Table of Content

25 May 2014, Volume 23 Issue 3

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Improvement of visual quality after refractive surgery

WANG Yan, XU Lu-lu

2014, 23(3):  145-148.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.001

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 Visual quality is an ability which is more important than vision. Meanwhile, it is a comprehensive visual perception on object. The most distinguished difference between refractive surgery and other surgery is that refractive surgery is not only to improve vision, but also to improve visual quality. Therefore, postoperative visual quality is extremely important. Following the development of techniques, the outcomes of refractive surgery are elevated. However, some patients still have suffered low contrast sensitivity, monocular diplopia, glare, haloes etc. after refractive surgery. This article analyzes the reasons of effecting on the visual quality after surgery and the effective control measures to cause the attention to the visual quality.

Applications of optical coherence tomography on the corneal refractive surgery

ZHOU Yue-hua, ZHENG Yan

2014, 23(3):  149-151.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.002

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Optical coherence tomography (OCT), a non-contact, non-invasive high resolution imaging of biological tissue structure technology, can provide morphological image and quantitative analysis. Application of OCT on the corneal refractive surgery is not confined to the corneal thickness measurements, corneal flap assessment and evaluation of the effect of negative pressure on the retina. OCT can also play an important role in keratoconus screening, corneal disease observation and operation design, preoperative screening  of the pathological changes in the macular area and postoperative prediction of vision. OCT optimal application is important for the improvement of efficacy in corneal refractive surgery.

Study of βIGH3 gene mutation in a Chinese pedigree with Avellino corneal dystrophy

ZHOU Min1, WANG Chun-fang1， LIANG Qing-feng2

2014, 23(3):  152-156.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.003

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Objective  To study the clinical manifestations and the molecular defects in the βIGH3 gene in a Chinese family with Avellino corneal dystrophy (ACD). Design Experimental study. Participants A Chinese family with ACD. Methods Five generations (75 subjects) of this family were enrolled in the present study. The detailed family history was collected. All subjects were underwent the examinations sequentially as follows: visual acuity, slit lamp microscope examination, ocular fundus examination and anterior segment optical coherence tomography (AS-OCT). Polymerase chain reaction (PCR) amplification and nucleotide sequencing of exons 4, 11 and 12 of βIGH3 were performed. Main Outcome Measures Gene sequences. Results The clinical features of the disease were characterized by granular and lattice opacities in the stroma of the cornea. AS-OCT showed corneal lesions were deposited in the epithelium and anterior-middle stroma. Molecular genetic analysis revealed a single heterozygous C>T at nucleotide 370 in exon 4 of βIGH3 (R124C gene) in all members (eighteen) affected with ACD, but not in the unaffected members. Conclusion The R124C gene mutation was associated with ACD in this Chinese families. This mutation in the βIGH3 gene may induce different phenotypes of corneal dystrophy.

Biocompatibility of different chitosan membrances in rabbit anterior chamber

CUI Rui, LI Na, WEI Xiao-juan, HAN Bao-qin, LIU Wan-shun

2014, 23(3):  156-160.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.004

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Objective To observe the anterior chamber compatibility of three different chitosan membranes and explore the possibility of these chitosan membranes to be the carrier of corneal endothelial cells transplantation. Design Experimental study. Participants Thirty-three New Zealand rabbits. Methods Thirty healthy rabbits were divided randomly into three groups, different degree of deacetylation of chitosan carrier (group A, B, C was 63%, 74%, 95%, respectively ) was implanted into the anterior chamber of the left eyes, and the right eyes were blank control group. Other three rabbits were only performed paracentesis of anterior chamber in the left eyes as controls. The reaction of ocular anterior segment was examined under the slit lamp microscope at different times in different groups. Corneal thickness was measured at postoperative 1st, 2nd, 4th and 8th week. Corneal endothelium cell density and morphology were examined under the corneal endothelia microscope at postoperative 2nd and 4th week. Corneal samples were collected for the regular histopathological examination and hematoxylin-eosin staining to observe the inflammatory reaction at postoperative 1st and 3th month. Main Outcome Measures Corneal thickness, cell density, hexagon cells rate, cell size.  Results Different degrees of corneal edema, anterior chamber exudation, iris hyperemia were observed within 1 week in all three groups. Hypopyon, iris neovascularization, decreasing of membrane transparency were observed at 2nd week and nearly disappeared at 2nd month in group A and B. Hypopyon and iris neovascularization were not observed at 2nd week in group C. The corneal thickness was statistically significant thinner in group C than in group A and B only at 2nd week after operation (F=13.425，P=0.000). No significant differences were found in cell density, hexagon cells rate, cell size between three groups and normal rabbit eyes (all P>0.05). The histopathological examination showed that the inflammatory cells gathered around the membrane in 1 month, ranuloma and wrapping of membrane were observed at the 3th month in group A and B. Wrapping of membrane by inflammatory cells was not found in group C in 1 month. Only few inflammatory cells were observed at the contracting area between cornea, iris and membrane. Inflammatory reaction disappeared at 3th month in group C. Conclusion Chitosan membrane with 95% degree of deacetylation has better anterior chamber compatibility than other two membranes (63%, 74% degree of deacetylation).

Clinical observation of changes in posterior corneal surface after transepithelial photorefractive keratectomy

SU Yan, HOU Jie, ZHENG Xiu-yun, LEI Yu-lin

2014, 23(3):  161-164.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.005

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Objective To observe the changes of posterior corneal surface after transepithelial photorefractive keratectomy (T-PRK) and epipolis laser in situ keratomileusis (Epi-LASIK) for myopia. Design Prospective comparetive case series. Participants 134 eyes of 68 miopia patients were divided into T-PRK group (81 eyes) and Epi-LASIK group (53 eyes). Methods Posterior corneal elevation and Q-value were analyzed using pentacam before and 1 week, 1, 3 and 6 months after operation，respectively. Main Outcome Measures Posterior coneal elevation and Q-value. Results In the T-PRK group, at 1st and 6th month after surgery and in the Epi-LASIK group at 6th month after surgery, the posterior corneal elevation have a statistically significant backward displacement（all P＜0.05）. No statistically significant difference was found in the postoperative corneal Q-value in both groups before and after surgery（all P＞0.05）. There was also no statistically significant difference of postoperative corneal surface elevation and Q-value between the two groups （all P＞0.05）. Conclusion The posterior corneal elevation showing a backward displacement after T-PRK for myopia，while posterior corneal asphericity has no changed.

Short-term influence on corneal endothelium cells after femtosecond lenticule exraction and femtosecond laser in situ keratomileusis

LIU Qian, ZHOU Yue-hua, ZHANG Jing, ZHENG Yan, WANG Yong-hua, ZHANG Qiu-lu, HU Ya-bin

2014, 23(3):  165-169.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.006

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Objective To compare the short-term influence on the corneal endothelium cells after femtosecond lenticule exraction (FLEx) and femtosecond laser in situ keratomileusis (FS-LASIK). Design Prospective comparative case series. Participants Two hundreds eyes of one hundred consecutive patients were enrolled in this prospective study and divided into two groups: FLEx group (100 eyes of 50 patients) and FS-LASIK group (100 eyes of 50 patients). Methods Preoperatively, and at 1 day, 3 days, 1 week and 1 month after the operation, the mean cell density (CD), coefficient of variation(CV), and hexagonality of the corneal endothelial cells were examed and determined by Konan FA-3709P noncontact specular microscope, and the results were statistically compared. Main Outcome Measures The mean CD, CV, and hexagonality of the corneal endothelial cells. Results Compared with at pre-operation, the mean CD at 1 day, 3 day, 1 week, 1 month after surgery in the FLEx group and the FS-LASIK group were significantly decreased (all P<0.05). But there was no statistical significant between the two groups in CD at any time point (all P>0.05). Compared with at pre-operation, the mean CV at 1 day (P=0.007), 3 day (P=0.014), 1 week (P=0.003), 1 month (P=0.069) after surgery in the FLEx group were increased; the mean CV in the FLEx group were significantly increased at 1 day (P=0.039), 3 day (P=0.021), 1 week (P=0.001), 1 month (P=0.002) after surgery. There was no statistical significant between the two groups in CV at any time point(all P>0.05). Compared with at pre-operation, the hexagonalities of the corneal endothelial cells in the FLEx group were not significantly decreased at 1 day (P=0.091), 3 day (P=0.254) after surgery, were significantly decreased at 1 week (P=0.007) and 1 month (P=0.003) after surgery; the hexagonalities of the corneal endothelial cells in the FS-LASIK group were no statistical significant change at 1 day (P=0.619), 3 day (P=0.166), 1 month (P=0.135) after surgery, but were significantly decreased at 1 week after surgery (P=0.040).  There was no statistical significant between the two groups in the hexagonalities of the corneal endothelial at any time point. Conclusion Compared with  at pre-operation, the CD decreases slightly, and the CV slightly increases in FLEx group and FS-LASIK group at early postoperation. But the hexagonality of the corneal endothelial cells almost has no change in FLEx group and FS-LASIK group after surgery. There is no statistical significant between the two groups in CD, CV and hexagonality of the corneal endothelial cells.

Long-term efficacy of endothelial keratoplasty for graft failure after penetrating keratoplasty

LI Shao-wei1, CHEN Tie-hong2, LIU Chang1, NING Jian-hua2, LU Fang-qi2, CAO Li-na2, ZHAO Ning2

2014, 23(3):  170-173.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.007

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Objective To report clinical long-term efficacy of non-descemet stripping endothelial keratoplasty (EK) to treat graft failure after penetrating keratoplasty（PKP）. Design Retrospective cases series.  Participants 6 cases (6 eyes) who accepted EK because of graft failure after PKP in Aier Eye Hospitals from 2008 to 2010. Methods Clinical data of the participants after EK were reviewed retrospectively. The visual acuity, IOP, endothelial density, immune rejection, and complications were recorded. The follow-up time was (36.17±10.11) months. Main Outcome Measures Visual acuity, IOP, endothelial density, immune rejection, and complications. Results In all the 6 cases, corneal grafts restored clarity, visual acuities were improved and symptomes dispeared after EK. One graft dislocated at 1 day after operation, and was reattached by rebuble; one graft was noted with immune rejection at 5th month after operation, and medicine was effective; but immune rejection episodes was noted at another graft at 26th month because of irregular follow-up. The other grafts were clear during the follow-up period. Conclusion EK appears to be a good alternative surgical method for the patients of grafts failure after PKP, especially for high risk patients of immune rejection.

Corneal endothelial cell changes in 5 years after cataract surgery in patients with type 2 diabetes mellitus

XIONG Shi-Hong, AN Xin，WANG Yan-ling

2014, 23(3):  173-176.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.008

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Objective To explore the changes of corneal endothelial cells in 5 years after phacoemulsification in patients with type 2 diabetes mellitus by corneal endothelial microscope. Design Retrospective case series. Participants 71 cataract patients who were underwent phacoemulsification in Beijing Friendship Hospital from Jan. to Dec. 2008. Methods Cataract patients underwent phacoemulsification were divided into diabetic group (38 cases, 44 eyes) and control group (33 cases, 43 eyes). Routine examinations were done and the parameters of corneal endothelial cells were recorded by corneal endothelial microscope at pre-operation and  five years post-operatively． Main Outcome Measures  Cell density (CD)，average area of endothelial cell (AVE), and coefficient of variation (CV). Results There were no significant differences with respect to the average CD, AVE, and CV at pre-operation between two groups (all P＞0.05).  In diabetic group, the CD was significantly lower, the AVE was significantly higher, and CV was significantly increased in five years post-operatively than at pre-operation (all P＜0.01). In control group, the CV was significantly increased in five years post-operative than in pre-operation (P＜0.01), while there were no significant differences of the average CD and AVE at five years post-operatively from at pre-operation (P＞0.05). After 5 years, the CD of the diabetes group was significantly lower than that of the control group (P＜0.01), and the AVE was significantly higher than that of the control group (P＜0.05), while CV had no significant differences between two groups. Conclusion This small sample retrospective case series study shows that the damage of corneal endothelial cell after phacoemulsification in patients with diabetes are more servere and continue longer time than in normal people and should be followed-up for a long time even more than 5 years.

The cost-effectiveness analysis of fundus photography-based primary open angle glaucoma screening

LIANG Qing-feng, PENG Xiao-xia, WANG Ning-li

2014, 23(3):  177-181.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.009

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Objective To assess the cost-effectiveness of fundus photography-based primary open angle glaucoma (POAG) screening which will provide evidence for the development of open angle glaucoma screening strategy in community. Design Cost-effectiveness analysis. Participants The epidemiological results about Beijing Eye Study and Handan Eye Study. Methods Based on the epidemiological investigation results of POAG in Beijing Eye Study and Handan Eye Study, the disability-adjusted life years (DALY) attibuting to POAG was calculated between two modles of population-based POAG screening and case-opportunity diagnosis using R software. At the same time, direct costing for two models, including the cost of screening, diagnosis, intervention, was compared. Main Outcome Measures  Direct costing, DALY. Results  Assuming patients with POAG among 10 000 population aged 40 years and above can be screened every 5 years, the incidence of visual function damage is 30% which is lower than that of case-opportunity diagnosis (50%). The direct cost for population based screening of POAG was estimated 1 750 000 Yuan which is lower than that of hospital medical mode (4 060 000 Yuan). Strikingly, DALY attributing to POAG for population-based screeing (1.33) is lower than that of hospital medical mode (2.76). Conclusion Population-based screening for POAG can reduce DALY due to POAG, decrease the risk of visial function demage, improve the quality of life, and save the direct medical cost.

Application of surgery guidance system on aspheric diffractive multifocal intraocular lenses implantation: a preliminary clinical observation

ZHAO Yang, LI Lei, ZHU Si-quan

2014, 23(3):  182-186.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.010

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Objective To compare the refraction effects of the implantation of the aspheric diffractive multifocal intraocular lens (IOL) with the Lenstar LS900 surgical guidance system to the traditional oprerations without the guidance system. Design Retrospective case series. Participants 36 patients (45 eyes) with senile cataract that underwent phacoemulsification and aspheric diffractive multifocal IOL implantation in Beijing Tongren  Hospital in Aug. 2013 were included. Methods 36 patients (45 eyes) were divided into two groups. Guidance group, include 17 patients (22 eyes), the sugeries of phacoemulsification and aspheric diffractive multifocal IOL implantation of whom were performed with the assistance of Lenstar LS900 surgery guidance system, the refraction parameters (axial length, anterior chamber depth, corneal curvature and astigmatism) of whom were measured with Lenstar LS900 and IOL Master independently before the operation, and the same parameters of whom were measured with Lenstar LS900 at 1 and 3 months after the operation. The control group, include 19 patients (23 eyes), the same parameters of whom were measured with IOL Master pre- and 3 months post-operation, and the sugeries of whom were performed without the assistance of the surgery guidance system. The parameters measured with Lenstar LS900 were compared to those measured with IOL Master in the guidance group at preoperation. The difference of astigmatism degrees between pre- and post-operation were compared between the two groups. Main Outcome Measures Axial length, anterior chamber depth, corneal curvature, and astigmatism. Results The mean axial length, corneal curvature, astigmatism diopter measured with Lenstar LS900 were not signifigantly different from the measurements with IOL Master (all P>0.05), and the mean anterior chamber depth was (2.82±0.46) mm with Lenstar LS900 and (3.14±0.52) mm with IOL Master (P=0.036). In the guidance group, the mean axial length was (25.48±3.26) mm at pre-operation, (25.38±3.01) mm at 1 month post-operation, and (25.40±3.01) mm at 3 months post-operation (P=1.000); the mean anterior chamber depth was (3.14±0.53) mm at pre-operation, (3.56±0.76) mm at 1 month post-operation, and (3.62±0.81) mm at 3 months post-operation (P=0.000); the mean astigmatism diopter was (0.97±0.37) D at pre-operation, (0.72±0.32) D at 1 month post-operation, and  (0.62±0.27) D at 3 months post-operation (P=0.003). The difference of astigmatism diopter between pre- and 3 months post-operation was (-0.35±0.27) D in guidance group, and (0.20±0.49)D in control group (P=0.000). Conclusion Real-time eye tracking based on Lenstar LS900 surgery guidance system can decrease the postoperative astigmatism diopter, thus increase the repeatability and accuracy of the surgery. It could be widely used in clinical practices.

Abnormalities of motor nerves and extraocular muscles in congenital fibrosis of extraocular muscles demonstrated by high-resolution magnetic resonance imaging

JIAO Yong-hong1, MAN Feng-yuan2, WANG Zhen-chang3, XIAN Jun-fang2

2014, 23(3):  187-191.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.011

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Objective  To investigate the structural basis of three types of congenital fibrosis of extraocular muscles (CFEOM) by high-resolution magnetic resonance (HR-MR) images and try to provide the etiological clue of CFEOM. Design Retrospective case series. Participants Twenty-one CFEOM patients. Methods Twenty-one CFEOM patients were performed MR examination on 1.5T MR unit (Twin Speed, GE). EOMs and the motor nerve branches in the orbits were displayed on T1 weighted image (2.0-mm thick) in triplanar scans by dual-phased coils. Ocular motor nerves were imaged in the cistern on 3D-FIESTA (0.8-mm thick) by head coils. Ocular motor nerves, nerves to EOMs and EOMs were observed. Main Outcome Measures The developmental condition of the ocular motor nerves and EOMs. Results Different degree of hypoplasia of oculomotor nerve was exhibited in patients with three types of CFEOM, and the abducens nerve and the trochlear nerve were also affected. Nearly every EOM was exhibited variable atrophy and abnormal brightness on T1 weighted image, particularly severe in superior rectus and levator muscles. Conclusion HR-MR imaging can directly demonstrate pathology of ocular motor nerves and affected EOM hypoplasia in CFEOM patients，especially the obvious hypoplasia of the ocular motor nerves which suggest that the neuronal hypoplasia is the etiological factor of CFEOM.

Efficacy of botulinum toxin A for congenital esotropia

WANG Wen-ying, WU xiao

2014, 23(3):  192-197.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.0012

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 Objective To observe the efficacy of botulinum toxin type A (BTXA) injections transconjunctivally into the medial recti muscles on the patients with congenital esotropia. Design Retrospective case series. Participants 12 patients（24 eyes）with congenital esotropia diagnosed at the age of 6~34 months（mean 19.69±8.61 months）. Methods Visual acuity, slitlamp, fundoscopy and cycloplegic refraction were examed. Near (33 cm) and far (6 m) horizontal deviation (in both prism degree and degrees) determined using the simultaneous prism and cover test. When cooperation was not possible, we used Hirschberg's or Krimsky's method. Concurrent bilateral medial rectus muscle BTXA injections (2.5 u) monitored with electromyographic recording under sedation-anesthesia were used for all the patients. Patients were followed regularly at 2 weeks, 3 months, 6 months, 1 year and 2 years till last visit. Far deviation ≤10△ was considered as orthophoria. During follow up,  if deviation≥ 20△ and persist over 3 months, second injection will be given. Deviation and stereoscopic vision were recorded. Main Outcome Measures Best-corrected monocular visual acuity, refraction, deviation and stereoscopic vision. Results The diopter of the 12 patients was +0.375~+3.625 D（mean 1.88±0.84 D）. Patients were followed up for 4 to 84 months (mean 25.83±13.13 M) after the last injection. 8 patients required once bilateral injection and 4 patients required twice bilateral injections to achieve a favorable outcome. During follow-up, success rate of  BTXA injection was 83.33% (10/12 cases) . One case underwent standard surgery with recession of the medial rectus and resection of the lateral rectus muscle at the 14th month after the injection, who achieved after surgery. The other one case received prism diopters after injection since the deiviation decreased to +15△. Till last visit all patients achived orthophoria after combined  treatment. 4 cases achieved gross stereopsis. Conclusion BTXA injection transconjunctivally into the medial recti muscles is an effective treatment modality for the management of congenital esotropia in infants and children. It can be injected repeatly 3 months later.

Clinical features and outcome of pediatric optic neuritis

JIANG Zhao-cai, LIU Zi-hao, LI Hong-yang, CHEN Ting-jun, WEI Shi-hui

2014, 23(3):  197-200.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.013

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Objective  To study the characteristics of pediatric optic neuritis for the better treatment and nursing for them. Design Retrospective case series. Participants 75 cases (124 eyes) with pediatric optic neuritis (<16 years) from Jan. 2010 to Dec. 2012 in General Hospital of PLA. Methods Retrospective analysis of clinical data of 75 cases (124 eyes) with pediatric optic neuritis was conducted, collecting and analyzing their predisposing factors, clinical features. The follow-up was for 6~42 months to get further analysis for their prognosis and outcomes. Main Outcome Measures Predisposing factors, clinical features, and prognosis. Results The mean age of scheduled patients was 10.67±3.57 years, with 56 females (74.67%) . 29 patients (38.67%) had causes before onset, and all patients had different levels of vision loss. 49 patients (65.33%) exhibited bilateral diseases. In total, 32 patients (42.67%) had eye pain or eye pain with movement. All children followed up exhibited optic disc pallor. 51.52% of patients had recurrent optic neuritis, but visual acuity had recovered to 0.5 in 70% of patients. The final diagnosis of these patients were 4 multiple sclerosis (6.78%) and 9 neuromyelitis optica (15.25%). Conclusion The clinical characteristics of pediatric optic neuritis were severe bilateral vision loss and complete recovery. Compared with developing multiple sclerosis, female and older patients were in the risk of developing neuromyelitis optica.

Predisposing factors and etiology analysis of 24 cases with endogenous endophthalmitis

SHEN Lin, WANG Hong, ZHAO Meng, WEI Wen-bin

2014, 23(3):  201-204.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.014

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Objective To analyze the predisposing factors and pathogenic microorganisms of 24 patients with endogenous endophthalmitis. Design Retrospective case series. Participants 24 patients (32 eyes) with endogenous endophthalmitis from Beijing Tongren Hospital from Jan. 2009 to Jan. 2013. Methods All patients were asked medical histories and routine ophthalmic examinations. Aqueous humor and vitreous specimens were taken by vitrectomy, and were smeared and cultured. Main Outcome Measures Predis -posing factors, the results of intraocular fluid cultivation. Results The main systemic predisposing factors included: diabetes mellitus in 4 cases (16.7%), surgeries in 3 cases (12.7%), liver abscess in 2 cases (8.4%), history of continuous high-strength working in 2 cases（8.4%）, urinary tract infection in 2 cases (8.4%), vaginitis in 2 cases (8.4%), long-term use of immunosuppressive agents in 1 case（4.2%）, oral infection in 1 case(4.2%), bacterial meningitis in 1 cases (4.2%) and respiratory infection in 1 case（4.2%）. Sixteen cases (66.7%) had a fever, and accepted systemic antibiotic treatment with a history of intravenous infusion. The positive rate of intraocular fluid cultivation was 54.8% (17 eyes). 45.2% (14 eyes) was fungal, especially candida albicans. 9.7% (3 eyes) was bacteria, and 2 eyes (6.5%) of the 3 eyes were pneumonia klebsiella bacillus. Conclusion The main predisposing factors of this group of patients were fever caused by different reasons, and the common causes included surgical operation, genito-urinary system infection and liver abscess. The main systemic disease was diabetes mellitus. The main pathogens were fungi, especially candida. And the main bacteria was pneumonia klebsiella bacillus.

Clinical efficacy of total vitrectomy for retinal detachment second to giant retinal tear

ZHANG Ying1, ZHANG Zhi-fei2, LIU Wen2, HUANG Su-ying2

2014, 23(3):  205-209.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.015

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Objective To determine the effectiveness of total vitrectomy in the management of giant retinal tears(GRTs). Design Retrospective case series. Participants Seventeen eyes of 17 consecutive patients with GRTs were enrolled at Zhongshan Ophthalmic Center from Jul. 2003 to Jan. 2008. Methods All patients were performed total vitrectomy, peeling off the adhesion cortical vitreous, perfluorocarbon liquid, partial retinectomy, endophotocoagulation, gas-liquid exchange and silicone oil tamponade. Nine eyes with ciliary epithelium detachment underwent resection of the detached ciliary epithelium. Scleral circling was placed in one eye with serious PVR. Pars plana lensectomy was performed in one eye with complicated cataract. The following-up times were 24.5±8.5 months. Main Outcome Measures The postoperative visual acuity, retinal attachment and complications. Results Retinal redetachment occurred in two patients. One with the occurrence of a new tear, the other one with serious postoperative PVR leading to tractional retinal detachment. The silicone oil was uneventfully removed in 15 patients between 2 and 18 monthes. One case was loss to follow-up. The final best-correcting visual acuity was light perception to counting fingers in 2 eyes, 0.02～0.3 in 5 eyes, 0.5～0.7 in 6 eyes, ≥1.0 in 3 eyes, The postoperative visual acuity was better than preoperation（χ2=17.01，P＜0.05）. Conclusion There is a favorable effect on the retinal detachment associated with GRTs of total vitrectomy, partial retinectomy, endophotocoagulation and tamponade of silicone oil during 2- year following-up.

Application of multimedia visual teaching method on teaching of ocular fundus diseases

SHI Xue-hui, WEI Wen-bin

2014, 23(3):  210-213.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.019

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The teaching of fundus diseases is a difficult course, because of involving the complicated etiopathogenisis and pathologic mechanisms, and the various clinical manifestations. Multimedia visual teaching method may optimize teaching structure, enrich teaching content, simplify teaching procedure, and so provide a better model for fundus disease teaching. Through this method, teachers may systemic expound all signs of etiopathogenisis and pathologic mechanisms, clinical manifestation, and further analyze their correlation clearly, and students will have more interest and comprehension in the courses. Multimedia visual teaching method may not only improve the teaching effects, but also plays important role in training the student’s comprehensive qualities, including concrete thinking, logical thinking, and dialectical analyzing abilities.

Public awareness rate of glaucoma needs to be improved urgently

WEI Xin, CHEN Xiao-ming

2014, 23(3):  215-后插I.  doi:10.13281/j.cnki.issn.1004-4469.2014.03.018

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Although glaucoma is the second leading cause of blindness globally, as the result of low public awareness rate and other reasons, the glaucoma diagnosis rate is always staying at a low level. Even in developed countries, up to 50% glaucoma patients not yet aware of their sick and without any treatment, furthermore, this number is as high as 90% in developing countries. Based on the analysis of the domestic and international researches, increasing the public awareness rate of glaucoma is in urgent need. By carrying out the propaganda of glaucoma in public, strengthening the training on ophthalmologists who are working in the primary hospital and allocating the necessary equipments, we hope the glaucoma awareness rate and diagnosis rate could be improved.