Table of Content

25 March 2016, Volume 25 Issue 2

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Emphasis on the prevention and treatment of the postoperative complications in pediatric cataract patients

CHEN Wei-rong

2016, 25(2):  73-75.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.001

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Pediatric cataract is one of the leading of childhood blindness, and can be treated surgically. However, the pediatric cataract surgical procedure is different from that of adult cataract due to the not well developed anatomical structures in children. Furthermore, pediatric cataract patients usually have other ocular abnormities, which also result in the high incidence of postoperative complications, such as postoperative inflammatory reaction, iris synechiae, postoperative high intraocular pressure and glaucoma, posterior capsule opacification, etc. Signs and symptoms of postoperative complications in pediatric cataract patients are relatively insidious and tend to be misdiagnosed, severely impacting the surgical effectiveness and even leading to the second-blindness. Therefore, we should pay high attention to the prevention of postoperative complications of pediatric cataract patients. Construction of professional pediatric ophthalmologist team, standardization of diagnosis and treatment, improvement of surgical techniques, and timely treatment of postoperative complications are all beneficial to improve the therapeutic effect of pediatric cataract surgery and decrease the incidence of childhood blindness and low vision. (Ophthalmol CHN,  2016，25： 73-75）

Second stage fixed to the ciliary sulcus of common capsular tension ring for moderate and severe lens subluxation

CHEN Zhi-min1， ZHANG Wu-lin1， WU Wei-jing2， LIN Zhi-hui1， YANG Rong1.

2016, 25(2):  76-81.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.002

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 Objective To observe the clinical effects of common capsular tension ring(CTR) fixed in the ciliary sulcus at the second stage for moderate and severe lens subluxation. Design Retrospective case series. Participants 45 eyes of 33 patients with moderate and severe lens subluxation were treated and followed up in the Department of Cataract of Hebei Province Eye Hospital from March 2013 to May 2015. Methods At the first stage the common CTR and the intraocular lens(IOL) were implanted in the lens capsule after phacoemulsification. At the second stage the CTR were sutured to the ciliary sulcus with polypropylene suture three months after the first stage. All patients were followed up for 3 months. The postoperative best corrected visual acuity(BCVA), the visual quality, the center of the IOL and the complications were recorded. Main Outcome Measures The BCVA, ocular coma, Strehl ratio, the IOL offset, the complications. Results We successfully fixed the CTR in the ciliary sulcus in 45 eyes. The postoperative BCVA was 0.6~1.0 in 32 eyes(71%), 0.3~0.5 in 8 eyes(18%) and 0.1~0.2 in 5 eyes(11%). The BCVA improved after 3 months in all the 45 eyes. The mean ocular coma after the first stage was (4.08±3.17) μm, which improved to (0.39±0.10) μm after the second stage, the difference was significant (t=5.102, P=0.000). The mean Strehl ratio after the first stage was (0.035±0.018), which improved to (0.164±0.041) after the second stage, the difference was significant (t=14.881, P=0.003). This illustrated the visual quality increased. The mean IOL offset after the first stage was (3.02±0.47) mm, which improved to (0.31±0.11) mm, the difference was significant (t=17.298, P=0.000).  The IOL offset at the first stage was correlated with the range of the lens dislocation(r=0.634, P=0.012). The intraocular pressure increased in 3 eyes. No complications such as macular edema or capsular contraction occurred. Conclusions The capsular tension ring fixed in the ciliary sulcus at the second stage was an effective treatment for moderate and severe lens subluxation． Separating operations into two stages reduces the difficulty and complications of surgery. (Ophthalmol CHN, 2016, 25: 77-81)

The effect of double incision joint nuclear extraction with two-dialer in extracapsular cataract extraction procedure for restoring-vision cataract projects

YANG Li-dong, YANG Yun-dong, XU Shen

2016, 25(2):  82-85.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.003

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 Objective To evaluate the effect of double incision joint nuclear extraction with two-dialer in extracapsular cataract extraction (ECCE) procedure for restoring-vision cataract projects. Design Retrospective case series. Participants We retrospectively analyzed the 305 patients (all 342 eyes) who underwent the double incision joint nuclear extraction with two dialers ECCE from September 2012 to February 2015. Methods All patients were treated in our hospital with double incision joint nuclear extraction with two-dialer ECCE, and the operation time, intraoperative and postoperative appeared complications were recorded. Uncorrected visual acuity (UCVA) was measured with standard Snellen visual charts, and was classified into ≥ 0.05, ≥ 0.3, ≥0.5. Non-contact tonometer was used to measure intraocular pressure (IOP). Corneal topography was used to measure K1 and K2 to determine the astigmatism. The measurements were repeated 1 month after surgery and compared to corresponding pre-operative values. Main Outcome Measures The average time length of operation, UCVA, IOP, corneal astigmatism, posterior capsule rupture, pupil deformation, and corneal edema. Results The average time length of operation was 4.1±0.2 min. There were 338(98. 83%) eyes whose post-operative UCVA ≥ 0.05, 305(89. 18%) eyes ≥0.3, and 179(52.34%) eyes ≥0.5. There were 251(73.39%) eyes whose post-operative best-corrected visual acuity ≥ 0.5. No posterior capsular rupture (PCR) happened. Mild pupil deformation due to iris injury during surgery happened in 2 eyes (0.58%). One eye (0.29%) couldn't implant artificial lens, 1 eye (0.29%) needed suture the scleral tunnel incision.  Post-operation corneal edema happened in 39 eyes (11.4%) and 12 eyes (3.50%) suffered transient intraocular hypertension post-operatively. The average corneal astigmatism was (0.93±0.33) D after 1 month, not significantly different from (0.89±0.36) D before the operation (P=0.12). Conclusions During restoring-vision cataract projects, double incision joint nuclear extraction with two dialers in ECCE procedure is safe and effective, could be the primary choice for primary hospitals. （Ophthalmol CHN，2016，25： 82-85）

Lens extraction combined with scleral-fixated intraocular lens implantation for ectopia lentis in Marfan syndrome

QU Ya, LI Fu-liang, YU Tao, LI Jia-wen

2016, 25(2):  86-89.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.004

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Objective To evaluate the clinical effects of phacoemulsificatio or limbal-approach lensectomy and vitrectomy combined with scleral-fixated intraocular lens(IOL) implantation for ectopia lentis in Marfan syndrome.  Design Retrospective case series Participants 10 patients (18 eyes) with ectopia lentis in Marfan syndrome were reviewed. Methods 3 patient (older than 12 years, 5 eyes) were treated with phacoemulsification combined with the scleral-fixated IOL implantation. The other 7 patients (younger than 12 years, 13 eyes) were treated with limbal-approach lensectomy and vitrectomy combined with scleral-fixated IOL implantation. The mean follow-up period was (1.40±1.02) years  (range 0.5 to 3 years). Main Outcome Measures The changes of visual activity, intraocular pressure and surgery complications. Results The mean best-corrected visual acuity (BCVA) of the 18 eyes improved significantly, from preoperative 0.29±0.20,  to 0.51±0.24 (P=0.008). The mean BCVA of phacoemulsification group was 0.17±0.04 before operation, which significantly improved to 0.41±0.16 after operation (P=0.026). The mean BCVA of lensectomy group was (0.34±0.22) before operation, and (0.55±0.25) after operation. The improvement was significant (P=0.000). The pre- and post-operative visual acuity change was no significant between the two groups (P=0.062). The mean pre-opertive spherical equivalent refractive error was -2.76±14.1 diopters (D), which improved to -0.79±1.95 D after operation. Conclusion The two surgical approaches to treat ectopia lentis are both safe and effective. There was no significant difference between the two approaches in terms of visual improvement and refractive error. (Ophthalmol CHN, 2016, 25: 86-89)

The changes in axial length and refraction before and after cataract surgery

YU Qi-hua, WU Yi-nan, SHEN Jiang

2016, 25(2):  90-93.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.005

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 Objective To compare axial length and refraction before and after cataract surgery. To guide on the spectacle prescription time and reserved refractive outcome after surgery. Design Prospective case series. Participants 30 patients (37 eyes) underwent phacoemulsification cataract extraction with IOL implantation. Methods All the patients were separated into two groups. Group of over-long axial length included 15 patients(17 eyes) with axial length 29.71～32.89 mm and group of normal axial length included 15 patients(20 eyes) with axial length 22.16～25.54 mm. The axial length was measured by IOLMaster preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months. Refraction was also measured at 1 week, 1 month and 3 months after surgery. All the data were analyzed in the randomized block design with the SPSS 17.0 statistical software package. Main Outcome Measures Axial length and refraction. Results The axial length in group of over-long axial length was (31.07±1.02)mm preoperatively and was(30.60±0.88)mm 3 months postoperatively, and the difference was statistically significant. The axial length in group of normal axial length was(23.51±0.78)mm preoperatively and (23.37±0.75)mm 3 months postoperatively, and the difference was also statistically significant. The refraction in group  of over-long axial length was (-3.78±0.68)D 1 day postoperatively and was (-3.01±0.55)D 1 month postoperatively, and the difference was statistically significant. The refraction in group of normal axial length was (-0.53±0.10)D 1 day postoperatively and was (-0.40±0.07) D 1 week postoperatively, and the difference was also statistically significant. The difference in axial length has no statistical significance between 1 month (30.61±0.90 mm) and 3 months(30.60±0.88 mm) postoperatively in group of over-long axial length, and among 1 week(23.38±0.79 mm), 1 month(23.38±0.78 mm) and 3 months(23.37±0.75 mm) postoperatively in group of normal axial length. The difference in refraction has no statistical significance between 1 month and 3 months(-3.03±0.54)D postoperatively in group of over-long axial length, and between 1 week, 1 month(-0.42±0.11)D and 3 months(-0.41±0.08)D postoperatively in group of normal axial length. Conclusion The axial length shortened after phacoemulsification cataract extraction with IOL implantation, especially in over-long axial length eyes. The axial length and refraction both stabilized in 1 month in group of over-long axial length, while in 1 week in group of normal axial length. （Ophthalmol CHN，2016，25： 90-93）

Long term effects of rigid gas permeable contact lens control on adolescent myopia combined with high astigmatism

LIU Li-zhou1，2, WEI Rui-hua1, GUO Yin2

2016, 25(2):  93-97.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.006

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Objective To investigate the long term clinical effects of rigid gas permeable contact lens (RGPCL) control on adolescent myopia combined with high astigmatism. Design Retrospective case series. Participants 48 patients (69 eyes), with a mean age of (15.2±1.5) years with myopia combined with high astigmatism ( ≥-2.50 D) were fitted with RGPCL and followed up for 5 years. 51 patients (102 eyes),  with a mean age of (15.3±1.6) years with  myopia combined with high astigmatism ( ≥-2.50 D) were fitted with spectacles and followed up for 5 years. Methods For RGPCL group, after using tropicamide phenylephrine eye drops, the ocular refraction, corrected visual acuity and the radius of corneal curvature changes were observed for 5 years. For spectacles group, after using tropicamide phenylephrine eye drops, the ocular refraction, corrected visual acuity were observed for 5 years. The differences of the average sphere diopter, cylinder diopter, and corrected visual acuity were compared between RGPCL group and spectacle group.  Main Outcome Measures The average sphere diopter, cylinder diopter, corrected visual acuity, average horizontal radius, average vertical radius, average radius of corneal curvature. Results  Corrected visual acuity was (0.99±0.41) after wearing RGPCL for 5 years. Corrected visual acuity was (0.74±0.13) after wearing spectacles for 5 years.  During the 5-year follow up, the average sphere diopter increased significantly less in RGPCL group than in spectacle group(0.623±1.067 D vs. 2.018±1.461 D)(P<0.0001). More strikingly, the cylinder diopter decreased 0.696±0.694 D in RGPCL group, which is significantly different from spectacle group(increased 0.417±0.574 D)(P<0.0001). The average horizontal radius, average vertical radius, average radius of corneal curvature increased (0.046±0.106)mm, (0.189±0.184)mm,  (0.119±0.131)mm after wearing RGPCL for 5 years. Conclusion Myopia and astigmatism progression can be controlled by wearing RGPCL. (Ophthalmol CHN, 2016, 25: 93-97)

Efficacy and safety of Orthokeratology for myopic progression in children

TANG Xiao-lei1,2, FU Shi-jie1, WANG Xiao-li2, DING Qian2, ZENG Tao2, BAI Yu2

2016, 25(2):  98-101.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.007

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Objective To observe the efficacy and safety of Orthokeratology for controlling myopic progression in children. Design Prospective case series. Participants 105 children with myopia in the Department of Ophthalmology of Mianyang Central Hospital from 2010 to 2015, who were 8~12 years old, with the spherical equivalent (SE) degree -0.50~-5.00 D. Method 35 cases (70 eyes) were in experimental group using Orthokeratology, 70 cases were in control group wearing myopic single vision lenses. The participants were followed for 1 year, measuring the visual acuity (LogMAR) and SE, the axial length (AL) (measured with IOL Master); corneal topographic map (Humphery Atlas 8.0 corneal topography analysis system); central corneal thickness (CCT)(AL2000). Main Outcome Measures Uncorrected visual acuity, SE, AL, CCT. Results In the experimental group, before therapy the SE was -4.15±1.08 D, after Orthokeratology therapy it was -3.21±1.02 D, the difference has statistical significance (t=4.3, P<0.001). In the control group it was -4.71±1.36 D at the end of the follow up, which was significant different from experimental group (t=5.59, P<0.001). The difference of before and after Orthokeratology therapy was 0.9±1.6 D and 0.06±1.9 D in the experimental and control group respectively (t=2.35, P=0.02). In the experimental group, before therapy the visual acuity (LogMAR) before and after Orthokeratology was 0.69±0.14 and 0.42±0.11 respectively (t=10.8, P<0.001), and in the control group after treatment it was 0.58±0.15 (t=-5.43, P<0.001). The difference of before and after therapy was -0.26±0.19 and -0.03±0.19 in the experimental and control group respectively (t=-5.7, P<0.001). In the experimental group, the AL was 27.42± 0.91 mm, and 27.0±1.2 mm before and after therapy respectively (t=1.8, P=0.07), and in the control group was 28.2±1.1 mm (t=-16.97, P<0.001). The difference of AL before and after therapy was -0.35±0.6 mm and 1.3±1.1 mm in the experimental and control group respectively (t=8.02, P<0.001). In the experimental group, the CCT was 550.2±30.5 μm, and 548.1±26.8 μm before and after therapy respectively (t=0.31, P=0.71), and in the control group was 554.2±23.6 μm(t=1.55, P=0.24). The difference of CCT before and after Orthokeratology therapy was 2.3±1.36 μm and 1.8±1.31 μm in the study and control group respectively (t=1.78, P=0.08). In the experimental group, the cornea curvature was 43.52±1.07 D and  38.02±2.20 D before and after therapy respectively (t=17.2, P<0.001), and in the control group was 44.37±2.12 D (t=-13.87, P<0.001). The difference before and after Orthokeratology therapy was 3.81±2.17 D and 0.91±1.4 D in the study and control group respectively(t=8.03, P<0.001). The cornea was in good health condition, and the discomfort symptoms disappeared after treatment with appropriate medication. Conclusion Orthokeratology for children with moderate myopia was an effective and safe control method. (Ophthalmol CHN, 2016, 25: 98-101)

Refractive status and its accommodation of dominant eye in myopic anisometropia

FU Jia1，2, WU Jing-jing2, GOU Yin2, MI Lan2, WEI Rui-hua1

2016, 25(2):  102-105.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.008

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Objective To study the relationship between dominant eye, spherical equivalence (SE) of refractive error and accommodation in myopic anisometropia. Design Retrospective case series. Participants 59 myopic anisometropic patients were included in the study, with age varied from eight to thirty-five years. Patients were divided into two groups according to the anisometropic degree, group A (difference beween 1.00 D and 2.50 D in two eyes) and group B (difference more than 2.50 D). Methods Monocular and binocular positive relative accommodation (PRA), negative relative accommodation (NRA), amplitude of accommodation, and accommodative facility were all measured with phoropter. Dominant eye was identified by the means of hole shaped by two hands. Main Outcome Measures Dominant eye, SE, and monocular and binocular accommodation parameters (PRA, NRA, amplitude of accommodation, accommodative facility). Results 26 patients were included in group A. Dominant eye was right in 22 patients (84.5%). The mean SE was -4.01±1.96 D (mean ± standard deviation) and -3.19±1.80 D in dominant and non-dominant eye respectively. The mean anisometropia was 1.76±0.21 D. The refraction was significantly different in dominant and non-dominant eyes (z=-2.37, P=0.02). 33 patients were included in group B. Dominant eye was right in 21 patients (63.6%). The mean SE was -3.90±2.84 D and -3.47±2.20 D in dominant and non-dominant eye respectively. The mean anisometropia was 3.40±0.81 D. The refraction was no significantly different in dominant and non-dominant eyes (z=-0.57, P=0.57). The mean PRA was -2.68±1.44 D and -3.29±1.31 D in dominant and non-dominant eyes in group A(z=-2.27, P=0.02). The mean PRA was -3.14±1.84 D and -4.10±1.59 D in dominant and non-dominant eyes in group B (z=-3.54, P=0.00). The mean absolute PRA/NRA value was 1.15±0.58 and 1.36±0.52 in dominant and non-dominant eyes in group A(z=-1.89, P=0.06). The mean absolute PRA/NRA value was 1.34±1.57 and 1.74±0.62 in dominant and non-dominant eyes in group B(z=-3.03, P=0.00). Conclusion SE in dominant eyes of patients with low myopic anisometropia was higher than non-dominant eyes. PRA and PRA/NRA in dominant eyes were lower than non-dominant eyes in different degree anisometropic patients. (Ophthalmol CHN, 2016, 25: 102-105)

Three-year cohort study on the changes of ocular biological parameters of school children

WU Min1,2， LI Ning-dong1,3，GUO Yin2, LI Wei-wei1, LIU Juan2, TANG ping2, WANG Shuang4, FENG Yi2, CHEN Xia1

2016, 25(2):  106-109.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.009

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Objective To study the ocular biological parameters change in school children. Design Retrospective cohort study. Participants 6 to 7 years old students, 167 cases of eye data (of the right eye).  Methods 167 cases of children were measured twice (2011, 2014) in three years for ocular biometry and refractive error. According to myopia occurrence time, children were divided into non-myopia group (both 2011 and 2014 check did not show myopia), new myopia group (those showed myopia in 2014 but no myopia in 2011 ), and myopia group (myopia was noted both in 2011 and 2014). Paired sample t test was used to compare refractive parameters changes from 2011 to 2014. The comparison between groups was done with analysis of variance (ANOVA). Main Outcome Measures Spherical equivalence (SE), axial length (AL), corneal radius (CR), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and axial length/corneal radius of curvature ratio (AL/CR). Results Non myopia group included 105 cases, for which there were no significant difference in SE and CR noted from 2011 to 2014 (t=0.86, -1.75; P=0.36, 0.084). However, there were significant differences in AL, CCT, ACD, LT and AL/CR (t=-19.84, -2.28, -13.94, 9.81, -8.18; P=0.000, 0.025, 0.000, 0.000, 0.000 respectively). New myopia group included 45 cases, for which from 2011 to 2014 , there was no significant difference in CR (t=-1.68，P=0.099), but there were significant changes in SE, AL, CCT, ACD, LT and AL/CR (t=13.09, -15.54, 3.37, -15.30, 11.16, -61.90; P=0.000, 0.000, 0.002, 0.000, 0.000 respectively). Myopia group included 17 cases. From 2011 to 2014, there was no significant difference in CR (t=-0.35，P=0.733), but there were significant change in SE, AL, CCT, ACD, LT and AL/CR (t=4.30, -10.70, -2.43, -3.746, 4.439, -7.95;  P=0.01, 0.000, 0.027, 0.002, 0.000, 0.000 respectively). Among the 3 groups in 2011, there were significant differences in SE, AL, ACD, LT and AL/CR (F=46.14, 8.89, 9.29, 4.47, 11.76; P=0.000, 0.000, 0.000, 0.013, 0.000 respectively); and in 2014, there were significant differences in SE, AL, ACD, LT and AL/CR (F=134.85, 24.77, 11.17, 6.63, 41.08; P=0.000, 0.000, 0.000, 0.002, 0.000). Conclusions Three-year follow-up observations indicated that the eyes in 6~7 years old children showed significant SE decrease, AL increase, CCT thickening, ACD deepen, LT thinning, AL/CR increase. LT might be an early warning signal of myopia development. (Ophthalmol CHN, 2016, 25: 106-109)

The binocular visual function parameters and its relationship with visual display terminal related asthenopia

SU Jing, LIU Xin-quan

2016, 25(2):  110-114.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.010

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Objective To investigate factors associated with visual display terminal (VDT) related asthenopia. Design A prospective comparative case series. Participants 141 cases of adult subjects who often performed VDT operation. Methods 141 cases of adult human subjects, after informed consent being obtained, were exposed to one-hour computer operation (VDT operation). Eye movement parameters with refractive error correction, including the amplitude of accommodation (AA), near point of convergence, the ratio of accommodative convergence and accommodation (AC/A), phoria at distance and near, positive and negative relative accommodation(PRA and NRA) and stereoscopic detection were measured before the VDT operation. Visual fatigue questionnaire was performed for each subject after VDT operation and VDT visual fatigue was diagnosed if 2 or more symptoms were found. Univariate and multivariate analyses were performed to determine the parameters related to the occurrence of VDT related asthenopia. Logistic regression analysis was used in multivariate analysis. Main Outcome Measures AA, near point of convergence, AC/A, phoria at distance and near, PRA and NRA, stereoscopic detection, visual fatigue questionnaire. Results In 141 investigated objects, VDT related asthenopia occurred in 43(30.50%) cases. In the 43 cases of VDT related asthenopia, 32 were women(36.78%), which was significantly higher than that of men (11 cases, 20.4%) (χ2=4.597, P=0.032). The univariate analysis showed that compared to the asymptomatic group, the VDT related asthenopia group had significantly lower AA (3.98±1.52 D) and AC/A (2.47±0.84) value (P=0.003); and further near point of convergence (9.87±1.76 cm) (P=0.001), higher exophoria at distance indicated by close distance phoria, PRA and NRA (all P=0.001). Subjects with abnormal stereoscopia detected by Titmus stereo vision (>60 s) were more easily suffer from VDT related asthenopia (P=0.002). Logistic regression analysis indicated that the near distance phoria were related risk factors of VDT-related asthenopia. Higher AC/A, the ability of stereoscopic vision and greater PRA were protective factors for the pathogenesis of VDT related asthenopia. Conclusion Lower AC/A, larger near distance phoria degree, less PRA and abnormal stereoscopic vision are independent risk factors for the pathogenesis of VDT related asthenopia.  （Ophthalmol CHN, 2016，25： 110-114）

Irritant test of dihydroartemisinin ointment in rabbit eyes

WANG Zhi-qun, ZHANG Yang, QU Jing-hao, ZHANG Xiao-yu, SUN Xu-guang

2016, 25(2):  114-117.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.011

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Objective To investigate the irritant effect of dihydroartemisinin ointment on rabbit eyes. Design Animal experimental study. Participants Twenty New Zealand rabbits. Methods Twenty rabbits were divided into 2 groups randomly. There were 10 rabbits in short-time multiple drug group (once per 15 minutes for continuous 2 hours). Local irritation signs of rabbit eyes after 6, 24, 48 and 72 hours were recorded respectively. There were other 10 rabbits in long-time drug group (5 times per day for continuous 4 weeks). Local irritation signs of rabbit eyes were recorded every week. The two groups were tested in left eye with dihydroartemisinin ointment and in right eye with ointment accessories as control. The subjects in each group were further divided into low concentration (0.4%) group of 5 eyes and high concentration (1.6%) group of 5 eyes. The cornea, iris and conjunctiva of the rabbit eyes were observed with slit lamp, during and after the administration of the drug. The irritation results were scored. The values added to the total score and then were divided by the number of rabbit eyes, which was the final score. The value between 0~3 was non-irritating. Main Outcome Measures The score of irritation test. Results  The mean score of the short-term groups was 1.0, 1.0, 0.8 and 0.4 at 6h, 24h, 48h and 72h respectively. The mean score of control group was 0.2, 0.4, 0.4 and 0.2 at 6h, 24h, 48h and 72h respectively.  In the long-term group, the mean score of 0.4% group was 1.8, 2.0, 2.2 and 2.2; the mean score of 1.6% group was 2.0, 2.2, 2.6 and 2.4 at 1 week, 2 weeks, 3 weeks and 4 weeks respectively. The mean score of control group was 0.2, 0.6, 0.4, 0.4, respectively. The mean scores of the drug group and the control group were both less than 3. Conclusions Dihydroartemisinin ointment has no irritation effects in rabbit.  （Ophthalmol CHN，2016，25： 114-117）

Ocular surface microbial distribution and clinical analysis of blepharitis

GAO Rui, SUN Xu-guang, WANG Zhi-qun, ZHANG Yang

2016, 25(2):  118-122.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.012

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Objective To investigate the ocular surface microbial distribution characteristics of blepharitis patients, and analyze of the efficacy of antimicrobial therapy for blepharitis. Design Retrospective case series. Participants The study involved 101 patients with clinical diagnosis of blepharitis presented to Beijing Tongren Hospital between February 2015 to September 2015, and 85 normal controls. Methods Microbial samples of the ocular surface, including conjunctiva sac, eyelid, and Meibomian gland of blepharitis patients and normal controls were taken for culture and analyzed  for bacteria, anaerobic bacteria and fungi. The differences between the two groups were recorded analyzed. Furthermore, to analyze the effect of antimicrobial treatment, the blepharitis patients were divided into groups of non-antimicrobial group and antimicrobial group. The symptoms and ocular surface flora were compared before and two-weeks after treatment between the two groups. Main Outcome Measures Ocular bacterial test results, blood plate colony counting and blepharitis related symptoms and signs score. Results In blepharitis group, the Meibomian gland bacterial culture positive rate was 62%, while it was 53% in the control group (P=0.015). For anaerobic culture, the positive rate was significantly lower in blepharitis group and control group (19% versus 45%, P<0.001). Blepharitis and control group eyelid bacterial positive rate was 71% and 76% (P=0.533), conjunctival bacterial positive rates was 48% and 67% (P=0.062). The mean number of colonies on blood plate for eyelid, conjunctival and Meibomian gland was 15.78±5.25, 13.62±6.27 and 16.54±4.56 for blepharitis group respectively, which was significantly higher than the control group 6.13±3.40, 4.75±3.82 and 5.83±2.55 respectively, (all P<0.001). The proportion of Gram-positive cocci of the eyelid, conjunctival and Meibomian gland flora culture was 78.31%, 71.15% and 77.03% respectively, which was not significantly different from normal controls (76.71%, 82.14% and 76.74% respectively), blepharitis group of among Gram-positive cocci positive participants, the proportion of Staphylococcus positive rate was 81% and 88% for  conjunctival and Meibomian gland respectively for blepharitis patients, which was lower than the control group (96% and 100%, P=0.034 and 0.036 respectively). After two weeks of treatment or observation, the eyelid sterilization rate was 44% and 21% (P=0.034) for antimicrobial and non-antimicrobial treatment group respectively, and the difference between the two groups of symptoms and signs were also statistically significant (P=0.012). Conclusion The ocular surface bacterial positive rate in patients with blepharitis was not significantly different from control group, but the amount of bacteria carried on the ocular surface was higher in blepharitis patients, and the composition of Gram-positive cocci bacteria was different between the two groups. The amount of anaerobic bacteria contaminated Meibomian gland was lower in blepharitis patients than normal controls. Ocular antibiotic therapy can reduce the amount of bacteria carried, and improve patients' blepharitis related symptoms and signs. (Ophthalmol CHN, 2016, 25: 118-122)

Clinical features of 18 cases of ethambutol-induced optic neuropathy

CAO Shan-shan1, PENG Chun-xia1, LI Xiao-ming2, ZHANG Xiao-hui3, WEI Shi-hui1

2016, 25(2):  123-126.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.013

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Objective To investigate the clinical features and prognosis of ethambutol-induced optic neuropathy（EON）. Design Retrospective case series. Participants During June 2011 to June 2015, 18 patients were diagnosed as EON in People's Liberation Army (PLA) General Hospital. Methods A retrospective chart review of 18 patients diagnosed as EON was performed, collecting and analyzing their demographic characteristics, clinical features． The patients were followed for 6~50 months. Main Outcome Measures Demographic characteristics, best corrected visual acuity (BCVA), visual field, color vision, visual field and retinal nerve fiber layer (RNFL) thickness. Results The mean age of affected patients was 40.56±12.57 years. 11 of them were men, and all of them were presented with blurry vision in both eyes. 30 eyes (83.3%, 30/36) had dyschromatopsia. 23 eyes (63.9%) showed central scotoma. The mean BCVA was 0.09±0.59 at first sight. The mean dose and duration of ethambutol were (17.06±5.62) mg/kg over (5.97±5.12) months. The period of follow-up was (30.27±16.18) months. The visual function recovery after discontinuation of ethambutol was seen in 6 of the 18 patients. Between the vision improved group and non-improved group, there was a statistically significant difference of the ethambutol daily dose (P=0.037). During the follow-up, 16 eyes of 8 patients were examined by optical coherence tomography (OCT), which displayed RNFL thinning in temporal, superior and nasal side. Conclusions Ethambutol-induced optic neuropathy was more common in elderly men, and tended to involve both eyes. About 1/3 of the patients showed visual improvement after discontinuation of ethambutol. (Ophthalmol CHN, 2016, 25: 123-126)

Detection and analysis of NDP gene mutations in 22 Chinese children with Coats’ disease

YANG Qiong, WEI Wen-bin, LU Hai, LI Song-feng

2016, 25(2):  127-129.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.014

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Objective Previous literature reports that the NDP gene SNP may be associated with Coats disease. To investigate the NDP gene exon mutation in 22 Chinese children with Coats’ disease and explore its role in the pathogenesis of Coats. Design Gene study. Participants 22 cases of Coats disease and 6 cases of normal person. Methods Polymerase chain reation(PCR) amplification of exon sequencing was performed to detect the whole exon of NDP gene. Main Outcome Measures Gene sequences. Results No significant SNP in the three exons of NDP genes, only c.943T＞C(no 9,18)and c.943T＞Y (no 27 , 28; Y on behalf of C/T heterozygotes) were found, but these mutations are located outside the protein coding region. Conclusion None meaningful SNP in NDP gene were found in 22 Coats’disease cases. The pathogenesis of Coats’ disease in Chinese childhood may has no relation with NDP gene mutations. (Ophthalmol CHN, 2015, 24: 127-129)

Practice of problem-based learning method in strabismus course for residents

HONG Jie, FU Jing

2016, 25(2):  132-134.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.020

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Compared with other sub-specialties in ophthalmology, the strabismus has relatively independent theory and knowledge system. It has a higher requirement for the logical thinking ability to understand the disease, which makes the teaching of strabismus relatively difficult. We applied the problem based learning (PBL) method to the strabismus teaching. We take the case-based, problem-based, student-oriented and teacher-guided methods in strabismus clinical teaching to promote active learning and thinking in the residents. In addition, we compared the differences between the PBL and the traditional teaching methods. The former one will promote the mastery of strabismus related knowledge and improve the ability of solving the practical problems of strabismus in residents. (Ophthalmol CHN, 2016, 25: 132-134)

Application practice and exploration of workshop teaching method in ophthalmic surgical skills training in postgraduate students

LI Dong-mei, ZHOU Jin-qiong

2016, 25(2):  135-137.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.021

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Workshop teaching method is problem-oriented, aimed to establish a new teacher-student relationship, in which teachers inspire and assist students to discuss issues. It set up as a form of group cooperation in small class, focusing on developing self-learning ability and practical ability. This article reported the experience of applying workshop teaching method to surgical skills training in ophthalmology postgraduate students. We firstly set up certain learning tasks, combined the theoretical knowledge presentation with the practical operating training together. We began with the surgical instruments, supplies, and equipment identifying, then followed with common standardized operation under the microscope, such as porcine eye anatomy, common incision design, micro-stitching, making scleral flap, capsularhexis exercises, from easy to difficult, step by step. After training, the  learning enthusiasm of students was greatly improved, and also their practical operating ability. （Ophthalmol CHN, 2016, 25： 135-137）

Factors affecting intraocular pressure measurement and comparison of different tenonometers

ZHANG Yong, XIE Lin

2016, 25(2):  138-141.  doi:10.13281/j.cnki.issn.1004-4469.2016.02.022

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Intraocular pressure is one of the most important indexes for the diagnosis and monitoring of glaucoma. A lot of factors may affect the intraocular pressure measurement such as central corneal thickness, refractive error, position, and systemic factors of patients, etc. Among them, central corneal thickness was found to be the most important factor affecting the measurement of intraocular pressure. There is a wide variety of tenonometers clinically. We selected several common tenonometers for comparison, analyzing their accuracy, applicable scope, advantages and disadvantages for a reference. （Ophthalmol CHN， 2016， 25： 138-141）