Table of Content

25 September 2022, Volume 31 Issue 5

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Systemic risk factors in patients with primary open-angle glaucoma

Pang Ruiqi, Peng Jieting, Wang Ningli

2022, 31(5):  325-329.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.001

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 Abnormally high intraocular pressure is the most significant risk factor for primary open-angle glaucoma(POAG). The clinical model of glaucoma treatment using intraocular pressure as the target has long been used. Various systemic risk factors such as circulating factors, body mass index, intracranial pressure, nutritional metabolism, constiturion types as defined by traditichal Chinese medicine, and some systemic diseases have been found to be related to glaucoma onset, progression and regression, and are being tried to be applied as new therapeutic targets for optic nerve protection treatment of glaucoma. This manuscript aims to provide an overview,  on systemic risk factors of POAG, to advocate glaucoma doctors to pay attention to systemic risk factors and to build a new glaucoma diagnosis and treatment system combining systemic risk factor assessment and personalized ocular and physical co-treatment. (Ophthalmol CHN, 2022, 31: 325-329)

Extracellular deposits associated with age-related maculopathy: basal laminar deposit

Huang Houbin

2022, 31(5):  330-333.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.002

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With age, many deposits predominantly lipoprotein-derived debris can accumulated in the basal lamina of basement membrane of retinal pigment epithelium (RPE) besides between the basal lamina of basement membrane of RPE and the inner collagenous layer of Bruch's membrane. This kind of deposit is called basal laminar deposit, while thickens the basal lamina of RPE. Basal laminar deposit is difficult to be detected clinically, while appears as a high reflex line by OCT between outer retina and sub-RPE space in the some case of RPE atrophy. (Ophthalmol CHN, 2022, 31: 330-333)

Comparison of the efficacy and safety of endoscopic-assisted transluminal trabeculotomy and microcatheter-assisted trabeculotomy for primary congenital glaucoma

Chen Xiaoya, Wang Ruixue, Ding Wenjun, Lu Yanan

2022, 31(5):  334-339.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.003

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 Objective To evaluate the efficacy and safety of endoscopic-assisted transluminal trabeculotomy (EATT) and microcatheter-assisted trabeculotomy (MAT) in the treatment of primary congenital glaucoma (PCG). Design Retrospective case series. Participants Consecutive 16 patients (20 eyes) with PCG underwent EATT and 17 patients (21 eyes) with PCG underwent MAT in the  Xuzhou First People's Hospital from January 2020 to October 2021. The mean age of EATT group and MAT group was (40.4±26.9) months and (38.3±29.0) months, respectively. Method The medical records of the patients before operation and 1, 3, 6, 9, 12 months after operation were reviewed. Intraocular pressure (IOP), numbers of anti-glaucoma medication, the rate of surgical success and postoperative complications were recorded. Success was defined as IOP<21 mmHg with (qualified success) or without (absolute success) the use of anti-glaucoma medication. Main Outcome Measures IOP, numbers of anti-glaucoma medication, the rate of absolute success and qualified success, postoperative complications. Results All cases were followed up for≥6 months. In EATT group, the IOP at 12 months postoperatively was lower than that before operation, which was (15.8±3.1) mmHg and (36.3±7.0) mmHg respectively (Z=-3.408，P=0.001）. In MAT group, the IOP at 12 months postoperatively were lower than that before operation too, which was (17.2±3.7) mmHg and (35.5±6.2) respectively（Z=-3.519，P＜0.001）. In both groups, the IOP and numbers of anti-glaucoma medication were significantly decreased at all time points of the follow-up periods compared to the preoperative values (all P<0.01). There was no statistical significance in IOP between the two groups (all P>0.05). At 12 months postoperatively, the absolute success rates were 71.4% in EATT group and 68.8% in MAT group, and the qualified success rates were 85.7% in EATT group and 81.3% in MAT group. There were no statistical significance between the two groups (P=0.888, 0.748). There were no significant differences in the incidence of anterior chamber hemorrhage and transient intraocular hypertension between the two groups （χ2=1.003，0.344，P=0.317，0.558）. There were no severe complications such as cataract, intraocular infection, retinal detachment and ocular atrophy in both groups. Conclusions There was no significant difference in efficacy and safety between EATT and MAT in the treatment of PCG. EATT provides a minimally invasive surgical option for PCG with corneal opacity. (Ophthalmol CHN, 2022, 31: 334-339)

Efficacy and safety of Ahmed glaucoma valve implantation in silicone oil eyes with different lens states

Du Xiujuan, Wang Yirong, Sha Fang, Sun Xuan, Bi Hongsheng

2022, 31(5):  340-345.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.004

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Objective To evaluate the safety and efficacy of Ahmed glaucoma valve in the treatment of refractory glaucoma in eyes with silicone oil tamponade under different lens statuses. Design Retrospective case series. Participants 62 patients (62 eyes) with refractory glaucoma after vitrectomy with silicone oil tamponade who were admitted to the glaucoma department of the Eye Hospital affiliated to Shandong University of Traditional Chinese Medicine from June 2015 to December 2021. Methods The medical records of the patients before and after operation 3 months later were reviewed. Included patients (eyes) were divided into three groups: phakic group (26 patients 26 eyes), IOL group (16 patients, 16 eyes) and aphakic group (20 patients, 20 eyes). The successful operation is defined as the introcular pressure (IOP) being 6~21 mmHg with or without the anti-glaucoma drugs after the operation, without serious complications and other anti-glaucoma operations. Main Outcome Measures The success rate, IOP, the number of anti-glaucoma drugs and the incidence of silicone oil entering drainage tube, the incidence of other complications. Results The total post-operative success rate was 85.5% for all patients 3 months later. The success rate of phakic eyes, IOL eyes and aphakic eyes was 96.2%, 87.5%, 70.0% respectively, with significant difference among the three groups (P=0.041). The success rate of phakic eyes was higher than aphakic eyes (P=0.033), with no significant difference among the other groups. The IOP of phakic eyes（16.93±1.75）mmHg and pseudophakic eyes (18.45±2.78) mmHg were lower than aphakic eyes (22.56±3.10 ) mmHg after 3-month follow-up, with statistically significant difference among the three groups（all P<0.01）. The number of anti-glaucoma drugs used before the operation was 4 (4, 5) and was 0 (0, 1.25) after operation for all patients, the difference was statistically significant （Z=6.96, P=0.000). There was no significant difference in the number of anti-glaucoma drugs used before and after operation among the three groups. The proportion of silicone oil entering the drainage tube in aphakic, pseudophakic and aphakic groups was 1/26, 2/16 and 6/20 respectively (P=0.041). The incidence of shallow anterior chamber in each group was 2/26, 2/16 and 0/20 respectively（P=0.282）, The incidence of anterior chamber hemorrhage in each group was 2/26, 2/16 and 2/20 respectively （P=0.871）. No other serious complications occurred. Conclusion The success rate is relatively higher in phakic and pseudophakic eyes than aphakic eyes. The risk of silicone oil entering the drainage tube in aphakic eyes is higher. (Ophthalmol CHN, 2022, 31: 340-345)

Study on the normal intraocular pressure in infants under 1 year old by ICare hand-held rebound tonometer and the effect of retinal examination with RetCam on it

Zheng Jiao, Mu Ge, Zhao Huanhuan, Gao Caifeng, Zhang Zhenyu, Xu Haoli

2022, 31(5):  345-348.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.005

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Objective To observ the normal intraocular pressure (IOP) of infants under 1 year old and to analyze the effect of retinal examination with wide field digital fundus imaging system (RetCam3) on their IOP. Design Prospective case series. Participants 285 cases (570 eyes) of ≤1 year old infants born at 24~40 weeks of pregnancy, wherein 176 were males, and 102 adult cases (204 eyes) with normal IOP, in Guangdong Women and Children Hospital between 2019 to 2020. Methods IOPs before and after RetCam3 retinal examinations in infacts as well as adults were measured by the ICare hand-held rebound tonometer. The differences of IOP between before and after RetCam3 retinal examinations and between infacts and adults were compared. Main Outcome Measures IOPs. Results The mean IOP of both eyes of infants was (13.04±3.04) mmHg, there was no significant difference between left and right IOP (t=-1.68，P=0.10). The both eyes mean IOP of adults was (16.82±2.36) mmHg. The IOP of infants was lower than that of adults (t=-18.14，P＜0.01). There was no statistical difference of IOP between different genders for infants (t=0.20，P=0.85). The IOP after RetCam3 examination was (13.93±3.20) mmHg, which was higher than that before examination (12.88±3.12 mmHg) (t=5.09，P＜0.01). The difference of IOP before and after fundus examination was more higher in <32 weeks group (1.64±3.76 mmHg) than ≥32 weeks group (0.75±3.22 mmHg) (t=2.12，P=0.04).  Conclusion The mean IOP of infants ≤1 year old is lower than adults. RetCam3 retinal examinationcan cause mild IOP increase in infants, and the effect is more obvious in the infants with smaller gestational age. (Ophthalmol CHN, 2022, 31: 345-348)

Refractive parameters of rhesus and cynomolgus monkeys in non-human primates

He Hailong, Ma Ya, Mou Hao, Liu Zhuolin, Jin Zibing

2022, 31(5):  349-354.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.006

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Objective To examine the ocular components to refraction of 2~5 years old rhesus monkeys and cynomolgus monkeys. Design Experimental study. Participants Twenty-four rhesus monkeys and 12 cynomolgus monkeys aged 2~5 years old. Methods Axial length (AXL), anterior chamber depth (ACD), lens thickness (LT),  vitreous chamber depth (VCD) and spherical equivalent (SE) were measured by A-scan ultrasonography and automatic computer optometry. A nonmydriatic fundus camera and optical coherence tomography were also performed to exclude ocular diseases. Normal distribution data was described as mean ± standard deviation and compared the two groups using t-test. Wilcox on Rank-Sum test was used to compare the continued non-normal distribution data, which was described as median (interquartile range). Given that data of both eyes of monkeys was used, linear mixed-effects model was used to adjust the inter-correlation between right and left eye. Main Outcome Measures SE, AXL, ACD, LT, VCD and correlation analysis between associated parameters and AXL. Results For 24 rhesus monkeys(48 eyes), the SE was (0.14±1.15) D, the AXL was 19.80 (19.18, 20.08) mm, the ACD was 3.65 (2.65, 3.84) mm, the LT was 3.93 (3.74, 4.19) mm, the VCD was 12.10±0.69 mm, there was no significant difference between both eyes (all P＞0.05). For 12 cynomolgus monkeys(24 eyes), the SE was(-0.46±0.96) D, the AXL was (18.11±0.54) mm, the ACD was (3.57±0.32) mm, the LT was (3.20±0.20) mm, the VCD was (11.34±0.48) mm, there was no significant difference between both eyes (all P＞0.05). The AXL of 48 rhesus and 24 cynomolgus monkeys’ eyes were included for linear mixed-effects model. The results of multiple stepwise regression analysis showed that the ACD, VCD, and weight were positively associated with a longer rhesus AXL (β=0.492, 0.572, 0.550, all P<0.05), while ACD and VCD were statistically significantly associated with a longer cynomolgus AXL (β=0.780, 0.876, both P<0.05). Conclusion We found that the ACD, VCD, and weight were positively associated with rhesus axial elongation and ACD and VCD were positively associated with cynomolgus axial elongation in the natural growth development conditions of Beijing, China. The ocular parameters could provide a foundation for future rhesus monkeys and cynomolgus monkeys research. (Ophthalmol CHN, 2022, 31: 349-354)

Clinical study of an extended depth-of-focus intraocular lens Symfony ZXR00

2022, 31(5):  355-359. 

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Objective To evaluate visual quality of patients implanted with the extended depth-of-focus IOL Symfony ZXR00 after cataract surgery. Design Prospective nonrandomized controlled comparative study. Participants The study included 42 patients (42 eyes) who had cataract phacoemulsification surgery in the Sixth Medical Center of Chinese PLA Gereral Hospital from June 2021 to January 2022, wherein Symfony ZXR00 IOLs were implanted in 18 cases (18 eyes), and single focus IOLs A1-UV in 24 cases (24 eyes). Methods Visual acuity (VA), defocus curves and contrast sensitivity (CS) were compared 3 months postoperatively between the two groups. Optical interference, spectacle independence and visual satisfaction were also investigated and analyzed. Main Outcome Measures VA (LogMar), CS, defocus curves, optical interference, spectacle independence and visual satisfaction. Results After 3 months, uncorrected distant VA (UDVA)(-0.04±0.08)、uncorrected intermediate VA (UIVA)(-0.03±0.08)、uncorrected near VA (UNVA)(0.28±0.16)、corrected near VA (CNVA)(-0.03±0.05)、distance-corrected intermediate VA (DCIVA)(-0.04±0.07) and distance-corrected near VA (DCNVA)(0.27±0.13)were better in the Symfony ZXR00 group than in the A1-UV group (0.03±0.10, 0.32±0.09, 0.39±0.17, -0.01±0.02, 0.30±0.11, 0.48±0.19), all  P＜0.05. CDVA was similar in the two groups. The Symfony ZXR00 still provided visual acuity greater than 0.3 for a defocus level of -2.50 D. Contrast sensitivity was similar in the two groups at any spatial frequency. The patients in the Symfony group had no serious optical interference, and the spectacle independence rate was 77.8%, which was significantly higher than 0% in the A1-UV group (χ2=28.000, P=0.000). There was no significant difference in the satisfaction rate for distance vision between the two groups. The patient satisfaction rates for intermediate vision in the Symfony group was 100%, which was significantly higher than 20.8% in the A1-UV group (χ2=26.022, P=0.000).For near vision, the satisfaction rates were 77.8% and 0% in the two groups, respectively (χ2=28.000, P=0.000). Conclusion Symfony ZXR00 can provide excellent distance, intermediate and functional near visual acuity, with no significant decline in contrast sensitivity and close to monofocal IOL.   (Ophthalmol CHN, 2022, 31: 355-359)

Surgery through corneal incisions for infant persistent fetal vasculature with complicated anterior segment anamolies

Liu Jinghua, Li Songfeng, Deng Guangda, Yang Wenli, Chen Wei, Li Liang, Ma Jing, Yuan Mingzhen, Lu Hai

2022, 31(5):  360-363.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.008

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Objective To investigate short-term clinical effects of infant patients with persistent fetal vasculature (PFV) with complicated anterior segment anamolies, treated by lensectomy combined with vitrectomy through corneal incisions. Design Retrospective case series. Participants Patients diagnosed with PFV with complicated anterior segment anamolies, and underwent lensectomy combined with vitrectomy through corneal incisions in Beijing Tongren hospital from May 2019 to January 2022 were studied. Seventeen patients (17 eyes) including 10 males, with an average age of (13.4±9.2) months were included. Methods The clinical data of the patients were retrospectively described. Pre- and postoperative visual acuity and postoperative complications were observed. Main Outcome Measures Visual acuity, changes of opacity of the optical media of the pupillary zone and postoperative complications. Results At last visit, 9 of the 12 patients had postoperative fix and follow ability of visual acuity improvement compared with that of preoperative, None patients had clear optical media of the pupillary zone preoperatively, and all the 17 patients had clear optic media postoperatively; 4 eyes complicated with postoperative recurrent pupil membrane formation, which needed further operation; no cases with intraoperative or postoperative intraocular hemorrhage, secondary retinal detachment or ophthalmitis were observed. Conclusion Infants with PFV complicated anterior segment anamolies may have optimistic visual and anatomical prognosis after surgical treatment of lensectomy combined with vitrectomy through corneal incisions. (Ophthalmol CHN, 2022, 31: 360-363)

The clinical effect of scleral buckling on localized rhegmatogenous retinal detachment with poor results after retinal laser photocoagulation

Tian Chaowei, Ma Wenxia, Wu Jing, Wang Yusheng

2022, 31(5):  364-368.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.009

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Objective To observe the clinical effect of scleral buckling on localized rhegmatogenous retinal detachment (RRD) with poor results after retinal laser photocoagulation. Design Retrospective case series. Participants A total of 19 eyes of 19 patients with localized RRD with poor results after retinal laser photocoagulation who were treated with scleral buckling during January 2017 to January 2021 in the Ophthalmology Department of Xijing Hospital, Air Force Military Medical. Methods All patients were treated with scleral buckling and postoperative supplemental retinal laser photocoagulation. Follow-up from 6 months to 2 years to observe the therapeutic effect. Main Outcome Measures Retinal reattachment, visual acuity and other related complications after operation. Results The retina was reattached in 17 eyes (89.5%) after scleral buckling, the cristae was clear in 2 eyes (10.5%), but there was subretinal fluid under the cristae, and the subretinal fluid was completely absorbed within 2 weeks. Two months later, retinal detachment recurred due to proliferative vitreoretinopathy(PVR) in two eyes who need pars plana vitrectomy for retinal redetachment, both of them were patients who underwent scleral buckling within 1 week after the first laser and were supplemented with laser photocoagulation twice after operation. At the last follow-up, retinal reattachment was achieved in 19 eyes (100%), of which, 17 eyes (89.5%) were stable after scleral buckling. Visual acuity was obviously unchanged in 17 eyes (89.5%), and decreased in 2 eyes (10.5%). Conclusion The long-term efficacy of scleral bucking in the treatment of patients with poor outcomes after retinal laser photocoagulation for localized RRD is definited. The laser treatment for localized rhegmatogenous retinal detachment was not only ineffective, but also has many negative effects. The density of the laser spot, multiple laser photocoagulations, and a short period between laser photocoagulation and scleral buckling are potential factors in the recurrence of retinal detachment. (Ophthalmol CHN, 2022, 31: 364-368)

Clinical observation of improved inner limiting membrane flap covering technique for treatment of large diameter IMH

Zhuo Wenzhi, Zheng Zhenyou, Li Lei

2022, 31(5):  369-374.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.010

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Objective To observe the clinical effect of vitrectomy (PPV) combined with modified internal limiting membrane (ILM) flap in the treatment of large diameter idiopathic macular hole (IMH). Design Randomized controlled trial. Participants A total of 60 IMH patients were included in the study, including 7 males (7 eyes), aged 46-73 years. The maximum diameters of macular hole were all ≥600 μm. Methods 60 patients were randomly divided into group A and group B. 30 patients in each group were treated with PPV combined with ILM tamponade in group A, group B was treated with single ILM flap coverage. Main Outcome Measures BCVA, CMT, the clarity and regularity of the outer layer of the retina, the retention of subretinal hyperreflexive substances in the macular region and the scar in the macular region were measured before, 1 week, 1, 3 and 6 months after the operation. Results All postoperative fissures were closed in both groups. The postoperative BCVA at the corresponding time points between the two groups was not statistically significant (all P>0.05). There was a difference in BCVA from 1 month postoperatively (1.17±0.29), (1.13±0.25) compared to BCVA at 1 week postoperatively (1.47±0.38), (1.45±0.33), (1.40±0.34), and (1.39±0.31) within the two groups (all P<0.01), and within the group at 3 months postoperatively (0.88±0.26), (0.85±0.27), 6 months (0.81±0.24), (0.78±0.21) compared with 1 month postoperatively also differed (all P<0.01). There was no significant difference between 3 and 6 months postoperatively (all P>0.05). The results of CMT in both groups basically did not change significantly (all P>0.05) preoperatively, at 1 month postoperatively, and at about 3 months postoperatively. However, the CMT in the group was significantly thickened at 1 week postoperatively (275.34±18.76) and (266.58±18.26) relative to preoperatively (254.32±17.83) and (252.17±17.12) (all P<0.01), and at 6 months postoperatively (238.49±24.43) and (236.52±22.71) compared to preoperatively compared with the preoperative period (all P<0.01). There was no statistical difference between the two groups in the time points corresponding to the discernibility of the outer layer structure and smoothness and regularity after surgery (all P>0.05). All 60 patients showed hyperreflesive signals preoperation. After operation, 6 cases in the two groups still showed obvious hyperreflexive signals in the macular structure, and the remaining 54 cases gradually became smaller and disappeared in 1~3 months after operation. Conclusion PPV combined with ILM flap has a significant clinical effect in the treatment of large-diameter IMH. It can effectively close the hole and promote the recovery of macular structure. (Ophthalmol CHN, 2022, 31: 369-374)

Clinical characteristics of 538 cases of Behcet's syndrome in Xinjiang Uygur Autonomous Region

Wei Bixia, Ai’erxiding.abudukeremuahong, Ding Lin

2022, 31(5):  375-378.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.011

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Objective To summarize the clinical characteristics of Behcet's syndrome, further understand the clinical characteristics and pathogenesis in Xinjiang Uygur Autonomous Region. Design Retrospective case series. Participants 508 BS patients in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2005 to 2020. Methods The demographics and clinical data of BS patients were reviewed. Main Outcome Measures Age, gender, initial symptoms, eye lesions, medication drugs and complications. Results Among the 538 BS patients, the ratio of male to female was 1:1.96. The average age was 37.37±12.83 years, the average course of disease was 4.72±6.40 years, and the average hospital stay was 13.44±8.70 days. The first visit department was mostly rheumatology(57.0%), and oral ulcer was the most common initial symptom (69.7%) and clinical manifestation (94.1%). For medication, immunosuppressant accounted for 76.4% and thalidomide was used most frequently. Oral hormone accounted for 37.7% and the use rate of biological agents was 1.5%. About 1/5 BS patients underwent eye examination during hospitalization. 1/3 patients had uveitis, and binocular uveitis was the most common type. Uveitis had more serious visual impairment and a higher hormone use rate. Conclusion Most BS in Xinjiang Uygur Autonomous Region is young and middle-aged people. The rheumatology department and is the most common first visit departments. The oral ulcer is the most common symptom. Hormones and immunosuppressants are still the most commonly used for the treatment of BS. The use rate of biological agents is low. (Ophthalmol CHN, 2022, 31: 375-378)

Efficacy of immunoadsorption in the treatment of optic neuritis associated with neuromyelitis optica spectrum disorders

Mei Ni, Huang Shuqi, Chen Weimi, Zhang Zhen

2022, 31(5):  381-385.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.012

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Objective To investigate the therapeutic effect of immunoadsorption on neuromyelitis optica spectrum disease-associated optic neuritis (NMOSD-ON). Design Prospective concurrent non-randomized controlled clinical trial. Participants The data of 75 Patients with AQP4 antibody positive patients who were treated in Shanghai Deji Hospital from November 2017 to July 2020 with NMOSD-ON were collected. All patients had no obvious recovery of visual acuity after 14 days of steroid pulse therapy during acute attack. Methods 39 cases were included in the study group and 36 cases in the control group according to patients' choice. The study group was given intensive treatment with immunoadsorption therapy on the basis of hormonal pulse-decrease therapy, while the control group only continued to use steroid-pulse and post-decrease therapy. The changes of specific antibody (AQP4-IgG) titer and vision recovery in the two groups of patients before and after treatment were retrospectively analyzed. The antibody titer was detected by CBA method, and the data was statistically analyzed by SPSS25.0. Main Outcome Measures Clinical effect, visual acuity distribution, and titer changes. Results The overall effective rate of the study group was 76.92%, which was higher than the control group which was 38.89% (χ2=9.65, P=0.002). The improvement rate of visual acuity in the study group was 74.1% (43/58) , which was higher than the control group which was 17.5% (10/57) (χ2=34.81, P=0.000). The antibody titer decline rate in the study group was 94.87% (37/39), which was higher than the control group which was 30.56% (11/36) (χ2=30.88, P=0.000). Conclusion Immunoadsorption therapy can effectively reduce the specific antibody titer in patients who are not sensitive to the effect of steroid pulse therapy, and promote the recovery of vision. For acute and subacute NMOSD-ON, immunoadsorption is more effective than hormonal pulse-decrease therapy. (Ophthalmol CHN, 2022, 31: 381-385)

Clinical analysis of VEP changes in children with Leber hereditary optic neuropathy  

Zheng Panpan, Wang Ziyang, Peng Chunxia, Meng Zhaoyu, Sun Yanhong, Shi Wei

2022, 31(5):  386-389.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.013

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Objective To analyze the changes of visual acuity and visual evoked potential (VEP) in children with Leber hereditary optic neuropathy (LHON) at different disease courses and different mutation sites, and to explore the relationship between them. Design Retrospective analysis. Participants 36 LHON children diagnosed by clinical features and gene assay were included, wherein 27 cases with complete visual acuity records were used for visual acuity related analysis. Methods All cases were divided into two subgroups: subacute(≤6 months) versus chronic (>6 months) subgroups according to diseases courses, 11778 mtDNA mutations versus 14484 mtDNA mutations subgroups, male versus female subgroups. Their differences in best-corrected visual acuity(BCVA), latency and amplitude of P100 detected by VEP were compared. Correlation of VEP indexes with visual acuity and onset time were also analysed. Main Outcome Measures Disease courses, BCVA, latency of P100 and amplitude of P100. Results There were 36 children with LHON, with an average age of (10.75±4.64) years, including 27 males. There were no statistically significant differences in the BCVA between genders, disease courses and mutation sites. The latency of P100 in subacute subgroups (109.54±29.05) μs was evidently shorter compared to that of chronic subgroup (127.28±6.95) μs (t=-2.93, P=0.007). There was no significant difference in amplitude of P100 between the two groups. The 14484 mtDNA mutation subgroup was better than that of 11778 mtDNA mutation subgroup both in latency and amplitude, but the difference was not statistically significant. There was a positive correlation between BCVA and amplitude of P100 (r=0.459, P=0.014). Conclusion The VEP of LHON children mainly displayed decreasing in P100 amplitude at subacute stage and displayed worsening both in latency and amplitude of P100. BCVA was positively correlated with the P100 amplitude. The optic nerve conduction of LHON children caused by 14484 mtDNA mutation was slightly better than that of 11778 mtDNA mutation. (Ophthalmol CHN, 2022, 31: 386-389)

Effectiveness of EyeSi simulated surgery training system in cataract surgery training for ophthalmologists#br#

Liu Ziyuan, Zeng Siyan, Ao Mingxin, Wang Wei, Sun Yanxiu

2022, 31(5):  390-393.  doi:10.13281/j.cnki.issn.1004-4469.2022.05.014

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Objective To evaluate the application effect of EyeSi cataract phacoemulsification training system (EyeSi system) in cataract surgery training for ophthalmologists. Design Self-controlled study. Participants Ten Ophthalmologists under specialist training in Peking University Third hospital. Methods Using EyeSi system for cataract surgery training and the evaluation of capsulorhexis steps were recorded. Five cataract surgeons with senior professional titles scoring the trainees’ operation videos before and after the training according to the blind method of the International Council of Ophthalmology Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR). The trainees filled in the self-evaluation scale. Main Outcome Measures Assessment results of the EyeSi system, the ratings from the cataract specialists and the trainees'  self-evaluation scale. Results EyeSi system showed that after training the uniformity of capsulorhexis radius was improved from (24.51 ± 30.58)% to (95.90±7.00)% (t=-7.600，P=0.000), suggesting that the capsulorhexis was more round. The distance from the center of the capsulorhexis decreased from (0.38±0.14) mm to (0.11±0.06) mm (t=4.726，P=0.001), suggesting that the capsulorhexis was more centered. The operation time was shortened from (138.12±34.92) s to (84.15±27.34) s (t=3.813, P=0.004), indicating that the operation was more skilled. The total score increased from (44.10±31.08) to (95.30±4.40) (t=-5.523，P=0.000). The ICO-OSCAR showed that the performance of capsulorhexis was improved from (3.70±0.59) before training to (4.44±0.31) after training (t=-3.922, P=0.004). The score of capsulorhexis opening shape was improved from (3.74±0.71) to (4.14±0.30), but the difference was not statistically significant (t=-1.519，P=0.163). In addition to the obvious progress in the operation of capsulorhexis flap and capsulorhexis shape, the students' self-evaluation scale showed other surgical skills such as intraocular lens implantation, instrument stability, reducing tissue traction, protecting posterior capsule and operation speed, were also significantly improved(all P<0.05). Conclusion EyeSi system can be effective in cataract surgery training represented by the procedure of capsulorhexis. (Ophthalmol CHN, 2022, 31: 390-393)