Table of Content

25 November 2022, Volume 31 Issue 6

Previous Issue   

Theory of trabecular meshwork pump regulation and its implications for glaucoma diagnosis and treatment

Xin Chen

2022, 31(6):  405-412.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.001

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 Abnormality in trabecular meshwork pathway leads to high intraocular pressure (IOP), which is the most significant risk factor for primary open angle glaucoma (POAG). Pulsatile characterize the aqueous outflow and originates the development of pumping theory. Trabecular meshwork is prestressed elastic tissue sensitive to IOP variation. Trabecular meshwork is the mobile wall of the compressible chamber, Schlemm canal (SC). It links the IOP induced motion to valve-like structure in SC, which cooperates with opening/close of deep scleral plexus of channels. All above factors involve in regulation of IOP. This article introduces the concept of aqueous pumping system and its potentials in clinic. It could provide new perspective for glaucoma specialist to better understand the mechanism of POAG, optimize the treatment and develop new strategies. (Ophthalmol CHN, 2022, 31: 405-412)

Extracellular deposits associated with age-related maculopathy: subretinal drusenoid deposits and reticular pseudodrusen

Huang Houbin, Xie Hainan

2022, 31(6):  413-418.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.002

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 Lipoprotein-derived debris accumulated between photoreceptors and retinal pigment epithelium (RPE) is called subretinal drusenoid deposits or reticular pseudodrusen, which is very common clinically but usually misrecognized as drusen. Reticular pseudodrusen is associated with retinal angiomatous proliferation and outer retinal atrophy.  (Ophthalmol CHN, 2022, 31: 413-418)

Study on color sensitivity and color discrimination in normal and congenital color vision deficiency

Wang Peihong, Ou Li, Li Zhaohui, Jia Liang

2022, 31(6):  419-422.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.003

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 Objective To compare the differences of color sensitivity and color discrimination between normal and congenital color vision deficiency by using self-designed percentile color vision quantitative test table(percentile table). Design Diagnostic technique evaluation. Participants Forty-eight subjects with normal color vision (46 males and 2 females), 28 patients with abnormal red vision (27 males and 1 female) and 71 patients with abnormal green vision (68 males and 3 females). Methods The color sensitivity and color discrimination of the subjects were measured by the percentage table, and the scores were compared and analyzed, and described by the median (quartile). Main Outcome Measures Color sensitivity scores of red, green and blue; color discrimination scores of red-green, red-blue and green-blue. Results Using the percentile table, the color sensitivity scores of red, green and blue were 96 (95, 97), 98 (97, 98) and 95 (92.25, 96), respectively. The color discrimination scores of red-green, red-blue, and green-blue were 97 (97, 98), 96 (95, 97) and 98 (97, 98), respectively. Compared with normal controls, the scores of red color perception [91.5 (89.25, 93)], blue color perception [93 (90, 95)] and red-blue color discrimination [90.50 (86.25, 92)] were decreased in patients with congenital abnormal red perception (Z=-6.837, -3.151, and -6.780, all P<0.01). The scores of red color perception [95 (94, 96)], blue color perception[91 (88, 93)], red-green color discrimination [96(96, 97)] and red-blue color discrimination [94(93, 95)] decreased in patients with congenital green abnormalities (Z=-3.982, -4.863, -3.789 and -5.370, all P<0.001). The diagnosis of red color deficiency by red color perception score: the area under the curve (AUC) of ROC was 0.874 (95%CI: 0.800-0.949, P<0.001). The diagnosis of green color deficiency by green color perception score: AUC of ROC was 0.650 (95% CI: 0.539-0.762, P=0.02). The cut-off point of red color perception was 93.5, sensitivity 85.7% and specificity 83.1%. Conclusion It is feasible to objectively detect congenital color vision deficiency with a self-made percentile color vision quantitative test table, and the red color perceptionis more sensitive. (Ophthalmol CHN, 2022, 31: 419-422)

Safety and efficacy evaluation of CTR model capsular tension ring implanted for more than 5 years

Chen Weirong, Ye Jian, Yu Ayong

2022, 31(6):  423-428.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.004

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Objective To evaluate the 5-year or longer clinical safety and efficacy of CTR model capsular tension ring implantation. Design Prospective cohort study. Participants 36 subjects completed 5-year continuous observation, including 18 subjects in the study group and 18 subjects in the control group. The clinical research centers were Zhongshan Ophthalmic Center, Sun Yat-sen University; Department of Ophthalmology, Army Medical Center of PLA, Army Characteristic Medical Center (Daping Hospital) and Eye Hospital; Wenzhou Medical University. Methods The subjects who underwent lens extraction combined with capsular tension ring and intraocular lens implantation and completed 1 year follow-up(monocular enrollment) were observed for more than 5 years. In the early stage, the subjects were randomly divided into two groups, the subjects in study group were implanted with the CTR model capsular tension ring and the subjects in control group were implanted with the TENSIOBAG model capsular tension ring. Main Outcome Measures Uncorrected distance visual acuity(UDVA) (LogMAR), best-corrected distance visual acuity (BCDVA) (LogMAR), spherical equivalent (SE), intraocular pressure (IOP), corneal endothelial cell density, slit lamp examination results, subjective visual evaluation results, hyperopia out of lens rate and overall satisfaction. Results There were no significant differences between the two groups in terms of baseline basic data and ophthalmologic examinations, balanced and comparable. At different visit time points after operation, there was no significant difference in UDVA, BCDVA, and objective SE between the two groups (all P>0.05). At 5 years after operation, UDVA was improved from 0.49±0.41 to 0.20±0.20 in the study group and from 0.52±0.51 to 0.32±0.33 in the control group. The UDVA reached 0.30 or better ratio was 88.89% in the study group, and was 72.22% in the control group; BCDVA was from 0.44±0.37 to 0.09±0.12 in the study group and from 0.34±0.23 to 0.10±0.21 in the control group; the objective SE was from -3.52±8.70 D to -0.70±2.05 D in the study group and from -4.49±7.14 D to -0.51±1.32 D in the control group. There was no significant difference in visual acuity and SE between 5 years or above after operation and other time points after operation in the study group, while the control group fluctuated to a certain extent. At 5 years or above after operation, there was no significant difference in IOP between the two groups (all P>0.05), and there was no significant difference compared with the baseline period (all P>0.05). At 5 years or above after operation, there was no significant difference in corneal endothelial cell density between the two groups (P=0.128). There was no IOL deviation, abnormal position and shrinkage of the capsular bag in two groups. There were no significant differences in slit lamp examination, subjective evaluation of poor visual symptoms, hyperopia out of lens rate and overall satisfaction between the two groups at 5 years or above after operation (all P>0.05). Conclusion Through a small sample size study of 5 years or more after CTR model capsular tension ring implantation, it was found that the long-term visual acuity and SE of the subjects after operation were relatively stable, IOP and corneal endothelial cell density were normal, the subjects complained of no obvious visual adverse symptoms, and the overall satisfaction was high, and has good long-term safety and efficacy. (Ophthalmol CHN, 2022, 31: 423-428)

Study on the difference of digital eye strain impact between head mounted display and desktop display

Zhang Wei, Zhen Yi, Du Lihua, Wang Ningli

2022, 31(6):  429-434.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.005

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 Objective To compare the influence difference of digital eye strain between head mounted display (HMD) and desktop display (DP) when using for reading application. Design Two stage cross-over design study. Participants 42 college students aged 18-21 years old. Methods The subjects were randomly divided into two groups, 21 cases in each group. The first group used HMD first, and then used DP to read the same text for 40 minutes, with an interval of 30 minutes. The second group was in the reverse order. An open-field autorefractor was used to measure the refraction and accommodative lag before and after reading. Likert scale was used to record subjective visual fatigue scores before and after reading. Reading efficiency was defined as a product of reading accuracy and reading rate per minute. Main Outcome Measures Refraction, corrected visual acuity, accommodative lag, and visual fatigue scale score, reading efficiency. Results Using HMD, the diopter before and after reading was -0.045 (-0.56, 0.31) D and -0.025 (-0.45, 0.31) D, respectively (P=0.144), and the accommodative lag was (1.13±0.57) D and (1.16±0.62) D, respectively (P=0.612). The corrected visual acuity was 1.00 (0.8,1.2), 1.00 (0.8,1.2), respectively (P=0.978). There were no significant differences in refraction, accommodative lag and corrected visual acuity before and after reading with HMD. The subjective score of visual fatigue before and after reading was 0.50 (0, 3.25), 2.50 (1.00, 6.00), respectively (P=0.004). The mean value of visual fatigue score increased after reading, and the difference was statistically significant. Using DP, the diopter before and after reading was -0.070 (-0.50, 0.23) D and-0.020 (-0.50, 0.26) D, respectively (P=0.305), the accommodative lag was (1.09±0.58) D and (1.13±0.59) D, respectively (P=0.491), and the corrected visual acuity was 1.00 (0.8, 1.0), 1.00 (0.8, 1.0), respectively (P=1.000). There were no significant differences in refraction, accommodative lag and corrected visual acuity. The subjective score of visual fatigue before and after reading was 0 (0, 3.00), 3.00 (1.00, 6.25), respectively (P<0.001). The mean value of visual fatigue score increased after reading, and the difference was statistically significant. There were no significant differences in the variations of refraction variation (P=0.126), accommodative lag (P=0.962), corrected visual acuity (P=0.894) and visual fatigue score (P=0.160). There was a significant difference in reading efficiency between HMD and DP devices (P=0.009). The reading efficiency of HMD was lower than that of DP (20.11±6.09, 22.01±6.91, P=0.009). Conclusion Compared with DP, HMD did not cause more digital eye strain during 40 minutes text reading.  (Ophthalmol CHN, 2022, 31: 429-434)

The six months efficacy of corneal intrastromal lenticule implantation for hyperopia and its influence on the change of corneal posterior surface elevation

Yang Shirui, Hou Jie, Zhang Jing, Lei Yulin, Tang Min

2022, 31(6):  435-439.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.006

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 Objective To investigate the efficacy of corneal intrastromal lenticule implantation for hyperopia and its influence on higher order corneal aberrations and posterior corneal elevation. Design Retrospective case series. Participants Thirty-one hyperopic eyes of 25 patients who underwent corneal intrastromal lenticule implantation with 18 to 45 years old were enrolled in Jinan Mingshui Eye Hospital from 2020 to 2021. Methods Uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCDVA), spherical equivalent (SE), anterior segment OCT, and Pentacam corneal topography were performed preoperatively and 1 week, 1 month, 3 months, and 6 months postoperatively. Corneal higher order aberrations (HOA) and posterior corneal elevation from different concentric radial zones were obtained and compared using Pentacam before and after surgery. Main Outcome Measures UDVA, BCDVA, SE, corneal curvature, HOA, posterior corneal surface elevation. Results The UDVA and the BCDVA were significantly improved after surgery (all P<0.001). Six months after surgery, the UDVA of 26 eyes was equal or better than the preoperative BCDVA. The BCDVA of 14 eyes was better than the preoperation. The SE was significantly decreased at each time point after surgery than before surgery (all P<0.001). The SE was (+0.36±0.93) D 6 months after surgery. The anterior surface of corneal curvature increased obviously after surgery, but no change was found in the corneal curvature of posterior surface. The total HOA and spherical aberrations of the whole cornea after surgery (0.98±0.34 μm, -0.13±0.25 μm) were significantly different from those before surgery (0.41±0.09 μm, 0.17±0.11 μm) (all P<0.001). No significant difference was found in the posterior corneal elevationat the corneal apex before and after surgery (P>0.05). The elevation at 1 mm and 2 mm radius reduced significantly at one week (2.76±3.30 μm, -2.29±2.11 μm) compared with baseline (3.86±2.57 μm, -1.63±1.88 μm) (all P<0.05). However, there was no significant difference in posterior corneal elevation before and 6 months after surgery (3.69±3.28 μm, -1.69±1.93 μm) (all P>0.05). Conclusions The 6 months follow-up showed that good visual outcomes were obtained after corneal intrastromal lenticule implantation for hyperopia, no significant refractive regression was observed. Corneal HOA increased after surgery, the elevation of posterior corneal surface decreased first and then returned to the preoperative level. (Ophthalmol CHN, 2022, 31: 435-439)

Comparative study of central corneal thickness measurements with four non-contact optical instruments

Zhang Cong, Yang Wenli, Yao Ning, Diao Lili, Li Lei, Zhang Han, Kang Lihua, Liu Chenchen

2022, 31(6):  440-445.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.007

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 Objective To compare the central corneal thickness (CCT)  measurements obstained by Pentacam HR, specular microscopy (SP-3000P), swept-source optical coherence biometry(OA-2000) and optical coherence tomograhpy (Optovue Angiovue OCT with anterior segment lens). Design Diagnostic technique evaluation. Participants 118 eyes of 118 patients with healthy cornea at cataract clinic of Beijing Tongren Hospital from September to Novermber 2021. Method CCT values were obtained by these four instruments. The differences among CCT values of cornea apex from these four instruments, and the agreement between each two were evaluated. CCT values of cornea apex and pupil center from Pentacam HR, and CCT of cornea apex and average CCT of central 2 mm zone from Optovue OCT were also compared. Main Outcome Measures CCT, intraclass correlation coefficient (ICC), the mean difference and 95% limits of agreement (LoA) of Bland-Altman diagram. Results CCT of cornea apex obtained by Pentacam HR, SP-3000P, OA-2000 and Optovue OCT was 532.29±30.35 μm, 512.20±30.88 μm, 516.89±31.25 μm and 515.58±29.78 μm respectively. CCT of pupil center obtained by Pentacam HR was 531.25±30.75 μm, and average CCT of central 2 mm zone with Optovue OCT was 516.75±29.72 μm. Significant difference was found between CCT of cornea apex and CCT of pupil center from Pentacam HR (t=6.275, P＜0.001), and also between CCT of cornea apex and average CCT of central 2 mm zone from Optovue OCT (t=4.364, P＜0.001). There was significant difference among CCT of cornea apex obtained by these four optical instruments (F=559.469, P＜0.001) and between each two values with further pairwise comparison (OA 2000-Optovue OCT: P=0.022; other each two values: all P<0.001). ICC between Pentacam HR and other devices was 0.806-0.878, and Bland-Altman diagram showed that the mean difference was 15.40~20.09 μm, with 95% LoA 5.9~32.4 μm. ICC between SP-3000P and OA-2000, and between SP-3000P and Optovue OCT was 0.973 and 0.974, while the mean difference was -4.69 μm and -3.38 μm, and 95% LoA -15.6~8.6 μm. ICC between OA-2000 and Optovue OCT was 0.986, with the mean difference of 1.31 μm and 95%LoA -8.3~10.9 μm. Conclusions  SP-3000P, OA-2000 and Optovue OCT showed very strong correlation and comparable agreement with narrow 95% LoA when measuring the CCT of cornea apex, so the values could be used interchangeable in clinical practice. Penctacam HR overestimates other instruments with poor agreement, and the measurements are not interchangeable directly. (Ophthalmol CHN, 2022, 31: 440-445)

Comparative study on CASIA2 optimized NK and KS formulas for predicting ICL (V4c) vault and actual vault

Liu Shuaishuai, Liu Yong, Zhao Lili, Yin Xiliang

2022, 31(6):  446-452.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.008

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 Objective To study the consistency between actual vault and the vault predictedby NK and KS formulas optimized by CASIA2. Design Diagnostic technique evaluation. Participants 68 cases (68 eyes) of ICL implantation in Hefei Aier Eye Hospital. Methods The Nomogram online formula was used to calculate 68 eyes' ICL models, and they were divided into three groups of 12.1 mm, 12.6 mm and 13.2 mm according to the recommended results of the online formula. Then CASIA2 was used to measure the actual vault. The difference, correlation and consistency were compared between the actual vault(V1d12.1, V1d12.6, V1d13.2) 1 day after operation, actual vault (V1m12.1, V1m12.6, V1m13.2) 1 month after operation in the above three types of groups and the vault predicted by NK and KS formulas before operation built-in CASIA2, and the coincidence rate was also compared among the ICL (V4c) model recommended by the online formula NK and KS, respectively. Main Outcome Measures Correlation and consistency between actual vault and formula predicted vault.  Results One day after surgery, the actual vault of all eyes (68 eyes) was (528.8±176.9) μm. One month after operation, it decreased to (476.8±161.2) μm. The vault predicted by NK formula was (656.2±204.5) μm and KS formula was (707.1±173.8) μm. The total coincidence rate between Nomogram online formula and NK formula was 55.88%, and the total coincidence rate with KS formula was 42.65%. The actual vault (V1d12.1, V1d12.6, V1d13.2) and the actual vault (V1m12.1, V1m12.6, V1m13.2) of the three ICL (V4c) groups at one day and one month after surgery were compared with the vault predicted by NK formula (VNK) and KS formula (VKS) respectively, except that there was no statistically significant difference between the vault of V1d12.1 group and VKS group (t=-2.056, P=0.079), the actual vault of other model groups were lower than those predicted by NK formula and KS formula (all P<0.05). The predicted vault of NK formula and KS formula was linear with V1d (Y=0.4728 * X+218.6, Y=0.5450 * X+143.4), it was also linear with V1m (Y=0.3985 * X+215.3, Y=0.4604 * X+151.2). The intra group correlation coefficients (ICC) between V1d and VNK, V1d and VKS formula was 0.541 and 0.536; the Cronbach coefficients was 0.702 and 0.700, respectively. The ICC between V1m and VNK, V1m and VKS formula was 0.492 and 0.495, the Cronbach coefficient was 0.659 and 0.662, respectively. Bland-Altman analysis showed that 95% LoA between V1d and vault predicted by NK formula and KS formula was (-486.5~231.7) μm, (-509.6~153.0) μm, respectively. 95% LoA between V1m and vault predicted by NK formula and KS formula was (-543.4~184.5) μm, (-560.6～99.86) μm, respectively. Conclusions The predicted vault of CASIA2 optimized NK and KS formulas is higher than the actual vault, and the accuracy of CASIA2 optimized NK and KS formulas for predicting small model group ICL (V4c) is slightly better. (Ophthalmol CHN, 2022, 31: 446-452)

The changes in constituent ratios of acute acquired concomitant esotropia and intermittent exotropia hospitalized for inpatient operation after COVID-19 pandemic

Shen Jiang, Hua Chaoqun, Lou Hong, Wang Pengyun, Long Yonghua

2022, 31(6):  454-457.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.009

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 Objective To observe the changes of the constituent ratios of acute acquired concomitant esotropia and intermittent exotropia hospitalized for inpatient operation after COVID-19 pandemic. Design Retrospective case series. Participants A total of 3140 patients with acute acquired concomitant esotropia and intermittent exotropia were included for strabismus surgery in the Department of Strabismus and Pediatric Ophthalmology of Ningbo Eye Hospital from January 2018 to December 2021, and divided into pre-epidemic group (1330 cases from 2018 to 2019) and post-epidemic group (1810 cases from 2020 to 2021). Methods The case data were reviewed in medical record management system. Main Outcome Measures Constituent ratio. Results The constituent ratios of acute acquired concomitant esotropia (2.87%) and intermittent exotropia (47.24%) in the post-epidemic group were significantly increased than those in the pre-epidemic group (0.90% and 37.29%) (χ2=14.912, P<0.001; χ2=30.928, P<0.001). And the proportions of small angle intermittent exotropia (55.09%) and intermittent exotropia with myopia (77.89%) in the post-epidemic group were also significantly increased than those in the pre-epidemic group (46.37% and 68.15%) (χ2=10.996, P=0.001; χ2=15.632, P<0.001). Conclusion After the COVID-19 pandemic, the constituent ratios of acute acquired concomitant esotropia and intermittent exotropia were also increased signifieantly. The proportion of intermittent exotropia with small angle, as well as with myopia, also increased significantly. (Ophthalmol CHN, 2022, 31: 454-457)

Clinical features of parafoveal exudative vascular anomalous complex

Xiao Yuanyuan, Li Yibin, Liu Guangfeng, Peng Xiaoyan

2022, 31(6):  458-462.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.010

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Objective  To summarize the clinical features of parafoveal exudative vascular anomalous complex(PEVAC). Design Retrospective case series. Participants Twelve eyes of 12 patients with PEVAC in Beijing Tongren Hospital from 2014 to 2022. Methods The clinical data and medical records of the enrolled patients were collected, including best-corrected visual acuity (BCVA), slit-lamp examination, ophthalmoscopy, color fundus photograph (CFP), optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescence angiography(FFA). Main Outcome Measures Findings and manifestations on CFP, OCT, OCTA and FFA. Results Twelve patients were all subjected to monocular onset, with a mean age of (57±13) years old. The follow-up period ranged from 2 to 72 months, with an average of [8(5, 35)] months. Hard exudation and cystoid macular edema (CME) were respectively seen in 6 patients (50%), and only 1 patient (8.3%) was accompanied with parafoveal hemorrhage. The foveal retinal thickness was 197 to 422 μm with an average of [218(210, 286)] μm. The horizontal distance of the aneurysmal lesion to the central fovea ranged from 241 to 843 μm with an average of (527±205) μm, whereas horizontal distances to the fovea in 7 patients (58.3%) were less than 500 μm. All the patients suffered from the parafoveal isolated aneurysmal lesion with a mean diameter of [113(96,119)] μm ranging from 84 to 329 μm. The aneurysmal lesion of 9 patients (75.0%) were located at deep retinal capillaries. Two patients underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection treatment, of which 1 patient was aggravated after intravitreal anti-VEGF. One patient was subjected to a micropulse laser treatment due to the failure of twice continuous intravitreal injection, and CME was relieved 1 month after giving a micropulse lasertreatment. Besides, the CME of another patient spontaneously subsided during follow-up, however, the diameter of the aneurysmal lesion in one patient was gradually dilatated. One patient was complicated with chronic angle closure glaucoma. Conclusions PEVAC is commonly manifested as a monocularly parafoveal isolated aneurysmal lesion, often located in the deep retinal capillary. The aneurysmal lesion either subsided or gradually expanded and CME can spontaneously resolve. （Ophthalmol CHN, 2022, 31: 458-462）

Preliminary efficacy of preoperative process improvement on intravitreal drug injection 

Wang Lei, Liu Shuxian, Song Wei

2022, 31(6):  463-466.  doi:10.13281/j.cnki.issn.1004-4469.2022.06.011

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 Objective  To explore the preliminary efficacy of preoperative process improvement on intravitreal drug injection. Design Prospective comparative case series. Participants 500 patients undergoing intravitreal injection surgery in ophthalmic daytime operation room of Beijing Tongren Hospital. Method The preoperative process of intravitreal injection procedures was improved (study group, n=260 cases), including adjusting the order of application items in the surgical appointment form, adding color blocks to distinguish different injectable drugs, marking the surgical eye with multiple stickers with different color and fonts, and adjusting the frequency and timing of topical anesthetics. Traditional preoperative procedure (control group, n=240 cases) was compared with study group. Main Outcome Measures The time for checking surgical appointment form, the satisfaction of doctors and nurses on the improved surgical appointment form, the proportion of difficult surgical checking due to various reasons, and the intraoperative pain score of patients. Result The time for checking surgical appointment form in control group and study group were 5.00±0.51 min and 2.00±0.49 min, respectively (t=64.132, P<0.001). The proportion of satisfied with the surgical appointment form in surgeons and itinerant nurses was 100% in the study group and 20% in the control group. The proportion of unclear eye-marker caused by eyewash was 41.7% in the control group and 0.0% in the study group, respectively (χ2=135.41, P<0.001). The proportion of the huck towel covering the surgical eye-marker was 100% in the control group and 0% in the study group, respectively (χ2=192.4 , P<0.001). Intraoperative pain score in study group was 2.14±0.15, less than in control group (2.82±0.54) (t=8.708, P<0.001).  Conclusion Preoperative process improvement on intravitreal drug injection can help to increase the efficiency of intravitreal injection surgery, and increase medical staff satisfaction, and decrease the intraoperative pain of intravitreal injection. (Ophthalmol CHN, 2022, 31:  463-466)