Table of Content

25 May 2021, Volume 30 Issue 3

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Eyes on the future ophthalmology

Jin Zibing

2021, 30(3):  169-172.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.001

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As the saying goes, history is a mirror of the past and a lesson for the present and future. From the ancient time, the level of vision has been vital for competition and adaptation, which allows human being with successive generations. Thus, human has been obsessively curious about the mechanism of vision development for thousands of years. In the human history, ancient people had left numerous records related to vision development, ocular anatomy and physiology. Since the Renaissance, historical records of ophthalmological knowledge had been largely increased. In the modern society, with the general advances in basic medical sciences and clinical medicine, the diagnosis and treatment in the ophthalmology has progressed considerably, building critical milestone for preventing and curing blindness. Overall, the development of ocular anatomy and physiology allows noninvasive intraocular imaging and investigations of pathogenic mechanism. It boosts innovations of intraocular surgery, which has a continuous trend of minimal invasive. Entering to the new century, breakthroughs and technical achievements in the field of biology and optometry would promote diagnostic decisions and treatments of clinical ophthalmology. This paper will analyze the future development directions of ophthalmology from the history of biology that promoting the development of medicine. (Ophthalmol CHN, 2021, 30: 169-172)

Objective evaluation of eye exercise based on evidence-based consideration

Yan Hongxiang, Zhang Zifeng, Li Manhong, Wang Yusheng

2021, 30(3):  173-176.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.002

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As a long-term implemented policy aim at preventing and controlling myopia, eye exercise was not universally recognized during 60-year course of promotion. In this paper, we review the empirical literature on the historical evolution and actual effectiveness, as well as present an outlook on possible policy interventions represented by the eye exercise in this new era, which can provide a reference for the prevention and control of myopia. Due to the active role in relieving the visual fatigue and decreasing the duration of focused continuous reading, eye exercise is one of the effective intervention to prevent and control myopia. Nevertheless, eye exercise should not be considered the sole pathway to dependent given. The preventing and controlling of myopia is a complex systematic enterprise. (Ophthalmol CHN, 2021, 30: 173-176)

Short-term efficacy of oral bromohexine hydrochloride on dry eye

Zhong Zubin, Feng Bing

2021, 30(3):  195-198.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.006

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Objective To explore the efficacy of oral bromhexine hydrochloride tablets combined with sodium hyaluronate on ocular symptoms and inflammation in patients with dry eye. Design Prospective case series. Participants 120 patients with different types of dry eye who were treated in Department of Ophthalmology, Affiliated Hospital of Southeast University, Jiangbei Hospital from June to December 2018 were selected. Methods patients were divided into observation group and control group by random number table, 60 in each group. The control group was treated with sodium hyaluronate eye drops. The observation group was combined with bromhexine hydrochloride tablets on the basis of the control group, orally 1 tablet each time, 3 times/day, the course of treatment was 4 weeks. After 4 weeks of treatment, the clinical effect, Ocular Surface Disease Index (OSDI) score, tear film rupture time (BUT), tear secretion test (SIt), inflammatory factors [interleukin-6 (IL-6), IL-8, IL-1β)] levels and adverse reactions were compared between the two groups. Main Outcome Measures OSDI score, BUT, SIt, iIL-6, IL-8, IL-1β levels in tears and adverse reactions. Results The total effective rate in the observation group was significantly higher than that in the control group（95% vs. 85%, χ2=6.667, P=0.010）; at 4 weeks after treatment, BUT and SIt in the two groups were significantly higher than those before treatment （all P=0.000）, and BUT and SIt in the observation group were significantly higher than those in the control group （t=9.506，8.767, all P=0.000）, OSDI scores in the two groups were significantly lower than those before treatment （all P=0.000）, and OSDI scores in the observation group were significantly lower than those in the control group （18.84±5.33 vs. 32.21±6.76, t=-17.014, P=0.000）. The levels of IL-6, IL-8 and IL-1β in the two groups were significantly lower than those before treatment （all P=0.000）, and the levels of IL-6, IL-8 and IL-1β in the observation group were significantly lower than those in the control group （t=-19.033, -13.904, -6.212, all P=0.000）; there was no significant difference in adverse reactions between the two groups （3.33% vs. 3.33%, χ2=0.000, P=1.000）. Conclusion Oral bromhexine hydrochloride tablets for 4 weeks has a good clinical effects for the patients with dry eye, which can effectively improve the patients' ocular symptoms, reduce the level of inflammatory factors in the patients' tears, and has good safety. (Ophthalmol CHN, 2021, 30: 195-198)

Efficacy of vitrectomy combined with internal limiting membrane peeling for proliferative diabetic retinopathy with macular detachment

Jia Liyun, Zhang Yongpeng, Ma Kai

2021, 30(3):  222-226.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.011

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Objective To observe the clinical efficacy of vitrectomy combined with inner limiting membrane (ILM) peeling in the treatment of proliferative diabetic retinopathy (PDR) with macular detachment. Design Retrospective comparative case series. Participants 39 cases (45 eyes ) diagnosed as PDR with macular detachment in Tongren Eye Center． Methods Vitrectomy and ILM peeling were performed in the ILM-removed group, in which there were 21 patients ( 24 eyes ); vitrectomy only were performed in the control group, in which there were 21 eyes of 18 patients. All the surgeries were performed by the same surgeon. Best corrected visual acuity (BCVA, LogMAR), complications, and the center macular thickness (CMT) and subretinal fluid height (SFH) were examined before the surgery and during follow-up at one week, one month, three month and six month postoperative． Main Outcome Measures BCVA, SFH, and CME. Results The BCVA of the combined group and the control group were significantly higher at 1 week, 1 month, 3 months and 6 months after operation than before operation (F=17.63, 16.94; P<0.001). The BCVA in the ILM-removed group (0.71±0.65) was higher than the control group (1.02±0.53) at three month after operation (t=2.73，P=0.009). The SFH of the two groups at 1 week, 1 month, 3 months and 6 months after operation was significantly lower than that before operation (F=17.63, 16.94; P<0.001). The CMT in the ILM-removed group (218.56±49.51 μm) was thinner than in the control group (289.32±65.34 μm ) at six month after operation (t=2.84，P=0.006). The SFH of the two groups decreased significantly at 1 week, 1 month, 3 months and 6 months after operation (F=17.63, 16.94, P<0.05). The SFH in the ILM-removed group (15.07±12.01 μm) was lower than in the control group (42.67±30.21 μm) at three month after operation (t=2.24，P=0.003). Conclusion In the treatment of PDR with macular detachment, vitrectomy combined with ILM peeling can effectively and safely improve visual acuity, reduce the thickness of macular center area and promote SRF absorption． (Ophthalmol CHN, 2021, 30: 222-226)

Efficacy comparison of 2 mg or 3 mg doses of ganciclovir intravitreal injection on cytomegalovirus retinitis in acquired immunodeficiency syndrome

Liu Xiyao, Li Dan, Mao Feifei, Lu Dan, Wang Shengnan, Sun Huiyu

2021, 30(3):  227-231.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.012

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Objective To compare the efficacy and safety of 2 mg and 3 mg ganciclovir intravitreal injection on cytomegalovirus retinitis (CMVR) in patients with acquired immunodeficiency syndrome (AIDS). Design Prospective comparative case series. Participants 63 cases (86 eyes) of patients with AIDS complicated with CMVR in Beijing Ditan Hospital from 2016 to 2020. Methods All patients were randomly divided into 2 mg group (41 eyes) and 3 mg group (45 eyes) and received ganciclovir intravitreal injection of 2 mg or 3 mg based on the systemic ganciclovir treatment. Before vitreous injection, aqueous humor was extracted for PCR detection of cytomegalovirus. Intravitreous injection was given once a week until the fundus lesion was controlled and cytomegalovirus PCR in the aqueous humor was negative. Main Outcome Measures The fundus statues, cytomegalovirus (CMV) load in aqueous humor[log（CMV DNA）], the frequencies of the injection, visual acuity, complications. Results All the active retinal necrosis lesions were controlled and gradually transformed into atrophy lesions. Viral load in aqueous humor decreased weekly and eventually turned negative. The viral loads of CMV in the 2 mg group was 3.90±0.73 copies/ml, 3.88±0.82 copies/ml, 3.06±0.93 copies/ml, 2.85±0.75 copies/ml and 2.32±0.50 copies/ml respectively before initial treatment, and at the first, second, third and fourth weeks of treatment (F=28.54，P<0.01). In 3 mg group, the viral loads of CMV was 4.10±0.94 copies/ml, 3.76±0.90 copies/ml, 3.50±0.81 copies/ml, 2.90±0.91 copies/ml, 2.57±0.79 copies/ml, respectively (F=18.21，P<0.01). Initial CMV viral load was positively correlated with the frequency of injection in both 2 mg groups (r=0.69, P<0.01) and 3 mg groups (r=0.82, P<0.01). Visual acuity improved or remained unchanged in 31 of 41 eyes in the 2 mg group and 33 of 45 eyes in the 3 mg group (χ2=0.06，P=0.81). No serious complications occurred in any of the patients. There were no significant differences in lesion recovery rate, viral load in aqueous humor, number of injections, complications between the two groups (all P>0.05). Conclusion Intravenous ganciclovir combined with ganciclovir intravitreal injection of 2 mg or 3 mg can effectively treat CMVR. In order to reduce retinal toxicity, 2 mg of intravitreal ganciclovir is a relatively safe and effective dose for the treatment of CMVR. (Ophthalmol CHN, 2021, 30: 227-231)

Distribution of lens vault and its correlation with primary angle-closure glaucoma in people over 45 years old: Beijing Eye Study

Chen Changxi, Cao Kai, Wang Jinda, Li Jianjun, Xu Liang, Wang Yaxing

2021, 30(3):  200-203.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.007

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Objective To describe the characteristics of lens vault (lens vault, LV) in people over 45 years old in Beijing Eye Study and explore its correlation with primary angle closure glaucoma (PACG). Design Cross-sectional study. Participants 2792 subjects of 45-years old or more in 5-year followed population of Beijing Eye Study. Methods Detailed eye examinations were performed for the subjects, including refractive measurement, intraocular pressure (non-contact tonometer), digital anterior segment photography of slit lamp after mydriasis, and axis of the eye measurement of academic parameters (Lenstar) and fundus photography. The Heidelberg anterior segment OCT was used to take pictures and the LV (the vertical distance between the anterior pole of the lens and the horizontal line of the two scleral processes) was measured through the built-in software. The content of the questionnaire involved smoking history, drinking history, diabetes and hypertension and other medical history. Logistic regression was used to explore the correlation between LV and PACG, and odds ratios (OR) and 95% confidence interval (CI) were used to assess the strength of the association. Main Outcome Measures LV, OR value and 95%CI. Results The average LV level of people over 45 years old in Beijing Eye Study was 0.43±0.26 mm, the average LV level of men was 0.38±0.28 mm, and that of women was 0.45±0.28 mm (t=4.76, P<0.001). The LV levels of people 45~54 years old, 55~64 years old, 65~74 years old and ≥75 years old are 0.33±0.26 mm, 0.42±0.27 mm, 0.48±0.29 mm and 0.58±0.29 mm, respectively, increasing with the increasing of age (F=7.84, P<0.001). The LV levels of myopia, emmetropia, and hyperopia were 0.26±0.31 mm, 0.43±0.26 mm, and 0.56±0.26 mm, respectively. As the refractive status changed from nearsightedness to farsightedness, the LV level also showed an upward trend (F=4.86, P<0.001). The average LV levels of healthy people and PACG patients were 0.42±0.28 mm and 0.84±0.25 mm, respectively (t=5.66, P<0.001). Logistic regression showed the correlation between LV and PACG(OR=1.022; 95% CI: 1.005, 1.040). Conclusion The average LV value of healthy people over 45 years old in Beijing area is 0.42±0.28 mm. LV increases with age. Women's LV value is higher than that of men, and the LV value of hyperopia is higher than that of myopia. larger LV is a risk factor for PACG. (Ophthalmol CHN, 2021, 30: 200-203)

Establishment and evaluation of ovalbumin induced allergic conjunctivitis in mice

Bao Jiayu, Zhang Peng, Zhu Lei, Wen Ya, Wang Jingyi, Wang Yinghui, Feng Jun, Li Siyuan, Tian Lei, Jie Ying

2021, 30(3):  189-194.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.005

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Objective To establish a mouse model of allergic conjunctivitis by intraperitoneal injection of ovalbumin (OVA) and ovalbumin eye drops. Design Experimental study. Participants 20 SPF BALB/c mice aged 6~8 weeks. Methods 20 BALB/c mice were randomly divided into normal control group (PBS group) and allergic conjunctivitis group (OVA group). OVA group was intraperitoneally injected with 200 μl ovalbumin sensitizing solution on day 0, 2, 4, 6 and 8. On the 10th, 11th, 12th, 13th and 14th day, 10 μl ovalbumin solution drops was applied to the eyes of mice respectively. In PBS group, the intraperitoneal injection and eye drops were replaced with PBS. The ocular surface state was evaluated 15~30 minutes after the allergic provocation solution was applied. Animals were sacrified by euthanasia on the 15th day, Giemsa staining and immunohistochemistry (IHC) staining revealed pathological change. The typical manifestations of allergic conjunctivitis, including lid edema, conjunctival redness, chemosis, tearing, and frequent scratching were examined with a slit lamp. On the 15th day, the spleen was separated, the weight of spleen was weighed, and the spleen index was calculated. The expression of interleukin (IL)-8, IL-6 and thyonic stromal lymphopoietin (TSLP) was detected by immunohistochemistry, and the infiltration of inflammatory cells was evaluated by Giemsa staining. Main Outcome Measures The symptom score of allergic conjunctivitis, the number of eyes scratching, spleen index, the expression of IL-8, IL-6, TSLP and inflammatory cells infiltration. Results The survival rate of OVA group was 100%. Compared with PBS group, the mice in OVA group showed obvious splenomegaly, eyelid edema, hyperemia and epiphora. The symptom scores of OVA group and PBS group were 3.1±1.45, 6.6±1.71, 5.7±1.34, 6.4±1.51, 10.1±1.66 and 1.3±0.95, 1.9±0.99, 1.7±0.82, 1.3±1.06, 1.4±0.84 on day 10, 11, 12, 13 and 14, respectively (all P<0.05); the times of eye scratching in two groups were 28.8±5.88, 29.3±7.42, 27.2±8.2, 28.0±6.82, 26.2±5.09 and 12.3±4.32, 12.7±5.03, 13.3±5.62, 12.7±5.54, 16.4±2.67, respectively (all P<0.05). On day 15, the spleen index of OVA group and PBS group were 6.67±0.66 and 4.21±0.40 respectively (t=10.02, P=0.0001). The average optical density of TSLP in PBS group and OVA group was 10.23±1.52 and 20.25±1.75 (t=7.482, P=0.0017), the average optical density of IL-6 was 13.15±1.68 and 24.93±3.02 (t=5.911, P=0.0041), and the average optical density of IL-8 was 12.23±3.22 and 22.12±4.00 (t=3.337, P=0.0289). The results of Giemsa staining showed that eosinophil infiltration was observed in the conjunctival tissue of OVA group. The eosinophil count in the conjunctival tissue of PBS group and OVA group was 266.67±57.74/mm2 and 1366.67±57.74/mm2 respectively (t=23.33, P=0.0001). Conclusion The mouse model of allergic conjunctivitis was successfully established by intraperitoneal injection of ovalbumin and repeated eye stimulation, which can provide a simple and reliable experimental tool for the mechanism research and drug development of human allergic conjunctivitis. (Ophthalmol CHN, 2021, 30: 189-194)

Clinical characteristics and treatment of eyelid lipogranuloma caused by autologous fat facial filling

Wang Yue, Xin Yue, Zhang Zheng, He Yueqing, Zhao Xiaoli, Li Yong, Ma Jianmin, Chen Tao

2021, 30(3):  204-209.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.008

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Objective To investigate the clinical characteristics and treatment of eyelid granuloma after autologous fat facial filling. Design Retrospective case series. Participants From August 2017 to December 2020, 9 patients (11 eyes) with orbital granuloma caused by autologous fat facial filling were collected from the Beijing Tongren Eye Center. Methods The sex, age, eye type of onset, location of eyelid mass, symptoms, clinical manifestations, location of autologous fat transplantation, time from autologous fat transplantation to eyelid mass, characteristics of imaging examination, treatment methods and therapeutic effects, and the results of pathological examination were collated and described, the follow-up period was 6 months. Main Outcome Measures Clinical characteristics, treatment, and efficacy. Results All patients were female, aged from 25 to 51 years old, with an average age 36.33±8.86 years old. Two patients had binocular involvement (22.2%) and 7 patients had monocular involvement (77.8%), including 2 cases in the right eye (22.2%) and 5 cases in the left eye (55.6%). Both upper and lower eyelids were involved in 1 patient (11.1%), upper eyelid in 5 patients (55.6%), lower eyelid in 3 patients (33.3%). The patient's eyelids were slightly red, swollen and painful, and the eyelids can touch a lump, and 2 patients were associated with ptosis. 3 patients received oral methylprednisolone, the tumor became smaller obviously and was not completely absorbed after 6 months. One patient received local injection of triamcinolone acetonide，the tumor became smaller obviously after 1 month, and the lower eyelid did not touch the tumor after 6 months. 3 patients underwent surgical resection of lipogranuloma. Histopathology showed the characteristics of lipogranuloma reaction, foreign body giant cells gathered around lipid-rich microcapsules of different sizes. No recurrence was found after follow-up for 6 months. 1 patient received ultrashort wave and laser physiotherapy, the inflammation subsided and the tumor decreased. The boundary gradually became clear, but there was a relapse after the cessation of physiotherapy. 1 patient refused operation and medicine because the tumor was small, and was observed regularly. Conclusion Facial injection of autologous fat can lead to a delayed benign lesion in the orbital region, the fat granuloma. and surgical resection can be taken when observation and drug conservative treatment are ineffective. (Ophthalmol CHN, 2021, 30: 204-209)

Short-term efficacy of vitrectomy combined with air tamponade on rhegmatogenous retinal detachment with inferior holes

Zhuang Jingjing, He Yongning, Luo wei, Tang Ruifei

2021, 30(3):  217-221.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.010

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Objective To observe the short-term efficacy and feasibility of vitrectomy combined with air tamponade for rhegmatogenous retinal detachment (RRD) with inferior holes. Design Retrospective case series. Participants Forty-five patients with RRD with inferior holes who underwent pars plana vitrectomy（PPV）combined with air tamponade from June 2017 to October 2020 in Nanjing Aier Hospital. Methods All patients underwent 23-gauge vitrectomy combined with air tamponade. Best corrected visual acuity (BCVA), non-contact intraocular pressure (NCT), slit lamp microscope, indirect funduscopy with slit lamp, wide-angle fundus photography, optical coherence tomography (OCT), ophthalmic AB ultrasound examination and length of optic axis with IOL-Master were performed before surgery and 5 days, 3 weeks and 3 months postoperation. Retinal reattachment, BCVA, intraocular pressure (IOP) and complications were observed. Main Outcome Measures Retinal reattachment, BCVA, IOP and complications. Results Local retinal redetachment occurred in one patient at the second month after surgery. This patient underwent scleral buckling and got final reattachment. Initial reattachment was achieved 97.8% in the rest 44 patients in 3 months after surgery. No other patient suffered retinal redetachment during follow-up. Preoperative LogMAR BCVA was 1.82±0.83, and postoperative LogMAR BCVA was 0.71±0.34, 0.59±0.32, 0.56±0.30 respectively at 5 days, 3 weeks, and 3 months after surgery. All patients gained better postoperative BCVA. Increased IOP was found in two cases on the first postoperative day. Conclusion Vitrectomy combined with air tamponade is an effective treatment for RRD patients with well relaxed retina and closed inferior retinal holes. (Ophthalmol CHN, 2021, 30: 217-221)

Prevalence and influencing factors of myopic maculopathy in myopic population aged 40 or more in rural area of China: Handan Eye Study

Cao Kai, Lin Caixia, Hu Ailian, Yang Xiaohui, Wang Bingsong, Zhang Qing, Hu Jianping, Hao Jie, Zhang Ye, Wang Ningli, Handan Eye Study Group

2021, 30(3):  177-183.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.003

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Objective To report the prevalence of myopic maculopathy in people over 40 years old in rural area of China, and to explore the influencing factors of myopic maculopathy based on Synthetic Minority Over-Sampling Technique（SMOTE） algorithm. Design Cross-sectional study. Participants 1177 myopia patients in the Handan Eye Disease Study from 2012 to 2013, aged 40 years and above. Methods Questionnaire was done to obtain subjects’ basic demographic data and behavioral data such as smoking and drinking history; Subjects’ height, weight and blood pressure were measured through physical examination; blood samples of each subject was collected for laboratory examinations; Early Treatment Diabetic Retinopathy (EDTRS) eye chart was used to measure the subject’s presenting visual acuity and best-corrected visual acuity (BCVA); Kowa applanation tonometer was used to measure the introcular pressure (IOP); Topcon automatic refractor (model KR8800) was used to measure diopter; A-ultrasound (10 MHz) was used to measure the eye axis and other biological parameters; use Canon fundus camera (model CR-2) to take two fundus photos that centered on the optic disc and the macula; the diagnosis method of maculopathy: based on the myopic population (spherical equivalent refraction less than -0.5 D), any of the following symptoms in the fundus was judged to be maculopathy: diffuse chorioretinal atrophy, patchy chorioretinal atrophy, macular atrophy, lacquer cracks, and myopic choroidal neovascularization appeared in the posterior pole. Fuchs spots were classified as myopic choroidal neovascularization. Using the sixth census data of China, the prevalence of maculopathy was graded and gender-standardized. The SMOTE algorithm was used to balance data. Logistic regression was used to explore the influencing factors of myopic maculopathy. the ROC curve was used to estimate the predictive power of the influencing factors. Main Outcome Measures Crude prevalence and age-sex standardized prevalence of maculopathy. Results Of the 5055 people over the age of 40 with clear-readable fundus photographs, 1177 had myopia, of which 35 had myopic maculopathy. In the myopic population, the prevalence of myopic maculopathy was 2.97%, and the age-gender standardized prevalence was 2.65%. Univariate analysis showed: for age (t=10.910, P<0.001), education (χ2=21.511, P<0.001), marital status (χ2=62.488, P<0.001), BMI (t=-6.400, P<0.001), blood glucose (t=-4.199, P=0.014), diopter value (Z=-15.766, P<0.001), intraocular pressure (Z=-7.384, P<0.001) and BCVA (t=-24.384, P<0.001), there was statistically significant difference between the myopic maculopathy group and the control group. Logistic regression results showed that age and diopter were risk factors for myopic maculopathy. IOP was a protective factor for myopic maculopathy. The odds ratio (OR) values were 1.056 (95% confidence interval, CI: 1.025, 1.087), 0.667 (95% CI: 0.603, 0.738) and 0.841 (95% CI: 0.762, 0.928) respectively; ROC curve analysis showed that using age, diopter and IOP to predict myopic maculopathy, the area under the curve can reach 0.936 (95% CI: 0.918, 0.953). Conclusion The age-gender standardized myopic maculopathy prevalence rate in myopic population over 40 years old in rural area of China is 2.65%. Age, spherical refractive error, and IOP are influence factors of myopic maculopathy. Older age, lower IOP, and larger refractive error will increase disease risk. (Ophthalmol CHN, 2021, 30: 177-183)

Genotypic and phenotypic characteristics of Chinese carriers with CHM gene variation

Song Yuning, Chen Chunjie, Xie Yue, Sun Tengyang, Xu Ke, Li Yang

2021, 30(3):  211-216.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.009

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Objective To summarize and analyze the phenotypic and genotypic characteristics of Chinese carriers with CHM gene variation and compare with foreign carriers. Design Retrospective case series. Participants Six carriers from five choroideremia families with CHM gene variation identifying in the Beijing Tongren Eye Center. Methods The proband and family members underwent detailed ophthalmological examination. Sanger sequencing, target exonm sequencing (TES) and real-time quantitative PCR were used to determine the pathogenic variations of CHM gene in 5 CHM families. Main outcome measures Visual acuity, fundus image, optical coherence tomography image (OCT), fundus autofluorescence (FAF) and gene variations carried by each carrier. Results 6 carriers came from 5 unrelated families. A total of 5 CHM gene variations were detected in these carriers. The average age of all female carriers was（34.00±14.83） years (range 8~53 years old). They had no symptoms, such as decreased vision, night blindness, and visual field contraction. The fundus images showed punctate or flaky hypopigmentation of the retina, which can be accompanied by small yellowish well-defined dots. Mottled flake or mosaic-like low fluorescence could be seen on FAF, with dotted hyperfluorescence. Two carriers were followed up for three years. Their eyesights were stable and their fundus was almost unchanged. Conclusion This study expanded the variation spectrum of CHM gene variations. Compared with European and American carriers with CHM gene variations, the damage of visual function and fundus changes of Chinese female carriers were slighter. (Ophthalmol CHN, 2021, 30: 211-216)

Association of diabetic macular edema with impaired renal function

Zhao Huiying, Liu Yan, Yin Yingxia, Wang Wei, Zhou Huaiyu, Wu Xiangli, Chen Dongjun, Chen Jianhua

2021, 30(3):  232-235.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.013

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Objective To investigated the association of diabetic macular edema (DME) with the impaired renal function in a sample of patients with type 2 diabetes. Design Retrospective case series. Participants A total of 1023 patients with type 2 diabetes hospitalized in the Endocrinology Department of Beijing Geriatric Hospital, who were consulted in ophthalmology, from Jan 2016 to Dec 2020. Methods Age, blood pressure, serum creatinine, fasting venous blood glucose, glycosylated hemoglobin and urinary microalbumin were obtained by reviewing the medical records. Estimated glomerular fifiltration rate (eGFR) was assessed using the CKD-EPI formula and graded (normal renal function ≥ 90 mL/min/1.73 m2; impaired renal function, 60~89 mL/min/1.73 m2; and renal inadequacy < 60 mL/min/1.73 m2). Stereoscopic color fundus image and optical coherence tomography image were also reviewed. DME was confirmed according to standard of Early Treatment Diabetic Retinopathy Study. The correlation between stage of eGFR and presence of DME was assessed by Logistic regression. Main Outcome Measures The presence of DME in different eGFR group. Results Of the 1023 patients with type 2 diabetes included, 120 patients had DME. In patients with normal, impaired and impaired renal function, the presence of DME were 8.30%, 20.51% and 24.63% (χ2=34.252, P=0.000). Logistic regression showed that the risk of DME in patients with impaired renal function and renal insufficiency was 1.604 and 2.573 times higher than those with normal renal function. Conclusion DME is associated with impaired renal function and its severity. (Ophthalmol CHN, 2021, 30: 232-235)

Effect of reducing the interval of spherical trail lens in improving the rate of red-green balance on the Duochrome test and visual quality

Zhen Yi, Wei Shifei, Gao Jie, Sun Yunyun, Wang Wenhua, An Wenzai, Zhang Wei, Wang Ningli

2021, 30(3):  184-188.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.004

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Objective Discuss whether reducing the interval of spherical trail lens can increase the Duochrome test realization rate and help myopia patients obtain better visual quality. Design Prospective clinical controlled studies. Participants 98 myopia patients who were recruited to undergo a vision test and refraction in Beijing Tongren Eye Center. Methods Use spherical trail lenses with 0.25 D intervals and 0.05 D intervals to perform Optometry using the same steps. If red and green balance can be achieved, the prescription of spherical power is equal to the count point; if the red and green balance cannot be achieved, record the maximum redness spherical power. Compare the rate of red-green balance on the Duochrome test, prescription spherical lens power, best corrected visual acuity (BCVA, LogMAR), and contrast sensitivity obtained by the same patient using different interval trail lens. Record the minimum spherical lens power change that can cause changes in the definition of the red and green background as the red-green difference perception threshold, and analyze the difference in the red-green difference perception threshold between different people. Main Outcome Measures The realization rate of red-green balance, prescription spherical lens power, BCVA. Results The realization rate of red-green balance on the Duochrome test for the 0.05 D interval group was significantly higher than for the 0.25 D interval group in both eyes (Right eye 82.6 % vs 11.2 %, χ2=100.38, P<0.01; Left eye 81.6 % vs 7.1%, χ2=110.14, P<0.01). The prescribed spherical power of the 0.05 D interval group was significantly higher than the 0.25 D interval group in both eyes (Right eye -3.79±1.52 D vs -3.70±1.52 D, t=11.86, P=0.000; Left eye -3.49±1.63 D vs -3.40±1.63 D, t=13.24, P=0.002). The BCVA (LogMAR) in the 0.05 D interval group was significantly better than in the 0.25 D interval group on both eyes (Right eye -0.039±0.076 vs -0.009±0.069, t=6.485, P=0.000; left eye -0.028±0.068 vs -0.003±0.070 t=6.209, P=0.000). 83.7% of people can distinguish the changes in the definition of the red and green visual indicators caused by the ≤0.05 D spherical trail lens. Conclusion Reducing the interval between spherical refraction lenses can significantly increase the realization rate of the red-green balance test. Myopias who use the red-green balance prescription obtained with 0.1 D interval spherical refraction lenses can obtain better visual quality. (Ophthalmol CHN, 2021, 30: 184-188)

Application of virtual reality technology in clinical teaching of ophthalmology

Xu Manhua, Wang Yanxi, Kang gangjin, Li Kaiming

2021, 30(3):  240-243.  doi:10. 13281/j. cnki. issn.1004-4469. 2021. 03. 015

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Objective To observe the applicational value of virtual reality technology in ophthalmology clinical teaching. Design Prospective randomized controlled study. Participants 48 undergraduate students of ophthalmology internship in Affiliated Hospital of Southwest Medical University from March to October in 2019. Methods 48 students were divided into two group, the experimental group (24 students) and the control group (24 students) randomly. The experimental group were taught with virtual reality technology and the control group were given traditional teaching. They were taught with the anatomy, physiology and biochemistry of the eyes. Six teachers were randomly assigned, and each teaching time was 120 minutes. The students were tested after the course on the day and 1 month after internship. The students and teachers were evaluated by questionnaire. Main Outcome Measures Paper tests and questionnaire score. Results The average paper test score of experimental group (90.63±6.65) was higher than that of control group (86.04±8.07) (t=-2.147, P=0.037); the average paper test score for one month after class of experimental group (85.21±7.14) was higher than that of control group (78.54±9.50) (t=-2.748, P=0.009). The questionnaire score of students in experimental group (8.53±0.49) was higher than that of control group (7.49±0.58) (t=-6.701, P=0.000); the questionnaire score of teachers in experimental group (9.03±0.21) was higher than that of control group (8.17±0.47) (t=-2.907, P=0.044). Conclusion Compared with traditional teaching, the virtual reality technology in clinical ophthalmology teaching has potential advantages, and it is a new teaching method worth popularizing. (Ophthalmol CHN, 2021, 30: 240-243)

Evalution of the macular function by microperimetry in dabetic macular edema

Li Hong, Song Yanping

2021, 30(3):  236-239.  doi:10.13281/j.cnki.issn.1004-4469.2021.03.014

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Objective To evaluate the visual function of diabetic macular edema (DME) patients by microperimetry, and evaluate the association of microperimetry measurements and visual acuity. Design Retrospective case series. Participants 220 eyes of 164 patients with DME were enrolled in Wuhan General Hospital of Chinese People's Liberation Army from April 2016 to January 2018. Methods All patients were examined with best corrected visual acuity (BCVA, logMAR), fluorescein fundus angiography (FFA), optical coherence tomography(OCT), full retinoscoppy, MAIA microperimetry. According to the fixation rate, the subjects were divided into 3 groups：stable fixation，relative unstable fixation, and unstable fixation. According to the difference of retinal sensitivity, 3 stages of fixation stability were divided: A1 (normal), A2 (suspicious), and A3 (abnormal), and the visual acuity of different retinal sensitivity groups in the fixation group were compared. Main outcome measures BCVA, average threshold (AT), 2 degree fixation rate (P1), 4 degree fixation rate (P2) and bivariate contour ellipse area for 63% (BCEA63), BCEA95. Results In patients with DME, the AT of stable group, relatively unstable group and unstable group was 23.55±3.90 dB, 20.87±6.04 dB, 19.30±5.41 dB, respectively (F=9.824，P=0.00). The BCVA (logMAR) of stable group, relatively unstable group and unstable group was 0.38±0.24, 0.59±0.29, 0.63±0.31, respectively (F=9.808，P=0.000). In the stable group, the BCVA of A1, A2 and A3 groups were 0.22±0.15, 0.36±0.21, 0.51±0.24, respectively (F=16.14, P＜0.001). In the patients of DME, logMAR BCVA was negatively correlated with AT（r=-0.712，P=0.000）、P1（r=-0.380，P=0.000）、P2 （r=-0.370，P=0.000）, and positively correlated with BCEA 63 (r=0.352, P=0.000), and BCEA95 (r=0.355, P=0.000). Multiple linear regression analysis showed that logMAR BCVA was independently affected by AT (OR=0.576，P=0.000) and P1（OR=0.800，P=0.000). Conclusion MAIA microperimetry can assess macular visual function in patients with DME. AT and P1 can be used as a good indicator for the evaluation of macular visual function and a predictor of logMAR BCVA. It can reflect the visual function of patients with DME. (Ophthalmol CHN, 2021, 30: 236-239)