Ophthalmology in China

Optical coherence tomography angiography for retinal diseases: pearls and pitfalls

You Qisheng

2022, 31(2): 81-88. doi:10.13281/j.cnki.issn.1004-4469.2022.02.001

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Optical coherence tomography angiography (OCTA) uses flowing blood cells as intrinsic motion contrast to produce depth-resolved images of blood flow in a rapid non-invasive fashion. Its limitations include limited field of view, unable to show vessel wall infiltration and leakage, imaging artifacts, and poor agreement of OCTA measurements among different devices. It is critical to recognize the artifacts while interpreting OCTA images. OCTA improved our understanding and clinical management of retinal diseases. OCTA is able to detect microvascular changes in diabetic patients before clinical retinopathy is detectable and quantify capillary dropout in different retinal plexus, which is significantly associated with visual prognosis and treatment requirement. OCTA can sensitively detect clinically unsuspected retinal neovascularization that is missed by experienced retinal specialist in diabetic patients. OCTA measured retinal neovascularization area is useful in monitoring treatment reaction in diabetic patients. For the first time, OCTA enable us to detect non-exudative choroidal neovascularization in vivo in patients with age-related macular degeneration. OCTA quantified choriocapillaris defect is significantly associated with the development and progression of geographic atrophy. （Ophthalmol CHN, 2022, 31: 81-88）

Decreasing the spherical lens adjustment interval maybe delay the progression of children's myopia

Zhen Yi, Cao Kai, Gao Jie

2022, 31(2): 89-93. doi:10.13281/j.cnki.issn.1004-4469.2022.02.002

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Objective To observe the progress of myopia in children with myopia after wearing frame glasses with 0.05 D and 0.25 D spherical lens interval. Design Retrospective case series. Participants 126 consecutive myopia children wore spectacles with 0.05 D spherical interval (53 cases, 25 males) and 0.25 D spherical interval (73 cases, 38 males) design from 2019 to 2021 in Beijing Tongren Hospital. Methods The data of 126 children in electronic medical record system of Beijing Institute of Ophthalmology was retrospectively analyzed. Extract relevant information including age, gender, diopter, time between before and after optometry, lens type, etc. The method and environment of optometry, material, manufacturing process and manufacturer of the two sets of lenses were the same, and the only difference was that the adjustment interval of the spherical lens when obtaining the prescription was 0.05 D and 0.25 D respectively. The data of the right eye was taken into the statistical analysis. The progression of myopia in the two groups was compared using independent sample t test and generalized estimating equation. Main Outcome Measures The monthly average changes of spherical equivalents. Results In 0.05 D spherical interval group and 0.25 D spherical interval group, the mean ages was 8.2±2.3 and 8.7±2.4 years, respectively (t=-1.276, P=0.204). The interval time between two adjacent prescriptions was 9.5±5.6 and 11.2±5.6 months respectively (t=-1.692, P=0.093). The equivalent spherical lenses was -2.24±1.49 D and -2.46±2.42 D respectively at the first prescription (t=0.587, P=0.558). The equivalent spherical lenses was -2.76±1.65 D and -3.36±2.62 D respectively in the second prescription (t=1.457, P=0.148). The equivalent spherical lens changes between the two prescriptions was -0.52±0.60 D and -0.89±0.79 D respectively (t=2.887, P=0.005). The monthly average changes of spherical equivalents was -0.05±0.05 D and -0.09±0.05 D, respectively (t=4.582, P<0.001). Through generalized estimating equation analysis, the average monthly equivalent spherical lens change was not correlated with age (χ2=11.241, P=0.260), but was correlated with the interval between prescription spherical lenses (χ2=32.826, P<0.001) and the time interval between two prescriptions (χ2=198.715, P<0.001). Conclusion Compared with adjusting the spherical lens at 0.25 D interval, the frame glasses made by adjusting the spherical lens at 0.05 D interval shows a tendency to delay the progression of children's myopia, which is worth verifying by further randomized controlled experiments. （Ophthalmol CHN, 2022, 31: 89-93）

Clinical features of patients with keratoconus misdiagnosed as optic neuropathy due to decreased vision

Guo Yin, Liu Lijuan, Li Jianjun, Liang Qingfeng, Tian Lei, Zhang Yang

2022, 31(2): 94-98. doi:10.13281/j.cnki.issn.1004-4469.2022.02.003

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Objective To study the clinical characteristics of patients with keratoconus who were misdiagnosed as optic neuropathy due to short-term vision loss. Design Retrospective case series. Participants 26 patients (33 eyes) were initially misdiagnosed as optic neuropathy, but finally diagnosed as keratoconus after relevant examinations from 2010 to 2020 in Beijing Tongren Eye Center. Methods The patients' medical records and auxiliary ophthalmic examination results, including corneal topography, visual evoked potentials (VEP), visual field and etc were reviewed. Main Outcome Measures Visual acuity, refraction, corneal curvature, ocular signs. Results Among all 26 cases, 20 patients were male (76.9%), and mean age was (27.8±8.2) years. 19 patients (73.1%) were affected unilaterally, and 7 patients (26.9%) were affected bilaterally. The corrected visual acuity was from 0.02 to 1.0 when diagnosed as neuropathy. The average sphere refraction of affected eyes was (-7.18 ± 3.63) D, cylinder refraction was (-2.09±1.86) D. The corneal curvature K1 and K2 was (52.83±3.89) D and (47.55±3.64) D respectively in affected eyes. Among 19 monocular patients, the sphere and cylinder refraction was (-6.51±2.99) D and (-2.27±1.60) D in affected eyes, significantly higher than the lateral eyes (-3.06±2.09) D and (-1.11±1.03) D (P<0.001 and P=0.048). The color fundus images of 28/33 eyes (84.8%) were slightly blurred. The corneal morphology with slit lamp microscopy was normal in 18/33 eyes (54.6%), and only 15/33 eyes (45.4%) were found slight corneal cone-like protrusion and mild stromal opacity. The relative afferent pupillary defect (RAPD) of all patients were negative. No abnormalities were observed in the posterior fundus, VEP and electroretinogram. Conclusion Keratoconus patients misdiagnosed as optic neuropathy due to decreased vision often have a short-term increased myopia and astigmatism, ignoring the signs of optic neuropathy. Corneal topography examination is beneficial to the diagnosis of keratoconus. （Ophthalmol CHN, 2022, 31: 94-98）

Analysis of disease composition in 434 children with pediatric keratoplasty

Yu Ting, Xiao Gege, Peng Rongmei, Hong Jing

2022, 31(2): 98-103. doi:10.13281/j.cnki.issn.1004-4469.2022.02.004

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Objective To analyze the disease composition of children keratoplasty. Design Retrospective case series. Participants 434 keratoplasty children (514 eyes) aged 14 years and below from Peking University Eye Center between January, 2008 and December, 2020. Method The electronic medical records of children keratoplasty were evaluated retrospectively, including gender, recipient age, disease diagnosis, surgical procedures and so on. Main Outcome Measures Composition ratio of disease and surgical procedures. Results In 434 patients, there were 225 males (51.8%). Mean primary recipient age was 3.8±4.1 years (range, 2 months-14 years), including 307 eyes (59.7%) which were less than 3 years. Of the 514 eyes accepted primary keratoplasty, 399 eyes (77.6%) were congenital corneal opacity, 47 eyes (9.1%) were acquired traumatic corneal opacity and 68 eyes (13.3%) were acquired non-traumatic corneal opacity. The main cause for keratoplasty among congenital corneal opacity was kerato-irido-lenticular dysgenesis (30.9%, 159 eyes), followed by limbal dermoid (18.7%, 96 eyes). Penetrating keratoplasty accounts for 56.6% of total keratoplaties. 60 eyes (11.7%) underwent two or more keratoplasty. Conclusion Congenital corneal opacity, especially kerato-irido-lenticular dysgenesis, is the most common disease of pediatric keratoplasty in Peking University Eye Center. Penetrating keratoplasty is the main surgical type. （Ophthalmol CHN, 2022, 31: 98-103）

Prognostic factors of 354 cases for eyelid sebaceous gland carcinoma#br#

Nie Zihan, Xu Xiaolin, Li Bin, Qi Chang, Ding Jingwen, Li Dongmei

2022, 31(2): 104-108. doi:10.13281/j.cnki.issn.1004-4469.2022.02.005

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Objective To explore risk factors of prognosis in eyelid sebaceous gland carcinoma (SGC). Design Retrospective case series. Participants 354 eyelid SGC patients with surgical treatment from 2006 to 2020 in Beijing Tongren Hospital. Method Medical records and follow-up data were reviewed. The tumor was graded by 8th American Joint Committee on Cancer (AJCC). Logistic regression was used to analyze the related factors of recurrence. Kaplan-Meier method and log-rank test was used for survival analysis. Main Outcome Measures Gender, age, habitation region, initial tumor location, size and classification of the tumor, duration of patient's complaints, recurrence and metastasis. Results 354 patients were with a mean age of 61.68±11.55 years and 212 cases (59.89%) were female. Upper eyelids were the most predilection sites of SGC with 214 cases (60.45%). The median duration time was 6.00 (3.00, 17.00) months before operations (range from 0.25~120 months). The classification of cases included T1 to T4 stage, with the number of 166 (46.89%), 129 (36.44%), 36 (10.17%) and 23 (6.50%), respectively. 68 patient relapsed with a rate of 19.21%. 3 of 22 metastasis patients died from the tumor. The 5-year metastasis rate was 4.69% (n=10), the 10-year metastasis rate was 7.98% (n=17), and the total metastasis rate was 10.33%. Older age (P=0.035) and severe AJCC stage (P=0.012) were the risk factors of recurrence. Conclusion The older the age and the higher grade of eyelid sebaceous gland carcinoma patients, the greater the chance of recurrence. （Ophthalmol CHN, 2022, 31: 104-108）

Efficacy and safety of gonioscopy assisted transluminal trabeculotomy (GATT) for primary childhood glaucoma

Gao Chuanwen, Zhang Weijia, Di Haohao, Qin Shujuan, Jin Jing, Zhao Zhiling, Jia Fei, Wang Huaizhou

2022, 31(2): 109-114. doi:10.13281/j.cnki.issn.1004-4469.2022.02.006

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Objective To evaluate the efficacy and safety of gonioscopy assisted transluminal trabeculotomy (GATT) for the surgical management of primary childhood glaucoma. Design Retrospective case series. Participants Consecutive 8 primary congenital glaucoma (PCG) patients (9 eyes) with mean age 2.4±1.5 years old and 15 juvenile open angle glaucome(JOAG) patients (20 eyes) with mean age 19.0±7.2 years old underwent GATT between April 2018 and July 2019 by a single surgeon in Zhengzhou Second Hospital. Methods Medical records of patients were reviewed. Intraocular pressure (IOP) and usage of anti-glaucoma medication were compared between before surgery and last visit after surgery. Surgical success was defined as a postoperative IOP of ≤ 21 mmHg with (qualified success) or without (complete success) the use of anti-glaucoma medication. Mean follow-up time was 27.5±3.7 months (range 24-36 months). Main Outcome Measures IOP, number of anti-glaucoma medications, surgical complications. Results Post-operative IOP (14.3±3.5 mmHg) and number of anti-glaucoma medication (0, range 0-3) decreased significantly compared with the pre-operative values (30.4±12.2) mmHg (t=7.4, P＜0.001), 3 (range2~5） (z=-4.7, P＜0.001), respectively. The complete success rate was 72.4% and the qualified success rate was 93.1%. Hyphema was seen in all eyes (29/29, 100%), 14/29(48.3%) eyes had IOP spike in early stage after surgery. There was no severe complications occurred in all cases. Conclusion GATT has a medium and long-term effectiveness and is safety in the management of PCG and JOAG. （Ophthalmol CHN, 2022, 31: 109-114）

Accuracy of refractive prediction in cataract patients with shallow anterior chamber and 22-25 mm axial lengths

Ding Ning, Feng Yu, Dong Zhe

2022, 31(2): 114-117. doi:10.13281/j.cnki.issn.1004-4469.2022.02.007

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Objective To compare the accuracy of 4 intraocular lens calculation formulas in the prediction of postoperative refraction in cataract patients with normal or nearly normal axial lengths (AL) but shallow anterior chamber depths (ACD). Design Retrospective case series. Participants A total of 66 cataract patients (86 eyes) with AL 22~25 mm but shallow and deep ACD in Beijing Tongren Hospital from December 2020 to August 2021. Methods All patients were performed cataract surgery with IOLMaster 500 optical biometry. Preoperative and postoperative ACD were measured. Manifest refraction was performed at 3-month postoperative visit. The performance on 4 formulas with respect to the error in predicted spherical equivalent was compared. Main Outcome Measures The mean prediction errors, mean absolute errors (MAE), median absolute errors and percentage of eyes with refractive prediction errors. Results At 3 months after surgery, the mean postoperative ACD (3.88±0.61 mm) was deeper than preoperative ACD (2.34±0.14 mm) (P<0.001). All formulas had mean prediction error values less than ±0.25 D that were not significantly different. There was no significant difference between Barrett (0.033 D) and Kane formula (-0.040 D) in the mean prediction errors. There was no significant difference in MAE between Barrett and Haigis formula (P=0.073), and between Barrett and Kane formula (P=1.000). The differences between the other formulas were statistically significant. Haigis formula had a highest percentage of eyes (30.23%) within the range of ±0.25 D, while Barrett formula had the highest percentage (60.47%) in the range of ±0.50 D. There were no significant differences between other formulas. Conclusion In eyes with normal or nearly normal AL but shallow ACD, modern biometric technology and new-generation formulas improved refractive prediction results. （Ophthalmol CHN, 2022, 31: 114-117）

Comparison of Pentacam AXL and IOLMaster 500 for measuring the parameters of pseudophakic eyes

Fan Rui, Chen Wei, Yang Wenli, Li Dongjun, Wang Ziyang, Zhao Qi, Li Yifeng, Cui Rui, Shen Lin, Liu Qian

2022, 31(2): 118-122. doi:10.13281/j.cnki.issn.1004-4469.2022.02.008

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Objective To compare the difference between two optical biometric instruments Pentacam AXL and IOLMaster 500 for measuring the parameters of pseudophakic eyes. Design Prospective cases series. Participants 69 cases (69 eyes) of pseudophakic eyes were selected in October 2021 in Beijing Tongren Hospital. Methods The axial length (AL), keratometry (K1, K2 and Km), anterior chamber depth ACD) and white to white (WTW) corneal diameter were measured by Pentacam AXL and IOLMaster 500 successively. The results of two groups were tested by paired t test and reliability analysis, and MedCalc software was used to do the Bland-Altman analysis. Main Outcome Measures AL, K1, K2, Km, ACD, WTW, intraclass correlation coefficient(ICC) value, 95% consistency limit of Bland-Altman diagram and points outside the 95% consistency limit. Results AL measured by Pentacam AXL and IOLMaster 500 was (23.57±1.18) mm, (23.58±1.18) mm respectively and K1 was (43.57±2.02) D, (43.65±2.09) D respectively (all P>0.05). The K2 was (44.55±2.04) D, Km was (44.06±2.01) D and WTW was (11.25±0.37) mm measured by Pentacam AXL, which were less than (44.80±2.07) D, (44.23±2.05) D and (11.48±0.38) mm measured by IOLMaster 500 (all P<0.001). ACD (4.14±0.82) mm measured by Pentacam AXL was greater than (3.82±0.59) mm of IOLMaster 500 (t=2.274, P=0.041). The ICC values of AL, K1, K2, and Km were all close to 1 (0.999, 0.990, 0.994, and 0.996 respectively). The 95% consistency limit of Bland-Altman analysis was also close, AL (-0.1345, 0.1039) mm, K1 (-0.9013, 0.7291) D, K2 (-0.8627, 0.3622) D, Km (-0.6815, 0.3451) D, ACD (-0.7055, 1.3397) mm, WTW (-0.7092, 0.2499) mm. Only the points of AL 3.28% (2/61), K1 5.78% (4/69), K2 7.25% (5/69), Km 5.78% (4/69), ACD 0 (0/14) and WTW 5.56% (3/54) were outside the 95% consistency limit. Conclusion There are some differences in axial length, keratometry, anterior chamber depth and white to white of pseudophakic eyes between Pentacam AXL and IOLMaster 500. Measurement results cannot be used instead of each other. （Ophthalmol CHN, 2022, 31: 118-122）

Huo Yanjiao, Guo Yan, Yang Lihong, Wei Wenbin

2022, 31(2): 125-129. doi:10.13281/j.cnki.issn.1004-4469.2022.02.009

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Objective To compare age-related changes of the macular vessel density and perfusion density with optical coherence tomography angiography (OCTA) measurements in normal adults between under and over beyond 40 years old. Design Cross-sectional study. Participants One hundred and forty-two subjects (76 males, aged 45.50±12.65 years) were recruited from October 2020 to December 2020 in the Beijing Tongren Health Center. Methods All subjects were divided into 18-39 years old group and ≥40 years old group. Visual acuity, spherical equivalent (SE), intraocular pressure, slit lamp microscope, color fundus photography and 6 mm×6 mm macular OCTA were conducted for all eyes. The data of right eye was analyzed. Simple regression analysis determined the association between age vs. macular vessel density, perfusion density and area of FAZ. Main Outcome Measures Macular vessel density, perfusion density and the area of FAZ. Results The macular of total vessel density was (17.49±1.15) mm-1 in age beyond 40 years group, which was significantly lower than that of the age under 40 years (17.88±9.76) mm-1(P=0.037). The outer-ring of macular vessel density in age beyond 40 years group was (17.83±1.12) mm-1, which was significantly lower than that of the age under 40 years (18.24±1.00) mm-1. There were no significant differences in other macular vessel density, perfusion density and the area of FAZ between the two groups (all P＞0.05). The macular total vessel density decreased by 0.02 mm-1 (t=-2.34, P=0.021) per year with increasing age. The outer-ring of macular vessel density decreased by 0.02 mm-1 (t=-2.42, P=0.017) per year with increasing age. Age have no impact on other macular vessel density parameters, perfusion density and the area of FAZ(all P＞0.05). Conclusion Macular vessel density shows age-related decrease with significant drop in the 4th decade. These factors should be considered carefully if using OCTA to measure macular vessel flow. （Ophthalmol CHN, 2022, 31: 125-129）

Function of macula and its correlation with visual acuity after intravitreal Conbercept for central retinal vein occlusion induced macular edema #br#

Wang Yunchang, Li Rongrong, Xiao Zhe, Cai Yi, Wei Ziyi, Shao Changliang, Zhang Mengge, Zhao Huiran, Wang Lifei

2022, 31(2): 130-134. doi:10.13281/j.cnki.issn.1004-4469.2022.02.010

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Objective To study the function changes of macula and its correlates with visual acuity after intravitreal Conbercept for central retinal vein occlusion (CRVO) induced macular edema (ME). Design Prospective case series. Participants 31 patients (31 eyes) with ME secondary to non-ischemia CRVO were enrolled from August 2020 to December 2020. Methods All the subjects were received Conbercept 3+PRN intravitreal injections. Before treatment and 1, 3 and 6 months after treatment, OCTA and mf-ERG were checked. Main Outcome Measures Best corrected visual acuity(BCVA) (LogMAR), amplitude density of P1 wave and implicit time of P1, N1 wave from mf-ERG ring 1 and ring 2. Results Compared to the baseline (0.87±0.27), BCVA was greatly improved at 1, 3, 6 months after treatment (0.71±0.22, 0.67±0.18, 0.51±0.14, respectively) (F=18.771, P=0.004). The implicit time of N1 wave from ring 1 at baseline and each follow-up point was 31.69±2.80 ms, 28.73±1.34 ms, 26.47±0.99 ms, 24.23±1.30 ms, respectively (F=86.023, P=0.007). The implicit time of P1 wave from ring 1 at baseline and each follow-up point was 50.52±3.80 ms, 48.68±4.01 ms, 46.43±3.35 ms, 43.59±3.69 ms, respectively (F=21.333, P=0.010). The implicit time of N1 wave from ring 2 at baseline and each follow-up point was 29.89±3.04 ms, 27.55±2.98 ms, 24.41±2.77 ms, 22.55±2.45 ms, respectively (F=38.566, P=0.002). The implicit time of P1 wave from ring 2 at baseline and each follow-up point wase 48.41±3.68 ms, 46.81±2.97 ms, 44.67±3.36 ms, 39.09±2.77 ms, respectively (F=46.681, P=0.003). The amplitude density of P1 from ring 1 at baseline and each follow-up point was 15.81±5.42 nv/deg2, 21.01±4.70 nv/deg2, 23.25±3.98 nv/deg2, 27.42±6.01 nv/deg2, respectively (F=26.622, P=0.001). The amplitude density of P1 from ring 2 at baseline and each follow-up point was 4.00±1.47 nv/deg2, 6.21±2.16 nv/deg2, 7.89±2.05 nv/deg2, 10.67±2.01 nv/deg2, respectively (F=71.764, P=0.005). Pearson correlation analysis showed there was no correlations between BCVA and the implicit time of N1 (r=0.112, P=0.609; r=0.284 P=0.188). However there was positive correlations between BCVA and the implicit time of P1(r=0.784, P=0.013; r=0.592, P=0.036) and negative correlations between BCVA and the amplitude density of P1 (r=-0.683, P=0.012; r=-0.853, P=0.010) after treatment. Conclusion Conbercept 3 + PRN injection can improve visual acuity and measured by mf-ERG macular function in patients with macular edema secondary to non ischemic central retinal vein occlusion. （Ophthalmol CHN, 2022, 31: 130-134）

Factors associated with visual prognosis of membrane insertion for unclosed macular hole after internal limiting membrane peeling

Liu Lingzi, Yu Yanping, Wang Zengyi, Yang Xiaohan, Liu Wu

2022, 31(2): 135-139. doi:10.13281/j.cnki.issn.1004-4469.2022.02.011

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Objective To analyze the factors associated with visual prognosis of pars plana vitrectomy (PPV) combined with membrane insertion for unclosed macular hole (MH) after internal limiting membrane peeling. Design Retrospective case series. Participants Twenty-seven eyes of 27 patients with unclosed MH after internal limiting membrane peeling who were treated in Beijing Tongren Hospital from January 2018 to November 2020. Methods The date about age, best corrected visual acuity (BCVA), intraocular pressure, axial length, morphological classification of MH, OCT measuring parameters, interval between two operations, material of insertion and BCVA at last follow-up were collected. The follow-up time was(12.07±8.65) months (1-36 months). Risk factors of BCVA (LogMAR) more than 0.70 at last follow-up was analyzed by univariate and multivariate Logistic regression analysis. Main Outcome Measures BCVA at last follow-up and its possible risk factors. Results Univariate Logistic regression analysis revealed that morphology of MH before operation (OR=14.667, 95% CI 1.970-109.204, P=0.009) and interval between two operations (OR=9.625, 95% CI 1.378-67.246, P=0.022) were associated with BCVA at last follow-up. Multivariate Logistic regression analysis showed that elevated MH (OR=20.230, 95% CI 1.640-249.561, P=0.019) and interval between two operations longer than 2 months (OR=13.899, 95% CI 1.072-180.278, P=0.044) increases the chances of BCVA more than 0.70 at last follow-up. Conclusion Elevated MH and interval between two operations longer than 2 months were the risk factors of poor postoperative BCVA after PPV combined with membrane insertion for unclosed MH after internal limiting membrane peeling. （Ophthalmol CHN, 2022, 31: 135-139）

Protection of photoreceptor degeneration in NADPH oxidase 2 deficiency-rd1 mice

Liu Qian, Zhou Jian, Wu Shen, Zhang Zijun, Zhang Jingxue, Zeng Huiyang

2022, 31(2): 140-145. doi:10.13281/j.cnki.issn.1004-4469.2022.02.012

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Objective To observe the delay of photoreceptor degeneration in the NADPH oxidase2 (NOX2) deficiency-rd1 mice. Design Experiment study. Participants 6 NOX2-deficiency rd1 mice (experimental group) at postnatal 14d and their control groups at same age, including 6 NOX2-deficiency C57BL/6N mice (control group 1), 6 rd1 mice without NOX2-deficiency (control group 2) and 6 C57BL/6N mice (control group 3) were included. Methods The experimental group were obtained and appraised through repeated mating of control group 1 and control group 2 mice. The thickness of outer nuclear layer (ONL) was measured on HE staining. Photoreceptor apoptosis was examined by TUNEL assay and the percentage of apoptotic cells in total cells of ONL was counted. The expression of gp91phox, a major subunit of NOX2, as well as activation of microglial cells were studied by immunofluorescence and double-labeling technique. Main Outcome Measures Thickness of outer nuclear layer; percentage of TUNEL positive cells; expression of gp91phox; microglial activation. Results In the experimental group, the thickness of outer nuclear layer was 36.18±2.59 μm, which was significantly higher than that of control group 2 (21.45±1.33 μm, t=8.77, P=0.001). TUNEL positive retinal apoptotic cells, which mainly appeared in the ONL of experimental group, were markedly reduced（t=8.46, P<0.001） when compared with aged matched control group 2. Compared with control group 3 and control group 1, microglial cells were markedly activated in the retina of control group 2 and infiltrated ONL. Expression of gp91phox was also increased in part of microglial cells. In contrast, the experimental group showed dramatically down-regulated expression of both gp91phox and activation of microglial cells. Conclusion Deficiency of NOX2 gene effectively delayed photoreceptor cell loss in the rd1 mice possibly through inhibition of microglial cells. NOX2 may become a new and potential therapeutic target for inherited retinal degeneration. （Ophthalmol CHN, 2022, 31: 140-145）

Effect of direct or internal cyclopexy on early postoperative corneal topography

Mo Bin, Shi Xiangyu, Liu Yi

2022, 31(2): 146-150. doi:10.13281/j.cnki.issn.1004-4469.2022.02.013

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Objective To compare the difference of the changes of corneal topography after direct cyclopexy from after internal cyclopexy. Design Retrospective case series. Participants 27 patients (27 eyes) with cyclodialysis were included in Beijing Tongren Eye Center from January 2018 to December 2020. 17 eyes with lens underwent direct cyclopexy and 10 eyes with intraocular lens or intraoperative combined lens resection underwent internal cyclopexy. Methods All patients were operated by the same surgeon. In the internal cyclopexy group, cyclodialysis was sutured without direct visualization which one of the two long straight needles of a double armed 10/0 polypropylene thread was pierced into the eye through corneal limbus. All patients were examined by ultrasound biomicroscopy (UBM) before and after operation to evaluate the cyclodialysis. Pentacam examination was performed before, 1 week and 1 month after operation to analyze the changes of corneal topography parameters. Main Outcome Measures Pentacam parameters including astigmatism of anterior corneal surface, Rper (mean radius of curvature in the 7-9 mm area of the cornea), index of surface variance (ISV) and index of vertical asymmetry (IVA). Results In the internal cyclopexy group, astigmatism of anterior corneal surface, Rper, ISV and IVA at 1 week after operation was (1.19±0.96) D, (8.10±0.30) mm, (18.50±6.13), (0.15±0.05) respectively; however, in direct cyclopexy group, astigmatism of anterior corneal surface, Rper, ISV and IVA at 1 week after operation was (2.02±1.03) D, (8.05±0.29) mm, (27.00±4.69), (0.18±0.05) respectively. There was significant statistical difference in astigmatism and ISV between the two groups at 1 week after operation (t=2.122, P=0.046; t=3.764, P=0.002). In 10 eyes of internal cyclopexy and 9 eyes of direct cyclopexy group, the differences of all the parameters between two groups in 1 month after operation were no statistically significant (all P>0.05). Conclusion Direct cyclopexy can cause early postoperative astigmatism changes while internal cyclopexy has little effect on postoperative astigmatism.（Ophthalmol CHN, 2022, 31: 146-150）

Clinical features of IgG4-related diseases with oculomotor impairment as first sign

Wu Yunqing, Wang Jiawei, Zhao Xiaoli, Cui Shilei

2022, 31(2): 151-156. doi:10.13281/j.cnki.issn.1004-4469.2022.02.014

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Objective To summarize the clinical features of patients with IgG4-related diseases （IgG4-RD）with oculomotor impairment as first sign. Design Retrospective case series. Participants From December 2020 to December 2021, 8 IgG4-RD patients with oculomotor impairment as first sign were collected in Beijing Tongren Hospital. Method The medical record data of all patients were reviewed, including primary eye position，the directions of oculomotor impairment, serum IgG4 level, abnormal extraocular muscles according to orbital MRI and treatment methods. Pathological examination results were also reviewed from orbital masses, sinus mucosa or thymus tissue. Main Outcome Measures Clinical features, abnormal extraocular muscles according to orbital MRI, pathological results. Results All 8 patients (100%) presented with oculomotor impairment, including abduction impairment 87.5%, upgaze impairment 75.0%, downgaze impairment and addcution impairment 37.5% respectively. The other main clinical manifestations were visual declines (62.5%) and headaches (37.5%). According to orbital MRI, the local supraocular muscles and lateral rectus muscle thickened with enhancement in 2 patients (25.0%), the local supraocular muscles and lateral rectus muscle were oppressed in 2 patients (25.0%), the diffused extraocular muscles thickened with enhancement in 3 patients (37.5%), extraocular muscles were normal but meningeal thickened with enhancement in 1 patient (12.5%). All patients were accompanied with other part involvements besides nervous system, including lacrimal gland enlargements (62.5%), paranasal mucosa hypertrophies (50.0%) and lymph node reactive hyperplasia (50.0%). All biopsy specimens from orbital masses, nasal mucosae or thymus tissue revealed a large number of IgG4 positive plasma cells with tissue fibrosis or obliterans phlebitis. Conclusion Hypotropia and esotropia in primary eye position and abduction impairment and upgaze impairment are the most common clinical features of IgG4-RD with oculomotor impairment as the first sign. The supraocular muscles and the lateral rectus muscle usually thickened or were oppressed with enhancement in imaging examination. （Ophthalmol CHN, 2022, 31: 151-156）

Expression and significance of Toll-like receptors and VEGF factors in different type of pterygium

Song Xiangyuan, Wang Hongjun, Sha Qian

2022, 31(2): 156-161. doi:10.13281/j.cnki.issn.1004-4469.2022.02.015

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Objective To compare the expression of Toll-like receptors (TLR2, TLR3, TLR4) and vascular endothelial growth factor (VEGF) in primary and recurrent pterygium. Design Experimental study. Participants 36 cases of primary pterygium tissue, 24 cases of recurrent pterygium tissue and 20 cases of normal conjunctiva tissue. Methods TLR2, TLR3, TLR4, VEGF and tumor necrosis factor (TNF)-α were detected with immunohistochemistry among normal conjunctiva, primary and recurrent pterygium. The correlation between VEGF and the expression of TLR2, TLR3 and TLR4 was analyzed. Main Outcome Measures The expression amount, positive expression rate of TLR2, TLR3, TLR4, VEGF and TNF-α; correlation coefficient. Results The expressions of TLR2, TLR3 and TLR4 in normal conjunctiva group were weaker, in two pterygium groups were stronger, and in recurrent pterygium was strongest. A large number of brown yellow particles of VEGF were distributed in the stromal layer of recurrent pterygium, and also expressed in the epithelial layer. VEGF was positively correlated with the expression of TLR2, TLR3 and TLR4 in recurrent pterygium (r=0.512, P=0.001; r=0.671, P=0.001; r=0.482, P=0.001). Conclusion The expression of TLR2, TLR3, TLR4 and VEGF in recurrent pterygium was higher than that in primary pterygium, suggesting that immune inflammation and VEGF may be important factors in the mechanism of pterygium recurrence. Autoimmune inflammatory pathway is involved in the recurrence of pterygium by regulating angiogenesis. （Ophthalmol CHN, 2022, 31: 156-161）

Practice of teaching pediatric eyelid defect diseases using video display system and problem-based learning

Cao Wenhong, Li Li, Fan Yunwei, Wang Yuan, Wu Qian

2022, 31(2): 161-164. doi:10.13281/j.cnki.issn.1004-4469.2022.02.016

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Objective To evaluate the teaching efficacy of video display system combined with problem-based learning (PBL) on pediatric eyelid defect diseases. Design Retrospective comparative teaching study. Participants 25 residents were analyzed retrospectively. Methods 12 residents accepted the traditional teaching mode and 13 residents accepted the reformed teaching mode, which was a new approach using video display system and PBL. The differences of teaching effects between the groups were compared. Main Outcome Measures The accuracy of disease diagnosis, the correct identification of important surgical steps and the mastery of basic ocular plastic microscopy. Results In the traditional teaching group, the accuracy of disease diagnosis was 58.3% (8/12), the correct recognition rate of important surgical steps was 50.0% (6/12), and the mastery rate of basic ophthalmoplasty microscopy was 41.7% (5/12). The outcome measures of the reform teaching group were 100% (13/13), 92.3% (12/13) and 92.3% (12/13), respectively. There were significant differences between the two groups (P=0.039, 0.030, 0.011). Conclusion Teaching effect of video display system of surgical microscope combining PBL teaching model has been significantly improved. （Ophthalmol CHN, 2022, 31: 160-164）

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