Table of Content

25 May 2018, Volume 27 Issue 3

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Enhance corneal infection safety of corneal refractive surgery in femtosecond era

ZHANG Feng-ju, LI Yu

2018, 27(3):  161-163.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.001

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In recent years, with the booming development of science and technology, the time of no keratome leading by the femtosecond laser has come. A large number of clinical trials have proved the corneal refractive surgery can increase the naked eye vision, improve the patient's quality of vision. It is precise, safe and effective. However, any complications that occur during or after surgery should receive high attention, especially postoperative corneal infections. This article combined with the recent analysis of corneal infections to explain the need to further strengthen the standardization of the operation, strengthen the monitoring mechanism of medical quality, and further improve the safety of surgery to effectively avoid and prevent related complications.

Clinical efficacy of acellular porcine corneal stroma deep lamellar keratoplasty for infectious corneal ulcer

LI Shang1, LU Hong-shuang2, ZANG Yun-xiao2, ZHANG Wei1, DONG Hong-wei1, GUO Chun-gang1, PAN Zhi-qiang2, JIE Ying2.

2018, 27(3):  164-170.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.002

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Objective To compare the clinical efficacy of deep anterior lamellar keratoplasty (DALK) using acellular porcine corneal stroma and fresh corneal tissue for the treatment of infective corneal ulcer. Design Retrospective case series. Participants Ten patients with infectious corneal ulcer admitted to Beijing You'an Hospital from Nov 2015 to Sep 2016, all patients’ Descemet’s layer was not affected. Methods Bubble-assisted DALK surgery data were retrospectively analyzed. Patients were assigned to acellular porcine corneal stroma treatment group and fresh corneal tissue treatment group with five cases in each treatment group. The best corrected visual acuity (BCVA)(LogMAR), intraocular pressure(IOP), spherical power on optometry, mean corneal curvature, astigmatism on corneal topography, corneal endothelial cell count, corneal thickness(CT), axial length(AL), corneal structure under confocal microscope, corneal transparency and grafts survival were observed one year after operation. Main Outcome Measures The BCVA (LogMAR), IOP, spherical power on optometry, mean corneal curvature, astigmatism on corneal topography, corneal endothelial cell count, CT, AL, corneal structure under confocal microscope, corneal transparency and grafts survival. Results During follow-up, all the grafts in both groups remained clear and the graft survival rate was 100%. BCVA was 0.53±0.21 in the acellular porcine corneal stroma group and 0.33±0.06 in the fresh corneal tissue group (P=0.184), the IOP was (8.00±2.00) mmHg and (10.33±0.58) mmHg (P=0.124), the spherical power was (-4.50±4.21) D and (-1.25±0.75) D (P=0.258), the mean corneal curvature was (47.59±5.40) D and (44.51±1.87）D (P=0.403), the astigmatism was (-5.52±1.97) D and (-5.14±1.66)D on corneal topography (P=0.812), the endothelial cell count was (1272.67±387.63)/mm2 and (1550.33±232.69)/mm2 (P=0.347), the CT was (439.33±67.86)μm and (534.00±14.42)μm(P=0.077), and the AL was (23.53±0.91)mm and (23.55±1.56)mm in the two groups respectively (P=0.981).  Corneal confocal microscopy showed that the corneal epithelial cells in the acellular porcine corneal stroma group could completely cover the graft. The shape and density of the basal cells and the wing cells were similar to that of the fresh cornea. However, high-reflective deposits were observed under the basal cells, and the density of the stroma cells was significantly lower than that of fresh corneal tissue. Moreover, acellular fibers were still observed between the endothelial cells and the deep stroma. Conclusion Acellular porcine corneal stroma has good biocompatibility and could be an alternative treatment with satisfactory results for infectious corneal ulcer when fresh corneal tissue is not available.

Design and preliminary application of the blepharometer

SONG Wen-xiu1, TIAN Lei1, WANG Li-ke2, SUN Xu-guang1

2018, 27(3):  171-175.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.003

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Objective To measrue the eyelid pressure with the designed blepharometer on normal and dry eye patients, and to analyze the influence factors of eyelid pressure. Design Prospective case series. Participants Forty-two cases of normal subjects and sixty-two cases of dry eye patients in the Beijing Tongren Hospital were collected. Methods The new type of eyelid pressure measurement instrument (blepharometer) was used to measure the pressure of the upper eyelid of normal and dry eye patients, and the influence factors of eyelid pressure were analyzed. For observing the repeatability of the instrument, each subjuct was measured 3 times. The symptoms and signs of the subjects were followed to observe the safety of the instrument. Main Outcome Measures Upper eyelid pressure. Results The upper eyelid pressure value of normal subjects is (0.40±0.13)N, lower than dry eye patients(0.55±0.21 N) (t=2.561, P=0.026). There are no statistical difference between each set of data measured three times (t=1.22, P>0.05) . None of the subjects appeared ocular abnormalities. The upper eyelid pressure was negatively correlated with age (r =-0.372, P=0.020). There was a significant correlation between the upper eyelid pressure and the BUT and Schirmer I test in dry eye patients (r=-0.262、-0.235，P<0.05), and no significant correlation was observed with the corneal staining score (r=0.205，P=0.063). Conclusion The new eyelid pressure instrument can safely, effectively and repeatably evaluate the upper eyelid pressure. With age, the pressure of the upper eyelid to the eyeball gradually decreases in normal subjects. Compared with normals, the eyelid pressure of the dry eye patients was elevated. The relationship between eyelid pressure and ocular surface epithelial cell lesion remains to be further studied.

Application of error-distinguished teaching method in ophthalmological course of refresher physician

SHAO Lei, QIAO Chun-yan

2018, 27(3):  175-177.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.021

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Error-distinguished teaching method used in the ophthalmological course may cultivate the abilities of finding, analyzing, and resolving problem of refresher physician by stirring up students' subjective motility. After studying in such classes, the basic ophthalmological knowledge would be enhanced, and the clinical thinking system would be established, which showed an good teaching efficiency.

Clinical efficacy of traditional Chinese herbs steam using potable dry eye steam instrument on dry eye

ZHANG Hai-juan, MA Yao, ZHANG Jun-xiu, WU Yu-ying, MA Ke

2018, 27(3):  178-181.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.004

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Objective To observe the efficacy of portable dry eye steam instrument using traditional Chinese herbs in treating dry eye patients in a daily home used model. Design Perspective comparative case series. Participants Ninety-six dry eye patients were all from outpatient section in Tongren Hospital from 2016 to 2017, the average age was 55.60±12.30 years old. Methods Ninety-six patients with dry eye were randomly divided into two groups, the testing group and the control group,  48 patients in each group. The testing group was given steam treatment twenty minutes every day with Zhenqi eye drop and anti-inflammatory drugs. The control group was given sodium hyaluronate eye drop 5 times a day. The symptoms and signs were observed after 4 weeks. The clinical effective index=(subjective symptoms score before treatment-subjective symptoms score after treatment)/subjective symptoms score before treatment×100%. The significant clinical effectiveness means clinical effective  index ≥90%, BUT, SIt, cornea fluorescence was recovered completely. The clinical effectiveness means 90%≥clinical effective index ≥30%, one of them includes BUT, SIt and cornea fluorescence was improved. No clinical effectiveness means clinical effective index <30%, any of them includes BUT, SIt and cornea fluorescence was not improved. Main Outcome Measures The total clinical effectiveness ratios（significant clinical effectiveness + clinical effectiveness）, total scores of symptoms, SIt, BUT, cornea fluorescence score. Results There was no significant difference between testing group and control group in total scores of symptoms, SIt, BUT, cornea fluorescence score before any treatment was given. The clinical effectiveness ratio was 79.17% in testing group, and 66.67% in control group after 4 weeks treatment, no significant was found (P=0.168). After 4 weeks treatment, the BUT was 5.54±2.39 s in testing group and 4.56±2.09 s in control group (P=0.03). The total score of symptom was 2.75±1.94 in testing group and 3.67±2.02 in control group (P=0.02).  Conclusion  Dry eye can be effectively treated by Chinese herb stream treatment, the effectiveness in Chinese herb stream treatment with Zhenqi on dry eye was found to be better than sodium hyaluronate eye drop only.

omprehensive study of symmetry patterns of axes in bilateral astigmatism of pre-school children

ZHUO De-yi, REN Xiao-fang, XIAO Lin

2018, 27(3):  182-185.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.005

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Objective To study symmetry patterns of axes (direct and mirror) in bilateral astigmatism of pre-school children. Design Cross-sectional study. Participants One hundred and sixty-four pre-school children aged 3~4 years old from new kindergartners being medically examined from June to August 2017 was collected. Methods Refractive status data were measured using hand held autorefractor (WelchAllyn). Descriptive statistics of symmetry patterns of axes data were analyzed through two symmetry models of axes (the mirror and direct symmetry models). The relationship between gender, spherical values, magnitude of astigmatism, type of astigmatism, anisoastigmatism and inter-ocular axis difference was analyzed respectively. Main Outcome Measures Inter-ocular axis difference. Results The median of the absolute inter-ocular axis difference from exact symmetry was 4° under the mirror symmetry model (mirror axes). Under the direct symmetry model (equal axes), the median of the absolute inter-ocular axis difference was significantly higher, at 8° (P<0.01). 6% and 0% had exact mirror and direct symmetry, respectively. In addition, 87% of cases with mirror symmetry model and 77% with direct symmetry model were within 15 degrees of exact symmetry. In direct and mirror symmetry model, the median of inter-ocular axis diffrence of with-the-rule(WTR)  astigmatism children were both the lowest, at 8° and 3°. In direct symmetry model, type of astigmatism and anisoastigmatism had a positive correlation with inter-ocular axis difference (R=0.42, P<0.01; R=0.22, P=0.01); while our data also shows a positive correlation between type of astigmatism (R=0.44, P<0.01), anisoastigmatism and inter-ocular axis difference(R=0.14, P=0.04), and a negative correlation between magnitude of astigmatism and inter-ocular axis difference in mirror symmetry model (R=-0.20, P=0.01). Conclusion The bilateral symmetry of the astigmatism axes was highly prevalent and mostly of the mirror pattern. Lower anisoastigmatism children and with-the-rule (WTR) astigmatism children showed better symmetry.

Agreement between traditional and telecontrolled subjective refraction

CUI Juan, WANG Xiao-bing, ZHEN Yi

2018, 27(3):  186-190.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.006

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Objective To evaluate the agreement of refractive error detected by the traditional and telecontrolled subjective refraction. Design Diagnosis test. Participants 49 volunteers with refractive error. Method Traditional and telecontrolled subjective refraction were processed the laboratory of different floors in National Ophthalmology Diagnosis and Treatment Engineering Research Center. The same volunteers were checked with traditional and telecontrolled subjective refraction by the same professional optometrist on different dates (within 7 days). Integrated automated phoropter was used to process traditional subjective refraction. Telecontrolled subjective refraction was operated with integrated automated phoropter via internet. A non-professional assistant operated the autorefraction. The results were transmitted to the tablet computer via Bluetooth, then conveyed to the optometrist's computer via internet. Optometrist remotely operated the integrated automated refractor through the internet and communicated with volunteers online. According to refractive power, all eyes were divided into myopia group [spherical equivalent (SE)≤-0.50 D] and hyperopia group (SE≥+0.50 D). The MedCalc12.7 software was used for statistical analysis. Agreement of refractive error among traditional and telecontrolled subjective refraction was analyzed by Bland-Altman plots. Main Outcome Measures The 95% agreement of limit (LoA) for spherical power (S), cylindrical power (C), cylindrical axis (A) and SE measured by traditional and telecontrolled subjective refraction. The ratio of S, C, A, and SE points outside 95% LoA. Results The 95% LoA of S, C, A, SE of all eyes was (0.00±0.54) D, (-0.02±0.34) D, (0.70±24.30) ° and (0.00±0.52) D respectively. The ratio of S, C, A, and SE points outside 95% LoA of all eyes was 1.02%, 4.84%, 4.84%, 2.04% respectively. The 95% LoA of S, C, A, SE of myopia and hyperopia group was (-0.01±0.52)D, (-0.01±0.32)D,  （1.10±18.40）°, （-0.01±0.51）D respectively, and (0.20±0.54）D, （-0.05±0.22）D, （-8.00±40.80）°, (0.18±0.53）D respectively; the ratio of points outside 95% LoA was 1.08%, 3.51%, 5.26%, 2.15% respectively and 0.00%、0.00%、0.00%、0.00% respectively. Conclusion The agreement is good for S, C, SE, but poor for A among traditional and telecontrolled subjective refraction.

Etiology and surgical management of acquired punctal stenosis

DING Jing-wen, SUN Hua, LI Dong-mei

2018, 27(3):  192-195.  doi:10.13281/j.cnki.issn.1004-4469.2018.02.007

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Objective To assess the etiology and surgery effectiveness of the acquired punctal stenosis. Design Prospective case series. Participants Sixty-one eyes of 40 patients presenting with epiphora who were diagnosed as acquired punctal stenosis and underwent surgical management from January 2016 to March 2017 were assessed. Female accounted for 83% and the mean age was 54±13.3 years. Methods The severity of the stenosis was graded based on slit-lamp examination according to Kashkouli’s method. Grade 0 is no papilla and punctum,  Grade 1 is papilla covered by a membrane or fibrosis and difficult to recognize,  Grade 2 is less than normal size but recognizable,  and Grade 3 is normal. Sequential punctal dilation combined with Ritleng silicone intubation was performed in grading 0~2 of punctal opening size. A 25-G needle was used to open the papilla and then progressively larger dilators were used to dilate the ampulla to introduce a Ritleng probe. Anatomical success was defined as a well-patent puncta (Grade 3-5) and functional success as Munk epiphora scoring ≤1 and negative fluorescein dye disappearance test (FDDT) at 6 months after removal of silicone stents. Main Outcome Measures Punctal grading,  Munk scoring,  and FDDT. Results Twenty-one cases (53%) were bilateral and both upper and lower puncta were involved in 40 eyes (66%). Thirty-one cases (78%) were idiopathic without any known causes. The mean pre-operative and post-operative punctal grading was 1.3±0.7 and 3.0±0.4 respectively with statistically significance (p<0.001). Anatomical success rate was 94% (95/101) and functional success rate was 92% (56/61). No serious complication was noted except for mild punctal laceration in 2 eyes. Conclusion The most common underlying cause for acquired punctual stenosis was idiopathic involutional change in this series. Sequential punctal dilation with Ritleng intubation is a safe and efficient technique in the management of acquired punctal stenosis.

Effect of mechanical stretch on the expression of VEGF in RPE cells in vitro

CHEN Jin-qiu, WU Shen, ZHANG Jing-xue, LIU Qian, LIU Wu

2018, 27(3):  200-205.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.009

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Objective To investigate the effect of vascular endothelial growth factor (VEGF) expression induced by cyclic stretch and the relationship between VEGF and cyclic stretch in retinal pigment epithelial (RPE) cells. Design Experimental study. Participates ARPE-19 cell line.Methods Flexcell-5000 strain system was applied in 3D-RPE models. According to different stretch elongations, ARPE-19 cell lines were divided into a control group (non-stretch group, Control), A group (20% elongation), B group (10% elongation) and C group (5% elongation). Collecting different time points samples from each group were estimated by a series of tests. Real-time PCR was utilized to detect nucleic acid levels in discrete time points (0, 24, 48 h). VEGFA-165 was examined by Western blot in different time points (0, 24, 48 h). Meanwhile, ELISA was utilize to measure VEGF-A expression in each group of cell supernatant (0, 12, 24, 36 and 48 h). Besides, in order to quantity angiogenesis ability of VEGF in vitro, tube formation assay was performed by time (24、48h) in the human umbilical vein endothelial cells (HUVEC). Main Outcome Measures The expression of VEGFA mRNA, VEGFA-165, and VEGFA expression in cell supernatant, and the tube fomation counts of HVEC. Results Compared with the control group, the expression of VEGFA mRNA in group A, B, and C at 24 h (F=7.99, P=0.009) and 48 h (F=75.09, P=0.000) was significantly higher than that of the control group, and group B VEGFA mRNA expression at any time point was higher than that in group A and C (all P<0.05). The expression of VEGFA-165 protein in the three stretch groups was significantly higher than that in the control group at 24 hours (F=51.62, P=0.000) and 48 hours (F=91.69, P=0.000). Besides, the relative expression level of VEGFA-165 protein in group B at 24 hours（0.794±0.045）was 1.3 fold (P=0.012) in group A and 1.2 fold in group C (P=0.043). The relative expression level of VEGFA-165 protein in group B at 48 h (1.192±0.042) was 1.4 fold that of group A (P=0.0001) and 1.3 fold that of group C (P=0.0001). With the extension of time, the VEGFA concentration in the supernatant of group A, B and C was dramatically higher than that of the control group at 24 h (F=131.16, P=0.0001), 36 h (F=66.56, P=0.0001) and 48h (F=605.19, P=0.0001). In the tube formation experiment, the number of each group meshes was significantly higher than that of the control group at 48 h (F=13.13, P=0.002), but only the group B meshes number were significantly increased at 24 h (P=0.029). Conclusion Cyclic stretch can up regulate the VEGF expression in RPE cells and have the function of angiogenesis in vitro.

Effects of β-elemene on the retina of proliferative diabetic retinopathy in rats

DAI Hai-yan, YANG Lan, PIAO Tian-hua

2018, 27(3):  206-209.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.010

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Objective To investigate the effects of β-elemene on the retina of proliferative diabetic retinopathy in rats. Design Experimental study. Participants 30 GK rats, 6 weeks old，males. Methods 30 GK rats were randomly divided into control group of 10 rats, model group of 10 rats, and elemene group of 10 rats. The rats of control group were feeded under normal atmospheric environment; the proliferative diabetic retinopathy model were established in the rats of model group and β-elemene group, and the rats of β-elemene group were given β-elemene 1 μl intravitreal injection after the establishment of model. The peak latency of wave a in ERG, the number of new blood vessels and the area of no perfusion area at 6 weeks after treatment were measured and recorded, and the levels of TGF-β 1 and Fn protein were detected and recorded. Main Outcome Measures The peak latency of wave a in ERG, the number of new blood vessels and the area of no perfusion area, and the levels of TGF-β 1 and Fn protein. Results The proliferative diabetic retinopathy models were all successfully established in the model group and the β-elemene group. The a wave latency in the control group, model group and β-elemene group was (19.44±1.59)ms, (23.40±1.42)ms and (21.49±1.94)ms, respectively, and the a wave amplitude was (225.20±66.23)Uv, (217.30±45.10)Uv and (233.10±54.01)Uv, respectively (all P<0.05). The retinal neovascularization hours in the control group, model group and β-elemene group as 8.01±1.24, 3.67±0.82 and 6.14±1.11, and the non perfusion area was (0.30±0.11)cm3, (3.09±0.44)cm3 and (0.29±0.13)cm3 (all P<0.05). Western blot analysis showed that the expression levels of Fn and TGF-β1 in the model group and β-elemene group were significantly lower than those in control group (P<0.05), and the expression levels in the β-elemene group were significantly higher than that of model group (P=0.000, 0.000). Conclusion β-elemene can improve the  retinopathy of proliferative diabetic retinopathy rats, inhibiting the proliferation of vascular endothelial cells and angiogenesis, and it can improve the electrophysiological injury.

Preliminary investigation of retinal white changes in infants’ ocular screenings

MA Yan, DENG Guang-da, MA Jing, LU Hai

2018, 27(3):  211-214.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.011

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 Objective To investigate the etiology and prognosis of retinal white changes in infants. Design Retrospective case series. Participants 481 infants who were born in Beijing Tongren Hospital from Apr. 2015 to Aug. 2016 were involved.  Method Infants aged 6 weeks around were underwent eye screening using wide-field digital imaging system. Etiology and prognosis of retinal white changes in these infants were investigated. Main Outcome Measures Etiology, shapes, location and prognosis of retinal white changes in infants. Results 481 infants aged 45.1±6.1 days were underwent ocular screening. Retinal white changes were found in 96 cases (20.0%) 142 eyes (14.8%). 11 cases (22 eyes) were pathological changes and 85 cases (120 eyes) were physiological changes. 56 cases (69 eyes) were dot shaped and 40 cases (73 eyes) were strip or patch shaped. Retinal white changes were on posterior retina in 22 cases (25 eyes) and on peripheral retina in 74 cases (117 eyes). Of all physiological retinal white changes, 58 cases (68.2%) were absorbed spontaneously at 3 months age, 14 cases (16.5%) were absorbed spontaneously at 6 months age and 3 cases (3.6%) of retinal white changes remained at 12 months age. There were 10 cases (11.8%) refused to revisit. Sex, family history of high myopia, premature, low birth weight, macrosomia, fetal distress, umbilical cord abnormality, neonatal asphyxia, Meconium aspiration syndrome, neonatal anemia, maternal delivery mode, abnormal labor stage, amniotic fluid pollution, maternal thyroid diseases, pregnancy-induced hypertension, gestational diabetes mellitus were not related to the physiological retinal white changes. Conclusion  The incidence of retinal white changes in infants is high, but most cases are physiological changes.

Efficacy of preoperative glucocorticoid application on vitrectomy for primary rhegmatogenous retinal detachment with choroidal detachment

YU Ya-jie, ZHENG Peng-fei, LIU Wu

2018, 27(3):  215-218.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.012

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Objective To study the effect of preoperative glucocorticoid application on anatomical reduction of rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) after vitrectomy. Design  Retrospective case series. Participants 155 cases (155 eyes) diagnosed as RRDCD were enrolled. Methods The patients were divided into 4 groups according to preoperative glucocorticoid use: 43 eyes without glucocorticoid (group A); 42 eyes with oral glucocorticoid (group B); 32 eyes with glucocorticoid peribulbar injection (group C); and 38 eyes with triamcinolone acetonide intravitreal injection (group D). All patients underwent vitrectomy for the first time. The retinal anatomic reattachment was observed 6 months after operation. Main Outcome Measures The retinal reattachment after vitrectomy. Results After vitrectomy, retinal reattached in 27 eyes (62.79%) in group A, 37 eyes (88.10%) in group B, 29 eyes (90.63%) in group C, and 34 eyes (89.47%) in group D. There were significant differences between group A and the other three groups (all P<0.05), while no significant difference was found among B, C and D groups (all P>0.05). Conclusion For patients with RRDCD, preoperative corticosteroids can improve the rate of retinal reattachment. No significant difference was found in successful rate of retinal reattachment after vitrectomy, no matter oral administration, peribulbar injection or intravitreal injection of different glucocorticoid was applicate. Suitable modes of administration and glucocorticoids types could be chosen for patients according to the systemic and ocular conditions.

Macular subregion morphology changes and its relationship with vision before and after 23G-minimally vitrectomy in idiopathic macular epiretinal membrane

LOU Xiang-feng, YANG Hong-xia, LUO Xue, SHEN Yin

2018, 27(3):  219-224.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.013

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Objective To evaluate the relationship between visual acuity and macular subregion morphology changes in the treatment of idiopathic macular epiretinal membrane (IMEM) via 23G vitrectomy combined with macular membrane dissection. Design Retrospective case series. Participants 78 cases (82 eyes) with IMEM which were treated via 23G vitrectomy combined with macular membrane dissection in Renmin Hospital of Wuhan University from 2015 to 2017. Methods According to the macular morphology of OCT before the operation, all patients can be categorized into four types, namely, normal group (24 eyes), diffuse edema group (39 eyes), cystoid macular edema group (9 eyes); the macular hole group (10 eyes). Record and analyze the preoperative clinical characteristics, surgical approaches, postoperative outcomes and postoperative complications at 7 days and 1 month after the operation. Main Outcome Measures The best corrected visual acuity (BCVA), fovea thickness, parafovea thickness and perifovea thickness before or after the operation. Results At the 7th days after vitrectomy, the BCVA was increased from 0.26±0.16 before operation to 0.36±0.16 (P=0.000); foveal thickness decreased from (506.41±112.67) μm to (442.39±82.10) μm (P=0.000); parafovea thickness recovered from (453.66±79.36) μm before operation to (409. 95±61.63) μm (P=0.000); perifovea thickness decreased from (365.93±50.84) μm to (356.76±54.20) μm (P=0.092); the BCVAs were all improved in the four groups (all P<0.05), and the improvement of visual acuity in the normal group was best (F=3.118, P=0.031). Compared with at the 7 days after the operation, the macular thickness decreased at one month after the operation, but the change of BCVA was not significant. Postoperative BCVA was correlated positively with preoperative BCVA (r=0.850，P=0.000), preoperative fovea thickness (r=0.7386，P=0.000), parafovea thickness (r=0.811，P=0.000), and perifovea thickness (r=0.799，P=0.000); and was correlated with postoperative fovea thickness (r＝-0.335，P＝0.035), parafovea thickness (r＝-0.376，P＝0.017), was not correlated with postoperative perifovea thickness (r=-0.310, P=0.052). Conclusion The removal of macular epiretinal membrane can significantly improve the visual function of patients and can also relieve the traction in the macular area and recover the structure of the macular region. The prognosis of visual acuity could be dicided at 1 weeks after operation, and the prognosis of visual acuity is best in patients with normal macular structure before operation.

Knowledge of diabetic retinopathy in type 2 diabetic patients and its relationship with diabetic retinopathy severity

ZHU Wan-lu1, SHE Chong-yang1, BAI Xiang-li2, WEI Wen-wen1, LIU Ju-hong2, LIU Ning-pu1

2018, 27(3):  225-230.  doi:10. 13281/j. cnki. issn.1004-4469. 2018. 03. 014

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 Objective To Investigate and analyze knowledge of diabetic retinopathy (DR) in type 2 diabetic patients, and its correlation with the degree of DR. Design Cross-sectional survey. Participants Recruited type 2 diabetic patients who visited Beijing Tongren Hospital(34 cases) and Beijing Desheng community health service center(80 cases). Methods All patients were surveyed using a standardized questionnaire, including general information, diabetes and its treatment, diabetic eye disease related knowledge. And fundus examinations were performed on all patients. We staged its severity according to the DR staging criteria and selected the more severe eye of each individual into analysis. We compared knowledge of DR between patients from hospital and community, and analyze its correlation with the severity of DR. Statistical analysis was performed using the R statistical software package. Main Outcome Measures Patients’ recognition rate of DR. Results Beijing Desheng community health service center (80 cases). All patients visiting Beijing Tongren Hospital had DR; including 85.3% PDR. The prevalence of DR in patients from community was 21.3%, with 6.3% PDR. 41.2% of the hospital patients knew diabetes could affect visual acuity, significantly less than 91.3% in the community patients (P<0.001). 17.7% of hospital patients knew diabetes can cause blindness, less than 90.0% in the community patients (P<0.001). 14.7%of the hospital patients knew they needed regular ocular examinations, less than 83.8% in the community patients (P<0.001)). 14.7% of the hospital patients knew DR, less than 81.0% of the community patients (P<0.001). 5.9% of the hospital patients knew DR could be prevented, less than 46.8% in the community patients (P=0.046). 27.3%(9/33) of Tongren patients’ physician suggested ocular examination, less than 71.8%(56/78) in the community patients (P=0.003). The recognition that diabetes mellitus (DM) could affect visual acuity, DM could cause blindness, the need of regular eye check and whether or not to know DR in DWR patients was significantly higher than DR patients (P<0.05). In Parallel, the knowledge in BDR patients was significantly better than PDR patients (P<0.05). Conclusion Lower recognition of DR was significantly correlated with more severe DR. Strengthen health education of DR in diabetic patients is essential for improving vision prognosis.

Performance evaluation of Chinese version vision-related quality of life scales of NEI-VFQ-25 in age-related macular degeneration

LI Juan-li1, JIANG Hong2, LIU Yan2, WU Chang-rui1, GUO Fang2, ZHANG Qiang2, LI Rui2, LI Jie-wen2, MA Le2

2018, 27(3):  232-236.  doi:10.13281/j.cnki.issn.1004-4469.2018.03.015

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Objective To evaluate the reliability and validity of the Chinese version of the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) in aged-related macular degeneration (AMD) patients. Design Diagnostic test. Participants A total of 107 AMD patients and 69 controls were included. Methods The health risk factors questionnaire and the Chinese version of NEI VFQ-25 were used to examine the baseline characteristics and vision-related quality of life, respectively. According to the scores of subjects, the internal consistency reliability, split-half reliability, construct validity and discriminant validity were carried out to evaluate the validity of the questionnaire. Main Outcome Measures Reliability and validity. Results The reliability of the questionnaire was good, and the Cronbach’ alpha coefficient and Spearman-Brown split-half coefficient were 0.827 and 0.772, respectively. Three common factors were extracted from 12 dimensionality by principal component analysis and the accumulated variance rate of contribution was 65.35%, suggesting a good construct validity. The discriminant validity test results between the AMD and control group were statistically significant in all the subscales of NEI VFQ-25 (P<0.05), indicating a good discriminant validity of the questionnaire. Conclusion The Chinese version questionnaire of NEI VFQ-25 has good reliability and validity in evaluating the visual function damage for patients with AMD, which can be implemented as a good scale and evaluation tool for the life quality of those persons with AMD.