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Table of Content

    25 September 2021, Volume 30 Issue 5
    Standardize the fitting of orthokeratology lenses to avoid the occurrence of infectious keratitis
    Liang Qingfeng
    2021, 30(5):  329-332.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.001
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    Overnight orthokeratology lenses reshaping the corneal morphology has become one of the important means to correct and delay the progress of myopia. In recent years, the prevalence of teenager’s myopia in China was higher and the demand for orthokeratology is increasing day by day. Corneal complications caused by overnight orthokeratology lenses are not uncommon in clinic. Infectious keratitis, as one of the most serious complications, poses a great threat to children's vision and should be paid great attention to. Identifying the risk factors, emphasizing the standard daily care, and regular follow-up are the keys to prevent the occurrence of orthokeratology lens-related infectious keratitis. Ophthalmologists should strengthen the understanding of early manifestation orthokeratology lens-related infectious keratitis, so as to early diagnosis and reasonable therapy, which contribute to better visual outcome. (Ophthalmol CHN, 2021, 30: 329-332)

    Some thoughts on the pathogenesis of primary angle-closure glaucoma
    Ren Zeqin
    2021, 30(5):  333-336.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.002
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    The existing understanding of the pathogenesis of primary angle-closure glaucoma(PACG) mainly centers on angle closure. Among them, the anatomical findings are the majority, and the related concepts and views are varied, but the specific relationship with the pathogenesis remains to be explored. This paper focuses on the outflow block of aqueous humor instead of angle closure. According to the concept of the “big posterior chamber” and the view of its combination with the lens-iris diaphragm, all the structures of the aqueous outflow pathway were reexamined and reintegrated to determine the predisposing links of outflow blocks. Furthermore, the anatomical properties of common terms and their connections with the pathophysiological mechanisms were largely sorted out, and the internal unified relationship between different blocking processes and different subtypes of PACG was also established. It is expected to provide a pathophysiological idea for understanding the pathogenesis of PACG. (Ophthalmol CHN, 2021, 30: 333-336)
    Association of brachial-ankle pulse-wave velocity and carotid-femoral pulse-wave velocity with retinal arteriosclerosis in a community-based population in Beijing
    Yan Shenshen, Sun Pengfei, Gao Lan, Jiang Yimeng, Fan Fangfang, , Jia Jia, , She Haicheng, Zhang Yan,
    2021, 30(5):  337-342.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.003
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    Objective To investigate the association of brachial-ankle pulse-wave velocity (baPWV) and carotid-femoral pulse-wave velocity (cfPWV) with retinal arteriosclerosis in a community-based population in Beijing. Design Cross-sectional study. Participants A total of 751 subjects with complete questionnaire, baPWV, cfPWV and fundus photograph data were included from an atherosclerosis cohort of Peking University First Hospital in Shijingshan District, Beijing, followed up from December 2019 to January 2020. Methods Retinal arteriosclerosis was graded according to Scheie’s classification by an experienced ophthalmologist. Logistic-regression model were used to investigate the association of PWV indices and retinal arteriosclerosis grading. Main Outcome Measures baPWV, cfPWV, retinal arteriosclerosis grading. Results Subjects were 62.3±7.3 years old, 61.0% (n=458) were female, 54.9% (n=412) had hypertension, 78.3% (n=588) had dyslipidemia, 32.8% (n=246) had diabetes, and 11.6% (n=87) had cardiovascular disease. baPWV and cfPWV was 17.1±4.0 m/s and 9.1±2.2 m/s respectively. In Logistic-regression model analysis, there was a positive correlation between baPWV and retinal arteriosclerosis grading after adjustment for sex, age, BMI, smoking status, fasting plasma glucose, systolic blood pressure(SBP), total cholesterol, triglycerides, eGFR group, hypoglycemic agents, lipid-lowering drugs, antihypertensive drugs, dyslipidemia and history of cardiovascular disease. Retinal arteriosclerosis increased 6% for every 1 m/s increase of baPWV (OR=1.06, 95%CI: 1.00-1.12, P=0.037). Compared with baPWV<14 m/s group, the risk of retinal arteriosclerosis aggravation increased 74% in subjects with baPWV≥14 m/s (OR=1.74, 95%CI: 1.12-2.70, P=0.013). Compared with baPWV<14 m/s group, the risk of retinal arteriosclerosis aggravation increased 66% in subjects with baPWV between 14 m/s and 18 m/s (OR=1.66, 95%CI: 1.07-2.59, P=0.025). Compared with baPWV<14 m/s group, the risk of retinal arteriosclerosis aggravation increased 125% in subjects with baPWV≥18 m/s (OR=2.25, 95%CI: 1.29-3.91, P=0.004). However, no significant relationship was observed between cfPWV and retinal arteriosclerosis grading. Conclusions baPWV was significantly associated with Scheie’s retinal arteriosclerosis grading. The higher the baPWV, the more severe the retinal arteriosclerosis. Compared with cfPWV, baPWV can better reflect the degree of retinal arteriosclerosis. (Ophthalmol CHN, 2021, 30: 337-342)

    Auto segmentation errors of optical coherence tomography in epiretinal membrane with different central macular thicknesses
    Huo Yanjiao, Guo Yan, Yang Lihong, Wei Wenbin
    2021, 30(5):  343-348.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.004
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    Objective To observe auto segmentation error (Seg E) determined by high definition optical coherence tomography (HD-OCT) in epiretinal membrane (ERM) with different central macular thicknesses (CMT). Design Diagnostic test. Participants Subjects were recruited from October 2018 to October 2019 in Beijing Tongren Hospital who were detected in HD-OCT and diagnosed as ERM (147 patients) and ERM with primary open-angle glaucoma (POAG) (32 patients). Methods The photographs of ocular fundus including color fundus camera, confocal scanning laser ophthalmoscope (cSLO) imaging, and HD-OCT were analyzed. The subjects were divided into A group ( ERM with CMT≤450 μm, 78 eyes), B group(ERM with CMT>450 μm, 69 eyes), C group (ERM with POAG, CMT≤450 μm, 32 eyes). HD-OCT images were evaluated by two doctors to discriminate the accuracy of segmentation of 11 layers  macular area. The number of the auto Seg E was calculated in A, B and C group separately and compared. Main Outcome Measures The rate of Seg E of ERM. Results 94 auto Seg E of eyes were determined among 179 ERM subjects (63.95%) (A group 37.18%, B group 94.20%, C group 40.63%). The percent of Seg Es in ganglion cell layer, inner plexiform layer inner nuclear layer and outer plexiform layer in group B were significantly higher than that of group A (all P<0.001). In addition, in other layers in group B shows no obvious differences compared with in group A (all P>0.05). There were no significant differences in all layers between group A and group C (all P>0.05). Conclusion The Seg E was easily found in HD-OCT scans of ERM, it was mainly located in macular inner layers. Especially when ERM with obvious macular edema, the number of Seg Es was significantly increased. (Ophthalmol CHN, 2021, 30: 343-348)

    The short-term analysis of different active age-related macular degeneration after anti-VEGF treatment by optical coherence tomography angiography
    Gu Zheyao, Yao Yong, Xi Ting, Zhang Chunyuan, Yang Guang
    2021, 30(5):  349-353.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.005
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    Objective To observe the response of different activity of age-related macular degeneration(AMD) to anti-vascular endothelial growth factor (VEGF) treatment observed by optical coherence tomography angiography(OCTA), and to analyze the correlation between the difference of response and the imaging features of choroidal neovascularization (CNV). Design Retrospective case series. Participants 54 patients (54 eyes) with wet AMD confirmed by fluorescein fundus angiography and/or indocybanine green angiography in Suzhou Municipal Hospital(North District). Methods According to the morphology of macular CNV based on OCTA, AMD patients were divided into active group and inactive group. The average number of anti VEGF was (4.06±0.89) in the active group and (3.83±0.79) in the inactive group. The differences of best corrected visual acuity (BCVA)(LogMAR) and central macular thickness (CMT) before and after anti-VEGF treatment were observed. The average follow-up was (4.17±1.02) months. Main Outcome Measures BCVA, CMT. Result In the active group, BCVA ( LogMAR)was (0.36±0.12) after anti-VEGF treatment, which was significantly higher than that before treatment (0.59±0.10) (t=5.962, P=0.000). In the inactive group, the BCVA of patients after anti-VEGF treatment was (0.62±0.11), which was not significantly higher than that before treatment (0.70±0.13) (t=1.445, P=0.182). In the active group, the CMT after anti-VEGF treatment was (286.17±97.47) μm, which was significantly lower than that before treatment (350.09±131.09) μm (t=3.792, P=0.001). In the inactive group, the CMT after anti-VEGF treatment was (222.40±34.93) μm, which was significantly lower than that before treatment (302.93±132.67) μm (t=2.756, P=0.015). Conclusion The morphological features of different active CNV observed by OCTA can effectively assess the response to anti-VEGF treatment in wet AMD patients. Wet AMD patients with active CNV have a good response to anti-VEGF treatment.  (Ophthalmol CHN, 2021, 30: 349-353)

    Evaluation of the diagnostic accuracy in three kinds of artificial intelligence diagnosis model for detection of diabetic retinopathy on fundus photographs
    Zhao Qi, Yang Wenli, Wei Wenbin, Zhang Yongpeng, Li Lei, Zhang Mengyu, Guo Jing
    2021, 30(5):  355-359.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.006
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    Objective To compare the consistency of artificial intelligence (AI) diagnosis models and ophthalmologist in grading diabetic retinopathy (DR). Design Diagnosis tests. Participants 236 cases (468 eyes) of diabetic patients in Beijing Tongren Hospital were selected. Methods Two-field non-mydriatic macula- or optic disc-centered fundus photographs were performed. Using ophthalmologist diagnosis as the golden standard, three kinds of AI diagnosis model(model 1, 2, 3) based on Convolutional Neural Network (CNN) were evaluated, including DR yes/no, referable DR and DR stagingtests. Main Outcome Measures Sensitivity (Se), specificity (Sp), area under curve (AUC). Results The Se, Sp and AUC of DR yes/no were 95.8%, 90.1% and 0.930 on model 1, 96.5%, 85.2% and 0.908 on model 2, and 96.2%,83.5% and 0.917 on model 3, respectively. The Se, Sp and AUC of referable DR were 93.9%, 90.1% and 0.933 on model 1, 97.7%,89.3% and 0.935 on model 2, and 95.4%, 89.8% and 0.926 on model 3, respectively. The Se, Sp and AUC of stages of DR were 72.9%~90.1%, 93.9%~97.8% and 0.854~0.930 on model 1, 68.8%~92.1%, 90.6%~98.2% and 0.831~0.914 on model 2, and 75.0%~83.5%, 89.2%~96.8% and 0.849~0.917 on model 3, respectively. Conclusion Three kinds of AI diagnosis model have good sensitivity and specificity for the determination of DR and referable DR, and it could be used as an auxiliary tool for DR screening of diabetic patients. (Ophthalmol CHN, 2021, 30: 355-359)

    The influence on corneal endothelial cells of anterior chamber bubbles during femtosecond laser in situ keratomileusis
    Wang Xingcun, Zhang Guangfeng, Zhu Liqiang, He Jiao
    2021, 30(5):  360-366.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.007
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     Objective To explore the influence on corneal endothelial cell of anterior chamber bubbles during femtosecond laser in situ keratomileusis (LASIK). Design Retrospective cases series. Participants Twenty-three patients (23 eyes with anterior chamber bubbles) in The Central Theater Command Air-Force Hospital of PLA from February 2012 to November 2017 who accept LASIK surgeries using femtosecond leaser. Methods The eyes with anterior chamber bubbles during IntraLase femtosecond laser LASIK were included in observation group, and the eyes without anterior chamber bubbles during LASIK were included in the control group. Anterior chamber bubbles based on the number of bubbles divided into first-level (a little bubbles in pupil area), second-level (medium dose bubbles covering pupil area) and third-level (a lot of bubbles covering completely pupil area). The mean central corneal endothelial cell density(CED), percentage of hexagonal endothelium (HEX) and coefficient of variation(CV) of corneal endothelial cell area measured by Topcon SP-2000P noncontact specular microscope of two groups were compared at preoperation, and at 1 day, 1 week, 1 month, 3 months, 6 months after operation.  Main Outcome Measures CED, percentage of HEX and CV of corneal endothelial cell area. Results Anterior chamber bubbles located on nasal side in 11 eyes (47.83%), on bitamporal side in 8 eyes (34.78%), on below side in 3 eyes (13.04%) and on upward side in 1 eye (4.35%). All anterior chamber bubbles moved from anterior chamber angle to pupil. 15 eyes (65.22%) were the first-level anterior chamber bubbles, 7 eyes (30.43%) were the second-level and 1 eye (4.35%) was the third-level. The CED of observation group at preoperative and postoperative 1day, 1 week, 1 month, 3 months, 6 months was 2901±180 cells/mm2, 2833±153 cells/mm2, 2852±149/mm2, 2835±171 cells/mm2, 2863±117 cells/mm2 and 2854±88 cells/mm2, respectively. The percentage of HEX of observation group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 45.2%±5.4%, 46.5%±5.4%, 46.2%±5.4%, 47.3%±5.5%, 47.6%±4.7% and 47.7%±4.5%, respectively. The CV of corneal endothelial cell area of observation group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 45.17%±5.39%, 46.50%±5.43%, 46.22%±5.43%, 47.32%±5.50%, 47.62%±4.68% and 47.72%±4.52%, respectively. The CED of control group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 2989±349 cells/mmm2, 2948±246 cells/mm2, 2958±331 cells/mm2, 2972±321 cells/mm2, 2958±342 cells/mm2 and 2962±355 cells/mm2, respectively. The percentage of HEX of control group at preoperative and postoper-ative 1 day, 1 week, 1 month, 3 months, 6 months was 46.3%±7.5%, 44.1%±8.2%, 43.9%±7.3%, 43.7%±7.4%, 44.3%±6.9% and 43.9%±7.1%, respectively. The CV of corneal endothelial cell area of control group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 43.81%±8.15%, 46.41%±6.37%, 46.58%±6.67%, 46.73%±7.12%, 46.81%±6.12% and 46.76%±7.06%, respectively. The difference of CED between control group and observation group was statistically significant (F=2.486, P=0.022), and the difference between postoperative and preoperative parameters of CED in the same group was not statistically significant (F=1.342, P=0.260). The difference of percentage of HEX between control group and observation group was not statistically significant (F=0.469, P=0.497), and the difference between postoperative and preoperative parameters of percentage of HEX in the same group was statistically significant (F=5.966, P=0.004). The difference of CV of corneal endothelial cell area between control group and observation group was not statistically significant (F=0.4106, P=0.746), and the difference between postoperative and preoperative parameters of CV of corneal endothelial cell area in the same group was statistically significant (F=21.248, P=0.000). Conclusion The anterior chamber bubbles produced in femtosecond laser LASIK have a certain effect on CED in a short time. However, it had no significant effect on percentage of HEX and CV of corneal endothelial cell area. (Ophthalmol CHN, 2021, 30: 360-366)

    Epidemiologic characteristics of acute spring allergic conjunctivitis in ophthalmic emergency in 2019-2021
    Ma Nan, Fu Jing, Meng Zhaojun, Yang Yiquan, Li Jian
    2021, 30(5):  369-373.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.008
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    Objective To investigate the trend changes and influencing factors of spring allergic conjunctivitis in ophthalmic emergency in 2019-2021. Design Retrospective cases series. Participants 1985 patients with acute allergic conjunctivitis in the ophthalmic emergency department of Beijing Tongren Hospital in March 2019, and 912 and 2343 patients with acute allergic conjunctivitis in the same period of 2020 and 2021. Method Date was extracted from hospital information system, including ages, genders, diagnoses and number of patients. The air quality index and pollen concentration index were analyzed with daily allergic conjunctivitis patient number. Patients were divided into juvenile group (0-17 years old), youth group (18-45 years old), middle-aged group (46-64 years old) and elderly group (≥ 65 years old). Main Outcome Measures Ages, number of patients, air quality index and pollen concentration index. Result In March 2019, 2020, 2021, there were 1985 cases (34.5%), 912 cases (29.9%) and 2343 cases (39.7%) of allergic conjunctivitis patients. In March 2019, there were 541 (27.2%), 1083 (54.6%), 301 (15.2%) and 60 (3.0%) cases in juvenile group, youth group, middle-aged group and elderly group, respectively. In March 2020, there were 125 (13.7%), 562 (61.6%), 177 (19.4%) and 48 (5.2%) cases, respectively. In March 2021, there were 549 (29.4%), 1266 (54.0%), 251 (13.4%) and 73 (3.1%) cases, respectively. In March 2019, 2020 and 2021, there was no correlation between the number of allergic conjunctivitis patients and the air quality index (r=0.186, 0.111, 0.172, all P>0.05). In March 2021, the number of allergic conjunctivitis patients was highly correlated with the pollen concentration index (r=0.908, P<0.001). Conclusion Influenced by the COVID-19 epidemic and home isolation, the number of ophthalmic emergency visits of allergic conjunctivitis in March 2020 was decreased 1/2. Moreover the number of juvenile groups visits were decreased 3/4 in March 2020 compared with in March 2019. Rising pollen concentrations increased the incidence of allergic conjunctivitis in Beijing in March 2021. (Ophthalmol CHN, 2021, 30: 369-373)

    Genotype and clinical phenotype analysis of lipoid proteinosis patients with pathogenic variants in ECM1 gene 
    Chang Haoyu, Xu Ke, Xie Yue, Shi Jie, Zhang Xin, Tian Lu, Li Yang
    2021, 30(5):  374-378.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.009
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     Objective To describe the clinical manifestations and characteristics of pathogenic gene variants in Chinese patients carrying ECM1 gene variants causing lipoid proteinosis. Design Retrospective case series. Participants 16 Chinese probands (2 patients from Beijing Tongren Hospital and 14 patients from 11 recent literatures) with pathogenic variants in ECM1 gene. Methods The clinical manifestations of the patients were reviewed. Peripheral blood samples of patients and their parents were collected to extract genomic DNA, and Sanger sequencing was used to sequence the ECM1 gene in probands. Multiple bioinformatics analysis software was used to predict the pathogenicity of the suspected pathogenic variants and the pathogenic variants were performed the co-segregated analysis. Main Outcome Measures ECM1 gene variants, ocular signs, voice changes, and skin mucosal abnormalities. Results The mean age of the 16 patients was (20.9±13.8) years, and all patients presented with varying degrees of hoarseness and eyelid bead-like papules. 8 patients had hoarseness since birth, 2 in infancy and 6 in early childhood. The missense variants were the main types of detected variants, accounting for 35.7% of the total variants. The variants were concentrated in exons 6 and 7, accounting for 58.7% of all variants. The p.(Cys220Gly) variant located in exon 6 was the hot spot of variants in the Chinese population. Conclusion Patients with lipoid proteinosis all have typical clinical features of hoarseness and eyelid bead-like papules. Chinese ECM1 gene variants are concentrated in exons 6 and 7, and the hot spot is p. (Cys220Gly) of exon 6. (Ophthalmol CHN, 2021, 30: 374-378)

    Clinical and pathological analysis of 112 cases of periorbital pilomatricoma in children
    Ren Yanhong, Shi Caiping, Zhu Huihui, Gu Weizhong
    2021, 30(5):  379-383.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.010
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     Objective To explore the clinical and pathological characteristics of periorbital pilomatricoma in children. Design Retrospective case series. Participants 112 children with periorbital pilomatricoma who underwent surgical treatment in Children's Hospital of Zhejiang University School of Medicine from January 2014 to June 2020. Methods The clinical and pathological data of all patients including the age, gender, location of onset, ultrasound and pathological characteristics were reviewed. Main Outcome Measures Children's age, sex, location of onset, ultrasound and pathological characteristics of the tumor. Results 112 cases of children had an operating age of 7 months to 11 years and 2 months, with median operating age of 3 years and 8 months. 54 cases were males. 74 cases (66.1%) located in the eyebrow, 29 cases (25.9%) in the upper eyelid, 7 cases (6.2%) in the lower eyelid, and 2 cases (1.8%) in the inner canthus of the eyelid. 57 cases underwent preoperative ultrasound examination, 38 cases (66.8%) had calcification in the tumor, and 38 cases (66.8%) had blood flow signals in or around the tumor. Histopathological examination showed shadow cells and basophils, of which 91 cases (81.3%) had calcifications. 78 cases (69.6%) showed multinucleated giant cell response. All cases were surgically removed, and there was no recurrence or malignant transformation after surgery. Conclusion Children with periorbital subcutaneous nodules should consider the possibility of pilomatricoma. Ultrasonography has a certain diagnosis value for periorbital pilomatricoma. Early surgical complete resection is effective treatment. (Ophthalmol CHN, 2021, 30: 379-383)

    Ophthalmological manifestations of neurosyphilis in 141 cases 
    Wang Shengnan, Sun Huiyu, Mao Feifei, Li Dan, Lu Dan, Liu Xiyao
    2021, 30(5):  386-390.  doi:10.13281/j.cnki.issn.1004-4469.2021.05.011
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    Objective To investigate the characteristics of ophthalmic manifestation of patients with neurosyphilis. Design Retrospective case series. Participants 141 cases (282 eyes) of neurosyphilis patients admitted to Beijing Ditan Hospital in 2016-2019. Methods Medical records of all patients data were reviewed, including best corrected visual acuity, slit lamp, intraocular pressure, ocular position, eye movement and fundus examination. Clinical manifestations and imaging characteristics of patients were reviewed. Main Outcome Measures Best corrected visual acuity, pupil, optic nerve, retinal choroidal changes and neuropathy associated with ocular movement. Results In all 141 cases (282 eyes), 74 cases(52.5%)(127 eyes) had ocular manifestations, of which pupil abnormalities (43.3%) were the most common, including Argyll-Robertson pupil was the only clinical manifestation in 18 cases (33 eyes) and Adie pupil was the only clinical manifestation in 6 cases (8 eyes). 35 cases(24.8%) (61 eyes) expressed as uveitis and ophthalmoplegia was found in 7 cases (5.0%) (8 eyes). 6 cases (4.3%) (11 eyes) expressed as optic neuropathy. Syphilitic scleritis was found in 2 cases (1.4%) (2 eyes). Conclusion The characteristics of ophthalmic manifestation of patients with neurosyphilis are various. The common manifestations are pupil change and uveitis involving optic nerve. (Ophthalmol CHN, 2021, 30: 386-390)