Table of Content

25 May 2017, Volume 26 Issue 3

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Embrace the new era of corneal transplantation

LI Shao-wei

2017, 26(3):  145-148.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.001

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Penetrating keratoplasty (PKP) is no longer the only standard and means of corneal surgery. The concept of corneal component keratoplasty has led to new breakthroughs in surgical procedures. The emerging of deep lamellar keratoplasty, endothelial keratoplasty (EK) and other operations significantly reduces postoperative complications such as immunologic rejection and also improve the visual quality and donor corneal utilization. Femtosecond laser assisted keratoplasty bring the corneal transplantation surgery into the era of refractive surgery. Corneal collagen cross linking (CXL) has enriched the doctor's surgical procedure, relieving the dependence of keratoplasty for the patients with corneal diseases such as keratoconus. Keratoplasy is brought into the scope of precision medicine by those advances.

Evaluation of therapeutic efficiency of laser peripheral iridotomy with or without laser peripheral iridoplasty under the guidance of angle closure mechanisms in eyes with primary angle closure suspect

FAN Su-jie1, LV Ai-guo1, HAO Jie2, LIANG Yuan-bo3, GUO Li-xia1, LI Ai-lin1, WANG Ning-li2

2017, 26(3):  149-153.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.002

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Objective To quantitatively measure the changes in anterior segment morphology by using ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) with or without laser peripheral iridoplasty under the guidance of angle closure mechanisms in eyes with primary angle closure suspect (PACS). Design Prospective case series. Participants Sixty-five eyes in 50 PACS consecutive patients with PACS were enrolled from Jan. to Nov. 2016 in Handan Eye Hospital. Methods Each pre-operated eyes was evaluated by UBM according to the different mechanisms of angle closure. All selected patients were first treated with LPI. UBM examination were performed again 3 days after LPI. If there are still at least one quadrant angle contact closure, laser peripheral iridoplasty (LPIP) will be combined. Three days after LPLP, UBM was reviewed, and the therapeutic effects were evaluated according to the changes of UBM measurement parameters. Main Outcome Measures The parameters of anterior chamber angle in UBM images, including central anterior chamber depth (ACD), angle of anterior chamber opening distance(AOD), trabecular iris angle(TIA), angle crypt area(ARA)、trabecular ciliary body distance (TCPD)、iris thickness (IT). Results Forty-seven eyes were only treated by LPI, which showed pure pupillary block. AOD, TIA, ARA, TCPD were significantly widen after LPI than that at presentation in eyes (all P<0.01). IT were unchanged after LPI than that at presentation in eyes (P=0.465). Eighteen eyes were treated by LPI combined LPIP, which presented multiplemechanism, the AOD, TIA, ARA, TCPD were significantly widen after LPI+LPIP than that at presentation in eyes (all P<0.01). IT were thinner after LPIP than that at presentation and after LPI in eyes (P<0.01). Conclusion After LPI, UBM can be used to determine the mechanism of angle closure, and to consider whether combined LPIP, which can further improve the efficacy of multiplemechanism PACS.

Efficacy and safety of gatifloxacin and levofloxacin for bacterial conjunctivitis: a Meta-analysis

LI Hui1, WU Wen-yue2, WU Dong-wen2, WANG Hua3, WANG Chao3, XU Ya-dong2, DAI Xue-jiao2, WANG Jie-yue3

2017, 26(3):  154-158.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.003

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Objective  To assess the efficacy and safety of gatifloxacin and levofloxacin in treating bacterial conjunctivitis by conducting a meta-analysis. Design Systemic review. Participants Collected randomized clinical controlled studies (RCTs) of gatifloxacin versus levofloxacin in the treatment of bacterial conjunctivitis, which were retrieved from Chinese Biomedical Database, Chinese periodical full text database(CNKI), Wan-fang database, Database of Chinese Periodicals of Science and Technology, PubMed, Cochrane Library and Embase. Methods According to the inclusion and exclusion criteria, data extraction and quality assessment were done by two researchers independently, and clinically important measures were selected. Outcomes were pooled with Revman5.3 and Stata 12.0. Main Outcome Measures Curative ratio, healing rate, adverse reactions. Results The curative ratio (OR＝3.20, 95%CI=2.37~4.31, P＜0.00001) and healing rate (OR＝1.88, 95%CI=1.56~2.27, P＜0.00001) of gatifloxacin group was better than the levofloxacin, and tends to be less total adverse reactions (OR＝0.47, 95%CI=0.27~0.80, P=0.006). Eyes prick (OR＝0.76, 95%CI=0.37~1.57, P=0.46) and eye itch (OR＝0.32, 95%CI=0.10~1.00, P=0.05) were non-statistical significance among two groups. Conclusion In the treatments of bacterial conjunctivitis, gatifloxacin has better efficacy and safety with higher curative ratio and healing rate, and less adverse reactions.

Experimental study on the toxic effect of dihydroartemisinine on rabbit corneal epithelial cells cultured in vitro

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

2017, 26(3):  159-162.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.004

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Objective To evaluate the toxic effect of dihydroartemisinine on rabbit corneal epithelial cells in vitro. Design Experimental study. Participants Rabbit corneal epithelial cells in vitro.  Methods Different concentrations (1.6%, 0.8%, 0.4%, 0.2%, 0.1%, 0.05%, 0.025%) of dihydroartemisinin was added to the cultured rabbit corneal epithelial cells in vitro. Chlorhexidine and PHMB were  used as controls. The morphology of cells were observed in 2, 6 and 24 hr under optical microscope. LIVE/DEAD staining was used to observe the changes of the rabbit corneal epithelial cells after drug action under fluorescence microscope. Main Outcome Measures Morphological changes of the epithelial cells under optical microscope and fluorescence microscope. Results At the point of 2 and 6 hr after culturing, the rims of cells were rounded and the gaps were widened under the action of 0.4% dihydroartemisinine. The gaps of cells began to appear widening and unclear under the action of 0.0125% chlorhexidine. The boundary of cells began to appear unclear and there were intracellular particle changes under the action of 0.003% PHMB. At the point of 24 hr after culturing, corneal epithelial cells were still alive under the action of 0.1% dihydroartemisinine. No effect on corneal epithelial cells under 0.025% dihydroartemisinine. The cells were dead under 0.006% chlorhexidine and 0.003% PHMB. Conclusion Dihydroartemisinine is hypotoxic for rabbit corneal epithelial cells in vitro and its effect on corneal cells in vivo remains to be further studied.

Clinical profiles of bacterial keratitis: a retrospective study on 146 cases

GAO Min1, ZHANG Yang2, XIAO Yang1, WANG Zhi-qun2, SUN Xu-guang2

2017, 26(3):  163-169.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.005

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Objective To elucidate the epidemiological characteristics, clinical signs, laboratory findings, and outcomes in bacterial keratitis. Design Retrospective case series. Participants 146 inpatients (146 eyes) with bacterial keratitis from January 2010 through April 2015 in Beijing Tongren Hospital. Methods The medical records of 146 inpatients (146 eyes) with bacterial keratitis were reviewed retrospectively for clinical features, pathogenic bacterium distribution and drugs sensitivity patterns. Main Outcome Measures Demographic information, clinical findings, treatment, outcomes, laboratory findings and the result of drug-susceptibility test. Results  All 146 cases of bacterial keratitis were single eye-affected. The average age was 46.7 ±18.97 years. Out of which, 82 cases (56.16%) were male. Ocular trauma was the most common cause of bacterial keratitis accounting for 31.5%. Majority of the patients (76 cases, 52.1%) presented after topical antibiotics administration. 19 patients(13.0%) utilized topical steroid and 15 cases (10.3%) used both topical antibiotic and steroid at presentation. 82 cases (56.2%) showed Gram-positive bacterium, and 64 cases (43.8%) showed Gram-negative bacterium. Pseudomonas was identified to be the most common isolate (34.9%), followed by Staphylococcus species (24.0%). As a whole, isolates were most sensitive to gatifloxacin, amikacin and levofloxacin. Most cases(139 cases, 95.2%) resolved with topical administration. Surgical therapies were adopted in 7 cases(4.8%). Conclusion Trauma was the most common risk factor of bacterial keratitis. The most common bacteria isolated were Gram-positives and most of the bacteria isolated were susceptive to gatifloxacin, amikacin and levofloxacin. Therapeutic penetrating keratoplasty (PKP) is the most frequently performed surgery to save the eye and preserve vision in severe infective keratitis.

Effects of refractive errors on postoperative short-term stereoacuity reconstruction in patients with intermittent exotropia

HONG Jie, FU Jing, ZHAO Bo-wen, ZHAO Guo-hong, WANG Jing-hui, SUN Xing-li, LI Lei

2017, 26(3):  169-173.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.006

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Objective To compare the postoperative short-term stereoacuity reconstruction with respect to refractive errors in intermittent exotropia (IXT). Design Retrospective case series. Participants 227 patients with IXT who had received strabismus surgeries in Beijing Tongren Hospital from Jul. 2014 to Aug. 2015 were involved. Methods All patients were divided into four groups according to preoperative refractive error: IXT with hyperopia (group I), IXT with emmetropia (group II), IXT with myopia (group III), and IXT with anisometropia (group IV). The preoperative and postoperative stereoacuity at distance and near were compared among the four groups. Main Outcome Measures Stereoacuity at distance and near. Results (1) The success rates of surgery depending on postoperative ocular alignment had no significant difference among different groups (P=0.775). (2) The preoperative ratio of having distance stereoacuity in group I, II, III and IV was 24.1%, 16.3%, 20.5%, 20.0%, respectively; and the postoperative ratio was 17.2%, 26.3%, 41.1%, 24.4%, respectively. There was no significant difference in preoperative distance stereoacuity among the four groups (P=0.802). The postoperative ratio of having distance stereoacuity increased in IXT patients with emmetropia, myopia and anisometropia, while only the increase of IXT patients with myopia was statistical significant (P=0.001). (3) The preoperative ratio of having near stereoacuity in group I, II, III and IV was 65.5%, 81.3%, 82.2%, 64.4%, respectively; and the postoperative ratio was 65.5%, 87.5%, 90.4%, 62.2%, respectively. The preoperative and postoperative ratios of having near stereoacuity in IXT with emmetropia and myopia were higher than that in IXT with hyperopia and anisometropia (all P<0.05). Conclusion The postoperative short-term distance stereoacuity reconstruction in IXT patients with myopia was better than that in IXT patients with hyperopia, emmetropia and anisometropia.

Relationship of hyperreflective foci with visual outcome in diabetic macular edema

MO Bin, ZHOU Hai-ying, JIAO Xuan, ZHANG Feng

2017, 26(3):  174-178.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.007

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Objective To explore if the numbers of the hyperreflective foci (HF) is relevant to visual outcome of diabetic macular edema (DME), and to observe the changes of HF number after anti-vascular endothelial growth factor (VEGF) treatment. Design Retrospective case series. Participants We reviewed 28 eyes of 28 patients with DME, who were treated with anti-VEGF at Beijing Tongren Eye Center from February 2013 and August 2016. Methods All patients underwent best-corrected visual acuity (BCVA) measurement, slit-lamp examination, spectral domain optical coherence tomography (SD-OCT) at baseline and at final time of the follow-up. Numbers of HF were counted based on different locations including the inner retinal layer, the outer retinal layer and the vitreous cavity. Meanwhile, the areas for each vitreous cavity had to be measured. Then, the ratio of HF numbers to the total areas of vitreous cavity (RATIO) can be calculated. The correlation of the HF numbers in different locations with final BCVA was analyzed. The changes of HF number after anti-VEGF treatment were analyzed as well. Main Outcome Measures The baseline and final BCVA, central retinal thickness (CRT), the HF number in retinal layer, RATIO. Results On SD-OCT images, HF could be located in each retinal layers, as well as in vitreous cavity, but mainly located around external plexiform layer (OPL) in DME. The mean HF number in the inner retinal layer was 156.00±118.76; in the outer retinal layer it was 3.57±4.08; RATIO was 0.05±0.06. HF could be seen in the outer retinal layers among 17 eyes (62.5%), while it was visible in the inner retinal layers for all 28 eyes (100%). BCVA was negatively associated with the baseline numbers of HF in the outer retinal layers (r=-0.506, P=0.006), as well as the RATIO (r=0.462, P=0.013). However, it was not related to the baseline numbers of HF in the inner retinal layers (r=-0.163, P=0.408). The average number of HF reduced significantly in the outer and inner retinal layer, while there was not apparent change for the RATIO after anti-VEGF treatment. Conclusion HF in the outer retinal layer is obviously negatively associated with the final BCVA in patients with DME after anti-VEGF treatment. However, HF in the inner retinal layer is not associated with final BCVA.

Retinal imaging charasteristics of patients with Bardet-Biedl syndrome

LI Qian, PENG Xiao-yan, ZHANG Yong-peng, ZHU Xiao-qing, ZHOU Hai-ying

2017, 26(3):  179-184.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.008

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Objective To characterize the retinal imaging of Bardet-Biedl syndrome (BBS). Design Retrospective case series. Participants Eight probands clinically diagnosed as BBS in Beijing Tongren Hospital were included. Methods Data of systemic evaluation were recorded. Sanger sequencing for BBS1-BBS12 genes for genetic diagnosis. Retinal imaging analysis on the probands were performed with fundus photography, spectral-domain optical coherence tomography (SD-OCT), enhanced depth imaging (EDI) OCT and Fundus autofluorescence (FAF) . Main Outcome Measures Retinal imaging charasteristics. Results Mutations in 6 patients were demonstrated in the BBS1, BBS2, BBS4 and BBS7 genes. All of the probands displayed waxy pale of the optic disc, attenuation of the retinal vessels and atrophy of the mid-peripheral retinal pigment epithelium as well as the choriocapillaris. Furthermore macular involvement was exhibited. According to shown as SD-OCT, the abnormalities in macula were observed to differ among patients, implying 3 major degenerative types: the extensive, the concentric and the centrifugal. In EDI-OCT, the subfoveal choriocapillaris were delineated to be thinning and loss in 12 eyes of 6 patients. Conclusion The major degenerative patterns of BBS were shown to be concentric, centrifugal or extensive on multiple reitnal imaging modalities.

Efficacy of subthreshold micropulse yellow laser (577 nm) photocoagulation for chronic central serous chorioretinopathy

LIAN Hai-yan, SONG Yan-ping

2017, 26(3):  185-190.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.009

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Objective To observe the efficacy of the subthreshold micropulse yellow laser（577 nm）for chronic central serous chorioretinopathy (CSC) and its effects on macular pigment. Design Retrospective cases series. Participants 32 eyes of 32 patients with chronic CSC treated with subthreshold micropulse yellow laser photocoagulation were enrolled. Method All patients were examined with best corrected visual acuity (BCVA), color fundus photography，fundus fluorescein angiography(FFA) combined with indocyanine green angiography(ICGA)，optical cohenrence tomography (OCT) and contrast sensitivity. Subthreshold micropulse yellow laser was performed in the micropulse mode, using 100 μm spot diameter and 0.2 s duration with 5% duty cycle, and power reduced 50% from the power of a single threshold burn. Micropulse yellow laser was applied on the leaking point on fluorescein angiogram and normal retina around the borderline area of serous retinal detachmen (50～100 μm). Retreatment was considered in clinic examination which was the same with that of baseline. Main outcome measures BCVA, centrel fovea thickness (CFT), contrast sensitivity, the rate of resolution of subretinal fluid (SRF), MPOD, and the factors associated with prognosis. Results The average BCVA was 0.36±0.15, 0.35±0.16, 0.32±.021 at 1th，3th，6th month respectively, significantly better than at baseline (all P<0.05). The average CFT was (305.56±62.53) μm, (298.29±46.42) μm, (253.81±57.18) μm reapectively, significantly decreased than at baseline (all P<0.05). The average contrast sensitivity was 14.32±1.02, 15.68±0.98, 17.53±1.32 respectively, significantly better than at baseline (all P<0.05). The rate of resolution of SRF was 100% in chronic CSC patients with point source leakage. The rate of resolution of SRF was 72.73% in chronic CSC patients with point source leakage and associated RPE atrophy. The rate of resolution of SRF was 64.25% in chronic CSC patients with diffuse RPE decompensation. Ages in nonresponder group was higher than that in responder group (t=-9.23，P=0.001). At 6 months，any structural laser damage were not showed. The average MPOD after treatment remained at the baseline level (all P>0.05). Conclusion Subthreshold micropulse yellow laser (577 nm) photocoagulation treatment is an effective and safe treatment option for patients with chronic CSC. The MPOD did not increased after subthreshold micropulse yellow laser (577 nm) photocoagulation.

Surgical approach and long-term outcome of uveal neurogenic tumor

HUANG Yao, XU Xiao-lin, LI Bin, WEI Wen-bin

2017, 26(3):  190-194.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.010

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Objective To study the surgical approach and long-term outcome of local resection for the uveal neurogenic tumor. Design Retrospective case series. Participants 15 cases with uveal neurogenic tumor which got local resection in Beijing Tongren Eye Center from 1999 to 2011. Methods Record and analyze the patients' preoperative clinical characteristics, surgical approaches, postoperative outcomes and histological pathology. Main Outcome Measures Preoperative best corrected visual acuity（BCVA), location and size of tumor, postoperative BCVA, postoperative complications. Results The locations of the tumor were in ciliary body (7 cases, 46.7%), ciliochoroid (2 cases, 13.3%), and choroid (6 cases, 40%). The pathologic examination showed that 10 were schwannoma, 4 were glioneuroma and 1 was neurofibromatosis.  If tumor only involved choroid (6 cases), endoresection was carried out. If tumor involved ciliary body (9 cases), exoresection combined with vitrectomy was carried out. Patients were followed from 1 to 9 years. Nine patients(60%) BCVAs were equal to or better than preoperative. The leading causes of visual acuity decreasing.are retinal detachment and proliferative vitreoretinopathy. There was no local recurrence in all the 15 patients. One eye (6.7%) was enucleated because of neovascularization glaucoma. Conclusion Endoresection or endoresection combined with exoresection was an effective means to remove tumor intactly, conserve vision in eyes with uveal neurogenic tumors and minimize the risk of tumor iatrogenic dissemination.

Two novel mutations in Best vitelliform macular dystrophy GONG

GONG Li-xue, GU Hong, LIU Shou-bin, LIU Ning-pu, MA Kai

2017, 26(3):  195-199.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.011

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Objective To investigate the mutations of BEST-1 gene in the patients who come from two different pedigrees with Best vitelliform macular dystrophy (BVMD) by molecular genetic analysis. Design Gene analysis. Participants Two BVMD pedigrees which have 4 and 3 individuals repectively and 50 normal controls. Methods The members of the two pedigrees received ocular examination, including best-corrected visual acuity, slit-lamp examination, fundus examination, fundus photography, EOG, fundus fluorescein angiography (FFA) and fundus autoflorescence. Direct DNA sequencing of the 11 exons of BEST-1 gene was used to detect the BEST-1 mutation in family members．Main Outcome Measures  BEST-1 sequencing map. Results In pedigrees 1, two patients exhibited yellowish lesions in the macular area of single eye. One of the two was able to conduct the EOG, which showed the Arden rate is 1.08 (<1.5). Genetic testing showed that the both had a point mutation (C.401C>G) at exon 4 of BEST-1 gene,which causes the 105th amino acid changed from Arg to Gly. In pedigrees 2, a BEST-1 missense mutation c.236T>A (p.Tyr50Asn) was identified in one patient and one normal individual cilinicaly. Other individuals in two pedigrees with normal retina had no mutations of Arg105Gly or Tyr50Asn, as well as the 50 normal controls. Conclusion The novel c.401C>G、c.236T>A mutation made a definite diagnosis of BVMD genetically in current study.

Diagnosis and management of fungal infected optic neuritis

TAN Shao-ying, XU Quan-gang, WEI Shi-hui, ZHAO Jie

2017, 26(3):  200-204.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.012

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Objective To understand the clinical features, diagnosis and treatment of fungal optic neuritis. Design Retrospective cases. Participants Three patients with fungal infected optic neuritis. Methods The symptoms, signs, imaging examination were evaluated in 3 patients of fungal infected optic neuritis, addition with literature review and summary of the clinical characteristics and key points of diagnosis in this disease. Main Outcome Measures Clinical symptoms, signs, imaging examinations, pathologic biopsy. Results Three patients of fungal infected optic neuritis were old aged men, monocular or binocular involved, coexisted with systemic disease. Clinical manifestations included acute severe visual loss, headache, eye pain, eyelid prolapse and eye movement disorders. CT showed soft tissue density and bone resorption in the lateral wall of the orbit. Orbital magnetic resonance (MRI) showed irregular enhancement signal with unclear boundary. Pathological biopsy helped to confirm the fungal hyphae and spores. After surgical lesions removal and long-term systemic anti-fungal treatment, symptoms could be controlled in a stable condition. Conclusion Fungus infected optic neuritis should be considered when suddenly unilateral visual loss with headache or eye pain. Imaging examination can help for diagnosis and pathological biopsy is the gold standard. Early managements were suggested with surgical removal of the lesions and long-term systemic anti-fungal therapy.

Correlation between ocular fundus lesion grading and ocular hemodynamics in patients with essential hypertension

LI Cheng-wu1, ZHUANG Zeng-yuan2, LIU Jing1, AN Na1, ZHU Yong-tao1

2017, 26(3):  206-209.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.013

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 Objective To investigate the relationship between ocular fundus lesion grading and ocular hemodynamics parameters in hypertensive patients. Design Case-control study. Participants A total of 120 medical hospitalized hypertensive patients in Wangjing Hospital. Methods The fundus color photographys of the both eyes of the 120 patients were collected using the TOPCON fundus camera in the pupil fully dispersed. The hypertensive retinopathy was graded according to the Keith-Wagener method. The retinal arteriosclerosis grade was performed according to the Scheie method. Hemodynamic parameters of ophthalmic artery (OA) and central retinal artery(CRA) were measured by color Doppler ultrasound. The differences of hemodynamics parameters, including peak systolic velocity (PSV), end-diastolic velocity(EDV), medial flow velocity (MFV), pulsatility index(PI), drag index (RI) of the OA and the CRA were compared between different grades. S/D=PSV/EDV. Main Outcome Measures The hemodynamic parameters, including PSV, EDV, MFV, PI, RI, S/D of the OA and the CRA. Results The EDV, PI, RI and S/D of the OA of the patients with hypertensive retinopathy level Ⅱ, level Ⅲ and above were (10.14±2.13) cm/s and (8.06±0.26) cm/s (t=-8.64，P=0.001), 1.28±0.21 and 1.56±0.24 (t=24.6，P=0.001), 0.69±0.12 and 0.75±0.12 (t=68.4，P=0.001), 3.22±0.87 and 4.18±1.14 (t=18.9，P=0.001). The EDV, PI, RI and S/D of the CRA of the patients with hypertensive retinopathy level Ⅱ, level Ⅲ and above were (3.73±0.39) cm/s and (3.18±0.44) cm/s (t=-23.41, P=0.000), 1.07±0.08 and 1.28±0.10 (t=18.7, P=0.001), 0.62±0.02 and 0.68±0.04 (t=17.32, P=0.000), 2.66±0.41 and 2.99±0.27 (t=35.6, P=0.002). The EDV, PI, RI and S/D of the OA of the patients with retinal arteriosclerosis level Ⅱ, level Ⅲ and level Ⅳ were (10.30±2.27) cm/s, (8.90±0.93)cm/s, (7.74±0.74) cm/s (F=7.509，P=0.003)；1.23±0.22, 1.40±0.24, 1.58±0.38 (F=36.214，P=0.003)；0.68±0.01, 0.72±0.02, 0.77±0.01 (F=121.615，P=0.000)；3.08±0.67, 3.61±1.01, 4.32±1.65(F=28.514，P=0.003). The EDV, PI, RI and S/D of the CRA of the patients with retinal arteriosclerosis level Ⅱ,  level Ⅲ and level Ⅳ were (3.78±0.33) cm/s, (3.47±0.28) cm/s, (2.91±0.27) cm/s(F=-22.377, P=0.000)；1.04±0.06, 1.16±0.13, 1.38±0.12(F=17.619，P=0.003)；0.61±0.02, 0.65±0.06, 0.72±0.02(F=24.156，P=0.000); 2.58±0.31, 2.89±0.40, 3.55±0.41 (F=15.424，P=0.000). Conclusion There was a correlation between ocular fundus lesion grading and ocular hemodynamics in hypertensive patients. With the increasing of retinopathy grading, the velocity of end-diastolic blood flow in the ophthalmic artery and central retinal artery decreased, the pulsatility index increased and the resistance index increased.

Clinical characteristics and causes of laser-induced maculopathy

CHEN Yan-yun, LI Ji-peng, LU Ning

2017, 26(3):  210-213.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.014

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Objective To study the clinical characteristics and causes of laser-induced maculopathy． Design Retrospective case series. Participants Nineteen patients (22 eyes) with decreased visual acuity due to laser injury were recruited into the study between April 2009 to December 2015． Methods  All patients underwent routine examination，fundus photography and optical coherence tomography (OCT)． Main Outcome Measures Morphic characteristics of laser-induced maculopathy, the reasons of laser injury. Results Laser-induced maculopathy included retinal pigment epithelium (RPE) and ellipsoid layer disruption (13 eyes, 59.1%), macular hole (5 eyes, 22.7%), macular edema with inner retinal hemorrhage (3 eyes, 13.6%) and focal macular detachment (1 eye, 4.5%). The reasons of  the injuries included lacking supervision (8 eyes, 42.1%), ignorance of laser harm (8 eyes, 42.1%), damage due to misoperation of laser instrument (3 eyes, 15.8%). Conclusion There are various patterns of laser-induced maculopathy. The outer retina was the most frequently damaged region after laser exposure. Education of laser harm is the key point to avoid laser-induced maculopathy.

Application of multimedia and internet on teaching of the capability of doctor-patient communication

WANG Yue

2017, 26(3):  214-216.  doi:10.13281/j.cnki.issn.1004-4469.2017.03.016

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With the growth of medical disputes, the doctor-patient contradiction is intensified and presents the violence tendency. The importance of the capability of doctor-patient communication is showed for the doctor’s clinical work. The teaching of the capability should be emphasized. With the progress and development of the times, the digital technique, internet, QQ, Microblog, WeChat, personal website integrated applications, which not only can improve doctor-patient communication and exchanges, but also can be convenient for popularization of medical knowledge to patients. It is convenient for patients see a doctor and plays a great role in guiding treatment. It also make every effort to improve harmonious doctor-patient relationship and to build a safe social environment.