Table of Content

25 March 2017, Volume 26 Issue 2

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The tactics in phacoemulsification training of cataract surgery

DONG Zhe, SONG Xu-dong

2017, 26(2):  73-75.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.001

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Cataract surgery is the most common operation in ophthalmology practice, and the cataract surgery rate has been increasing in recent years. To insure the quality of the surgery performed in different hospitals, we should enhance training the surgical doctors with effective methods such as visual reality electric model training, etc. to avoid the shortages of long learning time, low effacacy of previous methods. (Ophthalmol CHN, 2017, 26: 73-75)

Clinical application of phacoemulsification with a round blunt phaco tip

LI Shuai-fei, CHEN Bin-chuan, LI Jia-jia, WANG Yan-wu, WANG Yong-cheng, NAN An-chao

2017, 26(2):  79-83.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.004

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Objective To determine the influence of round blunt phaco tips on efficiency and safety in conventional phacoemulsification. Design Prospective cohort study. Participants This study enrolled 406 eyes of 342 senile cataract patients who had undergone phacoemulsification between October 2014 and December 2015 in the Second Affiliated Hospital of Zhengzhou University. Methods The eyes were divided into 2 groups according to its nuclear hardness, and phacoemulsification in each group was performed with round blunt phaco tips or standard phaco tips randomly. Main Outcome Measures Surgical time (ST), average ultrasound energy (AVE), accumulative phaco time (APT), effective phaco time (EPT), the rate of posterior capsule rupture and the central corneal thickness (CCT) preoperatively and postoperatively at 1 day. Results Clinical characteristics such as age and sex were similar in both tip groups of each nuclear hardness group (all P＞0.05). There was no statistical difference in all of intraoperative parameters between the two tip groups for patients with non-hard nuclear (all P＞0.05). In hard nuclear group, AVE (42.2%±5.1%, 38.9%±6.4%, P=0.004) and EPT(15.53±3.47 s, 13.34±3.18 s, P=0.001) were significantly higher in round blunt phaco tip group than in standard phaco tip group. But the rest of intraoperative parameters showed no difference between different tip groups (all P＞0.05). The overall incidence of posterior capsule rupture was 4.18%, with 3.79% in non-hard nuclear group and 5.17% in hard nuclear group respectively. In non-hard nuclear group, the incidence of posterior capsule rupture was 1.42% and 6.52% with round blunt phaco tips and standard phaco tips respectively (P=0.035). In hard nuclear group, the incidence of posterior capsule rupture was 1.78% and 9.26% with round blunt phaco tips and standard phaco tips (P=0.225). The change in CCT was similar in both tip groups for non-hard nuclear group (78.5±50.6 μm, 71.6±53.3 μm, P=0.263). But for hard nuclear patients, the change in CCT was significantly thicker in the round blunt phaco tip group (220.8±36.3 μm）, than that of traditional tip group（98.4±53.1 μm, P=0.01). Conclusion The round blunt phaco tip is a reliable and safe option in phacoemulsification, the rate of posterior capsule rupture can be reduced, but the average ultrasound energy and effective phaco time were increased for hard nuclear. (Ophthalmol CHN, 2017, 26: 79-83）

The comparison about complications and vision of iris retractor and radial pupil iris incision in small pupil cataract surgery

WANG Shui-chun, WU Fu-chao, JIN Ting

2017, 26(2):  85-89.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.005

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Objective To observe and compare the complications and vision of iris retractor and radial pupil iris incision in small pupil cataract surgery. Design Retrospective comparative case series. Participants Patients presented during April 2012 to June 2015 in Guangzhou Hospital of Integrated Traditional and Western Medicine accepted ultrasonic phacoemulsification combined with intraocular lens implantation for the treatment of 83 cases (90 eyes) of cataract patients. Methods 50 eyes of iris retractor in research group and 40 eyes of radial pupil iris incision in control group. The perioperative parameters, postoperative complications and visual acuity of two groups were recorded. Main Outcome Measures Ultrasound emulsification time, operation time, intraoperative and postoperative complications and postoperative visual acuity. Results The average time of phacoemulsification in control group was significantly higher than that in research group (104.8±17.9 s versus 57.8±11.9 s) (t=12.835, P<0.001). The control group average operation time was significantly lower than the research group (20.1±3.8 min versus 29.2±5.8 min) (t=-6.468, P<0.001). The patients in the control group, the rate of iris bite bleeding was significantly higher than that of study group (P<0.001). At post-operative 1-day, the proportion of corrected visual acuity better than 0.3 in the control group was 40%, significantly lower than 72% in the research group (χ2=9.328, P=0.002). At post-operative 3-month, in the control group the proportion of corrected visual acuity better than 0.3 was 80%, lower than 90% in the research group, but the difference was not statistically significant (χ2=1.798, P=0.18).  In the research group, at post-operative 1 day, pupil deformation rate was significantly lower than the control group (68% and 95%) (χ2=10.125, P=0.001)； and at 1 week, the pupil deformation rate was significantly lower than the control group (20% and 90%) (χ2=46.557, P<0.001). The research group and control group of patients with corneal edema rate were 86% and 90% respectively, the difference was not statistically significant (χ2=0.331, P=0.565). The anterior chamber reaction rate was 68% in the study group, significantly lower than the control group 95% (χ2=10.125, P=0.001). Conclusions Iris retractor in small pupil cataract surgery can enlarge pupil, and has advantages such as safe, less bleeding and less inflammation. It has positive significance on morphological and functional recovery of the pupil, is worth popularizing in clinical use. (Ophthalmol CHN, 2017, 26: 85-89)
 

The relationship between dry eye symptoms and lipid layer thickness

DU Xiang-hong1, WANG Xiao-bing1, LIANG Qing-feng2

2017, 26(2):  90-94.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.006

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Objective To study the relationship between dry eye symptoms and lipid layer thickness(LLT) in dry eye patients. Design Retrospective case series. Participants 139 dry eye patients were selected from ophthalmology department Tongren Hospital  from July 2015 to October (81 of females and 58 males, age range=18-77 years, mean age= 37.75 ±12.86 years). Methods All patients were required to complete the Ocular Surface Disease Index (OSDI) questionnaire after which their LLTs were evaluated using a new interferometer (LipiView, TearScience Inc, Morrisville, NC). Based on the OSDI questionnaire scores, 139 patients were divided into three groups: mild symptom group (0~20 scores), moderate symptom group (21~45 scores) and severe symptom group(46~100 scores). The relationship between the OSDI score and LLT, as well as the relationship between different degree symptoms and LLT were analyzed. Main Outcome Measures OSDI score and LLT. Results OSDI score was negatively correlated with LLT(r=-0.256, P=0.002), i.e. with the increase of OSDI score, lipid layer thickness decreased. OSDI questionnaire including 12 items, only foreign body sensation, painful or sore, watching TV or computer causing discomfort were correlated with LLT(r=-0.206, -0.232, -0.190, -0.179 respectively，all P<0.05)， the other 8 items had no relevance with LLT. Among three different severe groups, LLT was significantly different by analysis of variance, especially between the mild symptom group (64.89±16.403 nm) and the severe symptom group (54.65±14.481 nm)(F=10.092, P=0.027). There were 40% of (14 people) patients with LLT≤60 nm in mild symptom group, while 70% of (30 people) patients in severe symptom group; the proportion of the patients with LLT≤60 nm in severe symptom group was significantly greater than mild symptom group(χ2=6.953, P=0.008). Conclusion Dry eye symptoms have negative correlation with the lipid layer thickness of dry eye patients, especially foreign body sensation, painful or sore, watching TV or computer causing discomfort symptoms appear to be significantly associated with the lipid layer thickness, and as the symptoms increased lipid layer thickness decreased. The more serious of dry eye symptoms, the greater chance of lipid layer thickness was less than 60 nm. (Ophthalmol CHN, 2017, 26: 90-94)

Effect of ultraviolet irradiation on the stability of tear film and corneal tissue of rats

LIU Wei-yang，WU Xin-na, HUANG Yan，XIE Pin, CAI Xiang-heng, YAN Zhi-peng

2017, 26(2):  96-100.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.007

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Objective To investigate the impact of different ultraviolet(UV) irradiated intensity and duration on the stability of tear film  and corneal tissue of rats. Design Experimental study. Participants 50 male SD rats. Methods Fifty healthy male SD rats were randomly divided into the normal control group, test group A, B, C, D. Tested rats received UV irradiation three times a week for 6 weeks. Each irradiation had one-day interval. Every time，the rats in the test group A and C were exposed to the UV of 142 μw/cm2 for 8 min, and 12 min respectively. The rats in the test group B and D were exposed to the UV of 94 μw/cm2 for 12 min, and 18 min respectively. The results of examination at 14 d, 28 d, 42 d after exposure to UV irradiation were recorded. The examinations include slit lamp observation and photograph, sodium fluorescein dye; tear film break-up time (BUT) and basal tear secretion(Schirmer’s-I test, SIt). The rats were sacrificed by overdose of chloral hydrate and the corneal tissue sections were made. Main Outcome Measures Changes of morphological structure of conjunctiva, cornea and the tear film, corneal fluorescein staining scores, BUT, basic tear secretion, corneal tissue section observation. Results On slit lamp observation, higher-intensity group showed a earlier and severer conjunctiva congestion, corneal edema, and corneal opacity. Higher-intensity group appeared characteristic corneal neovascularization, while low-intensity group was characterized by the changes of the quality and quantity of tear-film. Comparison of Group A and C showed that longer-irradiation-duration group had a similar tendency with higher-intensity group, moreover, it appeared characteristic stripped ulcer in palpebral area. Fluorescein staining test showed the result of the control group was negative, group A was positive, group B was weakly positive, and group C and D was strongly positive. BUT at 42th day of group A, B, C, D were significantly lower than the control group (all P<0.01). SIt in 42th days of group A, B, C, D were significantly higher than the control group (all P<0.01). Tissue sections showed that higher-intensity group (group A and group C) appeared corneal neovascularization, reduced density of endothelial cell, disordered stroma fibroblasts. While lower-intensity group with shorter irradiation-time(group B) showed thickened epithelium, and lower-intensity group with longer irradiation-time (group C) showed corneal neovascularization and disordered stroma fibroblasts. Conclusions Ultraviolet irradiation can cause ocular surface damage, which contains conjunctival congestion, corneal epithelium damage, the changes of tear-film quality and quantity. These occurred earlier and severer with increasing irradiation intensity or increasing duration of irradiation. (Ophthalmol CHN, 2017, 26: 96-100)

Effect of bevacizumab on corneal neovascularization and immune rejection after corneal transplantation

LI Kun, WANG Ping, WU Shen, ZHANG Jing-xue, LIU Qian, LI Na

2017, 26(2):  101-105.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.008

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Objective To investigate the effects of bevacizumab on prevention of corneal neovascularization in a rat model of penetrating keratoplasty, and to evaluate its effect on the survival of corneal grafts. Design Experimental studies. Participants Fifteen F344 rats were used as donor and 30 Lewis rats as recipients. Methods After penetrating keratoplasty, recipients were randomly divided into three groups: control group(GA), bevacizumab group (GB) and dexamethasone group (GC).  A single dose of 40 μl  bevacizumab was injected subconjunctivally in GB at 0, 3, 6 and 9 days after operation. GC were subconjunctivally injected with 20 μl dexamethasone. GA was not treated. Grafts were examined every three day for two weeks by slit-lamp biomicroscopy, the rejection index (RI, edema, opacity, neovessels) and neovessel invasion area (IA) were calculated. After 14 days, the rats were killed and the expression of CD4+ and CD8+ cells in corneal grafts was detected by immunofluorescence. Main Outcome Measures Neovessel invasion area, grafts survival time and cell counting of CD4+ and CD8+. Results Seven days after surgery, IA in GA differed significantly from GB (P=0.00) and GC (P=0.01) , but GB and GC were closed to each other. At Day 7, IA was 22.50±3.67mm2(GA), 14.21±2.79mm2 (GB) and 15.38±0.84mm2(GC) respectively;  at Day 14, IA was 27.96±0.50mm2(GA), 18.76±2.73mm2 (GB) and 23.74±2.14mm2(GC) respectively. The corneal grafts survival in GB and GC was longer than GA (all P=0.000). The corneal grafts survival was 8(GA), 11(GB),13(GC) days respectively. At Day 14, the CD4+, CD8+ cells in GA were higher than GB and GC (all P=0.000). The number of CD4+ cells was 13.2±2.94(GA), 6.14±1.07(GB) and 3.5±1.78(GC) respectively. The number of CD8+ cells was 14.4±2.44(GA), 4.5±1.51(GB) and 3.38±1.68(GC) respectively. Conclusions Subconjunctival administration of bevacizumab may effectively inhibit neovascularization and corneal graft rejection. But bevacizumab is less effective than dexamethasone on inhibiting corneal allograft rejection. (Ophthalmol CHN, 2017, 26: 101-105)

The effect of corneal neovascularization on nerve regeneration in the injured cornea

WANG Ping, LI Kun, ZHANG Yang, ZHANG Jing-xue, WU Shen, LIU Qian, ZOU Xu-yan, LI Na

2017, 26(2):  106-111.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.009

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Objective To investigate the effect of corneal neovascularization on nerve regeneration in the injured cornea. Design Experimental study. Participants Sprague Dawley (SD) rats. Methods Eighteen SD rats were randomly allocated into 3 groups. Suture method inducing angiogenesis, cornea injury and subconjunctival injection of bevacizumab ware performed in Group A; Suture method inducing angiogenesis and cornea injury ware performed in Group B; Subconjunctival injection of bevacizumab was performed in Group C. At postoperative 1-day, 1-, 2-, 4-weeks, the slit lamp photographic method was used to observe surface area of corneal neovascularization; and confocal microscope was used to investigate corneal stromal nerve length. Corneal subepithelial nerves were stained with β tubulin antibody and pictures of subepithelial nerve plexus were taken at postoperative 4 weeks. The corneal sensation of suture zone was examined using the Cochet - Bonnet perception instrument. The Schirmer test 's tears line was used to measure the tear secretion in the right eye. Main Outcome Measures Corneal neovascularization surface area, corneal stromal nerve length, subepithelial nerve plexus density，corneal sensitivity, tear secretion. Results Corneal neovascularization grew in group A and B at 1-and 2-weeks and regressed at 4-weeks, and the cornea of group C was normal. There were significant difference of the corneal neovascularization area ratio between 1- and 2-weeks of group A and 1- and 2-weeks of group B[(10.86±1.57)% versus(25.42±2.65)%,(1.87±0.69)% versus(6.48±1.10)%, all P=0.000]. The length of injured cornea nerve decreased after experimental surgery in group A and B, and was normal in group C. There was no significant difference between group A and group B at 1-day after surgery[(151.02±4.74)μm versus(149.69±4.32)μm, P=0.306]，and there was significant difference among 1-,2-,4-weeks of group A and 1-,2-,4-weeks of group B[(193.84±2.25)μm versus(155.73±2.98)μm，(217.15±2.08)μm versus(166.21±2.41)μm，(220.70±1.41)μm versus(203.76±1.74)μm， all P=0.000]. The subepithelial nerve of injured cornea in the group C was normal and the subepithelial nerve plexus density was significantly higher in the group A than that in the group B[22.60±2.02)% versus(9.41±2.01)%，P=0.000]. The corneal sensitivity and tear secretion decreased after experimental surgery in group A and B, and were normal in group C, and there were no significant difference among 1-,2-,4-weeks of group A and 1-,2-,4-weeks of group B（all P＞0.05）. Conclusions Corneal neovascularization may retard nerve regeneration of damaged cornea, and inhibition of corneal neovascularization is helpful for nerve regeneration. (Ophthalmol CHN, 2017, 26: 106-111)

Studies on effects and meaning of micropulse subthreshold 577nm laser photocoagulation on mRNA expression of VEGF,PEDF and TGF-β2 in neural retina of rabbit

SUN Di, MA Dan-dan, GUO Yin-hua, XIAO Yuan-yuan, LI Liao-qing, LI Yi-bin

2017, 26(2):  112-116.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.010

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 Objective To investigate the effects of micropulse subthreshold 577nm laser photocoagulation on mRNA expression level of VEGF, PEDF and TGF-β2 in neural retina of rabbit. Design Experimental animal study. Participants 14 healthy adult livor blue rabbits. Methods Rabbits were randomly divided into 2 groups: blank control group (n=2) and experimental group (n=12). Micropulsed subthreshold photocoagulation was done using 577nm laser. The morphological changes of retina were observed at 3 days after photocoagulation under microscopy using HE staining of histopathological sections． The mRNA expression level of VEGF, PEDF and TGF-β2 in neural retina were analyzed by RT-PCR at 3 days, 7 days and 14 days after photocoagulation． Main Outcome Measures The mRNA expression level of VEGF, PEDF and TGF-β2 in each time point. Result There was neither visible laser lesion under ophthalmoscope nor retinal tissue damage observed by microscope observation in retina of all experimental rabbits after photocoagulation. RT-PCR results showed that the mRNA expression level of VEGF, PEDF and TGF-β2 increased after laser photocoagulation. The VEGF mRNA expression level was 2.1420±0.1217, 2.5207±0.2568 and 1.5525±0.2118 on day 3, day 7 and day 14 after photocoagulation respectively. There was no statistically significant difference between day 3 and 7 (P=0.099), while the difference between day 7 and 14 showed statistical significance (P=0.029, 0.005). The PEDF mRNA expression level was 3.2623±0.1442, 6.4050±0.1117 and 4.2976±0.2813 on day 3, 7 and 14 respectively. There was statistically significant difference between day 3, 7 and 14 (P=0.0003, 0.002, 0.0002). At the same time points, the expression level of TGF-β2 mRNA was 2.7054±0.1571, 2.5747±0.0858 and 2.3128±0.2742 respectively, with no statistically significant difference between each time point (P=0.155). Conclusion Micropulsed 577nm laser photocoagulation can upregulate the VEGF, PEDF and TGF-β2 expression in rabbit neural retina, which may be related to the mechanism of treating macular edema. (Ophthalmol CHN, 2017, 26: 112-116)

The effects of intravitreal injection of ranibizumab in treatment of macular edema secondary to central retinal vein occlusion

HU Xin-miao, HU Mei, HUANG Zhou-ji, JIN Yu-lin

2017, 26(2):  116-119.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.011

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Objective To discuss the effects of intravitreal injection of ranibizumab in treatment of macular edema secondary to central retinal vein occlusion (CRVO). Design Prospective comparative case series. Participants 46 patients with macular edema secondary to CRVO (46 eyes). Method Using random stratified method, they were divided into control group (n=23 cases, 4 mg/0.1 ml intravitreal injection of Triamcinolone Acetonide) and study group (n=23 cases, 0.5 mg/0.05 ml intravitreal injection of ranibizumab). At 1 week, 4 weeks, 8 weeks, 12 weeks and 24 weeks after the treatment, the therapeutic effects were observed. Main Outcome Measures Best corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure(IOP). Results (1) There was no statistically significant difference in terms of visual acuity improvement between the two groups (P=0.760, 0.765, 0.552, 0.767, 0.555); (2) The BCVA was significantly different at different time points within the two groups (F=4.373, P=0.000; F=3.472, P=0.008), but not significantly different between the two groups (P=1.000, 0.339, 0.484, 0.886, 0.502, 0.560); (3) The CMT was significantly different at different points withing the two groups (F=3.891, P=0.000; F=3.571, P=0.002), but not significantly different between the two groups (P=0.855, 0.869, 0.915, 0.892, 0.874, 0.564). (4) The IOP was not significantly different at different time points in the study group (F=2.341, P=0.137). The IOP was significantly different at different time points in the control group (F=2.569, P=0.049). However, at week 4 and week 24, the IOP value was significantly lower in the study group than the control group  (P=0.008, 0.042). At other time points the IOP was not significantly different(P=0.216, 0.161, 0.242). (5) During the follow-up, there was two patients(8.70%) in the control group showed elevated IOP. There was no complications recorded in the study group. Conclusion The intravitreal injection of ranibizumab for treatment of macular edema secondary to central retinal vein occlusion is effective and safe. (Ophthalmol CHN, 2017, 26: 116-119)

The short-term clinical effects of the ranibizumab intravitreal injection on age-related macular degeneration macular edema and retinal vein occlusion macular edema#br#  

LIU Yi-fan, LIU Dong-rui, XU Jin, LIU Ping

2017, 26(2):  120-124.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.012

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Objective To investigate the short-term clinical effects of the ranibizumab intravitreal injection on age related macular degeneration macular edema (AMD-ME) and retinal vein occlusion macular edema (RVO-ME)． Design Retrospective case series. Participants 30 patients (30 eyes) with 15 AMD-ME and 15 RVO-ME. Methods All patients received ranibizumab 0.05 ml intravitreal injection, using 1+PRN injection algarism. The follow-up examinations were at 1 day, 1 month after the treatment. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were observed and compared between AMD-ME patients and RVO-ME patients before and after injection. Main Outcome Measures BCVA, CMT, IOP. Results The BCVA of both AMD-ME group and RVO-ME group improved significantly at 1 day and 1 month after the ranibizumab intravitreal injection (P=0.000, 0.000). The CMT reduced significantly for both group as well (P=0.000, 0.000). The IOP did not change significantly during the treatment (P=0.096, 0.066, 0.213, 0.088, 0.240, 0.337 for different time points). Conclusion Ranibizumab intravitreal injection can reduce macular edema and improve the visual activity in patients with AMD-ME or RVO-ME． The treatment effect was similar for AMD-ME and RVO-ME． (Ophthalmol CHN, 2017, 26: 120-124)
 

Preliminary clinical observation of creatine phosphate sodium treatment for Leber hereditary optic neuropathy

YUAN Jia-jia1, MA Si-qi1, HE Heng1, SONG Yin-wei1, ZHOU Geng-xing2, HUANG Ling-li3, LI Bin1

2017, 26(2):  126-130.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.013

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Objective To observe the efficacy of sodium phosphate creatine in the treatment of Leber hereditary optic neuropathy (LHON). Design Retrospective case series. Participants Nineteen LHON patients diagnosed in Department of Ophthalmology, Wuhan Tongji Hospital from January 2014 to January 2016. They were divided into two groups according to whether the patients were admitted to hospital, 10 patients were Inpatient treatment and 9 in the untreated control group. Methods The 10 patients were treated with intravenous infusion of 1 g creatine phosphate sodium solved in 250 ml normal saline, twice a day for 7 days. The visual acuity and visual field of the patients before and after treatment were observed. Nine of the untreated patients were enrolled into the control group. The patients were followed for 1 year. Main Outcome Measures Visual acuity, visual field. Results The visual acuity of 3 treated patients (right eye of first patient, right eye of the 6th patient, left eye of the 7th patient) increased by 0.3 LogMAR, 0.4 LogMAR, 0.7 LogMAR, respectively. One year after treatment, visual acuity decreased in the 1st patient, no change in the 6th and 7th patient. There were 2 cases (6th and 7th) of 14484 mutation in these 3 responsive cases, 1 case (1st) of 11778 mutation, and 7 cases had no significant change in visual acuity. There were no significant differences in the visual field (VFI and MD) between the 10 patients before and after treatment (P=0.167, 0.20). Untreated patients were followed for 1 year with no change in visual acuity. Conclusion Sodium phosphate creatine may have some effect in maintaining or improving visual acuity of LHON patients with 14484 mutations. (Ophthalmol CHN, 2017, 26: 126-130)

The long-term clinical effects of orthokeratology in adolescent with myopic anisometropia

LV Yan-yun, WU Jing-jing, PENG Li, WANG Yan-xia

2017, 26(2):  131-134.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.014

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Objective To investigate the changes of axial length (AL), central corneal thickness (CCT), and corneal endothelial cell density(CECD) after wearing orthokeratology (ortho-k) lens in adolescent with myopic anisometropia. Design Retrospective case series. Participants 21 myopic anisometropic adolescent (42 eyes) from  2011 to 2013, aged between 8 and 15 years old, wearing the ortho-k lens more than 3 years in Beijing Tongren Eye Care Center. Methods The eyes were divided into high myopia and low myopia group according to the myopic degrees. The changes in AL, CCT, and CECD were measured before and 6 months, 1 year, 2 years and 3 years after wearing ortho-k lens. Data were analyzed using repeated measured ANOVA. Main Outcome Measures AL, CCT, CECD. Results The AL of high myopia group before and after ortho-k lens wearing for 6 months, 1 year, 2 years, 3 years was (25.16±0.78) mm, (25.27±0.81)mm, (25.43±0.91)mm, (25.50±0.85)mm and (25.64±0.87)mm respectively, and the data of low myopia group was (24.13±0.99)mm, (24.38±0.96)mm, (24.49±1.00)mm, (24.71±0.94)mm and (24.88±1.01)mm respectively. During the 3 years of observation period, the AL of both eyes increased every year after ortho-k lens wearing (F=48.2; P=0.000). The gap of AL between low myopic eyes and highly myopic eyes had significantly decreased (F=9.494; P=0.000) from (1.03±0.45)mm to (0.90±0.40)mm, (0.85± 0.39)mm, (0.79±0.41) mm and (0.76±0.44) mm. The CECD of highly myopic eyes before and after ortho-k lens wearing for 6 months, 1 year, 2 years, 3 years was (3362.57±278.73)/mm2, (3393.67±325.88)/mm2, (3333.76± 288.72)/mm2, (3276.90±240.49)/mm2 and (3259.71±357.41)/mm2, and the data of low myopic eyes was (3365.62±352.75)/mm2, (3387.62±363.57)/mm2, (3314.05±270.12)/mm2, (3290.71±327.64)/mm2 and (3307.05±357.12)/mm2 respectively. With the time prolonged, the CECD decreased (F=4.386; P=0.000), but there was no significant difference between the two groups. Before and after wearing ortho-k lens for 6 months, 1 years, 2 years and 3 years, the CCT data of highly myopic eyes was (548.81±28.34) μm, (531.43±33.30) μm, (526.05±30.84) μm, (523.38±27.54) μm and (525.29±27.92) μm respectively, and data of low myopic eyes was (549.76±28.72) μm, (536.90± 26.51) μm, (534.24±27.67) μm, (534.19±25.84) μm and (531.76±27.16) μm respectively. The baseline CCT of both eyes was not significantly different, both group reduced by the 6-month visit (F=56.843; P=0.000), and remained unchanged thereafter. Conclusions Orthokeratology treatment can reduce the axial length gap in adolescent with myopic anisometropia. The corneal shape remains stable within 6 months. (Ophthalmol CHN, 2017, 26: 131-134)

Profile of 322 patients with visual impairment presenting in Yinchuan City, Ningxia Hui Autonomous Region

LI Jia1, WANG Jun1, ZHAO Zhi-qing2, MA Zhan-xiu2

2017, 26(2):  135-138.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.015

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Objective To describe the demographic and clinical characteristics of the population with visual impairment attending Ningxia disabled rehabilitation center. Design Cross-sectional study. Participants 322 cases with visual impairment attending Ningxia disabled rehabilitation center were selected. Methods The clinical records of the patients attending Ningxia disabled rehabilitation center between January, 2015 and December, 2015 were retrospectively reviewed. The main data were age, gender, education, visual acuity, diagnosis and prescription of low vision aids.  Main Outcome Measures Age, gender, category of visual impairment, cause of visual impairment and prescription of low vision aids. Results Of the 322 patients, 56.2% were male. The mean age was 50.9±16.2 years. The majority (65.2%) of the patients were aged 40~69 years. There were 39.1% with moderate visual impairment, 15.5% with severe visual impairment and 45.3% with blindness. The leading causes of visual impairment were degenerative myopia（16.5%）. The most frequently prescribed low vision aids was non-optical aids（54.2%）. Near aids (45.1%) were dispensed more than distant aid tools (0.7%). The commonest near aids were handheld magnifier (35.9%) and spectacle-type magnifiers (32.3%). Conclusions  The majority of patients with visual impairment were elderly, the main cause of visual impairment was degenerative myopia. Non-optical aids had great help to patients' daily life. Near aids were dispensed more than distant aid tools. (Ophthalmol CHN, 2017, 26: 135-138)

Anesthetic effect of different local anesthetics in vitreous surgery

DU Lei, CHEN Jia, BAO Qing, XING Yi-qiao

2017, 26(2):  139-142.  doi:10.13281/j.cnki.issn.1004-4469.2017.02.016

Asbtract ( 235 )  

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 Objective To analyse and judge the anesthetic effect of lidocaine combined with bupivacaine or ropivacaine in retrobulbar anesthesia in vitreo-retinal surgery. Design Prospective comparative case series. Participants 93 patients treated by 23G were randomly divided into A, B, C groups. Methods For each group, 31 patients underwent retrobulbar anesthesia with different anesthesia drugs (group A: 2% lidocaine 2.25 ml combined with 0.5% bupivacaine 2.25 ml; group B: 2% lidocaine 3 ml combined with 1% ropivacaine 1.5 ml; group C: 2% lidocaine 4.5 ml). The intraoperative anesthestic effect and postoperative pain was recorded. Main Outcome Measures Time of onset of analgesia, akinesia, and intraoperative pain. Results Mean time of onset of sensory blockade for the three groups were 2.10±0.10 min, 2.13±0.11 min and 2.14±0.13 min respectively, there was no significant difference (F=0.800，P=0.456). Mean time of onset of motor blockade for the three groups were 3.10±1.16 min, 3.63±1.11 min and 3.24±1.63 min respectively, there was no significant difference (F=2.000，P=0.138). Mean time of onset of intraoperative pain of three groups were 140.57±22.23 min, 134.44±26.34 min and 87.34±26.53 min respectively, there was significant difference (F=3.500，P=0.035). The time of onset of intraoperative pain of Group A and B was longer than Group C (t=8.5626, 7.0146; all P=0.0001). The number of patients with anesthesia effect rating at level 5 in the three groups was 18, 14 and 9 respectively. Conclusion Lidocaine combined with ropivacaine has the equal anesthesia effect and duration compared to lidocaine combined with bupivacaine. The effect is better than that of using lidocaine anesthesia alone. (Ophthalmol CHN, 2017, 26: 139-142)