Table of Content

25 March 2020, Volume 29 Issue 2

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The influence of COVID-19 on clinical work of ophthalmology and its solution

Gao Ling, Ye Jian

2020, 29(2):  81-83.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.001

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Coronavirus Disease 2019 (COVID-19) is a newly emerging infectious disease of class B. Because of the sudden outbreak and the unfamiliar characteristics of the new disease, there is a risk of cross infection in close contact with patients during the procedure of ophthalmology diagnosis and treatment. Ophthalmic medical staffs are faced with a lot of confusion in the work. This article introduces the influence of COVID-19 on the hospital and patients, management of the outpatients and inpatients of ophthalmic department and the protective measures and clinical work protocols for ophthalmic medical staff, hoping to reduce the possibility of cross infection in the ophthalmic diagnosis and treatment work. (Ophthalmol CHN, 2020, 29: 81-83)

Opportunities and challenges of clinical and basic research on Bietti crystalline dystrophy

Li Yang

2020, 29(2):  84-86.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.002

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Bietti crystalline dystrophy (BCD) is a specific kind of retinitis pigmentoas（RP） and is comparatively common in East Asia, particularly in China and Japan. BCD is inherited in an autosomal recessive inheritance mode and its disease-causing gene is CYP4V2. Majority previously published studies have described the phenotypic and genotypic characterization of BCD, however, we are still unclear on natural history of BCD patients and pathogenesis of BCD, which is very important to determinate time window of BCD gene therapy, evaluate outcome of clinical trials, and explore other treatment. （Ophthalmol CHN, 2020, 29: 84-86）

Who touched my optic nerve? -The causative analysis of optic nerve damage in normal tension glaucoma

Ren Zeqin

2020, 29(2):  87-89.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.003

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Normal tension glaucoma (NTG) and high intraocular pressure (IOP) primary open-angle glaucoma (POAG) represent a “continuum”. Based on the pathophysiology, this paper discusses the relationship between IOP and optic nerve damage in NTG, and holds that the papillary lamina cribrosa is the intermediate link of the above relationship and its “continuum” concept, and that the IOP and the lamina cribrosa jointly constitute the initial factors of optic nerve damage in glaucoma. （Ophthalmol CHN, 2020, 29: 87-89）

Refractory inflammatory ocular involvement in rheumatic diseases

Wang Zhengang

2020, 29(2):  90-92.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.004

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Inflammatory eye diseases are a group of refractory blinding ocular disorders induced by non-infective and non-neoplastic factors. Eye is also an organ often involved in many rheumatic diseases such as spondyloarthritis, Behcet’s disease, rheumatoid arthritis, primary Sjogren's syndrome, relapsing chondritis, ANCA-related vasculitis and all of parts of eye ball can be involved. There are many similarties between inflammatory ocular diseases and ocular diseases related to rheumatic diseases. Rheumatic diseases-related ocular disease when occured as initial or major symptom is often misleading. Searching actively for etiology of recurrent inflammatory ocular disease should be emphasized thought out all of the body, including rheumatic as well as neoplastic diseases. Based on the common points of inflammatory eye diseases and rheumatic ophthalmopathy, the hope of better outcome would like to be relyed on improving the understanding of rheumatic ophthalmopathy, and strengthen the multidisciplinary cooperation on diagnosis and treatment. （Ophthalmol CHN, 2020, 29: 90-92）

Clinical features of Bietti crystalline corneoretinal dystrophy caused by mutations in the CYP4V2 gene

Xu Ke, Zhang Xiaohui, Xie Yue, Ye Hanwen, You Bing, Li Yang

2020, 29(2):  93-97.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.005

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Objective To analyze mutations of CYP4V2 gene in a cohort of patients with Bietti crystalline corneoretinal dystrophy (BCD) and their clinical features. Design Retrospective case series. Participants 138 unrelated Chinese patients diagnosed with BCD in Beijing Tongren Hospital. Methods All study participants underwent a detailed ophthalmological examinations, mutational screening of CYP4V2 gene was examined via directional Sanger sequencing and real-time quantitative PCR. Main Outcome Measures Visual acuity, slit-lamp biomicroscopy, fundus photography, mutations of CYP4V2 gene. Results All patients were identified CYP4V2 mutation, the most frequent mutation in this cohort were c.802-810del17insCG, c.1091-2A>G and p.H331P. The average best corrected visual acuity (LogMAR) was 1.17±0.95 and average age of onset was 29.19±9.64 years old. The degree of visual impairment was related to the course of disease but not affected by the age of onset. Fundus photograph of all patients revealed typical crystalline deposits, the range and density of it was related to the course of disease. Conclusion Our findings expand the spectrum of CYP4V2 mutation. The clinical characteristic of BCD is obvious, and it could be effectively diagnosed with image manifestation methods. Identification of mutation gene lays foundation for provision of genetic consultation for BCD patients. （Ophthalmol CHN，2020, 29： 93-97）

Genotype and clinical characteristics of Usher syndrome patients with pathogenic mutations in MYO7A gene

Ye Hanwen, Sun Tengyang, Xu Ke, Xie Yue, You Bing, Li Yang

2020, 29(2):  98-103.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.006

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Objective To analyze genotype and clinical characteristics of Usher syndrome patients with pathogenic mutations in MYO7A. Design Retrospective case series. Participants 33 Chinese probands (14 from Beijing Tongren Hospital and 19 probands from 10 related literatures) with pathogenic mutations in MYO7A gene. Methods All patients underwent ophthalmic examinations including best-corrected visual acuity, fundus examinations, retinal optical coherence tomography, and flash-electroretinogram, and auditory examinations including pure-tone audiometry, acoustic immittance tests, and otoacoustic emission tests. The patients were classified into Usher syndrome type 1 (USH1) and Usher syndrome type 2 (USH2) according to their clinical characteristics. Main Outcome Measures Mutations in MYO7A gene, age of onset, and degree of hearing impairment. Results Of the 33 probands, 27 probands presented with USH1 and 6 probands presented with USH2. A total of 44 mutations of MYO7A gene were detected in these patients, including 17 missense mutations, 6 nonsense mutations, 12 splicing mutations, 6 frame-shift mutations, and 2 copy number variants. The rate of missense mutations in USH2 patients (9/12, 75.0%) was significantly higher than that in USH1 patients (21/54, 38.9%). The rate of nonsense mutations (12.1%) was significantly lower than that in Caucasians. The rate of splicing mutations (19.7%) and frame-shift mutations (19.7%) was higher than that in Caucasians. The mutation p.1240R>Q that was most common in Caucasians was not found in these patients. Conclusion This study preliminarily confirms the mutation spectrum of MYO7A in Chinese Usher syndrome patients, which differs from that in Caucasians. Usher syndrome patients with missense mutations have milder hearing impairment. （Ophthalmol CHN， 2020, 29： 98-103）

A preliminary study of transcriptome in patients with diabetic retinopathy

Liu Ying1, He Xujun2, Chen Jianbin1, Li Zhichen1, Mei Weiqun1, Zhang Huabei1, Ouyang Jian1, Qian Jiali1

2020, 29(2):  105-113.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.007

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Objective To study the differentially expressed genes and DR-related genes in patients with diabetic retinopathy (DR) by using transcriptome technology. Design Prospective comparative case series. Participants Fourteen patients with T2DM were recuited, among them, eight patients with moderate or higher non-proliferative DR (NPDR) or proliferative DR (PDR) were enrolled in the DR group and six patients without DR were enrolled in the DM group. Methods Peripheral blood of each patient was collected, white blood cells were isolated, total RNA was extracted, and retranscribed to DNA. Transcription group library was constructed. Illumina HiSeqTM2000 system was used to sequence the results. Bioinformatics analysis was used to analyze the sequencing results. RT-q PCR was used to detect the levels of calmodulin 1 (CNN1) and lysophosphatidic acid receptor 3 (LPAR3) in peripheral blood leukocytes. To validate transcriptome sequencing results. Main Outcome Measures Differentially expressed genes, GO annotation and enrichment, biochemical metabolism and pathway annotation and enrichment, and differential gene interaction network between the two groups. The levels of CNN1 and LPAR3 in peripheral leukocytes were different between the two groups. Results Compared with DM group, DR group screened 103 differentially expressed genes. Among them, 41 were up-regulated and 62 were down-regulated. The most significant down-regulation was killer cell immunoglobulin like receptor 2DS1 (KIR2DS1), and the most significant up-regulation was small nucleolar RNA gene (RNU105B). GO enrichment analysis showed that the GO items significantly enriched in biological process (GO-P) and molecular function (GO-F) were cell process, single biological process and binding function. Glutathione S-transferase mu1 (GSTM1), early growth response 1 (EGR-1), LPAR3 and CNN1 were all enriched in the above items. The analysis of significance enrichment of pathway showed that the most abundant differential genes were antigen treatment and presentation, natural killer cell-mediated cytotoxicity pathway, in which KIR2DS1 was involved. The analysis of gene interaction network showed that there was interaction between GAS1 and multiple genes. qPCR results indicated that the levels of CNN1 and LPAR3 in DR group were higher than those in DM group (all P＜0.05). Conclusion Using transcriptome technology, we found that there were many differential expression genes in peripheral blood leukocytes of DR group. Among them, whether KIR2DS1, GSTM1, EGR-1, and GAS1 in the down regulated genes, and RNU105B, LPAR3, and CNN1 in the up regulated genes are related to the occurrence and development of DR remains to be further verified. （Ophthalmol CHN， 2020, 29： 105-113）

Ocular manifestations and gene detection of transthyretin-related vitreous amyloidosis

Yang Qiong, Wang Hong, Mo Bin, Zhou Wenjia, You Bing, Wei Wenbin

2020, 29(2):  114-117.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.008

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Objective To describe ocular manifestations and gene detection results in transthyretin (TTR) -related vitreous amyloidosis. Design Retrospective case series. Participants Four cases with TTR-related vitreous amyloidosis performed vitrectomy. Methods The clinical features with slit lamp, ophthalmoscope, intraocular pressure(IOP), best corrected visual acuity(BCVA) and ultrasound were reviewed. Subjects’ venous blood was collected and DNA was extracted, whole exons of TTR gene were amplified with polymerase chain reaction (PCR). 25G vitrectomy was performed. The vitreous humor was examined for HE staining and pathological diagnosis. Main Outcome Measures TTR sequencing results, and clinical manifestation. Results 2 male cases with average age of (50.5±8.4) years old in all 4 cases. The vitreous opacity was the main manifestation in all cases. Direct sequencing revealed the heterozygous mutation in TTR Tyr134Cys, Lys55Asn, Tyr89His, Gly103Arg in 4 patients. Vitreous pathology revealed that the vitreous humor was stained with amorphous amyloid. The BCVA of the 5 eyes before surgery were from HM to 0.1 and after surgery were from 0.1 to 0.7. IOP was normal before and after vitrectomy. Conclusion TTR gene mutation may cause vitreous amyloidosis. Genetic and pathological testing are key diagnostic evidence for TTR-related vitreous amyloidosis. Vitrectomy can improve vision of TTR-related vitreous amyloidosis. （Ophthalmol CHN， 2020, 29： 114-117）

The correlation study between keratoconus subbasal nerves and corneal morphology

Guo Lili, Zhang Yang, Li Dan, Wang Zhiqun, Tian Lei, Li Na

2020, 29(2):  118-122.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.009

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Objective To study the correlation between corneal morphology and corneal subbasal nerves in patients with keratoconus(KC). Design Prospective comparative case series. Participants Seventy-four eyes of 74 patients with KC (25 of the other 74 eyes as frustrate keratoconus) and 24 eyes of 24 healthy patients were enrolled in this study from March 2018 to March 2019 in Beijing Tongren Hospital. Methods Patients were diagnosed and grouped as KC, frustrate KC or the normal by ophthalmic examination and Pentacam. Kmax (the maximum anterior corneal refractive power)and Minpachy (the minimum corneal thickness) of KC were applied as parameters of corneal shape. Images of subbasal nerves obtained with in vivo confocal microscopy (IVCM) were analyzed and calculated into 6 parameters by ACCmetrics software: corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal total branch density (CTBD), corneal nerve fiber area (CNFA), and corneal nerve fiber width (CNFW). The correlation between subbasal nerves and corneal morphology in KC group was analyzed, and the differences of parameters between each group pair were compared. Main Outcome Measures Kmax, Minpachy, CNFD, CNBD, CNFL, CTBD, CNFA and CNFW. Results Qualitative analysis of IVCM showed that the subbasal nerves in KC showed a reduced density and increased tortuosity as compared to controls. The subbasal nerves in KC were arranged in bundles sometimes. Intergroup comparison showed statistically significant reduction in CNFD, CNBD, CNFL and CNFW in group KC as compared to group normal (all P<0.05). Intergroup comparison showed statistically significant reduction in CNFL and CNFA in keratoconus as compared to frustrate KC (both P<0.05). Intergroup comparison showed statistically significant reduction in CNFD and CNFL in the normal as compared to frustrate KC (both P<0.05). In correlation analysis, CNFD, CNFLand CNFW of KC patients were correlated with Kmax (P=0.001, 0.001 and 0.006, respectively) and the CNFD, CNFL CNBD, and CNFW of KC patients were correlated with Minpachy (P=0.01, 0.01, 0.004, 0.02). Conclusions In keratoconus, the changes in subbasal nerve may be earlier than the corneal shape. Subbasal nerve will change with the progress of keratoconus. Corneal nerve fiber density (CNFD) and corneal nerve fiber length (CNFL) might be applied as indicators for early diagnosis of keratoconus. (Ophthalmol CHN, 2020, 29: 118-122)

The effect of femtosecond laser-assisted LASIK and Trans-PRK on corneal curvature and corneal posterior surface height in high myopia

Pei Tianxu, Zhang Jiahuan, Jiang Danni, Han Dong, Zhao Qi

2020, 29(2):  123-127.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.010

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Objective To analyze the effect of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and trans-epithelial photorefractive kerectomy (Trans-PRK) on corneal curvature and corneal posterior surface height in high myopias. Design Prospective comparative case series. Participants 23 cases of FS-LASIK and 24 cases of Trans-PRK in high myopia patients within -8.00 D. Methods The corneal curvature and corneal posterior surface height were measured and analyzed with Pentacam analyzer before the surgery and 1, 3, 6 and 12 months after the surgery. Main Outcome Measures The corneal curvature and corneal posterior surface height. Results There were significant decreases in corneal curvature from both groups in different times after operation (all P<0.05). There were no significant differences in the corneal curvature that were compared between the two groups, except the 6 month and 12 month, in which K1 of Trans-PRK group were higher than FS-LASIK group (P<0.05). Meanwhile, there was no significant increase in corneal curvature at 6 months after operation in the FS-LASIK group, and no significant increase in corneal curvature at 3 months after surgery in the Trans-PRK group. The mean height of the posterior corneal surface in the Trans-PRK group was smaller than that in the LASIK group in different times (all P<0.05) except the 3 month (P=0.150). Conclusion Both FS-LASIK and Trans-PRK are safety used in the treatment of high myopia within -8.00 D. However, the Trans-PRK is more effective and safer for high myopia within -8.00 D, and with less effect on corneal curvature and posterior corneal surface height, and better recovery after 12 months follow-up. Therefore, Trans-PRK surgery is more suitable for patients with high myopia within -8.00 D. (Ophthalmol CHN, 2020, 29: 123-127)

Effect of orthokeratology on ocular imaging quality

Jiang Bingcai1 Yang Jiwen1,2

2020, 29(2):  128-132.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.011

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Objective To investigate the change trend of corneal, internal, ocular imaging quality parameters of subtracted lower order aberration before and after orthokeratology (OK). Design Prospective case series. Participants Thirty-four patients (34 right eyes), mean (11.68±1.70) years old, spherical equivalent diopter (-3.43±1.42) D, who had undergone OK treatment from March to June 2017 in Shenyang Aier Eye Hospital, were chosen for the study and followed up for 6 months. Methods Corneal, internal, ocular imaging quality parameters were measured with the iTrace visual function analyzer under a 5 mm pupil diameter at baseline and after 1 week, 1 month, 3 months, and 6 months of OK lens wearing. Imaging quality parameters include the subtracted lower order aberration modulation transfer function (MTF) at spatial frequencies of 5, 10, 15, 20, 25, 30 cycle/degree (c/d) and strehl ratio (SR). Imaging quality parameters before and after OK were compared with repeated ANOVA. Main Outcome Measures MTF, SR. Results Corneal, internal, ocular low-middle-high spatial frequencies MTF and SR were significantly reduced at different time points after OK in comparison with baseline (all P<0.05). At a spatial frequency of 25 c/d, the corneal MTF decreased after 1 month of OK compared with 1 week after OK (P=0.042). At a spatial frequency of 5 c/d, the internal MTF decreased after 1, 3 months of OK compared with 1 week after OK (P=0.027, 0.004). At spatial frequencies of 10, 20 and 25 c/d, the internal MTF decreased after 3 months of OK compared with 1 week after OK (P=0.029, 0.013, 0.020), and increased after 6 months of OK compared with 3 months after OK(P=0.020, 0.019, 0.042). At a spatial frequency of 15 c/d, the internal MTF increased after 6 months of OK compared with 3 months after OK (P=0.037). The internal SR decreased after 1, 3 months of OK compared with 1 week after OK (P=0.039, 0.015)，and increased after 6 months of OK compared with 3 months after OK(P=0.032). There were no statistical differences among the other time points of post-OK (all P>0.05). Conclusion All the subtracted lower order aberration imaging quality parameters decreased after OK, indicating that the subtracted lower order aberration imaging quality declined. Corneal high spatial frequency MTF, internal low-middle-high spatial frequencies MTF and SR changed between the post-OK groups, but the change of 6 months returned to the level of 1 week after OK. （Ophthalmol CHN, 2020,29: 128-132）

Comparative study of subjective squint deviation in patients with intermittent exotropia measured with synoptophore method and computer-based perceptual eye position test

Wu Baojian1,2， Fu Jing1， Hong Jie1， Wang Jinghui1, Sun Xingli1, Chu Hang3, Yan Li3

2020, 29(2):  133-137.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.012

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Objective To compare the subjective squint deviation(SSD) in patients with intermittent exotropia detected with synoptophore method and computer-based perceptual eye position (PEP) test. Design Prospective comparative case series. Participants 355 patients with intermittent exotropia. Methods The long-distance SSD was detected with synoptophore method and, at the same time, middle-distance SSD was detected with the computer-based PEP test. Main Outcome Measures Horizontal SSD and vertical SSD. Results With synoptophore method, the mean SSD in the horizontal direction was (-8.85±5.39) °, and mean vertical deviation of eye position was (2.13±1.33)°. With PEP test, the mean SSD in the horizontal direction was (287.41±220.80) (1°=53 pixels) pixels, and mean vertical deviation of eye position was (25.06±33.95) pixels. The detection rate of horizontal SSD was higher with PEP test (84.79%, 301/355) than with synoptophore method (63.10%, 224/355) (χ2=51.115, P=0.000). The detection rate of vertical eye position deviation was higher with PEP test (82.82%, 294/355) than with synoptophore method (6.44%, 23/355) (χ2 = 267.033, P=0.000). The horizontal SSD was (-10.48±3.19)° and the vertical SSD was (-2.13±1.33)° in 23 patients with vertical eye position deviation detected with synoptophore method, and there was no linear correlation between them (r=-0.211, P=0.335). The horizontal SSD was (291.05±220.43) pixels, and the vertical SSD was (25.06±33.95) pixels, and there was a linear correlation between them (r=0.406, P=0.000). In 206 patients simultaneously having horizontal SSD of two methods, the SSD was (-8.84±5.31)° in synoptophore method and (296.14±222.19) pixels in PEP test, respectively. And there was a linear correlation between them (r=-0.301, P=0.000). In 22 patients simultaneously having the vertical SSD of two methods, the SSD was (2.09±1.34)° in synoptophore method, and (42.95±40.88) pixels in PEP test. And there was no linear correlation between them (r=0.119, P=0.598). Conclusion In patients with intermittent exotropia, both SSD and PEP can reflect the horizontal eyes position deviation in the state of binocular differentiate gaze, but the detection rate of PEP test in the vertical direction was much higher than that of synoptophore method. The vertical PEP increased accordingly with the enlargement of the horizontal PEP. PEP test was a more sensitive and more comprehensive test of the eye position deviation. （Ophthalmol CHN，2020, 29： 133-137）

Primary observation of clinical features in acute acquired distance esotropia

Yan Lijuan, Ji Ang, Chen Xu

2020, 29(2):  138-141.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.013

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Objective To observe the clinical features of acute acquired distance esotropia (AADE). Design Retrospective case series. Participants 18 AADE patients. Methods The optometry, deviation and another related ophthalmic examination were reviewed in 18 AADE patients. Continually near-distance use of eyes for long time, and outdoor activities were questionnaired. Main Outcome Measures Age, near and distance esotropia deviation, diplopia, time of near-distance use of eyes and outdoor activities each day. Results In all 18 patients, 11 cases (61.11%) were males. All patients complained diplopia. 13 cases (72.22%) had distance diplopia only, 5 cases (27.78%) had both near and distance diplopia, but more severe in distance. 13 cases (72.22%) were computer aplication related occupation. Mean age was 26.89±5.20 years. Mean diplopia period was 14.94±21.09 month. Mean time of near-distance use was 13.28±3.52 h/d. Mean time of outdoor activities was 0.77±0.43 h/d. Mean sleeping time was 7.36±0.51 h/d. Mean corrected esotropia deviation of 33 cm distance was 7.06±10.98 prism diopters(PD). Mean corrected esotropia deviation of 6 meters distance was 12.83±11.73 PD. Mean equivalent spherical(ES) refraction of both eyes was -3.81±2.11 D. Conclusion AADE can occur in myopia young adults for long time near-distance eye use and rare outdoor activities, which characterized by diplopia when look far away. （Ophthalmol CHN, 2020, 29: 138-141）

Clinical characteristics of non-arteritic anterior ischemic optic neuropathy associated with congenital occupying lesions in optic disc

Wu Rihan1, Liu Lijuan1, Yang Bentao2, Jiang Libin1

2020, 29(2):  141-146.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.014

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Objective To summarize the clinical characteristics of non-arteritic anterior ischemic optic neuropathy (NAION) associated with congenital occupying lesions in optic disc. Design Retrospective case series. Participants A total of 9 rare cases (11 eyes) with NAION associated with congenital optic disc occupying lesions, in Beijing Tongren Hospital between January 2010 and June 2019 were collected. Methods Ophthalmic and cranial neuroimaging data of patients were reviewed. All patients were followed up for at least 6-mouths. Main Outcome Measures Age, the effected single/both eyes, visual field defect, neuroradiology data. Results There were 4 cases of melanocytoma, 3 cases of drusen and 2 cases of myelinated nerve fiber which were associated with NAION in this study. The median age of disease occurred were 39 years old (range: 26-65 years). Involvement of monocular congenital optic disc occupying lesion was happened in all patients of melanocytoma and myelinated nerve fiber which were also suffered from unilateral NAION at the same eye. However, the opposite situation occurred in 3 patients of drusen, whose lesions were all bilateral but 2 patients were suffered from NAION in both eyes successively. The best corrective visual acuity variation of 11 eyes was 0.05 to 1.0 and automated static perimetry was presented with horizonal inferior depression and concentric defection in 4 patients. The deterioration of visual function and the reoccurrence of disease were never happened in all patients on last follow-up. Conclusions Some congenital optic disc occupying lesions could suffer severe visual dysfunction on account of the occurrence of NAION. （Ophthalmol CHN, 2020, 29: 141-146）

Efficacy comparison of two trans-scleral diode laser cyclophotocoagulation protocols based on “pop” for refractory glaucoma

Pei Xueting, Wang Shuhua

2020, 29(2):  147-151.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.015

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Objective To evaluate the efficacy and safety of two trans-scleral diode laser cyclophotocoagulation (TDLCP) protocols based on “pop” for refractory glaucoma. Design Retrospective comparative case series. Participants Sixty-two eyes in 62 patients with refractory glaucoma. Methods Thirty patients (30 eyes) were treated with pop-titrated TDLCP, and 32 patients (32 eyes) were treated with fixed-energy TDLCP. The laser power was adjusted depending on the occurrence of an audible “pop” in pop-titrated group. The laser power was constant in fixed-energy group. The patients were followed up 3 months. Main Outcome Measures Total mean laser energy, pop numbers, intraocular pressure (IOP), visual acuity, anti-glaucoma medications, and complications. Results In pop-titrated group, mean IOP decreased from 46.1±10.7 mmHg before surgery to 15.8±6.9 mmHg 3 months after surgery. In fixed-energy group, mean IOP decreased from 44.9±12.3 mmHg before surgery to 16.7±8.2 mmHg on 3 months after surgery. 80% patients in pop-titrated group whose IOP reduced to less than 21 mmHg without medications was significantly higher than 65.6% patients in fixed-energy group (χ2=5.643, P=0.018). The IOP reduction was moderate correlated with the number of pops both pop-titrated group( r=0.517，P=0.001) and fixed-energy group( r=0.572，P=0.001). In pop-titrated group, BCVA decreased in 1 eye after TDLCP. In fixed-energy group, BCVA decreased in 2 eyes, and prolonged hypotonia occurred in 1 eye after TDLCP. Conclusion The pop-titrated TDLCP is more effective than the pop-fixed TDLCP for the treatment of refractory glaucoma. （Ophthalmol CHN, 2020,29: 147-151）

Efficacy of modified meibomian gland acupuncture dredging method for early acute meibomian gland inflammation

Gao Xiuyun, Gao Yingying, Ye Wenwen, Li Xiulan

2020, 29(2):  151-157.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.016

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Objective To observe the efficacy of modified meibomian gland tube acupuncture dredging method for early acute meibomian adenoiditis. Design Prospective comparative case series. Participants 105 patients with early acute syringopsitis in Second Hospital affiliated to Fujian Medical University from March 2015 to August 2017. Methods Patients were randomly divided into treatment group (56 cases) and control group (49 cases). Patients were also divided into severe and mild subgroup according to the severity of symptoms and degree of diffusion. There were 31 severe cases and 25 mild cases in treatment group, and 28 severe cases and 21 mild cases in control group. The treatment group was treated with modified meibomian gland tube acupuncture dredging method. The control group was treated with conventional conservative method. The mean follow-up time was（6.50±3.84） days. Main Outcome Measures Cure rate. Results The total cure rate in treatment group was 92.86%, significantly higher than that of control group (67.35%) (P=0.000). In mild patients, the cure rate of treatment group (96.00%) was higher than that of control group (80.95%) (P=0.04). In severe patients, the cure rate of treatment group (90.32%) was higher than that of control group (57.14%) (P=0.000). The duration of disease in treatment group was（5.0±2.98）days and (8.4±3.86）days in control group. The surgical rates（4.00% , 9.68% of mild and severe patients） in treatment group were lower than those of the control group (23.81%, 42.86% of mild and severe patients）(all P<0.05). Conclusions The modified meibomian gland tube acupuncture dredging method can effectively dredge meibomian gland tube in early acute meibomian adenoiditis, and shorten the course of disease, decrease the surgical rate. （Ophthalmol CHN， 2020, 29： 153-157）

Clinical features of blepharokeratoconjunctivitis in 83 children

Yu Jifeng, Liu Xue, Chu Huihui, Li Li

2020, 29(2):  157-160.  doi:10.13281/j.cnki.issn.1004-4469.2020.02.017

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Objective To observe the clinical features of blepharokeratoconjunctivitis (BKC) in children. Design Retrospectively case series. Participants Eighty-three BKC patients in Beijing Children's Hospital from November 2015 to November 2018. Methods General conditions, clinical symptoms, signs, misdiagnosis, therapeutic method and clinical efficacy were reviewed. All patients were treated with physical therapy such as meibomian gland massage and hot compress. Glucocorticoid eye drops were used in moderate and severe patients in the early stage. Main Outcome Measures Changes of eyelid, eyelid margin, conjunctiva and cornea, treatment results. Results The 83 BKC patients were aged from 1 to 11 years (median: 5.8years). There were 46 (55.42%) female patients. Most patients occurred in 3~6 years old (35, 42.17%). Ocular redness (67, 80.72%), photophobia, tearing and ocular pain (39, 46.99%), eye secretion (30, 36.14%) and rubbing (24, 28.91%) were the most common complain. The clinical signs were conjunctival hyperemia(83, 100%), papillary follicular hyperplasia (61, 73.49%), punctate epithelial infiltration (61, 73.49%), and neovascularization (45, 54.22%). The BKC had been misdiagnosed as keratitis (41, 49.4%), allergic conjunctivitis (22, 26.5%), bacterial conjunctivitis (12, 14.46%), chalazia (5, 6.02%), and viral conjunctivitis (3, 3.61%). The follow-up time was 3~25 months, average 7.3±3.6 months. There were 67 patients (80.72%) used glucocorticoid and physical therapy earlier achieved clinical recovery. Conclusion BKC in children often occur in 3~6 years old girls. The clinical symptoms are different. Whole course physical therapy combined with early use of glucocorticoid can significantly improve the efficacy. （Ophthalmol CHN, 2020, 29: 157-160）