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    25 July 2022, Volume 31 Issue 4
    Extracellular deposits associated with age-related maculopathy: Baseal linear daposit and drusen
    Huang Houbin
    2022, 31(4):  245-252.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.001
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     With ageing, many deposits predominantly lipoprotein-derived debris accumulated outside RPE result in various lesions. The deposits between the basal lamina of basement membrane of RPE and the inner collagenous layer of Bruch's membrane form gradually lipid wall, basal linear deposit, hard drusen and soft drusen. Cuticular drusen and pachy drusen are variations of hard drusen. All of the above deposits which can be recognized clinically to a variable extent are associated with age-related macular degeneration and of high significance. (Ophthalmol CHN, 2022, 31: 245-252)

    Macular retinal microvascular changes and associated factors in diabetic retinopathy patients: Kailuan Eye Study
    Wang Qian, Yan Yanni, Yang Jingyan, Wei Wenbin
    2022, 31(4):  253-259.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.002
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     Objective To detect the changes of retinal micro-vessels in patients with diabetic retinopathy (DR) in different disease stages with optical coherence tomography (OCTA), and to analyze its systemic and ocular related influencing factors. Design cross-sectional study. Participants 1096 patients with type 2 diabetes were included in the “Kailuan Eye Disease Study”. Methods All patients underwent systemic health examination and eye examination, DR was diagnosed and graded according to fundus photography, and OCTA was used to measure superficial retinal vascular density (VD), perfusion density (PD) and foveal avascular zone (FAZ) parameters. Differences in ocular and systemic parameters between different DR groups were compared with Kruskal-Wallis rank-sum test, analysis of variance or Chi-Square test. Univariate linear regression and multiple linear regression methods were used to analyze the influencing factors of OCTA measurement parameters in diabetic patients, and to analyze the ocular and systemic variables related to the severity of DR. Main Outcome Measures VD, PD, FAZ area, FAZ perimeter and FAZ morphology index. Results The results of multivariate linear regression analysis showed that in diabetic patients, retinal PD and VD decreased gradually with age (both P<0.001), and increased with the increase of foveal macular thickness (MT) (all P<0.001). Except for the foveal area, PD and VD in the entire macular area and parafovea area were also negatively correlated with the axial length, that is, the longer the axial length, the smaller the PD and VD in these areas (P<0.05). With the increase of age and fasting blood glucose, FAZ area (all P<0.01) and FAZ perimeter (all P<0.01) increased gradually, while FAZ morphological index decreased (P=0.005, 0.003). With the aggravation of DR, macular VD (P=0.003) and perifoveal VD (P=0.001) gradually decreased. The macular VD of eyes without DR, mild NPDR, moderate NPDR, severe NPDR and PDR was 15.7±3.2, 15.7±3.2, 15.4±3.2, 14.3±3.9, 13.4±3.3 (mm/mm2) respectively (χ2=15.9,P=0.003)and perifoveal VD was 16.9±3.4, 16.9±3.3, 16.4±3.3, 15.4±4.1, 14.4±3.3 (mm/mm2) respectively (χ2=18.0,P=0.001). Multivariate linear regression analysis showed that the more severe the DR, the higher the fasting blood glucose, the longer the duration of diabetes, and the smaller the macular VD (P=0.029) and the parafoveal VD (P=0.023), while the DR stage had no significant correlation with PD and FAZ measurement parameters. Conclusion VD in the superficial retina in the macular region gradually decreased with the aggravation of DR, VD may become a quantitative analysis indicator for evaluating the progression of DR. While the PD showed no significant difference after adjustment of blood glucose and disease duration in different stages of DR. OCTA measurement parameters in diabetic patients are related to age, axial length and MT, suggesting that the influence of the above factors on OCTA quantitative analysis parameters should be considered in the process of relevant measurement and follow-up of DR patients. (Ophthalmol CHN, 2022, 31: 253-259)
    Relationship between retinal arteriosclerosis grading and predicted 10-year risks of cardiovascular disease (China-PAR Equations) in a community-based population in Beijing
    She Haicheng, Yan Shenshen, Sun Pengfei, Fan Fangfang, , Jiang Yimeng, Jia Jia, , Liu Bo, Zhou Jinqiang, Zhang Yan,
    2022, 31(4):  260-265.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.003
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    Objective To explore the relationship between retinal arteriosclerosis grading and China-PAR model in predicting10-year cardiovascular disease (CVD) risk in a Beijing community. Design Cross-sectional study. Participants The subjects were from the atherosclerosis research cohort in Shijingshan community, Beijing. This study was a cross-sectional study followed up from December 2019 to January 2020. A total of 673 participants who had no history of cardiovascular disease, with complete questionnaire data and fundus photograph were finally included. Methods The degree of retinal arteriosclerosis was graded according to the Scheie’s classification. Multivariate Logistic regression was used to analyze the relationship between retinal arteriosclerosis grading and 10-year CVD risk, and further adjustment including hypoglycemic drugs, lipid-lowering drugs and estimated glomerular filtration rate (eGFR) was made. Main Outcome Measures 10-year CVD risk calculated by China-PAR model. Results The subjects were 61.9±7.4 years old and 422(62.7%) were women . Of all the subjects, 53.0% (n=357) had hypertension, 78.0% (n=525) had dyslipidemia, 30.5% (n=205) had diabetes and 23.5% (n=158) had a family history of CVD. The percentage of subjects with grad 0-1, grad 2 and grade 3-4 arteriosclerosis were 57.1% (n=384), 37.3% (n=251) and 5.6% (n=38), respectively. Of the10-year CVD risk calculated by China-PAR model, 209 (31.1%) subjects were at low risk, 206 subjects (31.1%) were at medium risk and 258 (38.3%) subjects were at high risk. Multivariate regression analysis showed that the retinal arteriosclerosis grading was positively correlated with the10-year risk of CVD. Compared with grade 0-1 retinal arteriosclerosis, the risk ratio of medium risk CVD increased by 52% (OR=1.52, 95%CI: 1.00~2.31, P=0.048) in grade 2 retinal arteriosclerosis; and the risk ratio of high risk CVD increased by 92% (OR=1.92, 95%CI: 1.24~2.96, P=0.003) in grade 2 retinal arteriosclerosis. Compared with grade 0-1 retinal arteriosclerosis, the risk ratio of medium risk CVD increased by 6.47 times (OR=7.47, 95%CI: 1.62~34.52, P=0.010) in grade 3-4 retinal arteriosclerosis; and the risk ratio of high risk CVD increased by 7.62 times (OR=8.62, 95%CI: 1.87~39.69, P=0.006) in grade 3-4 retinal arteriosclerosis. Conclusion The grade of retinal arteriosclerosis is significantly correlated with the 10-year CVD risk predicted by China-PAR model. The heavier the degree of retinal arteriosclerosis , the higher risk of predicted 10-year CVD risk. (Ophthalmol CHN, 2022, 31: 260-265)

    Characteristics differences of the retinal pigment epithelium-Bruch’s membrane-choroidal capillary complex in different subtype of central serous chorioretinopathy
    Zhou Rong, Sun Zuhua, Lin Bing, Jin Zibing, Liu Xiaoling
    2022, 31(4):  266-271.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.004
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     Objective To evaluate the imaging characteristics of retinal pigment epithelium-Bruch’s membrane complex in acute and chronic central serous chorioretinopathy (CSC) using high-definition B-scan optical coherence tomography angiography (OCTA) Dense ART (DART) scan modality.  Design Retrospective case series. Participants 43 patients that presented with acute (12 cases), chronic (16 cases) or neovascular (15 cases) CSC were reviewed. Methods Patients’ medical records were reviewed. All of the patient underwent multimodal fundus imaging including B-scan optical coherence tomography(OCT), fluorescein angiography, indocyanine green angiography, and OCTA. The Dense DART scan modality, an updated software feature of Heidelberg SPECTRALIS OCT2, was used to assess the cross-sectional retinal pigment epithelium-Bruch’s membrane complex and acquire high-definition B-scan OCTA images. Main Outcome Measures Dark zone under Bruch’s membrane, flat irregular retinal pigment epithelial detachments (PED), crossing-sign. Results Hyporeflective signals, also referred as dark zone under Bruch’s membrane, was observed in 10 of 12 (83.3%) acute CSC, and 10 of 31 (32.3%) chronic CSC (P=0.0052).  Of 15 cases with neovascular CSC, 15 cases (15/15, 100%) were accompanied by flat irregular PED (fiPEDs), while only 7 of the 16 cases (7/16, 43.8%) with non-neovascular CSC were accompanied by fiPEDs (P=0.0008). 14 cases with neovascular CSC (14/15, 93.3%) exhibited the crossing-sign, but none of 16 cases with non-neovascular CSC had the crossing-sign (P<0.0001). Conclusion OCTA-DART enables accurate overlay between high-resolution structural B-scan and blood flow signal, which can be applied to the observation of alterations in choroidal capillary blood flow beneath the retinal pigment epithelium-Bruch’s membrane-choroidal capillary complex in eyes with CSC. The blood flow of choroidal capillaries was decreased in acute CSC, but not in chronic choroidal capillaries. The presence of flat irregular PED with concomitant crossing signs contributes to the early diagnosis of CNV in patients with chronic CSC. (Ophthalmol CHN, 2022, 31: 266-271)

    Comparison of the 48 weeks curative effect of two treatment regimens of Conbercept for neovascular age-related macular degeneration
    Han Cong, Yang Yi, Yang Rui, Guan Tingting, Zhang Wenfang
    2022, 31(4):  272-276.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.005
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    Objective To compare the 48 weeks efficacy of two different treatment regimens of Conbercept in the treatment of neovascular age-related macular degeneration (nAMD). Design Randomized controlled clinical trial. Participants 30 nAMD patients in the Department of Ophthalmology of the Second Hospital of Lanzhou University. Methods  nAMD patients met the inclusion criteria were divided into two groups by simple random sampling. There were 16 cases in the 3+T&E group (Treat and Extend) and 14 cases in the 3+PRN group (pro re nata, as needed). The eyes were injected with 0.05 ml of Conbercept into the vitreous, and the patients were followed up according to the treatment plan for 48 weeks. Main Outcome Measures The best corrected visual acuity (BCVA), central retinal thickness (CRT) changes, choroidal neovascularization (CNV) changes and the times of vitreous injection. Results 4 patients were lost to follow-up. Among the 26 patients who completed the follow-up, 15 patients (15 eyes) were in the 3+T&E group and 11 patients (11 eyes) were in the 3+PRN group. Compared with baseline, at 4, 16, 20, 32, and 48 weeks after treatment, the average BCVA in the 3+T&E group was increased, but the difference was not statistically significant (all P>0.05). Compared with baseline, at 4, 16 and 20 weeks after treatment in the 3+PRN group, the difference was not statistically significant (P=0.378, 0.097, 0.090), and at the 32nd and 48th week, the difference was statistically significant (P=0.034, 0.025, respectively). The mean CRT after treatment in the two groups was significantly different from the baseline (all P<0.01). At 4, 16, 20, 32, and 48 weeks after treatment, the average BCVA of the affected eyes in the two groups increased and CRT decreased, and there was no significant difference between the two groups (all P>0.05). Compared with the baseline, 48 weeks after treatment, the CNV area in the 3+T&E group was 0.06±0.12 mm2, and the difference was statistically significant compared with the baseline value of 4.45±6.61 mm2 (P=0.017). At 48 weeks, the CNV area in the 3+PRN group was 0.44±0.71 mm2, which was significantly different from the baseline value of 3.94±3.93 mm2 (P=0.003). There was a statistically significant difference between the two groups at 48 weeks after treatment (P=0.046). After 48 weeks of treatment, the average times of vitreous injection in the 3+T&E group and in the 3+PRN group were 6.33±1.35 times and 6.09±2.70 times (P=0.788). There was no significant difference in the mean intraocular pressure between the two groups before treatment and at any time point after treatment (all P>0.05). During the follow-up period, except for 1 eye with subconjunctival hemorrhage, the other patients had no ocular complications and systemic adverse reactions. Conclusion Conbercept can achieve good anatomical, visual effects and good safety in the treatment of nAMD with both the 3+T&E and the 3+PRN treatment regimens for 48 weeks. (Ophthalmol CHN, 2022, 31: 272-276)

    Clinical features of paradoxical responses to initial anti-tuberculosis therapy in tuberculous uveitis
    Xiao Yuanyuan, Mao Yu, Cao Xusheng, Peng Xiaoyan
    2022, 31(4):  277-281.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.006
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     Objective  To summarize the clinical features of paradoxical reactions in tuberculous uveitis. Design Retrospective case series. Participants  8 tuberculous uveitis patients (10 eyes) with paradoxical reactions after initial anti-tuberculosis treatment in Beijing Tongren Hospital from 2012 to 2020. Methods All the patients’  medical records were reviewed. Mean follow-up time was (10.0±5.6) months. Main Outcome Measures  Anterior segment and  fundus manifestation, treatment situation. Results The average age of 8 patients with paradoxical reactions was (45.0±10.8)years. One patient (12.5%) had active pulmonary tuberculosis, 6 patients (75.0%) had suspected previous pulmonary tuberculosis infection,  and one patient (12.5%) had no clear history of tuberculosis. Paradoxical reactions occurred 0.5 to 1.5 months (average 0.9±0.3 months) after the initial anti-tuberculosis treatment. Among the 10 eyes with tuberculous uveitis, 2 eyes (20.0%) had choroidal tuberculoma, and the paradoxical reaction was manifested as tumor enlargement and superficial retinal detachment; 3 eyes (30.0%) had pan uveitis, manifested as aggravated inflammatory reaction of anterior chamber and vitreous body, and increased macular edema; 2 eyes (20.0%) had intermediate uveitis, manifested as aggravated vitreous opacity; 3 eyes (30.0%) had serpiginous choroiditis, which showed increased yellow-white lesions and increased areas of high autofluorescence in the fundus. All patients received regular antituberculosis drugs and systemic or local glucocorticoids after the occurrence of paradoxical reactions, and the inflammatory reactions were effectively controlled. Conclusion The paradoxical reactions in patients with tuberculous uveitis mostly occurred within 1 month after initial anti-tuberculosis treatment for tuberculosis latent infection or previous infection. The combined application of standardized anti-tuberculosis drugs and anti-inflammatory drugs could significantly reduce the paradoxical reactions. (Ophthalmol CHN, 2022, 31: 277-281)
    Understanding of glaucoma continuous health management: ophthalmic medical staff questionnaire survey
    He Meng, Liao Jinying, Zeng Jihong, Zhang Xin, Shi Yinwen, Zhang Yi, Zhang Yangyang, Zhang Yao, Tang Li
    2022, 31(4):  281-286.  doi:10.13281/j.cnki.ISSN.1004-4469.2022.04.007
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    Objective To survey the current opinions of the ophthalmic medical staffs on glaucoma continuous health management. Design Cross-sectional survey. Participants A total of 1329 questionnaires (WeChat customers) were collected from 31 provinces. Methods An online questionnaire survey was conducted to collect information on current opinions and the actual status of clinical practice regarding glaucoma continuous health management. Main Outcome Measures Ophthalmologists’ opinions and satisfaction degree with glaucoma continuous health management. Results Among the 1329 questionnaires, 98.42% believed that it is very important to carry out continuous health management for glaucoma patients, but only 17% were satisfied with the status of glaucoma management, and 26.94% of the participants had developed glaucoma management. 66.37% had the plan to carry out continuous health management of glaucoma but faced various difficulties. 57.56% participants supported that primary open-angle glaucoma should be included in continuous health management as the most priority. 52.82% considered that the chronic non-communicable disease surveillance information system model was the best mode. Hospitals with more than 3000 glaucoma outpatients per year had a higher proportion (62.07%) for glaucoma management (P<0.05). The proportion of tertiary hospitals (31.1%) that had carried out glaucoma management was significantly higher than that of secondary hospitals (14.8 %) (P<0.05). Conclusions Most ophthalmologists have realized that continuous health management is important for glaucoma patients and wanted to carry it out actively. However, the current status of implementation is not promising and needs to be standardized and fully promoted. (Ophthalmol CHN, 2022, 31: 281-286)

    Efficacy of endoscopic dacryocystorhinostomy for congenital lacrimal dot hypoplasia with lacrimal sac mucocele
    Zheng Yingjie, Zhang Yi, Fan Jinlu, Zheng Qun
    2022, 31(4):  286-291.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.008
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    Objective To observe the efficacy of endoscopic dacryocystorhinostomy for congenital lacrimal point hypoplasia with lacrimal sac mucocele. Design Retrospective case series. Participants 13 cases (17 eyes) with congenital lacrimal dot dysplasia and lacrimal sac mucocele underwent endoscopic dacryocystorhinostomy in Nanjing Aier Ophthalmic Hospital from 2004 to 2021, with an average age of (8.1±14.2) years (range: 6 days to 43 years). Method Medical records of patients were reviewed. All patients underwent endoscopic dacryocystorhinostomy. The mean follow-up was (20.0±15.7) months. The successful operation was defined as that the cyst disappeared and the diameter of nasolacrimal sac anastomosis was 1.0 mm or larger. Main Outcomes Measure Surgical success rate and complications. Results At the last follow-up, the success rate was 94.1% (16/17 eyes) and the failure rate was 5.8% (1/17 eye). One case had nasal septal mucosa injury during operation, and 1 month after operation there was adhesion between the mucosa of lacrimal sac anastomosis area and nasal septum. The adhesion was separated with gelatin sponge, and the anastomotic hole was formed 2 months later. One case of lacrimal cyst recurred 1.5 months after operation, and free dead bone was found on the foramen area. Conclusions Endoscopic dacryocystorhinostomy for the treatment of congenital lacrimal insufficiency with lacrimal sac mucocele is a good method. However, the lacrimal passage bypass drainage and intubation operation still needs to be carried out in stage II. (Ophthalmol CHN, 2022, 31: 286-291)

    Distribution of higher-order aberrations in normal human cornea and its correlation with age: Handan Eye Study
    Li Jing, Xiong Ying, Cao Kai, Wan Xiuhua, Wang Ningli
    2022, 31(4):  292-296.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.009
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     Objective To analyze the distribution of human corneal aberrations in different optical zones and its changing trend with age. Design Cross-sectional study. Participants From 2006 to 2007, a total of 2308 healthy people aged 30-87 years-old were recruited for the Handan Eye Study. Method The subjects' corneal aberration was measured with i-trace visual analyzer. Main Outcome Measures Zernike coefficients and root mean square (RMS) values of trefoil, coma and spherical aberrations in the 3rd and 4th order higher-order aberrations of human cornea in the 3~6 mm optical zone. Results Corneal trefoil, coma and spherical aberration in the 6 mm optical zone accounted for 27.7%, 27.7%, and 44.2% of the total corneal higher-order aberrations, respectively. The RMS values of the corneal vertical trefoil, vertical coma, horizontal coma, oblique trefoil and spherical aberration in the 6 mm optical zone wss (0.194 ±0.508)μm, (0.199±0.309)?滋m, (0.135±0.108)μm, (0.137±0.131)μm, (0.295±0.145)μm respectively, and the r values were positively correlated with age: 0.173 (P<0.001), 0.181 (P<0.001), 0.083 (P<0.001), 0.154 (P<0.001), 0.073 (P<0.001). Linear regression shows that: with the increase of age, the vertical trefoil changes to the negative direction R2=0.021, P<0.05, the vertical coma, oblique trefoil and spherical aberration change to the positive direction R2 was 0.004, 0.007, 0.008, respectively (all P<0.05). Vertical trefoil and vertical coma were significantly larger in the older age group than in the younger age group, with H values of 75.89 (P<0.001) and 74.97 (P<0.001), respectively. Oblique trefoil was the next with 62.71 (P<0.001). The difference in horizontal coma and spherical aberration among different age groups was the smallest at 16.17 (P=0.003) and 22.47 (P<0.001). Conclusion Within a 6 mm corneal optical zone, spherical aberration accounts for the highest proportion of higher-order aberrations. With the increase of age, the corneal vertical trefoil increased in the negative direction, and the vertical coma, oblique trefoil and spherical aberration increased in the positive direction. The trefoil and vertical coma increased significantly in the older age group, while horizontal coma and spherical aberration increased less with aging. (Ophthalmol CHN, 2022, 31: 292-296)

    Effect of HLA-A/B/DR allele matching on immune rejection of penetrating corneal allograft
    Luo Fei, JieYing, Hu Jianping, Zhang Xiaozhao, Li Li, Pan Zhiqiang
    2022, 31(4):  297-301.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.010
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    Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China

    Preliminary application of 5-second tear secretion measurement in normal children aged 7-14 years
    Liu Chang, , Fan Chunlei, Zhen Ni, Sun Xuguang,
    2022, 31(4):  301-304.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.011
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    Objective To measure the amount of aged 7-14 years normal children’s tear secretion by 5 second tear secretion measurement method and study its application value. Design Diagnostic test. Participants 49 subjects of aged 7-14 years normal children from Beijing Aier-Intech Eye Hospital were included. Methods All subjects underwent 5-second tear secretion measurement and the data was analyzed statistically. The consistency of two measurement results were tested by Bland-Altman method. Main Outcome Measures The amount of tear secretion, Bland Altman 95% consistency limit, intraclass correlation coefficient (ICC). Results The mean value of 98 eyes was 3.71±2.36 mm. There was no significant difference between right and left eye groups (right eye 3.69±2.10 mm, left eye 3.73±1.98 mm), male and female groups (male 3.79±2.16 mm, female 3.55±2.06 mm), and different age groups(3.94±2.23 mm in 7-10 year old group, 3.31±1.73 mm in 11-14 years old group). The consistency of the two measurements are good. The mean value of right eye difference was -0.061, the 95% consistency limit of Bland Altman was -4.10~-3.98, and ICC was 0.763. Conclusions The 5-second tear secretion measurement method can quickly assess the amount of children's tear secretion function, which has high repeatability in children. (Ophthalmol CHN, 2022, 31: 301-304)

    Short term effect observation of 3% diquafosol sodium eye drops in mild and moderate dry eye according to signs grouping 
    Wang Wenying, Tian Lei, Pan Zhiqiang
    2022, 31(4):  305-311.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.012
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    Objective  To observe the short term effect basing  on the  signs of mild to moderate dry eye with 3% diquafosol sodium eye drops treatment. Design Multi-center, single-arm prospective phase Ⅳ clinical trial. Participants  2660 dry eye patients from 30 Eye Centres. Methods Patients with dry eye symptoms, positive corneal fluorescein staining (CFS), tear film breakup time (BUT)≤5 s or Schirmmer I test (SIt) ≤10 mm/5min were treated only with 3% diquafosol sodium eye drops 6 times a day. One of the eyes was selected for analyzed. CFS, BUT, slit lamp microscopy, SIt and other examinations at 3 visits of baseline, 2 weeks and 1 month of treatment were recorded. CFS improvement compare to baseline according to SIt and BUT grouping ; BUT improvement compare to baseline according to SIt and CFS grouping; SIt improvement compare to baseline according to BUT and CFS grouping were recorded. Main Outcome Measures CFS, BUT, SIt during at baseline,  2 weeks and 1 month of treatment were recorded. Results At 2 weeks and 1 month of treatment with 3% diquafosol tetrasodium eye drops, the differences of  changes of  BUT, CFS and SIt from the baseline in different age groups were all statistically significant respectively (all P<0.05). Subgroup divided according to degree of baseline SIt and BUT,  CFS improvement has no statistical significant difference among  groups at 1 month (all P>0.05). When subgroup divided according to degree of baseline SIt and CFS, while SIt≤5 mm/5min or SIt >10 mm/5min, BUT improvement is higher in  group of CFS 6-10 than group of CFS 1-5 (P<0.05) at 1 month; while SIt >5 plus ≤10 mm/5min, BUT improvement  is higher in CFS 1-5 group than CFS 6-10 group (P<0.05). While CSF 1-5, BUT improvement is higher in SIt≤5 mm/5min group than  SIt >5 plus ≤10 mm/5min  and SIt >10 mm/5min groups (P<0.05). When subgroup divided according to degree of baseline BUT and CFS at 1 month, while CFS 1-5, SIt improvement is higher in BUT>5 s group than  BUT≤5 s group (P<0.05). While BUT ≤5 s, SIt improvement is higher in CSF 1-5 group than CSF 6-10 group (P<0.05). Conclusion 3% diquafosol tetrasodium eye drops is effective in the treatment in different age groups. BUT improvement is affected by baseline SIt and CFS after 3% diquafosol tetrasodium eye drops treatment. Poor baseline SIt  won’t limit the improvement  of  CFS or BUT for mild and moderate dry eyes. (Ophthalmol CHN, 2022, 31: 305-311)

    Preliminary application of lacrimal irrigation needle combined with meibomian gland clip in excision of localized pigmented nevus of eyelid margin involved inner canthus
    Wang Yue, Song Bin, Hou Zhijia, Zhang Zheng
    2022, 31(4):  312-314.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.013
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    Objective To explore the application effect of lacrimal irrigation needle combined with meibomian gland clip in the excision of localized pigmented nevus on the eyelid margin of inner canthus. Design Retrospective non-comparative case series. Participants 16 patients (16 eyes) with localized pigmented nevus of eyelid margin in inner canthus were collected in Beijing Tongren Hospital from 2017 to 2021. Methods All cases were resected under microscope, and the pigmented nevus of eyelid margin was fixed with meibomian gland clip. The position of lacrimal passage and its adjacent relationship with pigmented nevus on eyelid margin with the aid of lacrimal passage irrigation needle inserted into lacrimal passage were observed. Conjunctival surface defect was treated with not repaired method, and eyelid anterior layer defect was repaired with skin transposition flap. Main Outcome Measures Situation of postoperative lacrimal passage, eyelid position and appearance. Results The average postoperative follow-up period was 8±1.5 months. 16 patients had clear visual field and less bleeding during surgery. At last follow-up, all 16 patients had no epiphora and the lower eyelid lacrimal passage was smooth. There was no obvious scar, angular deformity, eyelid entropion, ectropion, punctum atresia, and no recurrence of pigmented nevus at eyelid margin. Conclusions Using lacrimal irrigation needle and meibomian gland clip during surgery of localized pigmented nevus of the inner canthus can got effect of clear visual field and good hemostasis. It can also protect the lacrimal passage from injury. (Ophthalmol CHN, 2022, 31: 312-314)

    The clinical efficacy of trans-conjunctival lower eyelid retractor plication combined with lateral tarsal strip for involutional lower eyelid ectropion
    Qin Yi, Zhou Jun, He Lei, Shi Xiangyu
    2022, 31(4):  315-318.  doi:10.13281/j.cnki.issn.1004-4469.2022.04.014
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     Objective To observe the efficacy of trans-conjunctival lower eyelid retractor plication with lateral tarsal strip to correct involutional lower eyelid ectropion. Design Retrospective case series. Participants Thirteen patients (13 eyelids) with primary involutional lower eyelid ectropion in Beijing Tongren Eye Center. Methods All patients were performed plication of inferior retractor to the lower border of tarsus via a transconjunctival approach. Lateral tarsal strip was also performed simultaneously in all cases. The follow-up was (7.1±2.5) months. Main Outcome Measures Morphology and position of eyelid, vertical relaxation of eyelids, horizontal relaxation of eyelids. Results Until the last follow-up, all patients recovered well. According to the ectropion grading scale, the grade of ectropion was significantly reduced. The preoperative ectropion grade was II~IV, and the postoperative grade was 0~I (Z=-4.652, P<0.0001). The preoperative vertical relaxation of eyelids was (7.04±0.52) mm, and postoperative was (4.31±0.51) mm (t=22.45,P<0.0001).The preoperative horizontal relaxation of lower eyelid was (9.5±0.91) mm, and postoperative was (5.19±0.52) mm (t=19.96, P<0.0001). There were no cases of overcorrection, recurrent ectropion, suture abscess, wound dehiscence, or inferior fornix shortening after surgery. Conclusions This small sample size study shows that trans-conjunctival lower eyelid retractor plication combined with lateral tarsal strip for primary involutional lower eyelid ectropion is effective and simple. (Ophthalmol CHN, 2022, 31: 315-318)