Table of Content

25 September 2014, Volume 23 Issue 5

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Key points on the femtosecond laser assisted corneal refractive surgery

ZHANG Feng-ju, GUO Ning.

2014, 23(5):  289-291.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.001

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Although many clinical data have shown that the femtosecond assisted corneal refractive surgery is a safe and effective method for ammetropia, it still should be confirmed further by clinic data of improving visual quality by the method of femtoseond assisted corneal refractive surgery compared with conventional procedure. The key points to improve visual quality after femtosecond assisted refractive surgery are clarified in this article in order to customize performing the technique rationally and avoiding the complications, and providing the perfect visual quality for the patients. (Ophthalmol CHN, 2014, 23: 289-291)

The application of the KAB and KAP medical behavior management in the orthokeratology treatment

GUO Xi, YANG Li-na, XIE Pei-ying

2014, 23(5):  292-294.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.002

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 Medical behavior management is an intervention and management science to the patient's mental and physical activity from the medical point of view, which includes the two modes of KAB (knowledge-attitude-behavior) and KAP (knowledge-attitude-practice). Based on the patient's full understanding of the treatment principle, these methods establish the patient's correct opinions of the disease, which will ensure the patient's mental and physical maximum extent cooperation during the actual treatment process. The medical behavior management is mainly used for the children treatment to improve the pediatric patient's compliance and improve the treatment safety and effect. Medical behavior management is required in each step of the orthokeratology. We are trying to apply the medical behavior management (KAB and KAP) to the orthokeratology in current paper. The medical behavior management is playing a guiding role in the doctor-patient communication, fitting, pick-wearing education, follow-up review. In addition, the statistical analysis was also performed on results such as the patient's knowledge and understanding before and after practitioners's good explanation, the practitioner's assessment to the patient's complying. The results show that the medical behavior management plays a positive guiding role for the orthokeratology treatment. (Ophthalmol CHN, 2014, 23: 292-294)

Six months effects on SMILE for moderate and high myopia with astigmatism

XU Duo, KAN Qiu-xia, ZHANG Guo-wei, CHEN Kai-jian, LIU Li-na， LANG Min， BAI Ji

2014, 23(5):  295-300.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.003

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 Objective To analyze the therapeutic effect of astigmatism with moderate and high myopia by small incision lenticule extraction (SMILE) and investigate the characteristics of SMILE. Design  Prospective case series. Participants  A total of 47 patients (92 eyes) with moderate and high myopic astigmatism (-1.00 D~-5.50 D). Methods A total of 47 patients (92 eyes) with moderate and high myopic astigmatism (astigmatism≥-1.00 D) were treated by SMILE, which were divided into two groups. Group A included 54 eyes with moderate astigmatism (-1.00 D~-3.00 D),  group B 38 eyes with high astigmatism (-3.00 D~-4.50 D). The operation were carried with the VisuMax femtosecond laser. Intended flap diameters were 6.8~7.5 mm, cap with 120~130 μm， side cutting 2 mm, according to the normal operation of SMILE. Main Outcome Measures Preoperative best corrected visual acuity（BCVA），uncorrected visual acuity (UCVA), refraction, keratometry, residual astigmatism and visual contrast sensitivity at 1 day， 1 week， 1 month and 6 months after surgery. Results There were 92 eyes completed the procedure as designed, including 1 eye with negative pressure cone ring detached during the procedure, then absorbed again to complete the surgery. In three cases, air bubble was found between corneal lens layers. Corneal cap edge (epithelium loss was greater than 1 mm × 1 mm in 2 eyes. Laser scanning area shading resulted in difficult separation in 1 eye. No other complications were encountered. No microperforations were observed, and neither graft rejection nor failure occurred. Cornea was transparent and no epithelial defect and dry spot were observed in patients 1 day after surgery. Postoperative UCVA was greater than or equal to the preoperative BCVA in 89, 90, 92, 79 eyes respectively at 1 d, 1 wk, 1 mo and 6 mo as after surgery(only 79 eyes were followed at 6 mo). Furthermore post operation visual acuity improved more than 2 rows than preoperative BCVA was found in  14, 18, 22, 16 eyes at 1 d, 1 wk, 1 mo and 6 mo follow up respectively. No case with DLK,  epithelial implantation and obvious dry eye symptoms was found. There was no significant difference in UCVA after surgery between moderate and high astigmatism group. Conclusion SMILE operation could provide good clinical efficacy, safety and relatively good predictability in the correction of moderate and high myopic astigmatism. (Ophthalmol CHN, 2014, 23: 295-300)

The variation of cornea Q-value and curvatures in three years after receiving aspheric LASIK for treatment of myopia

CHEN Zhang-ming, ZHAO Ting-ting, HUANG Dan

2014, 23(5):  301-304.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.004

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 Objective  To compare the variation of cornea Q -value and curvatures in three years after receiving aspheric LASIK or LASIK for a treatment of myopia. Design A retrospective comparative case series. Participants 155 patients (295 eyes) who underwent LASIK in Haerbin 242 hospital were chosen to participate in current study. Methods Patients were divided into two groups, aspheric LASIK group and conventional LASIK group. According to the corneal matrix reservation, each group were divided into three subgroups: group A＞350 μm, group B  300~350 μm and group C 280~299 μm. Q-value and anterior cornea curvatures were measured with Orbscan II topography system before and 1 week，1 month，6 month，1 year, 3 year after surgery． Main Outcome Measures The Q-value and anterior cornea curvatures. Results At the third year after surgery, the Q-value of patients who received aspheric LASIK group was group A 0.27±0.21, group B 0.33±0.31 and group C 0.93±0.19 respectively. The anterior cornea curvatures of the three groups was 39.6±1.17 D, 39.9±0.83 D and 0.93±0.19 D respectively. In the LASIK group, the Q-value was group A 0.35±0.24, group B 0.71±0.35 and group C 1.03±0.36 respectively. The anterior cornea curvatures was 40.2±0.98 D, 39.6±0.33 D and 37.3±1.83 D respectively, and the difference was not significant. Conclusion After 3 years' follow-up, aspheric profile could maintain the corneal aspherical shape better than conventional LASIK when the corneal matrix reservation was 300~350 μm. When the corneal matrix reservation was greater than 280 μm, both of these surgeries were safe. (Ophthalmol CHN, 2014, 23: 301-304) 

Comparison of corneal ablation depth among three different types of laser corneal refractive surgery

ZHANG Ri-ping, GU Mei-shan, SUN Li-xia, LI Jin-yu

2014, 23(5):  305-307.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.005

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 Objective To compare the corneal ablation depth among three different types of laser surgery by online corneal pachymetry. Design Prospective comparative case series. Participants 200 eyes of 100 moderate and high myopia patients accepted laser surgery, including FEMTO-LASIK group 100 eyes of 50 patients, LASIK group 57 eyes of 30 patients and LASEK 43 eyes of 23 patients. Methods The corneal thickness was assessed intraoperatively with online optical coherence pachymetry (OCP) before and after laser ablation during surgery, and then the actual corneal ablation depth was calculated. The values of actual and theoretical ablation depth, and the difference in the three groups were compared. Main Outcome Measures Theoretical corneal ablation depth, actual corneal ablation depth. Results In FEMTO-LASIK group, the actual corneal ablation depth and theoretical ablation depth were117.22±31.13 μm and 99.52±25.47 μm respectively, t=-12.55, P<0.001; In LASIK group, the actual corneal ablation depth and theoretical ablation depth were 116.30±22.93 μm and 94.26±16.37 μm respectively, t=-12.44, P<0.001; In LASEK group, the actual corneal ablation depth and theoretical ablation depth were 106.72±23.77 μm and 99.31±20.46 μm respectively, t=-4.44, P<0.001. The difference between the actual corneal ablation depth and theoretical ablation depth were 17.69±14.10 μm in FEMTO-LASIK group, 22.04±13.38 μm in LASIK group and 7.41±10.95 μm in LASEK group. There were no difference between FEMTO-LASIK group and LASIK group, P=0.15, while the difference in LASIK and FEMTO-LASIK were significantly more than that of LASEK group, P<0.001. Conclusions The actual corneal ablation depth is more than theoretical ablation measured by online OCP during three different types of laser surgery. The difference between the actual corneal ablation depth and theoretical ablation depth should be taken into consideration while calculating the corneal stroma thickness preoperatively. (Ophthalmol CHN, 2014, 23: 305-307)

Keratometric induce calculated by parameters obtained by Pentacam HR

HUA Yan-jun1, WANG Qin-mei2, HUANG Jin-hai2

2014, 23(5):  308-312.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.006

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Objective To assess repeatability of  corneal parameters (curvature and central thickness) obtained by Pentacam HR in Chinese normal eyes and eyes after corneal refractive surgery, and to calculate keratometric index based on parameters obtained by Pentacam HR. Design Prospective study. Participants Subjects who received examinations for corneal refractive surgery were divided in to 2 groups. In group A, 207 eyes of 207 myopic subjects who received preoperative examinations were included. In group B, 133 eyes of 67 subjects who received preoperative examinations and postoperative examinations more than 3 month after LASIK or more than 6 month after PRK were included. Method In group A, subjective refraction and Pentacam HR were performed. In group B, subjective refraction and Pentacam HR were performed preoperatively and postoperatively. Pentacam HR performed 3 times and 3 valid results were obtained for every tested eye in both groups. Main Outcome Measures Coefficient of variation(CVw), intraclass standard deviation (Sw), and intraclass correlation coefficient(ICC) were used to evaluate the repeatability of mean anterior central corneal curvature in 3 mm zone(Ra), mean posterior central corneal curvature in 3 mm zone(Rp) and central corneal thickness(CCT) in both groups. Independent samples t test was used to compare keratometric induce from virgin eyes and post LASIK/PRK eyes. Results In group A, Ra, Rp and CCT obtained by Pentacam HR were (7.780±0.235) mm, (6.341±0.225) mm and (541.67±31.79) μm, respectively; in group B, Ra, Rp and CCT obtained by Pentacam HR were (8.625±0.412) mm, (6.379±0.237) mm and (461.89±34.70) μm, respectively. All the parameters obtained in both groups had good repeatability (all the CVw<1%, and all the ICC≥0.99). The corneal refractive index calculated based on the parameters obtained by Pentacam HR were (1.3278±0.0008) in group A and(1.3227±0.0019) in group B, and the difference was statistically significant (t=34.634, P=0.000). Conclusions Mean anterior and posterior central corneal curvature in 3 mm zone and central corneal thickness obtained by Peatacam HR had good repeatability in both virgin eyes and eyes after corneal refractive surgery. The keratometric index calculated based on Pentacam HR in eye after corneal refractive surgery was smaller than that calculated in virgin eyes. (Ophthalmol CHN, 2014, 23: 308-312)

The study of perceptual eye position and gaze stability of the children with normal visual acuity

ZHAO Guo-hong, LU Wei, YAN Li, ZHANG Ling-ge

2014, 23(5):  312-315.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.007

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 Objective To investigate the perceptual eye position and gaze stability of the children with normal visual acuity under dichoptic vision condition.  Design Prospective case series. Participants The study included 97 children with normal visual acuity and the age of 5 to 7 years. Method The main test method was the computer based visual perceptual test. The children should stare at the center of the screen, the distance between the child and the screen was about 80 cm. Each child must take the visual perceptual and gaze stability tests after regular ophthalmology examinations. Main Outcome Measures The deviation pixels of perception eye position and the gaze stability. Results When the target size was 3 degree, the horizontal eye position was 4.73~6.83 pixels, and the mean eye position was (5.78±1.51) pixels; the vertical eye position was 2.12~2.31 pixels, and the mean eye position was (2.72±0.85) pixels. When the target size was 1 degree, the horizontal eye position was 5.64~8.06 pixels, and the mean eye position was (6.85±1.74) pixels; the vertical eye position was 1.37~2.03 pixels, and the mean eye position was (1.70±0.48) pixels. The gaze stability deviation was 4.25~5.09 pixels, the mean deviation was (4.67±1.03) pixels. Conclusion The results of the perceptual eye position and gaze stability of this study may be taken as the clinical references of children with normal visual acuity.(Ophthalmol CHN, 2014, 23: 312-315)

Macular retinal thickness of children with low to moderate myopia measured by Cirrus HD-OCT

ZHANG Cong, LI Qian, LIU Wu, SHI Xue-hui, MIAO Wei-li

2014, 23(5):  316-318.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.008

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Objective To assess the macular retinal thickness of children with low and moderate diopter myopia with spectral domain optical coherence tomography (SD-OCT). Design Cross-sectional study. Participants Myopia group included 54 children（108 eyes） at age of 7 to 12（9.80±1.44）,  with best-corrected distance visual acuity（BCDVA）≥1.0 and spherical equivalent（SE)（-6.00 D~-0.50 D）, without other ocular pathology. The normal control group included 58 children(116 eyes) （-0.50 D~0.50 D） at age of 7 to 12(9.78±1.58). Methods After comprehensive ophthalmic examination, optical coherence tomography (Cirrus HD-OCT, 512×218 cube scan pattern) was performed, and the difference between myopia group and control group was analyzed. Main Outcome Measures Central macular thickness(CMT), macular volume (MV), average macular thickness (AMT), average macular thickness of inner circle(I-AMT) and average macular thickness of outer circle(O-AMT). Results The difference of CMT between myopia group (239.7±18.1 μm)and control group (238.4±18.1 μm) was not significant （P=0.539). MV, AMT, I-AMT and O-AMT of myopia group were significantly thinner than control group(all P=0.000), and had a statistically significant association with SE (r=0.276~0.424，P=0.000~0.004). Conclusions CMT in low to moderate myopic eyes is not thinner than that of, emmetropic eyes, while the parafovea retinal thickness was thinner in myopic eyes. (Ophthalmol CHN, 2014, 23: 316-318)

The association between accommodative response and refractive degree in  incipient myopia children

TANG Ping, FENG Yi, MENG Meng

2014, 23(5):  319-322.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.009

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Objective To investigate the association between accommodative response and refractive degree in incipient myopia children. Design Retrospective case series. Participants The study included 96 with age 8 to 10 years old, the vision blurring within 6 months, and the cycloplegic myopic degree lower than -1.00 D. Method All participants underwent ophthalmology examination, subjective refraction, accommodative response, accommodative facility, negative relative accommodation, and positive relative accommodation examination. The degree of less myopic eye was selected for statistical analysis. Main Outcome Measures Myopic diopter, accommodative response, accommodative facility, relative accommodation. Results The mean myopic refraction of participants was -0.66±0.25 D. The value of accommodative response was 0.25±0.36 D. The value of accommodative facility was 6.31±2.54 cpm. The value of negative relative accommodation was 2.20±0.40 D and the value of positive relative accommodation was -1.96±1.32 D. The accommodative response and myopic diopter were negatively correlated. The accommodative facility and accommodative response were positively correlated. The accommodative response and the negative relative accommodation were negatively correlated. The accommodative response and the positive relative accommodation were positively correlated.  Conclusion The accommodative lag has been existed in the incipient myopia children. The accommodative lag and positive relative accommodation reduced might be involved in the pathogenesis of myopia. (Ophthalmol CHN, 2014, 23: 319-322)

Accommodative change after retinal photocoagulation for diabetic retinopathy

ZHENG Lei, WEN Jia-min, ZHANG Fu-yan

2014, 23(5):  322-325.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.010

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Objective To observe the accommodative change in patients with diabetic retinopathy after retinal photocoagulation. Design Prospective case series. Participants 15 patients (30 eyes) treated with retinal photocoagulation for diabetic retinopathy, with average age 57.4±13.4 years. Methods Accommodative indexes and visual acuity of the same eyes of all the patients were measured before treatment and on 1st , 3rd , 7th , 14th day after treatment. Main Outcome Measures Amplitude of accommodation (AA), positive and negative relative accommodation (PRA/NRA), best corrected visual acuity (BCVA), near visual acuity (VA-N). Results The AA and PRA of post-treatment were lower than pre-treatment (all P＜0.05). The post-treatment change happened from the 1st day, reached peak on 3rd day, and partially recovered on 7th day, but could not recovery to the pre-treatment on 14th day. There was no significant difference between pretreatment and post-treatment NRA (P＞0.05). The VA-N of post-pretreatment was lower than pre-treatment (P＜0.05), and the change trend was similar with AA and PRA. There was no significant difference between pretreatment and post-treatment BCVA (P＞0.05). Conclusion In post-treatment 14 days, retinal photocoagulation can cause decline of accommodative amplitude in patients with diabetic retinopathy. （Ophthalmol CHN， 2014, 23： 322-325）

The MRI manifestations of the levator muscles in thyroid associated ophthalmopathy

AI Li-kun, HU Yi-bo, WU Yi, MAN Feng-yuan, WANG Xue

2014, 23(5):  326-331.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.011

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Objective  To observe the levator muscles using MRI at the different functional eye positions and to expose the main cause of eyelid retraction in thyroid associated ophthamopathy (TAO). Design Prospective case-control study. Participants Forty-two TAO patients. Methods TAO patients were divided into 2 groups: group A, with eyelid retraction; group B, without eyelid retraction. Normal controls were also included in this project, as group C. Area of each functional point along the levator muscle was measured at primary, down-gaze, up-gaze positions. Main Outcome Measures The area of each point along the levator muscle. Results Hypertrophy were presented in eyelid retraction group (group A 3.08±0.20, group B 2.60±0.20, control 1.41±0.06), highly related to the enlargement of superior rectus muscle(r=0.995).  Both systolic rate and diastolic rate were found significantly reduced, to 40% and 60% of the controls respectively. Muscle belly was the point that contributed the most of the reduction of muscle retraction function. The systolic curve of group B was quite close to that of the controls, whereas the diastolic curve matched that of group A. Conclusion In spite of the hypertrophy of levator, both contraction and relaxation functions of levtator are reduced in TAO patients.  Furthermore, the deficiency of the contraction may contribute the most to the eyelid retraction. (Ophthalmol CHN, 2014, 23: 326-331)

Comparing the effect of homemade corneal microgrinding drill and traditional hypodermic needles in dealing with cornea iron foreign body

ZANG Chuan-hai, QIU Rong, JU Jian-li

2014, 23(5):  332-334.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.012

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 Objective  To evaluate the effect of corneal micro drill for removing cornea iron foreign body. Design A retrospective comparative case series. Participants 3475 cases 3621 eyes with deep corneal iron foreign body were randomly divided into two groups, group A with 1730 cases 1758 eyes and group B with 1745 cases 1863 eyes. Methods For group A, traditional hypodermic needle was used to remove corneal foreign body, while in group B, self made corneal micro grinding drill was used. Main Outcome Measures Operation time, requiring second operation rate, corneal rust ring clearance time, corneal wound healing time, postoperative complications. Results The operation time and needing second operation rate in group A and B was 3.2±0.7 min and 1.1±0.2 min, 50.11% and 0.81% respectively. Corneal rust ring clearance was 3.6±0.6 d and 1.1±0.3 d in group A and B respectively. Corneal wound healing time was 6.8±1.1 d and 3.3±0.8 d. Postoperative complication rate was 7.0% and 1.23%. The difference was significant (all P < 0.05). Conclusions  Corneal micro drill has a greater advantage than the traditional injection needle in the cornea iron foreign body treatment. (Ophthalmol CHN, 2014, 23: 332-334)

The preliminary study on the inhibiting effect of saturated hydrogen water on suture induced corneal neovascularization in rats

YOU Yu-xia, LIANG Qing-feng, LI Yu-jie, MA Ke

2014, 23(5):  335-338.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.013

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Objective To investigate the inhibiting effect of saturated hydrogen water on suture induced corneal neovascularization in rats. Design Experimental study. Participants Healthy adult male SD rats. Methods The left eyes of SD male rats were selected as the experimental eyes. The suture induced corneal neovascularization model was successfully induced in 12 rats, and then divided into 2 groups (n=6). The rats of group A were given saturated hydrogen water by dropping three times a day, and those in group B were given saline by dropping three times a day for consecutive two weeks. The cornea were photographed with slit lamp photography and the area of corneal neovascularization were calculated on post-operation-day 1, 3, 5, 7, 9, 11 and 14. On post-operation-day 14, the rats were sacrificed, and then HE staining and the expression of 4-hydroxynonenal (4-HNE) protein were determined. Main Outcome Measures The area of corneal neovascularization. Results The area of corneal neovascularization of group A and B on post-operation-  day 5, 7, 9 , 11 and 14 were 6.43±5.20 and 11.56±4.80 mm2, 10.10±8.79 and 21.39±8.57 mm2, 15.73±12.93 and 33.76±13.96 mm2, 9.85±9.04 and 24.80±13.06 mm2, and 8.42±5.46 and 23.13±13.37 mm2 respectively. The difference at day 5 was not significant(t=-1.774, P=0.106), but a significant difference was found between two groups at day 7 (t=-2.252, P=0.048), day 9 (t=-2.320, P=0.043), day 11 (t=-2.305, P=0.044), and day 14(t=-2.494, P=0.032). Conclusion Saturated hydrogen eye drops inhibit angiogenesis on suture induced corneal neovascularization. (Ophthalmol CHN, 2014, 23: 335-338)

Timing of intubation silicone tube removal of in children with congenital nasolacrimal duct obstruction

HU Man, YU Gang, CAO Wen-hong, FAN Yun-wei, ZHANG Cheng-yue, WU Qian

2014, 23(5):  339-342.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.014

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 Objective To evaluate the results and complications of silicone tube intubation for children presenting with congenital nasolacrimal duct obstruction in relation to the timing of tube removal. Design Retrospective case series study. Participants 192 patients (215 eyes) with congenital nasolacrimal duct obstruction from Beijing Children’s Hospital, whose age ranged from 6 months to 7 years (average 18 months), underwent silicone intubation with the Ritleng lacrimal intubation system. Methods The patients ’ records were reviewed regarding type of obstruction of the nasolacrimal duct, procedure details, timing of tubal removal, and Complications. Main Outcome Measure The success rate in relation to duration of silicone intubation. Results The overall success rate was 91.6%. There was no difference in the success rate between cases of tube removal within (95.6%) and after 2 months (97.2%) in children with simple obstruction of nasolacrimal duct, whereas in complex obstruction group, children whose tube removed after 2 months showed a higher success rate (89.3%) than children whose tube removed within 2 months(55.6%). Conclusion Removal of the silicone tube at 2 months is less likely to affect the final result in children with simple nasolacrimal duct obstruction. Removal of the tube after 2 months is recommended for children with complex obstruction. (Ophthalmol CHN, 2014, 23: 339-342)

Expression of  PAX6，Ki-67 and MMP-9 and their relationship with clinical histopathological features in retinoblastoma

BAI Hai-xia， BAI Shu-wei， LI Bin， GAO Fei， SHEN Ling

2014, 23(5):  343-347.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.015

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Objective To investigate the expression of PAX6， Ki-67 and MMP-9 in retinoblastoma (RB) cells and to evaluate their relationship with clinical histopathological characteristics as well as their clinical significance. Design Experimental study. Participants 40 cases of paraffin-embedded RB tissues. Methods The expression of PAX6, Ki-67 and MMP-9 in paraffin-embedded RB tissues was detected by immunohistochemistry. The relationship between these expressions and clinical histopathological characteristics was analyzed. The inter correlation between these expressions was analyzed as well. Main Outcome Measures The expression of  PAX6, Ki-67 and MMP-9 in RB tissue； the clinical and histopathological features. Results The positive expression rates of PAX6, Ki-67 and MMP-9 in RB tissue were 52.5%, 55.0%, 57.5%, respectively. The expression of Ki-67 in the 3-year or older age group was significantly higher than that in the age <3 year  group(χ2=6.825, P=0.016), but no significant differences were found in the expression of PAX6 (χ2=0.631, P=0.511) or MMP-9(χ2=0.129, P=1.000) between different age groups. Meanwhile, no significant differences were found in the expressions of all three proteins between different genders or laterality groups. The expression of PAX6 (P=0.017), Ki-67 (P=0.046) and MMP-9 (P=0.038) in the retrolaminar optic nerve infiltrated group were all significantly higher than the retrolaminar optic nerve non-infiltrated group. The expression of PAX6 (χ2=8.120, P=0.010) and Ki-67 (χ2=6.465, P=0.025) protein in the non-preoperative chemotherapy group were significantly higher than the preoperative chemotherapy group. The expression of PAX6 was significantly correlated with Ki-67(r=0.347, P=0.028). Conclusion The high expression of PAX6 promotes the proliferation of retinoblastoma cells. The overexpression of PAX6, Ki-67 and MMP-9 may contribute to the invasion of retinoblastoma together. Chemotherapy inhibits the expression of PAX6 and Ki-67 in retinoblastoma, reducing the risk of invasion and metastasis to some degree. (Ophthalmol CHN, 2014, 23: 343-347)

The retrobulbar optic nerve sheath diameter in adults with normal intracranial pressure measured by ultrasonography

LI Zhen1, ZHANG Xu-xiang1, YANG Hui-qing1, ZHAO Li-ping1, SUN Fei2, LIU Da-chuan1

2014, 23(5):  347-350.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.016

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Objective To explore the normal range of retrobulbar optic nerve sheath diameter(ONSD) measured by B mode ultrasonography in adults with normal intracranial pressure. Design Diagnostic technique evaluation. Participants 60 consecutive outpatients who underwent lumber puncture in Xuanwu Hospital，  from March 2012 to May 2013, and confirmed with normal intracranial pressure（70~200 mmH2O） and without any central nerve system disease, were enrolled. Methods Ultrasonographic ONSD at 3 mm behind the globe was measured by two different operators. The mean value of ONSDs measured by two operators was recorded as the patient’s ONSD value. We recorded the range of these ONSD values in adults with normal intracranial pressure, and analysis the consistency between two operators. Main Outcome Measures  Intracranial pressure, optic nerve sheath diameter. Results The ONSDs 3 mm behind eyeballs measured by B mode ultrasonography in adults with normal intracranial pressure were 5.38±0.67 mm (range: 3.9~7.4 mm) in right eyes, and 5.45±0.73 mm（range: 3.5~7.0 mm）in left eyes. No obvious difference was observed between right eyes and left eyes （t=-0.9, P=0.372）. The ONSDs of right eye in men were 5.62±0.62 mm and in women were 5.11±0.64 mm (t=3.129, P=0.003); the ONSDs of left eye in men were 5.73±0.63 mm and in women were 5.13±0.71 mm (t=3.460, P=0.001). There has significant differences between men and women. There is a good consistency between the two operators. Conclusion B mode ultrasonography is a simple and reliable method to detect the retrobulbar ONSD． There is a variation of ONSD in adults with normal intracranial pressure. (Ophthalmol CHN, 2014, 23: 347-350)

The exploration of continuing medical education mode in ophthalmology

WEI Wen-bin

2014, 23(5):  351-354.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.017

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Continuing Medical Education(CME) goes along with the career of a doctor and is the key for a doctor to uprise his professional level. However, there are lots of difficulties in CME in ophthalmology, such as diversity of subjects, complexity of contents, formalism, rapid updating of knowledge, interdisciplinary and operation training difficultly in young eye doctors. In our practice in CME, we try the mode of the combination of correct side and opposite side, the combination of humanity and profession, the combination of theory and practice, the combination of foreign education and domestic education, the combination of attending a lecture and giving a lecture, the combination of public welfare and commercial mode, the combination of department and teams, the combination of tradition and modern, the combination of doctors and nurses. (Ophthalmol CHN, 2014, 23: 351-354)

The necessity and training mode of scientific research competence of clinical postgraduate candidates

ZENG Hui-yang

2014, 23(5):  354-356.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.018

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The scientific research competence of clinical postgraduates is obviously weak. The goal of the nation to train clinical doctor with high-quality requires to improve the doctor’s scientific research abilities. To meet this goal, we believe the short-term training and practice for clinical postgraduate candidates on basic scientific research is still necessary. The project-based basic research is an appropriate training mode which can significantly improve the clinical postgraduate candidates’ scientific thinking and capability. In this article, the advantage and limitation of this training mode will be further elucidated based on our previous discussion on this topic.(Ophthalmol CHN, 2014, 23: 354-356)

Brief introduction of management in childhood glaucoma

GUO Wen-yi, GUO Chun-yu

2014, 23(5):  357-360.  doi:10.13281/j.cnki.issn.1004-4469.2014.05.019

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Childhood glaucoma patients have distorted ocular anatomy, limited co-operational ability, higher anesthesia risk, aggressive healing response, tend to receive second surgery after failure of the first one, and changes of their appearance caused by regular surgery may have impacts on their mental health. All of these make the diagnosis and management of childhood glaucoma different from that of adults. Here, we would like to introduce what should be noticed, given all these features, in diagnosis, treatment and follow-up. (Ophthalmol CHN, 2014, 23: 357-360)