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    25 September 2016, Volume 25 Issue 5
    Indication and efficacy of botulinum toxin in ophthalmology
    AI Li-kun
    2016, 25(5):  289-293.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.001
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    Since the first introduction in strabismus, Botulinum toxin have been expanded to many clinical sub-specialties. In the 40 years, its use in ophthalmology has spread to cover a broad range, including strabismus, blepharal disease, cornea and lacrimal related diseases. (Ophthalmol CHN, 2015, 25: 289-293)

    Evaluation of the effect of wearing low-degree convex spectacle when reading on myopia prevention among school students
    XU Qin1,2, JIANG Shu-ying1,2, WANG Chao1,2, DUAN Jia-li3, SONG Yu-zhen4, ZHAO Hong5, WU Li-juan1,2, GUO Xiu-hua1,2.
    2016, 25(5):  294-298.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.002
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    Objective To evaluate the effect of wearing low-degree convex spectacle when reading on myopia prevention among school students. Design Prospective cohort study. Participants The high risk students (1-5 grade) with uncorrected visual acuity ≥ 4.7 and -1.0D ≤ the spherical equivalent refraction of right eye ≤ 2.0D. 286 students were selected as Intervention group to wear low-degree convex spectacle when reading. 308 students with no intervention were selected as the control group. The average age for the two groups were (7.81±1.48) and (8.44±1.59) years old, respectively. Methods 594 cases of school students were measured twice (at the end of 2010 and 2011) for refractive error. According to the examination results (data of the right eye), outcome indicators were the variation of spherical equivalence in the right eye and incidence of myopia. Multiple linear regression and logistic regression were used to evaluate the effect of wearing low-degree convex spectacle when reading on myopia prevention. Subgroup analysis by gender and grade (1-3 grade versus 4-5 grade) were also conducted. Main Outcome Measures Spherical equivalence in the right eye. Results The changed values of spherical equivalence in the intervention group were (-0.35±0.76)D, significantly lower than(-0.56±0.71)D in the control group(P=0.004). Results from the subgroup analysis showed the intervention was significant among girls (P=0.003) and among students of 1-3 grade (P<0.001). At the end of 2011, the incidence of myopia was 14.3% for intervention group and 29.5% for control group, respectively. Compared to control group, the OR value of the incidence of myopia in the intervention group was 0.593 (95%CI=0.371~0.946). According to the gender stratification, the OR value of the incidence of myopia in the intervention group was 0.704 (95%CI=0.358~1.385) for boys and 0.450 (95%CI=0.227~0.894) for girls. According to the grade stratification, the OR value of the incidence of myopia in the intervention group was 0.440 (95%CI=0.238~0.813) for students of 1-3 grade and 1.143 (95%CI=0.478~2.731) for students of 4-5 grade. Conclusion Wearing low-degree convex glasses when reading, especially for girls and for lower grade students, can slow the exacerbation of myopia and reduce the incidence of myopia. (Ophthalmol CHN, 2016, 25: 294-298)

    Effect of 1% topical atropine on the progression of myopia in the myopic astigmatism children
    SHEN Jiang, WU Xiao-lan, ZHOU Lei, YU Qi-hua, ZHANG Xiao-jin
    2016, 25(5):  298-301.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.003
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    Objective To study the effect of 1% topical atropine on the progression of myopia in the myopic astigmatism children. Design Case control study. Participants 120 cases (240 eyes) of highly myopic astigmatism (≥-1.50 diopter) children from 6 to 9 year old without amblyopia. Methods 120 (240 eyes) myopic astigmatism children were enrolled for the study, who were randomly divided into 3 groups, 40 cases (80 eyes) in each group. Group A was treated with glasses, group B was treated with glasses with compound tropicamide eye drops nightly, and group C was treated with 1% topical atropine gel every Friday evening combined with astigmatic glasses. The visual acuity, the status of refraction, the intraocular pressure and the axial length were examined monthly for 12 months. Main Outcome Measures Progression of myopic diopters and axial length. Results After 12 months, the progression of myopia in group C treated by 1% topical atropine gel every Friday evening combined with astigmatic glasses was significantly lower than group A and group B (F=58.031, P<0.001), and the increase of the axial length in group C was also significantly less than group A and group B (F=24.612, P<0.001). There was no significant reduction of astigmatic diopters among all groups (F=0.253, P=0.901). And there were no other complaints and complications such as high intraocular pressure and photophobia in children treated with 1% atropine gel. Conclusions It was a safe, effective resolution for most of high myopic astigmatism children treated with 1% topical atropine gel every Friday evening combined with astigmatic glasses for one year to slowdown the progression of myopia. (Ophthalmol CHN, 2016, 25: 298-301)

    Effect of orthokeratology lenses, peripheral defocus spectacle lenses, single vision spectacles of optic correction on myopia control
    GUO Yin1,2, LIU Li-juan2, GUO Xi3, ZHANG Rong1, LIU Yu-cheng1, XIE Xiao-fang4, TANG Ping1, LV Yan-yun1, XIE Pei-ying3, GUO Xiu-hua5, XU Liang2.
    2016, 25(5):  302-306.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.004
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    Objective To assess the effect of myopia control with single vision spectacle lenses(SV), orthokeratology lenses(OK), and peripheral defocus spectacle lenses(PD). Design Prospective, non-randomized case control study. Participant Three hundred and twenty one children were enrolled in the study from Beijing Institute of Ophthalmology, Tongren Eye Care Center and Beijing Beiyi Optometry & Ophthalmology Center. 141 children (43.9%, 141/321) completed the follow up, with a mean age of 11.41±2.29 years. Methods All children received a comprehensive examination, including visual acuity, cycloplegia refraction, slit lamp, Lenstar ocular biometry, color fundus photographs and were followed up one year later. Parents selected the types of correction on their own. Main Outcome Measures Change of refraction, axial length and parapapillary atrophy before and after wearing. Results The mean equivalent spherical(SE) and axial length(AL) of 141 children at baseline were -2.89±1.34 D and 24.92±0.34 mm, respectively. At one-year follow-up visit, elongation of AL in children with OK was 0.13±0.16 mm, significantly less than the other two groups (F=48.820, P<0.001). Progression of myopia was -0.77±0.79 D and -0.94±0.47 D in SV group and PD group respectively. There was no significant difference between groups (t=1.080, P=0.283). Presence of enlargement of parapapillary atrophy in OK group was 15.0%, significantly lower than SV group (66.7%) and PD group (38.6%). Conclusions Compared to single vision spectacle lenses and peripheral defocus spectacle lenses, orthokeratology is most effective for myopia control. (Ophthalmol CHN, 2016, 25: 302-306)

    The changes of corneal parameters after stopping wearing orthokeratology for more than one year
    ZHAO Ke-hao, LU Wen-xiu, WANG Wen-cui, LEI Hong, LI Zao-lan, GUAN wei
    2016, 25(5):  306-309.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.005
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    Objective To observe the changes of corneal parameters after stopping wearing orthokeratology. Design Retrospective case series. Participants 49 eyes of 26 patients with myopia who had received orthokeratology in Beijing Xinli Eye Clinic from October 2010 to March 2013 and planned to stop wearing orthokeratology in order to change new lens. Methods Corneal curvature, corneal astigmatism and corneal thickness were measured with Pentacam. The changes of corneal parameters were observed in the following time points: before wearing, twelve months after wearing, 3~4 weeks after stopping wearing. Main Outcome Measures Flat corneal curvature, steep corneal curvature, corneal astigmatism, corneal thickness. Results Before wearing, twelve months after wearing, 3~4 weeks after stopping wearing, flat corneal curvature was (42.32±1.87)D, (40.18±1.83)D, (41.97±1.86)D, respectively. Steep corneal curvature was (43.46±1.76)D, (41.46±1.74)D, (43.30±1.90)D, respectively. There was no significant difference before wearing and 3~4 weeks after stopping wearing(P=0.534, 0.777). The corneal astigmatism had no statistical difference between different time points. There was slightly reduction in corneal thickness twelve months after wearing, and corneal thickness gradually recovered 3~4 weeks after stopping wearing. The corneal thickness was (546.23±24.33) μm, (537.18±27.89) μm, (541.23±22.25) μm at the three different time points respectively. But the corneal thickness had no statistical difference among different time points. After the shaping effect was stable, correcting each -1.00 D myopia diopter the K value decreased (0.52±0.18) D and the corneal thickness reduced for (2.35±2.23) μm. After stopping wearing for 3~4 weeks, the recovery of K value was (86±15)% and the recovery of corneal thickness was (68±45)%. Conclusion Stopping wearing orthokeratology for 3~4 weeks, corneal parameters returned to near the level before wearing. (Ophthalmol CHN, 2016, 25: 306-309)

    The binocular rivalry of amblyopic children and children with normal visual acuity
    ZHAO Guo-hong1, FU Jing1, WANG Jing-hui1, CHENG Juan-juan1, LU Wei1, YAN Li2, LIU Jun2
    2016, 25(5):  310-313.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.006
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    Objective To find out the normal range of the binocular rivalry of children with normal vision and to investigate the characteristics of the binocular rivalry of amblyopic children. Design Prospective case series. Participants 97 children with normal visual acuity and 60 amblyopic children. Methods The binocular rivalry of the amblyopic children and children with normal visual acuity were assessed using the computer based visual perception examination. Main Outcome Measures The binocular visual balance point of dynamic contrast sensitivity (DCS), static contrast sensitivity (SCS), dynamic signal to noise ratio (DSNR), and static signal to noise ratio (SSNR). Result In the children with normal visual acuity, the SSNR point was 7.44±0.052 grade (95% CI: 7.34~7.55 grade), the DSNR point was 7.50±0.048 grade (95% CI: 7.41~7.60 grade); the SCS point was 8.46±0.085 grade (95% CI: 8.29~8.63 grade), and the DCS point was 8.57±0.089 grade (95% CI: 8.40~8.75 grade). In the amblyopic children, the SSNR point was 5.48±0.186 grade (95% CI: 5.47~6.21 grade), the DSNR point was 6.16±0.177 grade (95% CI: 5.81~6.52 grade); the SCS point was 7.24±0.244 grade (95% CI: 6.76~7.73 grade), the DCS point was 7.52±0.239 grade (95% CI: 7.05~8.00 grade). The binocular balance point value in amblyopic children was lower than in normal vision children (all P<0.001). The difference value between two eyes in the normal vision children was less than 1 grade while the difference value between two eyes in the amblyopic children was more than 2 grades. Conclusion We recommend that the binocular balance point of the contrast sensitivity over 7 grade and signal to noise ratio over 8 grade as the normal standard. There is obvious difference between the amblyopic children and the normal vision children in the binocular balance point value, and the differences between two eyes in amblyopic children are greater than that in normal vision children. (Ophthalmol CHN, 2016, 25: 310-313)

    Influence of glycosylated hemoglobin on diabetic retinopathy--Beijing Community Diabetes Study 18
    XU Jie, YUAN Shen-yuan, FU Han-jing, WAN Gang, ZHU Liang-xiang, YUAN Ming-xia, YANG Guang-ran, PAN Su-fang, BU Xiang-lei, ZHANG Jian-dong, DU Xue-ping, LI Yu-ling, JI Yu, GU Xiao-ning, LI Yue, CUI Xue
    2016, 25(5):  312-325.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.009
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    Objective We aimed to provide updated data for the relation between Glycosylated hemoglobin(HbA1c) and diabetic retinopathy(DR), and to estimate cut-off of HbA1c for DR. Design Community-based cross-sectional investigation. Participants The community health care center-based study included 2642 subjects with diabetes mellitus and an age of 20 years to 80 years, who were recruited from 15 community health centers in urban Beijing. Of 2642 eligible patients, 2007 (76.0%) subjects (1199 women) with a mean age of 64.1±9.0 years participated. Methods A cluster sampling technique was used to identify and include patients with type 2 diabetes mellitus from urban Beijing communities. HbA1c was measured by the liquid chromatography technique. Fundus photographs were graded using the modified Airlie House classification system. The area under the receiver operating characteristic (ROC) curve was used to determine the diagnostic value of HbA1c between the study groups. Main Outcome Measures Sensitivity, specificity, area under the curve(AUC). Results The overall prevalence of DR was (24.7±1.0)% (95% confidence interval [CI], 22.8~26.6). In binary logistic regression analysis, presence of DR was associated with higher concentration of HbA1c (OR=1.23; 95%CI, 1.14~1.33). With the increase of HbA1c, the prevalence of DR showed an increasing trend. The Receiver Operating Characteristic analysis showed that the cut-off value of 6.5% had 75.1% sensitivity and 43.4% specificity with 59.2% maximum. In binary logistic regression analysis, presence of DR was also associated with younger age (OR=0.97; 95%CI, 0.95~0.98), longer duration of diabetes (OR=1.10; 95%CI, 1.08~1.12), higher systolic blood pressure (OR=1.01; 95%CI, 1.01~1.02), lower body mass index (OR=0.95; 95%CI, 0.92~0.98), and elevated blood urea concentration (OR=1.01; 95%CI, 1.00~1.01). Conclusions HbA1c value ≥6.5% is significantly related with DR and PDR. In a screening program, the cut-off value of HbA1c≥6.5% may provide a maximum yield of DR. (Ophthalmol CHN, 2016, 25: 321-325)

    The clinical characteristics and treatment of obital eosinophilic granuloma in children
    ZHAO Shang-feng1, ZHANG Jia-liang1, SHI Ji-tong2, FU Ji-di1, LI Yong1, SUN Si1, WU Jiang-ping1, KANG Jun1
    2016, 25(5):  314-317.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 05. 007
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    Objective To investigate the clinical manifestation and treatment of orbital eosinophilic granuloma(EG) in children.Design Retrospective case series. Participants 27 patients with orbital EG admitted into Beijing Tongren Hospital from March 2006 to February 2014 were enrolled. Methods These patients were all preoperatively evaluated with computed tomography(CT) and Magnetic Resonance Image(MRI). Surgical excision of the 1esions was performed and some cases were treated with chemotherapy postoperatively. The clinical charts and prognosis were analyzed. Main Outcome Measures Epidemiology, manifestation of CT and MRI, pathology characteristics and prognosis. Results The lesion involved the superior-lateral wall in 16 cases, orbital roof in 6 cases, lateral wall in 3 cases and both lateral wall and skull base in 2 cases. Total excision of the lesion was performed in all cases and the symptom disappeared. No complications occurred postoperatively. The dura and temporal muscle were found with infiltration of EG in 3 cases and 4 cases respectively. 4 cases received adjuvant chemotherapy after operation. No recurrence was noted during the follow-up examinations with a mean follow-up period of 2.36 years. Conclusions Orbital EG is a benign disease. Surgical resection is the most effective therapy. Adjuvant chemotherapy after surgery may be suggested. The overall prognosis for EG of the orbit is good. (Ophthalmol CHN, 2016, 25: 314-317)

    The effect of long-term wearing RGPCL for children with keratoconus
    2016, 25(5):  317-320.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.008
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    Objective To evaluate effect and safety of long-term wearing RGPCL for mild to moderate keratoconus in young children. Design Retrospective case series. Participants 40 keratoconus children. Methods From 2001 to 2011, 40 keratoconus children (80 eyes) with age 3-16 years old (mean age of 12.80±3.09 years) wore RGPCL for three years. They all took refractometer and other ocular measurements. We observed the changes of corneal thickness, corneal endothelial cells, corneal topographic (including K values, SRI and corneal astigmatism) during 3 years of wearing RGPCL. The safety of RGPCL on both eyes were also evaluated. We evaluated the controlling effect of wearing RGPCL on keratoconus. Main Outcome Measures Corrected visual acuity, corneal K values, corneal astigmatism, SRI, corneal thickness, corneal endothelial cell density. Results Corrected visual acuity improved 0.19±0.03. There were no significant changes in corneal thickness (13.81±7.98 μm, P=0.274) before and after wearing RGPCL during three years. Flat K changed 0.26±0.59 D. Steep K changed 0.97±0.75 D. SRI changed 0.09±0.10, and corneal astigmatism declined 0.88±0.40 D. All these changes were not significant (all P>0.05). We had not found inflammation and obvious damages of cornea and conjunctiva. Conclusion Through observing the corneal thickness, corneal K value, corneal astigmatism for three years, we demenstrated long-term wearing RGPCL have certain control effect for keratoconus in children. No obvious damage was found in the cornea and conjunctiva. Long-term wearing RGPCL is safe and effective for. keratoconus children. (Ophthalmol CHN, 2016, 25: 317-320)

    Correlation between self-management behaviors and diabetic retinopathy in patients with type 2 diabetes in community
    GUO Li-hua, YANG Zhi-ming, CAI Liang-jie
    2016, 25(5):  326-329.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.010
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    Objective To investigate the association of self-management behaviors (SMB) and diabetic retinopathy (DR) in patients with type 2 diabetes(T2DM) in community. Design Cross-sectional study. Participants A total of 252 patients with T2DM in annual health examination in Yinhu community health care centers in Shenzhen. Methods All patients were surveyed using the summary of diabetes self-care activities questionnaire (SDSCA), and divided into behavior good, medium and poor according to the results, and tested fasting blood-glucose (FBG) and glycosylated haemoglobin(HbA1c ). Patients were classified into diabetic without retinopathy (DWR), non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) according to fundus examination. The differences of the levels of SMB and blood glucose between DR and DWR were compared. Main Outcome Measures The levels of SMB, FBG and HbA1c. Results 228 cases of 252 patients with T2DM completed the surveys and the response rate was 90%. There were 62 cases(27.2%) with DR. The duration of diabetes was more than 10 years in 34 cases (54.8%) with DR and 65 cases (39.2%) with DWR (χ2=4.519, P=0.034). Of 228 cases with T2DM, the level of SMB was satisfactory and good in 20.6%, medium in 50.9%, and poor in 28.5%. Of 228 cases with T2DM, 29.4% had achieved an ideal level of FBG and 28.5% had an ideal level of HbA1c. The good rate of the level of SMB in cases with DR and DWR was 11.3% and 24.1% respectively(χ2=4.524, P=0.033). Of the cases with DR, 19.4% and 17.7% had achieved an ideal level of FBG and HbA1c, and of the cases with DWR the corresponding rate was 33.1% and 32.5% respectively(χ2=4.129, P=0.042; χ2=4.844, P=0.028). The poor rate of SMB was 15.0%, 20.2% and 41.4% respectively in patients with duration of diabetes less than 5 years, 5~10 years and more than 10 years respectively, and 25.9%, 28.0% and 66.7% in patients which classified as DWR, NPDR and PDR(χ2=16.764, P=0.002; χ2=9.132, P=0.010). In the multifactor Logistic regression model, diet behavior (OR=0.241, 95%CI:0.163~0.287), exercise behavior (OR=0.536, 95%CI: 0.481~0.692), following directions to take medications (OR=0.056, 95%CI:0.018~0.172), FBG≤7.0 mmol/L (OR=2.255, 95%CI:1.315~3.873), HbA1c≤7.0% (OR=1.376, 95%CI:1.197~1.584) and duration of diabetes(OR=0.573, 95%CI: 0.038~0.714) were associated with higher risk of DR. Conclusion Higher risk of DR is associated with longer duration of diabetes, poor diet, less exercise, lower obedience to use medicine, lower rate of the control of FBG and HbA1c to normal level. This study suggested that improving the levels of SMB would be benefitial to controlling glucose levels and reduced the risk of DR in patients with T2DM in community. (Ophthalmol CHN,2016, 25: 326-329)

    Comparision of the clinical efficacy of vitrectomy combined with cyclophotocoagulation and trans-scleral cyclophotocoagulation to treat secondary glaucoma
    ZHOU Dan, HE Lei, PANG Xiu-qin
    2016, 25(5):  330-334.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.011
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    Objective To compare the clinical efficacy of vitrectomy combined with cyclophotocoagulation and trans-scleral cyclophotocoagulation to treat secondary glaucoma. Design Retrospective cases series. Participants 68 cases (68 eyes) of secondary glaucoma in Beijing Tongren Hospital from July 2011 to December 2014. Methods All cases were divided into two groups. 37 cases in one group were treated by vitrectomy combined with cyclophotocoagulation and 31 cases in the other group were treated by trans-scleral cyclophotocoagulation(TSCP). The postoperative follow-up periods were 1 to 50 months.The operative parameters of laser, changes of intraocular pressure(IOP), postoperative best corrective visual acuity (BCVA)and postoperative complications were observed and compared between the two groups. Main Outcome Measures Parameters of laser, postoperative BCVA, IOP and complications. Results Preoperative IOP of two groups was 28~55 mmHg(37.4±7.5 mmHg) and 30~53 mmHg(39.8±6.0 mmHg) respectively and there was no significant difference (P>0.05) between the two groups. The number of patients who got BCVA improvements within the two groups was 20 (54.1%) and 8 (25.8%) respectively. The difference was significant (χ2=23.92, P<0.001). The amplitudes of IOP decrease on the first postoperative day in the TSCP group was 10~29 mmHg (19.4±5.3 mmHg) , significantly less than that of the vitrectomy combined with cyclophotocoagulation group 12~33 mmHg(23.9±5.9 mmHg), and the last follow-up IOP of was significantly lower in the vitrectomy combined with cyclophotocoagulation group 12~30 mmHg(17.6±3.8 mmHg) than the TCSP group 16~32 mmHg(20.4±4.1 mmHg) respectively. While the energy and duration time of laser was different. Postoperative complications included hyphema, transient low IOP, fibrous exudates in anterior chamber, and exudative choroidal detachment in both groups. Moreover there was vitreous hemorrhage in vitrectomy combined with cyclophotocoagulation group and bulbar conjunctival congestion and edema in TSCP group. All those complications were recovered soon and no serious complications such as bulbi phthisis occurred. Conclusions Both these two operative models are safe and effective procedures in management of secondary glaucoma and have their own advantages. Vitrectomy combined with cyclophotocoagulation contributes to improve visual acuity and TSCP is simple and affordable, and they can be used jointly when necessary. (Ophthalmol CHN, 2016, 25: 330-334)

    Smoking increases adipogenesis of orbital fatty tissue in patients with thyriod-associated ophthalmopathy
    ZHOU Zhe, GAO Yu, SUN Yan, JING Ming, HU Jia-li
    2016, 25(5):  334-338.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.012
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    Objective To determine whether smoking increases adipogenesis of the orbital fatty tissue in patients with thyriod associated ophthalmopathy(TAO). Design Retrospective case series. Participants 40 patients (21 smokers, 8 ex-smokers, 5 passive smokers and 6 nonsmokers) were enrolled. Methods The expression levels of CCAAT/enhancer binging protein(C/EBP) and peroxisome proliferciter-activated receptor γ(PPARγ) of orbital fatty tissue were measured using real-time PCR. Main Outcome Measures C/EBP and PPARγ mRNA expressions. Results Orbital C/EBP and PPARγ mRNA expressions significantly increased in patients with history of smoking (C/EBP: smoker 12.04±4.26 vs non-smoker 2.32±0.92; PPARγ: smoker 4.82±1.41 vs non-smoker 1.37±0.25) (P<0.001), and their expression of ex-smokers and passive smokers were higher than nonsmokers (C/EBP: 4.29±1.26, 5.76±1.03; PPARγ: 2.91±1.23, 3.22±0.50; all P<0.05). Additionally, we found that the expressions of C/EBP (14.28±3.61) and PPARγ mRNA (5.65±1.02) in orbital adipose tissues from TAO patients with higher smoking index(≥100 cigarettes/day years) increased compared with those with lower smoking index(<100 cigarettes/day years)( C/EBP 8.42±2.30;PPARγ 3.48±0.74)(P<0.01). Conclusion Our study suggests that smoking at presentation for TAO increases the levels of C/EBP and PPARγ. (Ophthalmol CHN, 2016, 25: 334-338)

    Retinal vessel oxygen saturation in Chinese healthy individuals
    YANG Jing-yan, YOU Bing, WANG Qian, ZENG Si-yan, WEI Wen-bin
    2016, 25(5):  339-342.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.013
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    Objective To measure the normal retinal oxygen saturation (SaO2) values with retinal oximetry in healthy Chinese population. Design Observational cross-sectional study. Participants The study included 91 normal healthy subjects (mean age: 37.5±14.0 years;Male:37,Female:54). Method Healthy Chinese volunteers underwent systematic and ophthalmic examinations. Retinal oxygen saturation was examined by a noninvasive retinal oximeter. Main Outcome Measures The mean retinal arterial oxygen saturation (SaO2-A); the mean retinal venous oxygen saturation (SaO2-V); the mean retinal arteriovenous difference in oxygen saturation (SaO2-AV). Results The mean SaO2-A was 92.1±7.2%; the mean SaO2-V was 52.5±6.6%; the mean SaO2-AV was 39.6±7.5%. The mean SaO2-A(98.5±10.1%), SaO2-V(57.3±8.7%) and SaO2-AV(41.3±11.9%) were significantly higher in the superior nasal quadrant. Age was associated with increased SaO2-A (B=0.24, P=0.049) and SaO2-AV (B=0.219, P=0.046). Smoking was associated with decreased SaO2-V (B=-0.25, P=0.033). Hyperlipidemia was associated with increased SaO2-A (B=0.26, P=0.018). Male was associated with an increase in SaO2-AV(B=-0.253, P=0.019). Conclusions Aging may increase SaO2-A and SaO2-AV, whereas smoking may cause decreased SaO2-V. Male are likely to have higher SaO2-AV. (Ophthalmol CHN, 2016, 25: 339-342)

    Clinical etiology analysis of 189 patients with epiphora complaint
    XU Li-ping, ZHOU Ming, LIU Hao-jie, SHEN Jian
    2016, 25(5):  343-346.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.014
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    Objective To investigate the clinical etiology of epiphora complaint. Design Retrospective case series. Participants 189 adults (321 eyes) who complained of epiphora as the main symptoms were included from January 2013 to December 2014 in the Affiliated Zhongshan Hospital of Dalian University. Methods All the patients underwent questionnaire, extraocular examination, slit lamp microscope examination, nasal cavity examination and lavage of lacrimal passages. Those who had simultaneous dry eye symptoms or foreign body sensation and those whose tear river height was abnormally low under slit lamp examination underwent examinations of Schirmer I test (Sit) and tear break-up time (BUT). Main Outcome Measures Constituent ratio of etiology. Results The causes for epiphora were lacrimal duct stenosis or occlusion in 174 eyes(54.21%), dry eye syndrome for 27 eyes (8.41%), conjunctivochalasis in 8 eyes (2.49%), lacrimal caruncle hypertrophyin were conjunctivitism in 2 eyes (0.62%) , eyelid relaxation in 2 eyes (0.62%), of unilateral nasal diseases in 2 eyes (0.62%), conjunctivitis in 8 eyes (2.49%) , crocodile tears in 2 eyes (0.62%), visual fatigue in 20 eyes (6.23%). 76 eyes (23.68%) teared because of 2 kinds or more reasons: of which the lacrimal duct stenosis or obstruction with dry eye syndrome in 43 eyes (13.40%), lacrimal duct stenosis or obstruction and dry eye and conjunctivochalasis in 6 eyes (1.87%), lacrimal duct stenosis and dry eye and conjunctivitis in 2 eyes (0.62%), dry eye and conjunctivochalasis in 6 eyes (1.87%). Lacrimal duct stenosis or occlusion with conjunctivochalasis in 9 eyes (2.80%), conjunctivochalasis and lacrimal caruncle hypertrophy in 5 eyes (1.56%), lacrimal duct stenosis or occlusion with conjunctivochalasis and eyelid relaxation in 3 eyes (0.94%), lacrimal duct obstruction combined with lacrimal caruncle hypertrophy in 1 eye (0.31%), lacrimal duct obstruction with trichiasis in 1 eye (0.31%). Conclusion Lacrimal duct stenosis or obstruction is still the main reason for epiphora complaint. Dry eye syndrome combined with lacrimal duct stenosis or obstruction were the main reasons in multi-factors cases. (Ophthalmol CHN, 2016, 25: 343-346)

    The short-term efficacy of Zhenqi eye drop steam massage on the treatment of dry eye
    ZHANG Hai-juan, HUANG Rong, ZHANG Jun-xiu, WU Yu-ying, MA Ke
    2016, 25(5):  347-350.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.015
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    Objective To observe the efficacy of Zhenqi eye drop steam massage on dry eye patients. Design A perspective, randomized, opening, positive eye drop parallel controlled clinical study. Participants All the 96 patients were observed in Tongren hospital from 2013 to 2015 in out patients, the mean age was 60.95±12.22 year old. Methods Ninety-six patients with dry eye were randomly divided into two groups, the testing group and the control group, with 1 by 1 ratio. The testing group and the control group were both given vitrobolik eye drops, 4 times a day. In addition, the testing group were given Zhenqi eye drop stream massage, 20 min per day, and the control group were given Zhenqi eye drop 4 times a day without steam massage. All the patients were observed for 4 weeks for the improvement of symptoms and clinical signs. Main Outcome Measures The clinical effectiveness ratio, total scores of symptoms, Schimer I test(SIt), tear break-up time(BUT), cornea fluororencein staining. Results There were no significant difference between testing group and control groups in total scores of symptoms, SIt, tear BUT, cornea fleuororencein staining before treatment. The clinical effectiveness ratio was 81.25% in the testing group, significantly higher than 62.50% (P=0.041) in the control group after 4-week treatment. And the tear BUT improved significantly in testing group 7.53±3.78 s than in the control group(P=0.041). The total score of symptom was 1.92±1.99 in the testing group and 2.32±2.30 in the control group(P=0.031). Conclusion Dry eye can be effectively treated using Zhenqi eye drop steam massage. The efficacy of Zhenqi eye drop steam massage was better than vitrobolik eye drop. (Ophthalmol CHN, 2016, 25: 347-350)

    Cultivation of clinical and scientific research ability for master degree candidates whose major in the ocular tumor and orbital disease
    MA Jian-min, LIU Xiao, MA Ke
    2016, 25(5):  351-354.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.017
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    The ocular tumor and orbital disease is a multidisciplinary frontier science, it has obvious differences compared to other subspecialties in ophthalmology. The training model of the master degree candidates in ocular tumor and orbital disease not only has the general characteristics of the master degree candidates for the conventional fields of ophthalmology, but also has its special cultivation characteristics. To the master degree candidates whose major in ocular tumor and orbital disease, we should cultivate them from two aspects, including clinical comprehensive ability and scientific research ability. The training of clinical comprehensive ability mainly includes the training of basic theory, basic skills, clinical thinking ability and doctor-patient communication ability. The training of scientific research ability mainly includes the cultivation of reading documents, scientific research topic selection, basic laboratory techniques, scientific research writing ability and presentation skills. (Ophthalmol CHN, 2016, 25: 351-354)
    Application of problem-based study combined with case-based study teaching mode in the education of postgraduate students
    WANG Jun, CAO Ying-xue, XU Liang
    2016, 25(5):  355-356.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.018
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    Problem-based study (PBL) combined with case-based study (CBS) teaching mode is a clinical case-centered and group discussion-focused modern teaching method aiming at improving postgraduate students’ clinical thinking ability. After teacher explaining knowledge points, showing cases and then organizing group discussion followed by analysis and summary, we tried to find students’ reaction when facing real clinical cases, to explore their way of thinking and then to judge their final disposition in order to figure out how they went wrong and how to correct it correspondingly. Whose meant to help students understand and apply better the knowledge they have leant from books and let them show more certainty to some important procedures of treatment, accompanied with their accumulating clinical experience. (Ophthalmol CHN, 2016, 25: 355-356)
    The etiology and management of secondary glaucoma after vitrectomy
    XIONG Yu, XIA Xiao-bo
    2016, 25(5):  357-360.  doi:10.13281/j.cnki.issn.1004-4469.2016.05.019
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    The risk factors of high intraocular pressure (IOP) after pars plana vitrectomy(PPV) are various, mainly related to the complexity of disease and intraocular tamponade. So we need to control the high IOP after vitrectomy according to the high risk factors and the pathogenesis. Moreover, screening high-risk population before operation, choosing appropriate surgical procedure, and monitoring IOP after operation will be helpful to reduce the occurrence of high IOP. Once high IOP after vitrectomy happens, symptomatic treatment, anti-glaucoma medication or surgery should be performed as soon as possible in order to protect optic nerve and visual function. (Ophthalmol CHN, 2016, 25: 357-360)