye centers in China glaucoma optic nerve damage has been divided into 3 stages and 5 grades. However, there is no study on the corresponding relationship between above-mentioned visual field damage stage and optic nerve damage stage. The glaucomatous damage staging has important clinical and sociological significance. It is conducive to the treatment of patients with difference and to assess the effectiveness of treatment methods. It can improve the exchange and communication for glaucoma between doctors and patients. It is also important to make stage diagnosis of glaucoma for persuasion and communication with the administrative department of public health, medical insurance institutions.  (Ophthalmol CHN, 2014, 23: 6-8)

Ten-year incidence and risk factors of localized retina nerve fiber layer defect in adult Chinese 

REN Jie, Wang-Ya-Xing, YANG Hua, ZHANG Li, LI Jian-Jun, XU Liang, Jonas Jost B.

2014, 23(1):  9-12.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.004

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Objective  To describe the 10-year incidence of localized retina nerve fiber layer defects (RNFLD) and risk factors in adult Chinese. Design Population-based cohort study. Participants The Beijing Eye Study, which included 4439 subjects (40 years and older) in 2001, was re-conducted in 2011 with 2695 subjects participating (66.4% of the survivors). Methods The study participants underwent a detailed ophthalmic and physical examination. Fundus photographs in 2001 and 2011 were flickered for comparision and evaluated for the new development of localized RNFLD. A localized RNFLD can be defined as a wedge-shaped, not a spindle-like defect, running toward or touching the optic disc border for not more than 60° of the circumference of the optic disc. Logistic regression analysis was used for determining risk factors. Main Outcome Measures 10-year incidence of localized RNFLDs and the risk factors. Results The incident localized RNFLDs were detected in 78 subjects and 90 eyes, the incidence was 3.3%±0.2% (by person).  In Logistic analysis, the incidence of localized RNFLDs were significantly associated with the diabetic retinopathy (P=0.005; OR=5.41; 95% CI: 1.68, 17.41), cerebral infarction or hemorrhages (P=0.035; OR=2.55; 95% CI: 1.07, 6.11), and not significantly associated with rural region (P=0.078), intraocular pressure (P=0.126), systolic blood pressure (P=0.827), body mass index (BMI) (P=0.803), Hb1c (P=0.559), hypertension history (P=0.776) and diabetes history (P=0.600). Conclusions The 10-year incidence of localized RNFLD in adult Chinese is 3.3%±0.2%. It is mainly associated with the diabetic retinopathy and cerebral infarction or hemorrhages. (Ophthalmol CHN, 2014, 23: 9-12)

The preliminary study on effectiveness and safety of trabectome surgery for open angle glaucoma

WANG Huai-Zhou, SHI Yan, HONG Jie, ZHAO Bo-Wen, WANG Ning-Li

2014, 23(1):  13-18.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.005

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Objective To evaluate the effectiveness and safety of trabectome surgery (trabeculectomy-internal approach ) in patients with open angle glaucoma. Design Prospective non-comparative case series. Participants 12 eyes of 11 patients with primary open angle glaucoma(POAG), 1 eye with congenital glaucoma and 2 eyes of 2 patients with developmental glaucoma were recruited. Methods Trabectome（NeoMedix Corp.） was inserted to the viscoelastic installed anterior chamber through a 1.7 mm keratome near-limbal temperal corneal incision under operating microscope. The instrument electroablated the meshwork and inner wall of Schlemm’s canal for 120 degree under direct view assisted by goniolens. 2 cases had the Trabectome-phacoemulsification surgeries. The postoperative follow-up period ranged from 3 weeks to 12 months. Success was defined as intraocular pressure (IOP) ≤21 mmHg or ≥20% IOP reduction with or without medications and no secondary glaucoma surgery.  Main Outcome Measures IOP, numbers of adjunctive medications and intraoperative and postoperative complications. Results 53.3% patients finished 3 months follow-up and 20.0% further followed up for one year. Preoperative IOP averaged 27.57±9.46 mmHg in these 15 eyes, mean preoperative number of antiglaucoma medications were 2.27±0.88. Mean postoperative IOP was 20.07±7.86 mmHg and decreased by 17.3%. Postoperative medications reduced to 1.15±1.04. Seven (46.7%) cases achieved the criteria of success at the last visit. Intraoperative blood reflux had occurred in all eyes at instrument removal. Postoperative hyphema at 1 day was noted in 10 of the 15 patients (67.7%) with clearing by a mean of 5.4±3.1 days. Vision decrease of 2 lines or more occurred in 3 of these 10 patients and vision returned to preoperative levels in all patients after spontaneous clearing of hyphema. Gonioscopy revealed focal goniosynechiae in the areas ablated through the follow-up period in 4 eyes (26.7%). Conclusions This small sample and short follow-up period study demonstrated that trabectome surgery is an effective and safe surgery to treat open angle glaucoma. (Ophthalmol CHN, 2014, 23: 13-18)

Phacoemulsification combined with endoscopically controlled goniosynechialysis for angle-closure glaucoma co-existing cataract: a report of preliminary efficacy 

WANG Hua, TANG Xin, SUN Xia, WANG Ning-Li

2014, 23(1):  18-21.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.006

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Objective To observe the efficacy of phacoemulsification combined with endoscopically controlled goniosynechialysis for angle-closure glaucoma co-existing cataract. Design Perspective case series. Participants 53 patients (55 eyes) with chronic angle-closure glaucoma and cataract were recruited. Methods After intraocular lens implantation, injection of a viscoelastic material was used to open the synechial anterior chamber angle. Then, an endoscope was used to observe the extent of angle-closure and blunt dissection was used to re-open the rest synechial angle. The extent of the synechial angle after the first and second goniosynechialysis was analyzed statistically. The follow-up time after surgery was 3 months. Main Outcome Measures Best corrected visual acuity, intraocular pressure(IOP), closed range of anterior chamber angle. Results After the first viscoelastic goniosynechialysis, 13 of 55 eyes (23.6%)were totally opened, 1~3 hour-clocks close in 13 eyes (23.6%), 4~5 hour-clocks close in 16 eyes (29.1%), the closed extent more than 6 hour-clocks in 13 eyes (23.6%).  After the second endoscopically controlled goniosynechialysis, 24 of 55 eyes (43.6%) were totally opened, 1~3 hour-clocks close in 23 eyes (42%), 4~5 hour-clocks close in 4 eyes (7.2%), the closed extent more than 6 hour-clocks in 4 eyes (7.2%). The mean preoperative IOP was 25.6 ± 10.9 mmHg while that of the last follow-up was 15.7±6.3 mmHg(P=0.000). C/D ratio positively correlated with the numbers of angle colsed hour-clocks after the first goniosynechialysis (r=0.892, P=0.000). The local antiglaucoma medications were (3.0±0.7) kinds before surgery, while only one patient needed 2 local antiglaucoma medications after the surgery.  Conclusions Endoscopically controlled goniosynechialysis during phacoemulsification can significantly improve the success rate of goniosynechialysis for angle-closure glaucoma existing cataract. An endoscope allows the surgeon to observe the angle structures more conveniently. (Ophthalmol CHN, 2014, 23: 18-21)

One-year efficacy of canaloplasty for adult open-angle glaucoma

WANG Huai-Zhou, CAO Yi-Wen, ZHAO Bo-Wen, HONG Jie, FU Jing, WANG Ning-Li

2014, 23(1):  22-25.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.007

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 Objective To evaluate 1-year postsurgical safety and efficacy of canaloplasty for open-angle glaucoma (OAG) in adult patients. Design Retrospective case series. Participants 14 cases (17 eyes) of adult patients with OAG and with preoperative intraocular pressure (IOP) higher than 21 mmHg from Beijing Tongren Hospital in 2011-2012. Methods Canaloplasty was performed in all patients and evaluation was performed at baseline and 1, 3, 6, and 12 months postoperatively. Main Outcome Measures IOP, numbers of antiglaucoma medications and postoperative complications. Results The mean baseline IOP was 21.95±6.99 mmHg on a mean of 2.06±0.97 medications per patient. The mean IOP was 15.06±2.73 mmHg at 1 month, 15.34±2.53 mmHg at 3 months, 15.30±2.89 mmHg at 6 months and 15.23±2.64mmHg at 12 months  postoperatively(all P<0.05). Medication decreased to a mean of 0.59±1.12 per patient at 12 months (P=0.001). Surgical and postsurgical adverse events were reported in 12 eyes (79.60%) including hyphema (10 eyes), elevated IOP greater than 30 mmHg (1 eye), corneal stroma hemorrhage (1 eye), shallow anterior chamber (1 eye). All the complications were relieved after treatment. Conclusion Canaloplsty is a safe and effective surgical procedure to reduce IOP in adult patients with OAG. (Ophthalmol CHN, 2014, 23: 22-25， 36)

Comparison of the anterior chamber angle and related structures in fellow eyes of acute and chronic primary angle-closure glaucoma 

LI Si-Zhen, WANG Ning-Li, LIANG Yuan-Bo, FAN Su-Jie, SUN Lan-Ping, CUI Hong, LI Hui, Sucijanti

2014, 23(1):  26-30.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.008

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Objective To evaluate the anterior segment parameters in the fellow eyes of acute primary angle-closure glaucoma (PACG) and chronic primary angle-closure glaucoma using ultrasound biomicroscope.  Design Case-controlled study. Participents Two groups, 40 fellow eyes of acute PACG, 42 fellow eyes of chronic PACG, were included in the present study. Methods The related structure parameters of iris, pupil, ciliary body and anterior chamber angle were observed and analyzed with ultrasound biomicroscope.  Main Outcome Measures  Anterior chamber depth(ACD), pupil diameter(PD),  iris thickness (IT)1, IT2, maximal iris thickness(ITM), scleral spur iris distance(SIT), iris-bombe height(IH), angle A, angle B, trabecular-ciliary process distance(TCPD), trabecular-iris angle (TIA) and angle opening distence(AOD) were measured. Results  On ultrasound biomicroscopy the ACD of the fellow eye in acute PACG (FEACG) was shallower than the fellow eye of chronic PACG (FECACG), but was no significant difference (P=0.067). The PD of FEACG 3.094±0.782 mm was less than FECACG 3.613±0.925 mm (P=0.008). IT1, IT2, ITM of FEACG were thinner than FECACG (P=0.005, 0.000, 0.001). There was a positive correlation between IT2, ITM and PD (P=0.000) which were using covariance analysis. SIT of FEACG was bigger than FECACG (P=0.016). IH of FEACG was higher than FECACG (P=0.000). Angle A, and angle B of FEACG was wider than FECACG (P=0.004, 0.017). TIA and AOD of FEACG was wider than FECACG but there were no significant differences between two groups (P=0.417, 0.278). Conclusion There is a difference between the fellow eyes of acute PACG and chronic PACG. Compared with chronic PACG, beside the common features such as shallow anterior chamber depth, narrow anterior chamber angle, ACG has a smaller pupil, thinner iris, higher iris bombe, and a more posterior positioned iris insert and wider ciliary-trabecular-angle. The differences between the anterior segments of acute PACG and chronic PACG may result in the different disease courses of these two types of PACG. (Ophthalmol CHN, 2014, 23: 26-30)

The one-year changes of filtering bleb configuration after successful trabeculectomy: photographs analysis of slit-lamp microscopy 

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

2014, 23(1):  31-36.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.009

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Objective To observe the one-year changes of filtering bleb configuration with photographs of slit-lamp microscopy after trabeculectomy. Design Prospective case series. Participants Five patients with thin-wall bleb and five patients with thick-wall bleb were included. Methods The configuration of filtering bleb on photographs of slit-lamp microscopy were compared and analyzed with Photoshop software at 1~2, 3 weeks, 1, 3, 6 and 12 months after trabeculectomy.  Main Outcome Measures The area of the bleb, the distance between the upper edge of the bleb and the corneal limbus, the distance between the lower edge of the bleb and the corneal limbus, the height of the bleb and Shield’s test. Results In the thin-wall bleb group, at 3 week after the trabeculectomy, the distance between the lower edge of the bleb and the corneal limbus shortened significantly than that at 1~2 weeks after the surgery(P=0.042). The area of bleb decreased (P=0.043). There is no pale area in the bleb. At 1 month after trabeculectomy, the area of bleb decreased significantly (P=0.043), as well as the height of the bleb (P=0.042). The pale area increased. At 3 month after trabeculectomy, the pale area increased. Most vessels anastomosed around the margin of the bleb. The wall of the bleb thinned. No significant changes happened at 6 and 12 months after trabeculectomy. In thick-wall bleb group, after 3 weeks, the distance between the upper edge of the bleb and the corneal limbus shortened significantly (P=0.043) and the area of bleb decreased (P=0.043). Small pale area emerged. After 1 month, the distance between the upper edge of the bleb and the corneal limbus shortened significantly (P=0.042). The area of bleb decreased (P=0.043). Vessels around the bleb were dendrimer. No significant changes happened at 3, 6, 12 months after trabeculectomy. Conclusion In the 3 months after trabeculectomy, the bleb configuration changed dramatically. The lower edge of the thin-wall bleb invaded into the corneal limbus. After 3 months, the pale area of the thin-wall bleb enlarged and the wall thinned further. But the configuration of the thick-wall bleb changed little. (Ophthalmol CHN, 2014, 23: 31-36)

Visual comfort and fatigue measured by eye movement analysis when watching three-dimensional displays

ZHANG Li, Ren-Jie, Xu-Liang, Zhang-Jing-Shang, Zhao-Jing

2014, 23(1):  37-42.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.010

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Objective To assess and compare visual fatigue and visual discomfort induced by viewing stereoscopic displays using eye movement analysis. Design Observational cross-over study. Participants Twenty eight healthy subjects (age: 20~30 years), -3.0D  < refractive error <+1.0 D. Methods Three dimensional (3D) displays used the pattern retarder-spatial domain technology with linearly polarized three dimensional technologies. During this study performed at two subsequent days, 28 subjects watched a video shown on a 3D display or a two-dimensional (2D) display. Main Outcome Measures Blink frequency and duration, fixation duration, pupil size, and saccade frequency, duration, speed and amplitude of the saccades.  Results Blinking frequency was significantly lower when watching 3D display than watching the 2D display (left eye: P=0.02; right eye P=0.01). With increasing duration of watching the movie, blinking frequency increased during the 3D watching and remained unchanged during the 2D watching. Blinking duration did not differ significantly between the 3D watching and 2D watching.  Pupil diameter did not differ significantly between 2D viewing and 3D viewing (left eye, P=0.86; right eye P=0.64).  Fixation duration was significantly shorter during 3D viewing than during 2-dimensional viewing (left eye, P=0.02, and right eye P=0.02). Fixation duration did not differ significantly between the two eyes (P=0.94 for 3D viewing and P=0.98 for 2D viewing). The saccade parameters (frequency, duration, amplitude, velocity and acceleration) differed significantly between 3D viewing and 2D viewing.  Except for the difference in the saccade duration (P=0.046 for the left eye; P=0.035 for the right eye), all other parameters of the saccade measurements (frequency, saccade amplitude, saccade velocity and acceleration) showed highly significant differences between 3D viewing and 2D viewing (All P<0.001). Compared to 2D viewing, 3D viewing  was associated with a higher saccade amplitude, higher saccade frequency, shorter saccade duration and faster saccade speed.  The mean saccade frequency decreased from 980.8 / minute (left eye) in the first 5 min interval to 937.2 / minute (left eye) in the last 5 minute interval during the 3D viewing.  Saccade amplitude between the left eye and the right eyes did not differ significantly (P=0.94 for 2D viewing, and P=0.65 for 3D viewing). Saccade speed between two eyes did not vary significantly (P=0.90 for 2D viewing, and P=0.82 for 3D viewing). Conclusion 3D viewing, as compared with 2D viewing, was associated with lower blinking frequency, faster saccadic speed, higher saccadic frequency, and larger saccadic amplitude, while pupil size did not vary between them.  At the end stage of the 3D movie session, the increased values decreased to supra-normal values. This pattern of eye movements suggests that 3D viewing of movies, as compared to 2D viewing, is associated with an increased level of alertness which decreases to supra-normal values after 40 minutes of watching.  (Ophthalmol CHN, 2014, 23: 37-42)

Clinical characteristics of ethambutol optic neuropathy: 17 cases report

LIU Zi-Hao, Li-Hong-Yang, JIANG Zhao-Cai, WEI Shi-Hui

2014, 23(1):  43-46.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.011

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Objective To study the clinical features of ethambutol optic neuropathy (EON). Design Retrospective case series. Participants 17 patients diagnosed as EON in PLA General Hospital. Method General condition, clinical characteristics, and treatment outcome of all 17 patients based on medical records were analyzed. Main Outcome Measures Best corrected visual acuity, visual field, color vision, color of optic disc. Results The average duration of ethambutol use is (8.0±4.0) months, and the average dosage is (166.8±82.9) g. Both eyes were affected in all patients. 28 eyes (82.4%) were characterized with chronic, progressive, painless vision loss. The mean best corrected visual acuity was (0.12±0.09) at first visit. 26 eyes (76.4%) had optic disc color change. 23 eyes (67.7%) showed central scotoma of visual field. 20 eyes (58.8%) manifested anerythrochloropsia. Abnormal signals of optic chiasma were not detected on magnetic resonance imaging in all the 17 cases. The best corrected visual acuity was raised to (0.34±0.15) in the last follow-up (average 8.6±3.8 months) after oral mecobalamine. Conclusion EON affects both eyes, manifested with chronic, progressive vision loss. It mainly implicates fasciculus macula papillaris and the visual impairment is reversible or partially reversible. (Ophthalmol CHN, 2014, 23: 43-46)

MRI findings of Mikulicz's disease involving the lacrimal gland

FENG Li-Li, Yan-Fei, FU Lin, MA Zeng-Lin, XIAN Jun-Fang-

2014, 23(1):  47-50.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.012

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Objective To evaluate MRI features of Mikulicz’s disease involving the lacrimal gland. Design Retrospective case series. Participants Twenty-four patients with Mikulicz’s disease involving the lacrimal gland confirmed by operation and pathology. Methods MRI findings of 24 cases with Mikulicz’s disease involving the lacrimal gland were retrospectively reviewed. MRI examination and contrast-enhanced imaging were performed in all patients and dynamic contrast-enhanced MRI was performed in 11 patients. Main Outcome Measures The MRI features of the lesion. Results In 24 cases, the lesion invaded bilateral lacrimal gland in 17 cases (70.8%), and unilateral in 7 cases. In the 7 cases, the lesion located in the left side in 5cases and right side in 2 cases. Compared with the brain gray matter, the lesion showed isointensity or hypointensity on T1WI and iso-, hypo- or hyperintensity on T2WI. After injection of the contrast medium, they showed moderately to significantly enhancement homogeniously. 11 cases who underwent dynamic contrast-enhanced MRI, a gradually enhancing pattern displayed in 2 cases and platform in 9 cases in time intensity curve. Moreover, the ocular muscles, corpus adiposum orbitae, infraorbital nerve and frontal nerve were involved in 8 cases (33.3%), 2 cases, 1 case and 5 cases respectively. Conclusion The MRI features of Mikulicz’s disease involving the lacrimal gland was enlargement of bilateral lacrimal gland diffusedly, and the involvement of trigeminal nerve, extraocular muscles and corpus adiposum orbitae. MRI can show the extent of the lesion clearly. (Ophthalmol CHN, 2014, 23: 47-50)

Comparison of clinical outcomes between Epi-LASIK and LASEK for high myopia

JIA Yan-Wen, CHEN Hui, CHENG Xin-Liang, YU Ying

2014, 23(1):  51-56.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.013

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 Objective To compare the effectiveness and safety between epipolis laser in keratomileusis (Epi-LASIK) and laser epithelial keratomileusis(LASEK) for treatment of high myopia patients. Design Prospective comparative cases series. Participants Group A including 50 cases (100 eyes) was underwent Epi-LASIK and group B including 50 cases (100 eyes) underwent LASEK. Method Before surgery and at 1, 3, 5, 7 days after surgery corneal epithelial healing was observed, and at 1, 3, 6 months after surgery subjective and objective visual quality changes were observed. Main Outcome Measures UCVA, BSCVA, safety index (SI), effective index (EI) and Haze grade. Results  There were 87 cases finishing 6-month follow-up, including group A of 43 patients (86 eyes) and group B of 44 patients (88 eyes). The unhealed area in group B was （18.21± 1.16） mm2 larger than group A (18.21±1.16 mm2) (P=0.04) at 3 days after the operation and epithelium was healed 5 days after the operation. At 6 months postoperatively, the average UCVA between group A and group B were 1.02±0.03 and 0.94±0.03 (P=0.184). Average BSCVA between group A and group B were 1.02±0.03 and 1.20±0.02 (P=0.496). The BSCVA down two lines or more of group A was in 2 eyes (2.33%) at 6 months after surgery, and of group B in 0 eye. At 6 months, the SI of group A was 1.02±0.02 and group B was 1.01±0.01 (P=0.768). The EI of group A was 1.39±0.28 and group B 0.97±0.03 (P=0.079). There were 10 eyes (11.63%)  in group A and 6 eyes (6.82%) in group B with high intraocular pressure after two weeks. At 6 months, Haze grading of two groups was 0.02±0.02 and 0.10±0.05 (P=0.177). At 6 months, the residual diopter within ±0.5 D was 84.88% in group A and 88.64% in group B, respectively (P=0.465). At 18c/d spatial frequency of contrast sensitivity function (CSF) under mesopic condition in group B was better than in group A (P=0.020). There were no significant differences between two groups at the other spatial frequencies. Conclusion Generally, Epi-LASIK and LASEK for treatment of high myopia patients was safe and effective. The visual quality was no significant difference between Epi-LASIK and LASEK. Epi-LASIK can make corneal epithelial healing faster. (Ophthalmol CHN, 2014, 23: 51-56)
 

The one-year clinical effect of press-on prism test for eye position observation and adjustable suture of surgery intervention in congenital exotropia 

LIU Li-Li, YU Gang, WU Qian, Cao-Wen-Hong, Fan-Yun-Wei, CUI Yan-Hui, ZHANG Yan

2014, 23(1):  57-60.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.014

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Objective To evaluate the effect of press-on prism test for eye position observation and adjustable suture of recus muscle of early surgical intervention in congenital exotropia. Design Retrospective case series.  Participants We reviewed 25 subjects diagnosed with congenital exotropia in Beijing Children Hospital in 2008-2012, aged 10 months to 67 months (28.84±16.01 months). Of the 25 cases, 1 case of intermittent exotropia, 24 cases of constant exotropia. 4 cases existed with V sign, 4 cases with DVD, 1 case with V sign and DVD, 1 case with nystagmus. Methods Pressure prism test for deviation degree was used in young children before or after surgery.  Adjustable suture of recus muscle was used during surgery. The follow-up was performed on 1 day, 2 weeks, 1 months, 6 months, and 12 months after surgery. Main Outcome Measures The angle of near and far deviation in primary position. Result Pressure prism test has good compliance in young children. On 1 day after operation, 80% patients had a deviation of less than 10 PD, and 2 weeks after adjusting suture 100% patients had a deviation of  ＜10 PD (P＜0.05). On half a year eye position change of strabismus degree was not obvious. One year after the operation (-7.12±3.24△) had a tendency to develop in the direction of exotropia with time and surgical success rate was 88%. Conclusion Press-on prism test can be used in congenital exotropia in young children for preoperative strabismus degree examination. Application of adjustable suture obviously increases the success rate of congenital exotropia.  (Ophthalmol CHN, 2014, 23: 57-60)

Update in micro-invasive glaucoma surgery

CHEN Xiao-Ya, WANG Huai-Zhou, WANG Ning-Li

2014, 23(1):  64-68.  doi:10.13281/j.cnki.issn.1004-4469.2014.01.016

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The surgical treatment for glaucoma has undergone various modifications in recent years. Filtration surgery is not the only choice for glaucoma. The term micro-invasive glaucoma surgery (MIGS) is defined as procedures that share the following features: ab interno microincision, minimal trauma, efficacy, high safety profile, and rapid recovery. The definition of MIGS mainly includes two anatomical categories. The first is Schlemm’s canal, by improving trabecular outflow (Glaukos micro-bypass trabecular iStent, Hydrus Schlemm canal scaffold, Ab interno trabeculectomy trabectome, excimer laser trabeculostomy). The second is the suprachoroidal space, by improving the uveoscleral outflow through a connection between the anterior chamber and the suprachoroid (Cypass suprachoroidal micristent). This article will review the published literature and summarize clinically relevant information about above novel or emerging surgical techniques for the treatment of open-angle glaucoma and to describe indications, advantages and disadvantages of the devices and procedures. (Ophthalmol CHN, 2014, 23: 64-68)