Table of Content

25 March 2019, Volume 28 Issue 2

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Selection and progress of glaucoma combined with cataract surgery

YE Jian, YU Ling

2019, 28(2):  81-85.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 001

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 Glaucoma combined with cataract surgery will no longer be limited to a single mode of trabeculectomy combined with phacoemulsification. New equipment and new technologies are expected to further improve the safety and effectiveness of glaucoma surgery. Glaucoma combined with cataract surgery will develop in a minimally invasive direction. Although the reduction of intraocular pressure(IOP) in glaucoma minimally invasive surgery(MIGS), such as endoscopic cyclophotocoagulation(ECP), trabeculotomy, iStent implantation, Schlemn canaloplasty, XEN gel implant, is not comparable to traditional trabecular surgery, it provides safety for patients with mild or moderate open angle glaucoma, and reduces the dependence of glaucoma patients on drugs. The indications for MICS combined with cataract surgery may be extended to some primary angle-closure glaucoma(PACG). These need to be explored by carring out multi-center clinical randomized controlled trials in China. In future, MIGS and other new glaucoma surgery combined with cataract surgery in glaucoma patients, especially in PACG, will provide new ideas and new methods for the treatment of glaucoma with cataract. （Ophthalmol CHN， 2019, 28： 81-85）

Microcatheter based minimal invasive glaucoma surgery

XIN Chen, SHI Yan, WANG Huai-zhou, WANG Ning-li

2019, 28(2):  85-87.  doi: 10. 13281/j. cnki. issn.1004-4469. 2019. 02. 002

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The microcatheter based minimal invasive glaucoma surgery (MIGS) procedures could be classified into three types: trabecular tension surgery, trabecular bypass surgery and trabecular ablation surgery. Such procedures effectively reduce the resistance of aqueous outflow in proximal pathway. Thus, the patients with primary open angle glaucoma (POAG) whose target intraocular pressure (IOP) is lower than the pressure of the episcleral vein is not ideal for the microcathether based MIGS procedures. Neither was the POAG subjects with high resistance in the distal aqueous pathway. The hyphema, postoperative IOP spike and ciliary body detachment are main complications for such surgical procedures. （Ophthalmol CHN，2019, 28: 85-87）

The examination and indication of aqueous vein

XIN Chen, SHI Yan, WANG Huai-zhou, WANG Ning-li

2019, 28(2):  88-89.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 003

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Aqueous veins originate from the depths of the limbus. Aqueous veins generally contain clear aqueous at their origin and eventually join recipient episcleral vessels. Two to three aqueous veins are typically visible in an eye. The results of the compensation maximum test could be classified into four levels. Level I: aqueous influx phenomenon with compression. Level II: blood influx phenomenon with compression and aqueous reflux with relaxation. Level III: blood influx phenomenon with both compression and relaxation. Level IV: no change with both compression and relaxation. The classification of the compensation maximum test could assist to identify the region and degree of the diseased aqueous pathway. Thus it could help to screen the patients suitable for microcatheter based minimal invasive glaucoma surgery. （Ophthalmol CHN， 2019, 28: 88-89）

A retrospective study of vancomycin-related non-infectious inflammation after cataract surgery

TAO Li，SUN Min，CHEN Chun-lin，YE Jian

2019, 28(2):  90-95.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 004

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Objective To retrospectively analyze the characteristics of non-infectious inflammation associated with low concentration vancomycin injected into anterior chamber at the end of cataract surgery. Design Retrospective case series. Participants From January 2014 to November 2017, 24 916 patients underwent cataract surgery in our hospital. All patients were injected with vancomycin 0.1ml (0.01mg/ml) into anterior chamber at the end of operation. Methods We retrospectively analyzed the patients with low concentration vancomycin (0.01 mg/ml, 0.1 ml) injected into anterior chamber at the end of cataract surgery in our hospital. After operation, the visual acuity improved satisfactorily. Returned patients with visual impairment underwent slit lamp examination, B-mode ultrasonography, macular OCT examination, FFA examination and pathogenic microorganism examination of aqueous humor. After excluding patients with infectious endophthalmitis, the remaining patients with significant inflammation underwent, examination including interleukin-6 (IL-6) in aqueous humor, vascular endothelial growth factor (VEGF), transforming factor (TGF-β1), vascular cell adhesion factor (VCAM), 21 types of common inflammatory microbial nucleic acids, broad-spectrum bacterial nucleic acids and broad-spectrum fungal nucleic acids. The cornea, anterior chamber and intraocular lens were examined under slit lamp. B-mode ultrasonography was used to detect vitreous opacity. The change of treatment plan and prognosis of these patients were recorded. Main Outcome Measures Visual acuity, intraocular pressure, cornea, cornea  status under slit lamp, anterior chamber and intraocular lens status, vitreous opacity under B-mode ultrasound, inflammatory factors in aqueous humor, 21 kinds of common inflammatory microbial nucleic acids, broad-spectrum bacterial nucleic acids and broad-spectrum fungal nucleic acids in eyes. Treatment plan and prognosis of patients. Results After excluding infective endophthalmitis, 21 cases (25 eyes), including 17 unilateral cases and 4 bilateral cases were found with non-infections endophthalmitis. The average onset time of intraocular inflammation was 22.26±12.58 days after cataract surgery. The inflammatory factors detected in aqueous humor including VEGF (96.95±58.49) pg/ml (reference interval 0-40.0), TGF-β (175.05±33.55) pg/ml (reference interval < 1.0), IL-6 (29123.83±16066.97)pg/ml (reference interval 1.0-50.0), IL-10 (5.85±1.15)pg/ml (reference interval 0-50.0), VCAM (14650±10144.62)pg/ml (reference interval 200-1000). ) None of the 21 pathogenic microorganisms were detected, and no fungi and bacterial growth were detected by culture and microscopy. Under slit lamp, corneal edema was mild, anterior chamber plankton cells and Tyn sign were positive, and intraocular lens was transparent in situ. Eye ultrasound showed vitreous opacity. Vancomycin treatment led to no improvement or even aggravated. Vancomycin was discontinued and steroidal therapy was used instead, and the condition was obviously relieved. Conclusion Inflammatory factors in aqueous humor of these patients are elevated, and pathogenic microorganisms are not detected by multiple examinations, so non-infectious inflammation is considered. Because the onset time is the same as that of type III hypersensitivity reaction after systemic use of vancomycin, and vancomycin aggravates the condition and discontinuation of vancomycin relieves symptoms, so it is considered that the disease is related to the use of vancomycin. It is suggested that the pros and cons of vancomycin in preventing endophthalmitis should be weighed, follow-up should be emphasized and steroid therapy should be given to suspected cases. (Ophthalmol CHN, 2019, 28: 90-95)

Evaluation of the accuracy of Sirius ray-tracing method for IOL power calculation in post-corneal-refractive-surgery eyes

YU Zhou-xing, LI Shao-wei, HUO Dong-mei, XU Man, SHI Shuai, LIU Chang, ZHAO Rui-hua

2019, 28(2):  98-103.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 005

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Objective  To assess the accuracy of Sirius ray-tracing method for intraocular lens power calculation in post-corneal -refractive-surgery eyes. Design Comparative case series. Participants 21 post-LASIK eyes and 2 post-PRK eyes undergone phacoemulsification in Beijing Aier eye Hospital from June 2015 to December 2017. Methods The axial length, keratometry and anterior chamber depth was measured with IOL Master. The data of anterior segment including corneal power, anterior chamber depth and the angle of anterior chamber was measured with the Sirius three-dimensional corneal topography. The intraocular lens power was calculated using Sirius ray-tracing method, Haigis-L formula and Barrett True K No History formula. The implanting IOL power was determined mainly according to the result of Haigis-L formula, also referring to Barrett True K No History formula and Sirius ray-tracing method. All phacoemulsification operation were performed by the same operator. Postoperative refractions were measured with subjective refraction one month postoperatively. The predictive error （the difference between the actual postoperative refractive error and that predicted by the formula）, the absolutely predictive error （the absolute value of the prediction error）and the absolutely predictive error distribution（the percentage of absolute prediction error within 0.50 D  and the percentage of absolute prediction error within 1.0 D） of the four methods were calculated. The absolutely predictive error and the absolutely predictive error distribution of different methods were compared. Main Outcome Measures The predictive error, the absolutely predictive error and the absolutely predictive error distribution of the four methods. Results The predictive error of the four methods was (+0.22±0.57)D, (-0.07±0.73) D, (-0.18±0.81) D, (-0.00±0.57) D respectively. The absolutely predictive error was (0.47±0.38)D, (0.57±0.44) D, (0.64±0.52) D, (0.44±0.34) D respectively. The absolutely predictive error of the mean value method was the lowest, but there was no statistical difference in all the formulas (P=0.364). The absolutely predictive error of Sirius ray-tracing method was no more than 0.5 D in 16 eyes (69.57%), and no more than 1.0 D in 18 eyes (91.30%). The absolutely predictive error of Haigis-L formula was no more than 0.5 D in 11 eyes (47.83%), and no more than 1.0 D in 20 eyes (86.96%). The absolutely predictive error of Barrett True K No History formula was no more than 0.5 D in 12 eyes (52.17%), and no more than 1.0 D in 18 eyes (78.26%). The absolutely predictive error of the mean value method was no more than 0.5 D in 14 eyes (60.87%), and no more than 1.0 D in 20 eyes (86.96%). There was no statistical difference in all the formulas in the number of eyes in which the absolutely predictive error was no more than 0.50 D (P=0.453), and there was also no statistical difference in the number of eyes no more than 1.0 D (P=0.636). Conclusions  When used in IOL power calculation in post-LASIK or post-PRK eyes, the range of variation of Sirius ray-tracing method was narrower than Haigis-L formula and Barrett True K No History formula  which were commonly used in clinically. Sirius ray-tracing method could result mild hyperopia. The mean value method should be used in the IOL power for post-corneal-refractive-surgery eyes. (Ophthalmol CHN, 2019, 28: 98-103)

The visual effect of aspheric photochromic intraocular lens implantation at post-operative 3 months in different illumination conditions

ZHANG Jing-shang, WANG Jin-da, XIONG Ying, LI Jing, WAN Xiu-hua

2019, 28(2):  104-108.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 006

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 Objective To analyze and compare the differences of contrast vision and color vision of three kinds of intraocular lens (IOL) in different illumination conditions in cataract patients. Design Retrospective case series. Participants 300 cases with phacoemulsification and IOL implantation. Methods We chronologically collected 300 patients undergone cataract extraction and implanted with different IOL, 100 eyes in group 1 (implanted with aspheric photochromic IOL), 100 eyes in group 2 (implanted with aspheric yellow IOL) and 100 eyes in group 3 (implanted with spheric photochromic IOL). All eyes were reviewed at 3 months postoperatively. Visual acuity, intraocular pressure (IOP), slit lamp examination, fundus, contrast vision and color vision were recorded. Main Outcome Measures Visual acuity, contrast vision and color vision. Results There is no significant difference in postoperative uncorrected and corrected visual acuity among the three groups (P=0.935, P=0.681). The aspheric photochromic IOL group had better contrast vision than the other two groups at 30 lux, 5% contrast conditions (LogMAR 0.301 ± 0.17 vs LogMAR 0.472 ± 0.22 and 0.327 ± 0.23, both P<0.001). The total error scores of FM 100 test were not significantly different among the three groups at 400 lux conditions (P=0.163), but the total error scores of the aspheric photochromic IOL group was significantly lower than that the other two groups (36.45±14.89 vs 46.72 ±20.67 and 38.31±15.82) at the mesopic conditions (30 lux) (both P<0.001). Conclusion There was no significant difference of contrast vision among eyes implanted with aspheric photochromic IOL, aspheric yellow IOL and spheric photochromic IOL under photopic conditions, but the aspheric photochromic IOL group had better contrast vision and color vision under mesopic conditions. (Ophthalmol CHN, 2019, 28: 104-108)

International grand rounds based on the instant messaging software in the teaching of ophthalmology residents

LI Dong-mei, CUI Ying

2019, 28(2):  108-110.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 019

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 International grand rounds based on the instant messaging software is a new teaching method which is characterized by no limitation of space, making international communication possible in a convenient and economic way. We have used this method in the teaching activity of ophthalmology residents. This article will introduce this method from its application fundamentals, significance, preparation, conduction and organization. This method could improve the English level of ophthalmology residents, broaden their horizon and motivate their autonomic learning.  （Ophthalmol CHN，2019, 28： 108-110）

Comparison of two different regimens of intravitreal ranibizumab therapy for macular edema secondary to central retinal vein occlusion

ZHAO Xu-li, ZHANG Di, YANG Guang, HUANG Ge

2019, 28(2):  111-114.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 007

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Objective To compare the efficacy of two different regimens of ranibizumab for the treatment of macular edema secondary to central retinal vein occlusion (CRVO). The two different regimens were 1 initial injection+pro re nata (PRN) administration and 3 successive monthly initial injections + PRN.  Design Non-random case-control study. Participants 49 cases (49 eyes) who were diagnosed with macular edema secondary to CRVO in Chengdu second people's Hospital from December 2015 to February 2017. The average age was 60.5±12.1 years old.  Method All patients were treated with intravitreal injection of ranibizumab 0.5 mg. According to the different injection regimens, patients were divided into 2 groups: 29 eyes received 1 initial injection (1+PRN group) and 20 eyes received 3 monthly loading injections (3+PRN group). The patients with peripheral retinal non-perfusion area were additionally given with peripheral retinal laser photocoagulation. The patients were followed monthly for 1 year. The number of injections was counted. The changes of BCVA and CFT were compared between the two groups. Main Outcome Measures The number of injections, BCVA and CFT. Results The number of injections in the 1+PRN group was significantly lower than 3+PRN group (4.1±2.8 versus 5.9±2.1, P=0.02) during the 12-month follow-up period. The BCVA (logMAR) increased from baseline 0.481±0.258 to 0.344±0.376 in 1+PRN group and from baseline 0.467±0.343 to 0.325±0.315 in 3+PRN group. At month 12, the CFT decreased from baseline 599.3±191.3 μm to 318.8±124.8 μm in 1+PRN group and from 644.4±237.4 μm to 335.5±153.6μm in 3+PRN group respectively. There was no significant difference in BCVA and CFT between the two groups at both baseline and final visit.  Conclusions Using ranibizumab for macular edema secondary to CRVO, 1+PRN regimen achieved similar 12-month outcomes to 3+PRN regimen with fewer injections. (Ophthalmol CHN, 2019, 28: 111-114)

Vitrectomy combined with different dosing regimen of ranibizumab for treatment of proliferative diabetic retinopathy

ZHAO Ming-gui1, ZHANG Shi-hong1, SUN Yu-bo1, FANG Ke-shuang1, YOU Qi-sheng2

2019, 28(2):  115-119.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 008

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 Objective To investigate the effect of vitrectomy combined with different dosing regimen of ranibizumab on the central foveal thickness (CFT), visual recovery, serum cystatin C (CysC) and vascular endothelial growth factor (VEGF) levels in patients with proliferative diabetic retinopathy (PDR). Design Prospective case series. Participants Ninety-six patients (96 eyes) with PDR diagnosed and treated in the hospital from January 2016 to December 2017 were enrolled. Methods All patients underwent elective vitrectomy, and they were divided into 3 groups using the random number table method, 32 cases in each group. Group A was treated with intravitreal injection of ranibizumab before surgery. Group B was treated with intravitreal injection of ranibizumab during surgery and group C was not injected any drugs. The best-corrected visual acuity (BCVA) was measured before and after surgery. The optical coherence tomography (OCT) was used to measure CFT and serum levels of CysC and VEGF were determined by enzyme linked immunosorbent assay (ELISA).  Main Outcome Measures The BCVA before and after surgery, improvement of visual acuity, CFT, serum CysC and VEGF levels. Results The CFT, serum CysC and VEGF levels in the 3 groups were significantly decreased at 3 months after surgery (all P<0.05). The improvement of visual acuity in group A and group B at 3 months after surgery was significantly better than that in group C (both P<0.05). The CFT, serum CysC and VEGF levels in group A and group B at 3 months after surgery were significantly lower than those in group C (all P<0.05), but there was no significant difference between group A and group B (all P>0.05). The incidence rates of massive hemorrhage and iatrogenic retinal hole in group A (3.1% and 6.3%) and group B (3.1% and 3.1%) during surgery were significantly lower than those in group C (21.9% and 25.0%) (both P<0.05). The incidence of vitreous re-hemorrhage in group B was significantly lower than that in group C (3.1% vs 28.1%) (P<0.05), and there was no significant difference, compared with that in group A (12.5%) (P>0.05). Conclusion The injection of ranibizumab before or during surgery combined with vitrectomy can significantly reduce the CFT, improve the visual acuity of patients with PDR, significantly decrease serum CysC and VEGF levels and complications. In addition, the effect of intravitreal injection of ranibizumab during surgery is slightly better than injection before surgery. （Ophthalmol CHN， 2019, 28： 115-119）

Comparison of quantitative study for experimental choroidal neovascularization using two methods of choroid flat mounts

JIAO Jian1, MO Bin2, LIU Lu3, HUA Wen1

2019, 28(2):  120-124.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 009

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Objective To compare two methods of choroid flat mounts in quantitative study for experimental choroidal neovascularization (CNV). Design Experimental study. Participants Brown-Norway (BN) rats. Methods Normal 24 BN rats were randomly divided into two groups equally and CNV models were induced by laser photocoagulation with the same diameter spot. Choroid flat mounts were performed with fluorescein isothiocyanate-dextran (FITC-D) perfusion method or isolectin method at 1 week(W), 2W, and 4W after photocoagulation respectively. The photo of choroid flat mounts was taken under laser confocal microscope and the area of CNV was measured with Image J software. The experimental time was recorded form the start of anaesthesia to the end of choroid flat mounts. The expense of one choroid flat mount was calculated by the dose of FITC-D or lectin consumed in the experiment. Main Outcome Measures Area of CNV, experimental time and expense. Results At 1W, 2W, and 4W after photocoagulation, the areas (μm2) of CNV by FITC-D perfusion method or isolectin method were 5524±1847, 50653±7265, 121623±7128 or 14560±4508, 144209±8411, 204066±8546 respectively. The experimental time by two different methods was 119±21min or 390±34min respectively, while the experimental expense was 289±26.3￥ or 32±4.2￥ respectively. Conclusion There were obvious differences in the area of CNV, experimental time and expense between the 2 methods of choroid flat mounts. The appropriate method of choroid flat mounts for experimental CNV should be carefully selected according to the research purposes. （Ophthalmol CHN， 2019, 28： 120-124）

Clinical observation on the treatment of Sturge-Weber syndrome with severe exudative retinal detachment using domestic radioactive applicator

LIU Yue-ming, YAN Yan-ni, LI Yang, WEI Wen-bin

2019, 28(2):  125-128.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 010

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 Objective To observe the safety and efficacy of domestic radioactive applicator for treatment of Sturge-Weber syndrome with exudative retinal detachment. Design Retrospective study. Participants 15 patients of Sturge-Weber syndrome with exudative retinal detachment that were treated with domestic radioactive applicator in Beijing Tongren Hospital from June 2009 to June 2018. Methods We recorded the data of visual acuity, intraocular pressure, size of the tumor(maximum base diameter, maximum height) measured by color Doppler imaging (CDI), changes in the subretinal fluid observed by indirect ophthalmoscope, CDI and OCT, and the data were retrospectively analyzed using SPSS 22.0. Main Outcome Measures Visual acuity, intraocular pressure, size of the tumor, changes in the subretinal fluid, occurrence rates of complications. Results Visual acuity significantly improved at latest follow-up (average follow-up was 48 months) (pre-operation 0.01±0.02, latest follow-up 0.05±0.11，P<0.01). Intraocular pressure remained similar (pre-operation19.9±12.1 mmHg, latest follow-up 15.6±2.4 mmHg，P=0.132). Tumor regressed in all cases (maximum basal diameter, pre-operation 16.0±3.2 mm, latest follow-up 13.9±3.9 mm, P<0.01; maximum height, pre-operation 6.5±2.0 mm, latest follow-up 2.7±1.5 mm, P<0.01). No subretinal fluid was observed by indirect ophthalmoscope, CDI or OCT at the latest follow-up except for 1 case. Conclusion It seems to be a good choice to treat the Sturge-Weber syndrome with severe exudative retinal detachment by domestic radioactive applicator. (Ophthalmol CHN, 2019, 28: 125-128)

Effect of different doses of ultraviolet radiation on the activity and expression of aldehyde dehydrogenase in retina of rats

HUANG Qiao-hong,HUANG Yan, WANG Ting-ting, LIN Xin-xin, YANG Qian, ZHU Jing-yu

2019, 28(2):  129-134.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 011

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 Objective To investigate the effect of different doses of UV irradiation on the aldehyde dehydrogenase (ALDH) activity and expression in retina of rats. Design Experimental study. Participants 40 healthy male SD rats. Method A prospective comparative case-control animal study was conducted on 80 eyes of 40 healthy SD rats. The rats were randomly divided into 4 groups. The normal control group (N group) was routine fed. Experimental rats were exposed to 146 μw/cm2 UVB irradiation. The A, B and C groups were exposed for 12, 24, 48 minutes per-day respectively. Each group rats were sacrificed and the eyeballs were removed on the 42nd, 84th, 42nd and 21st day respectively. TUNEL was used to detect retinal cell apoptosis. Immunohistochemistry was used to detect the expression of bax and bcl-2. ELISA was used to detect the activity and expression of ALDH. Main Outcome Measures Retinal histological observation, retinal thickness, retinal apoptotic index, bcl-2, bax expression, ALDH activity and expression. Results The morphological structure of retinal tissue was normal in group N. The internuclear spaces of retinal tissues in A, B and C groups were enlarged, with sparse and disordered arrangement. The retinal thickness in N, A, B and C groups was (144.5±1.5) μm, (146.0 ±2.0) μm, (112.4±2.0) μm, (103.4±1.2) μm, respectively. There was no statistically significant difference between group N and group A (P=0.05) in retina thickness. But the retinal thickness was significantly thicker in group N than that of group B and C (both P<0.001). The apoptotic index of retinal cells in A, B, and C groups was (11.011±0.540)%, (16.880±1.125)%, and (28.850±1.224)%, respectively, which was significantly higher than that in  group N [(3.070±0.751)%,  all P<0.001]. The expression of bax in the retina in A, B, and C groups was (9.530±0.343)%, (21.237±0.183)% and (33.693±0.227)%, respectively, which was statistically higher than that in  group N (5.404±0.154)%. While the expression of bcl-2 in the retina in A, B, and C groups was (11.738±0.237)%, (6.463±0.252)% and(1.229±0.162)%, respectively, which was statistically lower than that in group N (15.380±0.289)%. The bcl-2/bax significantly decreased (P<0.001). ALDH activities in A, B, and C groups was (73.924±2.290) IU/L, (60.928±1.725) IU/L and (55.488±2.172) IU/L, respectively, which was statistically higher than that in group N [ (84.018±1.893) IU/L, P<0.001]. ALDH expression in A, B, and C groups was (51.725±3.059) ng/ml, (43.445±2.695) ng/ml, and (34.767±3.865) ng/ml, respectively, which was significantly lower than that in group N [(62.478±2.247) ng/ ml, P<0.001]. Conclusions When the total dose of ultraviolet radiation is constant, the expression of ALDH in retina decreases with increase of single irradiation dose, and the apoptosis of retinal cells increases and the degree of radiation damage deepens. （Ophthalmol CHN， 2019, 28： 129-134）

Association of polymorphism of VEGF gene and age-related macular degeneration in the Tujia population from Southwest Chongqing of China

ZHANG Bian-wen， LIU Sheng-chun， WU Ming-xing， XIONG Xiao-jing， WANG Hao， ZHOU Xi-yuan

2019, 28(2):  136-140.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 012

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 Objective To investigate the associations between the single nucleotide polymorphisms (SNP) of VEGF gene and the risk of AMD in the Tujia population from Southwest Chongqing of China. Design Case control study. Participants Tujia people over the age of 50-year old in Southwestern Chongqing. Methods We used cluster random sampling and case-control correlation analysis in this study. We screened 50-year old Tujia native people in Southwestern Chongqing. 196 patients with AMD and 408 age-matched healthy persons were included. We extracted 5-10 ml peripheral blood from each of the participants for DNA extraction. Four SNP sites were selected from VEGF genes, namely rs3025039, rs2010963, rs833061and rs943080. Genetic typing and sequencing of these sites were performed by the MALDI-TOF analysis software provided by the Sequenom mass spectrometer MassARRAY experimental platform. SPSS statistical software was used to analyze the results. The allele frequencies and genotype frequencies were analyzed using the chi-square test and the non-conditional logistic regression model. The odd radios (OR) and 95% confidence interval (CI) were presented. The Bonferroni adjustment was applied when multiple comparisons was performed. P<0.05 was considered statistically significant. Main Outcome Measures Expression of related VEGF gene loci. Results There were significant differences（P<0.05） in allele frequencies and genotype frequencies of two SNPs sites（rs833061and rs2010963）between the AMD group and the control group. But the significance was disappeared after Bonferroni adjustment (P>0.05）. Conclusion In the Tujia population from Southwest Chongqing of China, AMD had no association with the VEGF SNP rs3025039, rs2010963, rs833061and rs943080. （Ophthalmol CHN， 2019, 28： 136-140）

Misdiagnosis of 58 cases with idiopathic intracranial hypertension as ophthalmic disease

MA Zhong-hua, JIANG Han-qiu, WANG Jia-wei

2019, 28(2):  140-144.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 013

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Objective To analyze the clinical characteristics and the causes of misdiagnosis of Idiopathic intracranial hypertension（IIH） to reduce the diagnosis error rate. Design Retrospective case series. Participants 58 patients with IIH misdiagnosed as ophthalmopathy. Methods The clinical data of 58 patients with IIH （according to international of IIH）were analyzed in this retrospective research. These cases were selected from patients hospitalized in Tongren Hospital from January 2014 to December 2017, and were all misdiagnosed as ophthalmopathy before admission. Clinic data were extracted to ascertain the causes of misdiagnosis. Main Outcome Measures Clinical manifestations, misdiagnosis condition, visual function examination, imaging examination, treatment outcome after misdiagnosis and diagnosis after admission. Results 58 cases were under observation, including 22 males (37.9%) and 36 females (62.1%). The duration of disease ranged from 6 days to 8 years, with an average of 7.4 months, including 36 cases (62.1%) within 3 months. The main clinical symptoms were ocular symptoms, while continuous vision loss was the most common (62.0%). The top four misdiagnosis were optic neuritis (ON) in 32 cases (55.2%), anterior ischemic optic neuropathy(AION) in 12 cases (20.7%), papilledema in 6 cases (10.3%) and optic vasculitis in 5 cases(8.6%). 46 patients (79.3%) had received glucocorticosteroid therapy, with poor efficacy. After admission, lumbar puncture was launched and intracranial pressure of all patients was higher than 25 cmH2O. Combined with the medical history, physical signs, and results of brain/orbital imaging examination and laboratory tests, the diagnosis was confirmed as IIH. Medication or surgery may be administered depending on the patient's condition. Conclusions Patients with papilledema who are mainly characterized by decreased vision are easily misdiagnosed as optic neuritis or ischemic optic neuropathy. Timely measurement of intracranial pressure and head magnetic resonance and other auxiliary examinations can effectively improve the accuracy of clinical diagnosis. (Ophthalmol CHN, 2019, 28: 140-144)

Botulinum toxin in treatment of consecutive esotropia due to overcorrection of intermittent extropia

AI Li-kun, GUO Rui-lin, KANG Meng-tian, WU Xiao

2019, 28(2):  145-149.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 014

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Objective To assess botulinum toxin treatment in consecutive esotropia due to overcorrection of intermittent extropia. Design Retrospective case series. Participants 15 consecutive esotropia patients who completed more than 6 months follow up after botulinum toxin injection. Methods Botulinum toxin was injected into medial retus bilaterally in each patient based on the angle of esotropia. Main Outcome Measures At each visit, before and after injection, diplopia and eye motility were assessed. Deviation was measured with prism alternative cover test. Binocular vision was checked with synoptophore and Yan Shao Ming random dots stereoscopic chart. Complications of ptosis and vertical deviation were also recorded. Results The average esotropia was 18.71±6.02 PD. These eyes were injected with 2.83±1.02 U botulinum toxin. Consecutive esotroia was significantly reduced in the latest follow-up. Diplopia diminished in 13 cases. Only one case had residual constant exotropia. The other eyes resided with diplopic esotropia.  Convergence fusion range was enlarged, accomparied with a tremendous improvement when assessed with both synoptophore and stereoscopic chart.  One case of ptosis and 3 cases of vertical deviation occurred right after the injection, all recovered in 6 weeks. Conclusion Small angel consecutive esotropia, due to overcorrection of intermittent extropia can be treated using botulinum toxin with up to 85% success rate. The improved convergence and stereopsis may help to stabilize the orthoptic eye alignment. Given high success rate, reversible complications and less invasion, botulinum toxin is suggested to be the first line treatment in consecutive esotropia secondary to overcorrection of intermittent extropia. （Ophthalmol CHN， 2019, 28： 145-149）

Combination of Corvis ST and Pentacam HR for enhancing keratoconus detection

XIAO Ming1, MA Dai-jin1,2

2019, 28(2):  150-154.  doi:10. 13281/j. cnki. issn.1004-4469. 2019. 02. 015

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Objective To investigate the role of combining corneal visualization Scheimpflug technology (Corvis ST) and Pentacam HR in the diagnosis of keratoconus. Design Diagnosis test. Participants Twenty-one eyes with diagnosis of subclinical keratoconus (SKC group), forty-two eyes with keratoconus (KC group) and sixty normal eyes (control group) were included. Methods Tomography and biomechanical parameters of all eyes were obtained with the Pentacam HR and Corvis ST (Oculus Optikgerate GmbH, Wetzlar, Germany), respectively. BAD-D, CBI (Corvis biomechanical index) and TBI (tomographic and biomechanical index) were compared between the KC group, SKC group and control group. ANOVA and Kruskal-Wallis H rank sum test were used for statistical analysis. The receiver operating characteristic (ROC) curves were plotted to distinguish keratoconus and subclinical keratoconus from normal controls. Main Outcome Measures CBI, BAD-D and TBI. Results BAD-D and TBI were significantly different between the SKC group and the control group (P<0.05 for each parameters). The cut-off point of BAD-D, TBI was 2.44 and 0.58, respectively. For these two parameters, the AUC value was 0.759 (sensitivity 66.7%, specificity 95.0%) and 0.804 (sensitivity 71.4%, specificity 78.3%), respectively. Three parameters were significantly different between the KC group and the control group (P<0.001 for each parameters). The cut-off point of BAD-D, CBI and TBI was 3.77, 0.97 and 0.99, respectively. For these three parameters, the AUC value was 1.000 (sensitivity 100%, specificity 100%), 0.988 (sensitivity 92.9%, specificity 96.7%) and 0.950 (sensitivity 100%, specificity 90.0%), respectively. Conclusion Among the three parameters, TBI has the highest sensitivity for detecting subclinical keratoconus, followed by BAD-D. But CBI was not useful in detecting subclinical keratoconus. All the three parameters, BAD-D, TBI and CBI have good diagnostic power for keratoconus. （Ophthalmol CHN，2019, 28： 150-154）