Table of Content

25 March 2018, Volume 27 Issue 2

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Improve the outcomes of Toric IOL implantation with optimized clinical decisions

XU Wen, LI Qian

2018, 27(2):  81-84.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.001

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Toric intraocular lenses (IOL) implantation is an important choice to correct corneal astigmatism in cases undergoing cataract surgery. Toric IOL has been recognized by an increasing number of surgeons because of its favorable predictability and safety. However,  the outcomes after Toric IOL implantation are influenced by numerous factors:  right from the preoperative case selection,  detailed preoperative investigations,  accurate IOL selection and intraoperative alignment. Any mistakes would lead to a suboptimal result. To optimize the outcomes of Toric IOL implantation,  the surgical team need to pay more attention to the indications and contraindications of the operation,  make a personalized proposal for every single patient,  as well as ensure every standardized step of the operation. Accuracy is firmly required throughout the whole surgery. Making optimized clinical decisions helps improve the visual outcomes of cataract patients. (Ophthalmol CHN,  2018, 27：81-84）

Surgical treatment and pedigree analysis of FBN1 mutation for a Chinese family with isolated ectopia lentis

LI Bei-han1, SONG Xu-dong2

2018, 27(2):  85-90.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.002

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Objective To reveal mutations of the gene FBN1 of an isolated ectopia lentis family(EL),  and to sum up the surgical procedures of lens subluxation. Design Retrospective case series. Participants An isolated ectopia lentis family in Beijing Tongren Hospital was recruited in 2014. Methods We analyzed all members. Periperal blood was collected and genomic DNA was isolated. FBN1 were selected by a gene capture strategy,  using custom enrichment kit. The enrichment libraries were sequenced on HiSeq2000 sequencer to determine the mutation frequency in FBN1. The probable mutation was determined with the method of the first-generation sequencing. Four cases (8 eyes) with the range of lens dislocation 90~180 degree were performed phacoemulsification combined with capsular tension ring (CTR) and intraocular lens (IOL) implantation,  then after 2~3 months repositioning of CTR-IOL complex. One case (2 eyes) with the range of lens dislocation more than 180 degree were performed pars plana lensectomy combined with sclera-sutured IOL implantation (PPL+PPV+IOL). Two cases (4 eyes) were performed ICCE. One case (1 eye) was performed PPV. Main Outcome Measures Mutations of FBN1 gene,  surgical procedures,  best corrected visual acuity (BCVA). Results We found all the affected individuals carried FBN1 gene mutations,  c.4588C>T（p.R1530C）,  in exon38 by sequence analysis,  while the unaffected family members did not have this mutation. The BCVA in cases underwent Phaco+CTR+IOL was 0.5~0.8. BCVA in cases underwent PPL+PPV+IOL was 0.3~0.5. Conclusion Our study showed that FBN1 gene mutation,  c.4588C>T(p.R1530C),  was the underlying molecular pathogenesis of this family. The treatment with Phaco+CTR+IOL and adjusting the IOL 2-3 months after the surgery led to good BCVA results.（Ophthalmol CHN,  2018, 27：  85-90）

The characteristics and management of posterior capsule in congenital cataract

GUO Zheng1, LI Shi-lian1, XIANG Dao-man2

2018, 27(2):  91-94.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.003

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Objective To discuss the characteristics and management of posterior capsule in congenital cataract. Design Retrospective case series．  Participants Seventy cases (118 eyes) of congenital cataract in Guangzhou Children and Women’s medical center from 2012 to 2014. Methods Clinical data of the posterior capsules and surgical video were reviewed retrospectively. Main Outcome Measures The characteristics of posterior capsule（morphology,  color,  trait, etc）,  managements,  postoperative outcomes. Results The posterior capsule in 91 eyes (77.11%) of all 118 eyes was thansparent. The abnormalities were observed in 27 eyes (22.88%),  including central opacity in 12 eyes(10.17%),  protuberance backward and thin posterior capsular in 2 eyes (1.69%),  central defect in 2 eyes(1.69%),  vascularization posterior capsular in 2 eyes (1.69%) and the anterior and posterior capsular adherent in 9 eyes (7.63%). Diathermy capsulotomy alone or a combination of vitrectomy and capsulorhexis using forceps were performed. Of the 56 eyes that had an intraocular lens (IOL),  there were 4 IOL decentration postoperatively. Posterior capsule opacity developed in 15 eyes (12.71%). Conclusions Posterior capsular anomalies were about 20% in pediatric congenital cataract eyes, in which central opacity was frequent. Handling of abnormal posterior capsule often requires a combination of several kinds of operating equipments. （Ophthalmol CHN,  2018, 27：91-94）

A special local sclera degeneration in old people

DONG Zhe, LI Bin, SONG Xu-dong, YANG Wen-li, XU Xiao-lin, XIN Chen, LIU Han-ruo, WANG Ning-li

2018, 27(2):  95-98.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.004

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Objective To report a special local sclera degeneration located posterior to corneal limbus in old people. Design Retrospective case series. Participants 32 cases (51 eyes) of out-patients with cataract whose sclera showed local abnormal appearance from May 2016 to Dec 2017. Methods We reviewed the measurement of the eyes with slit-lamp,  anterior segment optical coherence tomography (OCT),  ultrasound biomicroscopy (UBM)，and B scan. We also had the opportunity to perform pathological examination in one case. Main Outcome Measures The location,  the morphology,  the size of the lesion,  and the pathological findings. Results The age of these patients ranged from 61~86 years (mean 71.12±11.43 years). Among them,  10 cases were male (31.25%),  and 22 cases were female (68.75%). In all 51 eyes the lesion located in the nasal side posterior to corneal limbus of the fissurae palpebrae,  which appeared cinerous,  sharply-defined,  oval shape of about 2 mm ×5 mm,  with micro cyst appearance under slit-lamp microscopy. The abnormal area showed low echo and low reflection on OCT and UBM. The distance from the upper edge of the low echo area to the outer surface of sclera was 0.11~0.29 mm,  and the distance from the lower edge of the low echo area to the inner surface of sclera was 0.31~0.48 mm. No sclera stampyloma was detected with B scan. Histopathological examination showed that the lesion was a  blue-purple amorphous degenerative change. Conclusion We primarily reported a special local sclera degeneration located posterior to corneal limbus in old people. This kind of pathological change occurred in the nasal side of the fissurae palpebrae,  and appeared cinerous,  sharply defined,  oval shape. But its pathogenesis,  the relative factors,  and the clinical significance need to be further researched.（Ophthalmol CHN,  2018, 27：95-98）

Clinical and histopathologic features of eyelid squamous cell carcinoma and its prognostic predictors

JIN Shu-hong1, WANG Yi-peng1, ZHANG Hong-ge2, CHEN Yong-jun1

2018, 27(2):  99-102.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.005

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Objective To analyze the clinical and histopathologic features and the factors associated with prognosis of the eyelid squamous cell carcinoma. Design Retrospective case series. Participants Forty-two cases of eyelid squamous cell carcinoma during January 2000 and March 2011 in Anyang Ophthalmology Hospital. Methods According to the initial records and follow-up feedback,  the clinical and histopathologic features were analyzed. The related factor of recurrence was analyzed by COX regression, and survival analysis using kaplan-meier method. The postoperative patients were followed-up for (45.7±9.87) months. Main Outcome Measures Age,  gender,  disease course,  disease region,  T classification,  pathological grade,  treatment methods. Results The age of 42 cases varied from 36 to 81 years old,  and the mean age was 61.9±7.82 years old. There were 24(57.1%) males and 18(42.9%) females. The tumors mainly located at the lower eyelid. The sample included four T1,  seven T2,  seventeen T3,  and fourteen T4 cases. The statistics analysis showed the length of the disease duration and the T classification were significantly associated with local recurrence(P＜0.05). The disease duration and the T classification were two risk factors for tumor recurrence. And the T classification was correlated with the five-year survival rate, the higher grade of T classification, the higher tumor-related mortality (r=8.818, P=0.035). Conclusion The clinical outcome of the eyelid squamous cell carcinoma is related with the length of the disease duration and the T classification of the tumor. The longer disease duration or the higher T classification,  predicted a higher recurrence rate of tumor. And the mortality rate increased with the higher T classification.（Ophthalmol CHN,  2018, 27：99-102）

Parameter changes of dynamic vascular patterns of contrast-enhanced ultrasound in uveal melanoma patients

LI Dong-jun1, 2, YANG Wen-li2, YANG Jun1

2018, 27(2):  103-106.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.006

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Objective To study the application of dynamic vascular patterns (DVP) curves and parametric images of contrast-enhanced ultrasound (CEUS) in uveal melanoma. Design Experimental research. Participants53 uveal melanoma patients (53 eyes) with CEUS examination. Methods Sonoliver software was used to analyze the CEUS images and construct the DVP curves and DVP parametric images according to the difference between the lesion and the normal control tissue of the same patient. According to the opening direction of the lesion's green curve and the relationship with the yellow line, the DVP curves were divided into I～IV type; according to different color composition, the DVP parametric images were divided into I～IV type. Main Outcome Measures Maximum of intensity (IMAX), rise time (RT), time to peak (TTP), mean transit time (mTT); The proportion of DVP curves and parameter diagrams type. Results The IMAX (210.08±102.14)% was higher than that in normal orbital tissue (100.00±0.00)% (t=7.846, P=0.000). The mTT(39.40±17.97)s was faster than that in normal orbital tissue (49.95±18.64) s (t=-3.417, P=0.001).  The four types of DVP curves (Ⅰ, Ⅱ, Ⅲ, Ⅳ) and DVP parametric images (Ⅰ, Ⅱ, Ⅲ, Ⅳ) were 71.70%, 18.87%, 5.66%, 3.77% and 81.13%, 9.43%, 5.66%, 3.77% respectively. Conclusions Dynamic vascular patterns of contrast-enhanced ultrasound can demonstrate the different characteristics of flow perfusion static between uveal melanoma and normal orbital tissue. Most of the uveal melanomas show type I DVP curves and type I DVP parametric images. （Ophthalmol CHN,  2018, 27：103-106）

Repeatability of quantitative assessment of the retinal microvasculature using optical coherence tomography angiography based on optical microangiography

microangiographyZHAO Qi1, WANG Xiao-na1, YANG Wen-li1, WEI Wen-bin1, WANG Ruikang K.1, 2,YOU Qi-sheng1, CHU Zhong-di2, XIN Chen1

2018, 27(2):  107-110.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.007

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Objective To determine the repeatability of optical coherence tomography angiography (OCTA) based on optical microangiography (OMAG) measurements of macular vessels in normal eyes. Design Diagnosis test. Participants A total of 40 eyes of 40 normal volunteers were examined at Beijing Tongren Eye Center. The mean age was 33.0±8.8 years (22~55 years). Methods OCTA data was acquired using Zeiss Cirrus HD-OCT 5000 angiography system. The following parameters were used for quantitative analysis:  vessel length density (VLD),  perfusion density (PD) and area,  perimeter,  circularity of foveal avascular zone (FAZ). Main Outcome Measures The coefficient of variation (CV) and intraclass correlation coefficients (ICC). Results All parameters showed high repeatability ［CV（1.2±1.0)%~(4.2±5.5)%, all ≤4.2% (intravisit) and  （1.4±0.8)%~(4.6±4.9)%,  all≤4.6% (intervisit)］ and interobserver reproducibility (ICC=0.923~0.994, all≥0.923). The CVs were higher for intervisit than for intravisit,  higher for fovea and FAZ than for parafovea. The ICCs were higher for fovea and FAZ than for parafovea. Conclusion The evidence presented here demonstrates good repeatability and reproducibility of OCTA based on OMAG for measurement of superficial vessel parameters in normal eyes.（Ophthalmol CHN,  2018, 27：107-110）

Morphologic predictors of visual outcome in patients with macular edema secondary to retinal vein occlusion treated with anti-VEGF therapy

MA Dan-dan, CAO Kai, XIAO Yuan-yuan, SUN Di, LI Yi-bin

2018, 27(2):  111-115.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.008

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Objective To evaluate the associations between baseline fundus fluorescence angiography (FFA) and optical coherent tomography (OCT) characteristics and visual outcome of patients treated using anti-VEGF therapy for macular edema (ME) secondary to retinal vein occlusion (RVO). Design Retrospective case series. Participants 125 Patients with ME second to RVO,  who received intravitreal injection of ranibizumab ( IVR ) and had good response in Beijing Tongren Hospital. Methods All the patients received monthly IVR till the ME resolved,  and underwent routine FFA and OCT examination using Spetralis HRA-OCT. Baseline changes in FFA and OCT were semi-automatically analyzed. The binary logistic regression was used to analyze the relationship between morphologic changes and best corrected visual acuity (BCVA) at final visit. Main Outcome Measures BCVA,  parafoveal capillary perfusion,  central retinal thickness,  central retinal volume,  the integrity of each retinal layers in OCT. Results Among 125 patients,  the percentage of them with BCVA ≥0.5 at baseline was 5.6% (7/125),  while 34.4% (43/125) at final visit. The   parafoveal capillary non-perfusion in FFA (P=0.01,  OR=0.213),  obscure  inner plexiform layer (IPL) (P=0.005,  OR=0.225),  and external limiting membrane (ELM) rupture in OCT (P=0.001,  OR=0.16) hindered patients from gaining good vision prognosis after treatment. Conclusion For patients with ME secondary to RVO,  parafoveal capillary non-perfusion in FFA,  obscure IPL,  and ELM disruption in OCT might predict poor vision after anti-VEGF therapy.（Ophthalmol CHN,  2018, 27：111-115）

Comparison of non-invasive tear function changes in two corneal refractive surgery

LV Ju-ling, WANG Lan, WU Ju-fen

2018, 27(2):  117-121.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.009

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Objective To analyze the influence of different corneal refractive surgical methods on non-invasive tear function indicators. Design Retrospective comparative case series. Participants 42 cases (42 eyes) who underwent corneal refractive surgery and followed-up for at least 6 months. There were 20 patients (20 eyes) in LASIK group and 22 patients (22 eyes) in SBK group. Methods Non-invasive first tear film break-up time (NIBUTf),  non-invasive average tear film break-up time (NIBUTa) and lower tear meniscus height (LTMH) were assessed pre- and post-operative 10 days, 1 month,  3 months,  6 months using oculus keratograph. The right eye data were analyzed for comparison between the two groups. Main Outcome Measures NIBUTf, NIBUTa and LTMH. Results There was no significant difference of NIBUTf and LTMH between the two groups at all time points (all P>0.05). Compared to LASIK group,  the NIBUTa was elevated at postoperative 3 months in SBK group (P=0.02). For LASIK group,  compared to preoperative value,  postoperative NIBUTf decreased at 1 month and 3 months (all P<0.05),  but not at 10 days,  and 6 months (both P>0.05); both NIBUTa and LTMH value reduced at postoperative time points,  but the differences were not statistically significant (all P>0.05). For SBK group,  compared to preoperative value,  NIBUTf decreased at postoperative 10 days,  1 month,  3 months  (all P<0.05),  but recovered at 6 months after surgery （P=0.14); NIBUTa decreased at postoperative 10 days (P=0.04),  but not at 1 month and 3 months(both P>0.05). There was no statistical difference of LTMH at every postoperative time point compared to preoperative value ( all P>0.05). Conclusion Compared to preoperative value,  NIBUTf and NIBUTa temporally decreased after LASIK and SBK,  recovered to preoperative level at postoperative 6 months. Compared to LASIK,  the NIBUTa was higher at postoperative 3 months in SBK group. The tear film function restored faster in SBK than LASIK group. （Ophthalmol CHN,  2018, 27：117-121）

Experimental study on mistletoe in prevention of perimenopausal xerophthalmia in female rabbits

YE Lin-hong1, SHAO Yi1, ZHANG Yi-yi2,JIANG Nan1, YE Lei1, YUAN Qing1, ZHU Pei-wen1, TANG Li-yuan1, BAO Jing1

2018, 27(2):  122-127.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.010

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Objective To investigate the effect of mistletoe eye drops in prevention of perimenopausal xerophthalmia in female rabbits. Design Experimental study. Participants Thirty-six healthy female rabbits. Methods Thirty-six healthy female rabbits were chosen,  among them,  24 female rabbits were cut off bilateral ovaries set up perimenopausal dry eye model. These 24 rabbits were randomly divided into 2 groups:  group A was treated with normal saline eye drops,  group B was treated with mistletoe eye drops. The other 12 rabbits (group C),  as a control group,  underwent sham surgery to open abdominal cavity,  but their ovaries were not removed. Schirmer’s test (SIT),  corneal fluorescein (FL) staining,  tear proteins,  and corneal confocal microscope were performed before intervention and at 1 week,  2 weeks,  1 month,  2 months after intervention. Main Outcome Measures SIT,  FL,  tear proteins,  and corneal confocal microscope. Results At 2 months after intervention,  rabbits in group B showed significant better results of SIT (7.48±3.16) l/mm,  FL score (1.91± 0.96),  total protein (10.71±2.37) ρ/g·L-1,  lysozyme (1.43±0.35) ρ/g·L-1,  iron egg milk (1.19±0.27) ρ/g·L-1,  amylase activity (87.75±62.79) IU,  corneal epithelium cell density (3174±379) cells/mm2 and corneal anterior substrate light emitting cell density,  compared to group A rabbits (all P<0.05). Compared with the nornal rabbit, corneal anterior substrate light emithing cells desity slightly increased, and corneal stromal layer nerve trunk slightly curved. Conclusion Mistletoe eye drops can effectively improve  SIT,  the score of FL,  lacrimal protein,  corneal epithelial cell density and other indicators in the perimenopolis. （Ophthalmol CHN,  2018, 27：122-127）

Analysis of mental status on patients with meibomian gland dysfunction

ZHENG Pan-pan, LIANG Qing-feng, SU Yuan-dong, SU Guan-yu, GAO Chao

2018, 27(2):  129-134.  doi: 10.13281/j.cnki.issn.1004-4469.2018.02.011

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Objective To analyze the mental status of patients with meibomian gland dysfunction (MGD) and its relationship with clinical parameters of ocular surface. Design Cross-sectional study. Participants 923 MGD patients and 114 controls. Methods All subjects were required to complete the Ocular Surface Disease Index (OSDI),  Modified-self-rating depression scale(M-SDS) questionnaire and 6 items of objective ocular surface examinations including TBUT, corneal fluorescein (FL) staining,  Schirmer I test(SIt),  meibomian gland loss rate (measured by meibomian gland infrared photography and ImageJ software),  lipid layer thickness (LLT)(measured  by LipiView ocular surface interferometer) and meibomian gland yielding secretion score (MGYSS)(measured by applying a constant pressure to the meibomian glands via a meibomian gland evaluator). The correlation between M-SDS and OSDI and ocular objective examination results of MGD patients was analyzed. Main Outcome Measures OSDI,  M-SDS,  TBUT,  FL, SIt,  meibomian gland loss rate,  LLT,  MGYSS. Results The OSDI of MGD group (33.88 ± 16.13) was higher than that of the control group (13.63 ± 8.91) (t=20.47,  P<0.001). The average TBUT in MGD group was significantly lower than that in control group (4.16±2.30 vs 7.28±4.17,  t=-7.84,  P<0.001). The average FL in MGD group was significantly higher (0.72±1.21 vs 0.23±0.64,  t= 6.91,  P<0.001). The SIt(10.07±8.05) mm has no significant difference compared to the control group (10.18±8.06) (t=-0.14,  P=0.89). Meibomian gland loss rate(14.33±12.23)% was higher than that of the control group (8.25±10.31)% (t=5.19，P<0.001). LLT (62.02±24.79) was lower than that of the control group (67.45±21.58) (t=-2.24,  P=0.03). MGYSS (9.06±7.12) was lower than the control group (15.61±10.76) (t=-6.33,  P <0.001). The average score of M-SDS in MGD group (37.91±9.48) was higher than that in control group (31.96±7.82) (t=6.42,  P=0.001). Among 923 patients in MGD group,  the M-SDS scores of youth and middle-age groups were higher than the elderly group (F=6.414,  P=0.002). Correlation test showed M-SDS was positively correlated with OSDI,  but negatively correlated with age. Multivariate linear regression analysis showed,  the odds of depression in MGD group were higher than control group (OR=2.789,  95 % CI:  1.004~7.553) (χ2= 4.121,  P=0.042).  Among the 85 depressed patients in the MGD group,  the most severe symptoms of depression were:  fear of blindness,  loss of appetite,  feeling useless,  confusion and lack of interest. Conclusion Patients with MGD are more susceptible to depression,  which may be related to the effect of MGD symptoms on mental status. The youth and middle-aged MGD patients had higher prevalence of depression compared with senile MDG patients.（Ophthalmol CHN,  2018, 27：129-134）

Surgical strategy analysis of modified excimer laser phototherapeutic keratectomy for band keratopathy

ZHAO Ke-hao, LU Wen-xiu, WANG Wen-cui, LEI Hong

2018, 27(2):  135-140.  doi: 10.13281/j.cnki.issn.1004-4469.2018.02.012

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Objective To explore surgical strategies of excimer laser phototherapeutic keratectomy for treatment of band keratopathy. Design Retrospective case series. Participants Eighteen consecutive cases (23 eyes) with band keratopathy in Beijing Xinli Eye Clinic from December 2012 to June 2015. Methods All cases underwent modified PTK or combined abnormal tissue peeling surgeries  for band keratopathy. The causes of disease,  surgical strategies,  epithelial healing,  complications and recurrence rate were analyzed.  The follow-up time was from 3 to 14 months,  and the average was (7.13±3.47) months. Main Outcome Measures Surgical strategies,  epithelial healing,  degeneration tissue removal and recurrence rate. Results The causes of band keratopathy included chronic uveitis in 12 cases (15 eyes),  infectious endophthalmitis in 2 cases (2 eyes),  acute retinal necrosis in 1 case (1 eye),  ocular trauma in 1 case (1 eye),  glaucoma in 1 case (2 eyes),  and unknown reason in 1 case (2 eyes). The removal methods:  13 eyes received modified phototherapeutic keratectomy（PTK),  2 eyes received mechanical abnormal tissue peeling only,  and 8 eyes received combined mechanical abnormal tissue peeling and modified PTK. Epithelial healing time was from 4 to 21 days,  and the median was 5 days. After operation band keratopathy tissue of all eyes was completely removed. Eye irritation symptom disappeared for patients who had eye pain before surgery. Visual acuity of 10 eyes improved.  5 eyes (21.74%) had ≥ 1 degree haze. 3 eyes (13.04%) experienced recurrence. Conclusions Modified excimer laser phototherapeutic keratectomy was minimal invasive effective approach for the treatment of band keratopathy. The reasonable surgical strategy was crucial to ensure the operation effects.（Ophthalmol CHN,  2018, 27：135-140）

The changes of axial length and corneal endothelial cell of overnight orthokeratology in adolescent with low to moderate myopia

LV Yan-yun1, WU Jing-jing1, CHI Hui2，PENG Li1, WANG Yan-xia1， XIE Pei-ying2

2018, 27(2):  141-145.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.013

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Objective To evaluate the effects and safety of long-term overnight orthokeratology (ortho-k) in adolescent with low to moderate myopia. Design Retrospective study. Participants 68 myopic juvenile (135 eyes) with ortho-k lens wearing more than 5 years. Methods Subjects were divided into low-myopia
(SE -0.75~-3.00 D) and moderate-myopia (SE -3.25~-5.75 D) groups. Axial length (AL) was measured at baseline and every year after ortho-k lens wearing. The cell density (CD),  hexagonal cell ratio (HEX),  and coefficient of variation (CV) of the corneal endothelial cell layer were measured at each year. Data were analyzed using repeated one-way ANOVA and t-test analyses. Main Outcome Measures AL,  CD,  HEX,  CV. Results During the five years of observation periods,  the AL of both groups increased (F=16.863,  6.780; P=0.000,  0.000). The annual axial growth after ortho-k lens wearing for 1 to 5 years was (0.28±0.15)mm,  (0.21±0.16)mm,  (0.17±0.15)mm,  (0.12±0.08)mm and (0.11±0.06)mm in low-myopia group; and the data of moderate-myopia group was (0.25±0.14)mm,  (0.16±0.10)mm,  (0.15±0.09) mm,  (0.10±0.07)mm and (0.08±0.05)mm respectively. With time prolonged,  the annual axial elongation of both groups decreased (F=28.434,  21.296; both P<0.001),  and the moderate-myopia group represented less axial elongation after 5 years (t=6.577; P=0.01). After ortho-k lens wearing for 1 to 5 years,  the CD (F=1.239,  1.421; P =0.290,  0.216),  HEX(F=2.156,  2.227; P=0.058,  0.051) and CV(F =2.147,  2.038; P=0.059,  0.073) of the corneal endothelial cell layer remained stable,  and there was no significant difference of corneal endothelial cell layer changes between two groups (all P >0.05). Conclusions Five-year follow-up showed that ortho-k lens has a better effect on myopia control in moderate myopia than low myopia. Long term overnight wearing of ortho-k lens has no significant effect on corneal endothelial cells. （Ophthalmol CHN,  2018, 27：141-145）

A study on the correction of acute concomitant esotropia by prism

ZHAO Shi-qiang1, 2 LIU Yang1, SUN A-li2, WANG Xiao- bing2, LI Lei2，WANG Bing2

2018, 27(2):  146-149.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.014

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Objective To investigate the treatment prescription for patients with diplopia caused by acute concomitant esotropia. Design Retrospective case series. Participants Fourty-two patients with diplopia caused by acute concomitant esotropia were treated with prism. Methods Patients with acute esotropia caused by diplopia were examined with Maddox Rod,  Synoptophore,  Von Graefe prism separated by strabismus examination,  and convergence measurement. The main intention of these tests was to determine a prescription volume to achieve maximum elimination of diplopia with no discomfort. The correlation between the results retrieved from each apparatus and the amount of prescribed was analyzed. Main Outcome Measures Degree of diplopia. Results The strabismus examination showed that the Maddox Rod was (20.57±9.53) △. The results of Synoptophore indicated (16.01±8.30)△. The Von Graefe prism was(15.95±7.07)△. The fracture point was (5.17±4.20)△. Measurement by prism and cover was (13.24±5.01)△,   and the regression point was (9.14±5.76)△. Prism prescription amount was (6.92±3.49)△. The correlation coefficients of among Von Graefe prism separation,  measurement by prism and cover,  fracture point,  regression point and prism prescription amount were 0.496,  0.546,  0.647,  0.408,  0.831 and 0.708,  respectively. Conclusion The fracture point has the maximum correlation to the prescribed prism amount. It can serve as the foundation for the prism correction.（Ophthalmol CHN,  2018, 27：146-149）

Pathogenic causes,  clinical features and prognosis of intraocular foreign bodies in children—170 case analysis

LI Lin, SHI Xiang-yu, HAN Song, LIU Yi, ZHOU Jun, LIU Ning-pu, LU Hai

2018, 27(2):  150-154.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.015

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Objective To study the etiological,  clinical characteristics and prevention strategies of children with intraocular foreign body(IOFB).Design Retrospective case series. Participants One hundred and seventy inpatients of Beijing Tongren Hospital with IOFB during January 1 2004 to December 31 2016 with age of 1 to 14 years old (mean8.73±3.12years),  among whom 157 were boys(92.4%). Method The basic information of patients,  causes of injury,  wounds,  eye complications,  IOFB characteristics,  surgical treatment and prognosis were collected and analyzed using SPSS. Main Outcome Measures Cause of the injury,  type of foreign body,  complications and blindness rate.Results Among the causes of the injury,  explosive injuries was the most common (59.4%,  n=101),  followed by sharp stick injuries (20.6%,  n=35). Fireworks were the most damaging items (41.2%,  n=70),  followed by detonators (8.8%,  n=15). Endophthalmitis occurred in 35  cases (25.0%). Retinal tears or detachment occurred in 96 cases (56.5%). 140  cases (82.4%) of foreign bodies located in the posterior segment. 148 cases (87.1%) underwent vitrectomy. 105 patients (61.8%) were blind (best corrected visual acuity<0.05) after operation. Blast injury patients had higher blinding rates than other causes of injury (72.3% vs 46.4%,  P<0.01). Conclusions The most common cause of injury in children with IOFB is explosion.Fireworks are the most damaging items.The vision prognosis is poor in children with IOFB.（Ophthalmol CHN,  2018, 27：150-154）

The clinical problem-based training for scientific research thinking of clinical graduate students

SHI Yan，WANG Ning-li

2018, 27(2):  157-159.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.017

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The goal of the nation to train clinical graduate candidates requires improving their scientific research abilities. To meet this goal,  the scientific research thinking is the most important part to be trained. The best way to get this competence is the clinical problem-based method,  in which the clinical graduate candidates have their own advantages. In this article,  based on our experience of transforming clinical demands to scientific researches,  how to do the scientific research thinking training through the clinical problem-based method will be elucidated specifically by introducing how to form a meaningful clinical problem from the clinical demand,  and how to figure out its breakthrough point,  ultimately obtain results serving clinic.（Ophthalmol CHN,  2018, 27：157-159）