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    25 January 2023, Volume 32 Issue 1
    How to use OCTA to help the diagnosis and treatment of glaucoma
    Wu Lingling
    2023, 32(1):  1-5.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.001
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    The progress of optical coherence tomography angiography (OCTA ) in recent years makes it possible to quantitatively detect the blood flow of fundus microvessels due to its fast scanning speed and high resolution, and has good repeatability in detecting the blood flow around the optic disc and in the macular region, which shows the potential ability to diagnose and monitor glaucoma as a supplement of structural OCT and perimeter. In this manuscript, the following issues were discussed: (1) The main detection parameters of OCTA for glaucoma, including the superficial peripapillary vessel density, the superficial vessel density of the macular region, and the choroidal or deep-layer microvasculature dropout (CMvD); (2) The ability and characteristics of OCTA in detecting glaucoma compared with structural OCT and perimeter; (3) How to use OCTA to detect glaucoma. (Ophthalmol CHN, 2023, 32: 1-5)

    Extracellular deposits associated with age-related maculopathy: differentiating drusen and drusenoid deposits
    Huang Houbin
    2023, 32(1):  6-15.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.002
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    There are a variety of entities which can result in drusen or drusenoid deposits, either eye disorders or disorders with systemic features, hereditary or non-hereditary. The visual cycle, retinal photoreceptors or retinal pigment epithelium are usually involved. Thoroughly recognizing and understanding these entities is of much importance for diagnosing and treating age-related maculopathy and miscellaneous diseases correctly. (Ophthalmol CHN, 2023, 32: 6-15)

    Analysis of regional distribution differences of visual disability among older adults in China
    Liu Yunduo, Dai Wanwei, Wang Yiran, Yu Yuanbo, Guo Shuai, Zhang Chun, Zheng Xiaoying
    2023, 32(1):  16-20.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.003
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     Objective To analyze the regional distribution of older adults with visual disabilities and to provide a basis for improving the efficiency of rehabilitation of the visually disabled population and the formulation of regional prevention policies. Design Cross sectional survey. Participants 354 859 elderly people aged 60 and above in the Second China National Sample Survey on Disability in 2006. Methods Based on the data of the Second China National Sample Survey on Disability in 2006, the prevalence of older adults with visual disability in China were calculated by urban and rural areas and economic regions under different causes of disability. We determined whether the regional differences were statistically significant using logistic regression models, and conducted a descriptive analysis of the composition of the severity of visual disability among older adults by region. Main Outcomes Measures Prevalence and constituent ratio. Results The prevalence of visual disability among rural older adults was higher than that in urban areas, with the prevalence of congenital, infectious, non-infectious, and unexplained and other causes of visual disability being 1.93, 3.30, 1.59 and 2.07 times higher than that of urban older adults, respectively. The severity of visual disability was also more severe in rural older adults. The causes of visual disability were mainly non-infectious diseases. The northern coastal region had the lowest prevalence of visual disability cause by non-infectious diseases (39.10‰, 95%CI: 37.56~40.65) and less severe disability, while the southern region and highland region had higher prevalence (great southwest region: 67.41‰, 95%CI: 65.59~69.22; southern coastal region: 72.16‰, 95%CI: 69.52~74.79; great northwest region: 84.00‰, 95%CI: 80.26~87.73). Conclusion There are regional differences in the causes and severity of disability among older adults with visual disabilities in China. Prevention and treatment strategies for visual disability of key groups should be adopted according by levels. (Ophthalmol CHN, 2023, 32: 16-20)

    Efficacy and safety of trabeculectomy combined anterior chamber proliferative membrane interception in neovascular glaucoma
    Zhou Mengtian, Zhu Shuqing, Li Haoyu, Chen Qi, Xu Shuxia, Xie Yanqian, Le Rongrong, Wang Xiaojie, Zhang Shaodan, Liang Yuanbo,
    2023, 32(1):  21-26.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.004
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    Objective To evaluate the safety and effectiveness of trabeculectomy combined with anterior chamber proliferative membrane interception (AC-PMI) on neovascular glaucoma (NVG).  Design Retrospective case series. Participants Twenty-eight patients (31 eyes) with NVG who underwent trabeculectomy combined with AC-PMI in the Eye Hospital of Wenzhou Medical University. Methods Medical records of patients were reviewed and followed up at one day, one week, month 1, 3, 6, and 12-momth postoperatively. Repeated measured ANOVA was applied to compare pre- and postoperative intraocular pressure (IOP) and number of anti-glaucoma medication. Kaplan-Meier survival-curve analysis was used to evaluate cumulative probability of surgery success.  Main Outcome Measures IOP, number of anti-glaucoma medication, surgery-related complications and success rate of operation. Results The mean follow-up was 11.3±3.8 months. The mean IOP decreased from (51.3±8.3) mmHg on 2(2, 3) medications before surgery to (14.2±5.1) mmHg (P<0.001) on 0(0, 0) medications (P=0.002) at 12 months post-operation, respectively. The cumulative complete success rate and qualified success rate were 72.6% and 87.3% at 12 months post-operation, respectively. The incidence of hypotension, hyphema, shallow anterior chamber, choroidal detachment and descemet’s membrane fold all were 3.2% (1/31). Conclusions Trabeculectomy combined with AC-PMI can effectively reduce and stabilize IOP in NVG patients, and is an alternative combined surgical approach for NVG. (Ophthalmol CHN, 2023, 32: 21-26)

    Expression and distribution of the mechanosensitive channel Piezo in eyes
    Wan Yue, Fan Xiaowei, Wang Ningli
    2023, 32(1):  27-32.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.005
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     Objective To investigate the expression profiles of mechanosensitive channel Piezo family members, Piezo1 and Piezo2, in eyes. Design Experimental study. Participants Nine eyes of 12-week-old adult male C57BL/6N mice, 3 eyes of adult male Piezo1td-Tomato mice, and one paraffin section of a human eyeball were used. Methods RNAscope fluorescence in situ hybridization in the frozen sections of the eyes of the C57BL/6N mice was performed to detect the expression of Piezo1 and Piezo2 mRNA. Quantitative real-time polymerase chain reaction (qPCR) of the eyeball tissues of C57BL/6N mice was performed to detect the relative expression of Piezo1 and Piezo2 mRNA. Western blot of the eyeball tissues of C57BL/6N mice was performed to detect the expression of Piezo1 and Piezo2 proteins. Immunofluorescence staining in the frozen sections of the eyes of Piezo1td-Tomato mice was performed to detect the expression of Piezo1-tdTomato protein. Immunofluorescence staining in the paraffin section of the human eyeball was performed to detect the expression of Piezo1-tdTomato protein. Main Outcome Measures Relative fluorescence intensity and cycle threshold (Ct value). Results RNAscope fluorescence in situ hybridization in the frozen sections of the eyes of the C57BL/6N mice showed that Piezo1 mRNA was expressed in the cornea, iris, ciliary body, lens epithelium, sclera, retina, the neural tissues in the glial laminar region of optic nerve head; and Piezo2 mRNA was expressed in the cornea, iris, and sclera tissues. The qPCR of ocular tissues of the C57BL/6N mice showed that the average Ct value of Piezo1 cDNA was lower than 30 in the cornea, iris, lens, retina, the neural tissues in the glial laminar region of optic nerve head, sclera, and extraocular muscle tissues. The mean Ct value of Piezo2 cDNA was higher than 30 in lens and retinal tissues. Western blot of ocular tissues of the C57BL/6N mice showed that Piezo1 protein was expressed in the cornea, iris, lens, retina, and the neural tissues in the glial laminar region of optic nerve head, sclera, and extraocular muscles. Piezo2 protein is expressed in the cornea, iris, and sclera. Immunofluorescence staining of frozen sections of the eyeball of Piezo1td-Tomato mice showed that Piezo1-tdTomato protein was expressed in the neural tissues in the glial laminar region of optic nerve head. Immunofluorescence staining of the human eyeball paraffin section also showed that Piezo1 protein was expressed in the neural tissues in the laminar region of optic nerve head. Conclusions Piezo1 is widely expressed in the murine eye, including the anterior segment, the posterior segment of the eye, and the optic nerve tissue in the glial lamina area. Piezo1 protein was robustly expressed in the neural tissues in the laminar region of optic nerve head of the human eyeball, which may be an important mechanical sensor that receives and responds to the changes in intraocular pressure, cerebrospinal fluid pressure in the optic nerve sheath space, and the pressure difference between them. (Ophthalmol CHN, 2023, 32: 27-32)
    A multicenter study of clinical efficacy and safety of NOR aspherical orthokeratology lenses
    Chen Yueguo, Zhang Yu, Qu Xiaomei, Wang Ti, Lan Fangfang, Xie Yalin, Li Jianhua, Zhao Dongqing, Lv Tianbin, Liu Longqian, Wu Zhengzheng, Yang Yin, Du Xianli, Jiang Jun, Pei Cheng, Wu Jie, Yang Xiao (The order of authors is arranged by the first letter of the name of their unit of work, each author contributed equally)
    2023, 32(1):  33-38.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.006
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    Objective To evaluate the clinical efficacy and safety of NOR aspherical orthokeratology lenses for the correction of myopia. Design A prospective multicenter cohort study. Participants 456 patients (912 eyes) with myopia who wore NOR aspherical orthokeratology lenses in 11 hospitals of China from May 2019 to December 2020. Methods All patients were fitted with NOR aspherical orthokeratology lenses and were followed up before wearing lenses and 1 day, 1 week, 1 month, and 3 months after wearing lenses. Main Outcome Measures Uncorrected distance visual acuity, spherical diopter, cylindrical diopter, spherical equivalent, intraocular pressure, corneal endothelial cell density, corneal endothelial polymorphism grade, complications, lens fit, and lens status. Results All 456 patients were enrolled, including 300 females, with an average age of 15.59±8.24 years. At each follow-up time point after wearing lenses, uncorrected distance visual acuity in both eyes was significantly improved compared with baseline (all P<0.05). After wearing lenses for 3 months, the proportion of uncorrected distance visual acuity reaching 0.0 LogMAR was 67.76% (right eye) and 65.88% (left eye). The spherical diopter of the right eye decreased from -2.47±0.87 D to -0.30±0.62 D (P<0.001), and the spherical diopter of the left eye decreased from -2.37±0.87 D to -0.26±0.57 D (P<0.001). The cylindrical diopter of the right eye decreased from -0.41±0.44 D to -0.12±0.30 D (P<0.001), and the cylindrical diopter of the left eye decreased from -0.50±0.45 D to -0.16±0.38 D (P<0.001). Compared with baseline, the spherical equivalent was reduced by 2.31±1.04 D (right eye) and 2.26±1.01 D (left eye). There was no significant difference in corneal endothelial cell density and corneal endothelial polymorphic grading in both eyes compared with baseline (all P>0.05). Non-contact intraocular pressure in both eyes was significantly reduced compared with baseline (all P<0.05). There were no serious complications in both eyes, and only individual cases had grade 1 or 2 bulbar conjunctival hyperemia, corneal epithelial spotting and corneal invasion, and continued glasses wearing could be achieved after stopping glasses or drug control therapy. Lens fit and lens conditions are good. Conclusion Wearing NOR aspherical orthokeratology lens can effectively improve the juvenile myopia patient's uncorrected distance visual acuity, reduce the spherical equivalent, and have less impact on corneal endothelial cell parameters and intraocular pressure. Lens fitting and lens condition are good. (Ophthalmol CHN, 2023, 32: 33-38)

    Correlation of the clinical characteristics and prognosis of cranio-orbital meningiomas
    Zhu Jianbo, Shi Jitong, Qiu E, Li Bin
    2023, 32(1):  39-44.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.007
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    Objective To analyze the clinical characteristics and associated projnostic factors of cranio-orbital meningiomas. Design Retrospective study. Participants Fifty-six patients with 27 male and 29 female were recruited who were diagnosed to be cranio-orbital meningiomas by surgery or biopsy. Methods The clinical characteristics, imaging features, involvement lesions, histopathological grading, Ki-67 values, and treatment schemes of all the cases were reviewed retrospectively. The information of tumor progression (TP) and time to tumor progression was also obtained. The correlation of those variables and TP was analyzed by Logistic multivariate analysis. Main Outcome Measures clinical manifestation; MRI features (including T1WI and T2WI signal changes, enhancement degree, enhancement uniformity, and invasion range); the change of adjacent bone showed by CT bone window; treatment plan; histopathological grading; Ki-67 index; tumor progression and progression time. Results 35 cases (62.5%) had exophthalmos and 23 cases (41.1%) had decreased vision. The most involvement lesion of cranio-orbital meningioma was orbital apex (82.1%,46/56). 89.3% of cases showed iso-intensity on T1WI(50/56), and 80.4% of cases with slight hyper-intensity on T2WI(45/56), all the tumors (100%) showed obvious enhancement, and 16.1% of cases (9/56) showed heterogeneous enhancement after contrast media injection. Surgery is the most common treatment (98.2%, 55/56), with 11 cases (19.6%) performed adjuvant radiotherapy after operation. 42 cases had histopathogical grading WHO-I (75%), and 14 cases with WHO-II or III (25%). Ki-67 index was obtained in 38 cases with 6 cases showing the values of ≥5% (15.8%). Logistic regression analysis showed that the variables including operation method, enhancement pattern on MRI, brain involvement, WHO grading and Ki-67 value were correlated with TP significantly. Conclusion Orbital apex involvement is the most common feature of cranio-orbital meningiomas. Total tumor resection, homogeneous enhancement on MRI, no brain involvement, grading WHO-I and Ki-67 <5% were associated with better tumor prognosis significantly. (Ophthalmol CHN, 2023, 32: 39-44)

    Efficacy of preoperatively applying novel eye dressing with central window in alleviating ocular surface symptoms among thyroid associated ophthalmopathy patients with lagophthalmos#br#
    #br#
    Sha Ying, Zhang Ruiheng, Huang Kun
    2023, 32(1):  45-48.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.008
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    Objective To observe the effect of a novel type eye dressing with central window in alleviating ocular surface symptoms among thyroid associated ophthalmopathy patients with lagophthalmos. Design prospective randomized controlled trial. Participants 40 patients with thyroid-associated ophthalmopathy underwent orbital decompression surgery in Beijing Tongren Hospital. Method Forty patients were randomly divided into groups by the numerical table method, 20 of whom used the new eye dressing with central window (observation group), and the other 20 were in the control group. The observation group received the novel eye dressing with central window during night sleeping, while the control group was treated with the original mode for three consecutive days. The patient's subjective and objective symptom improvement was evaluated. The Kolcaba comfort scale and pain score were questionnaired.Main Outcome Measures corneal fluorescein staining, tear film rupture time, Schirmer II test, the Kolcaba comfort scale and pain rating scale. Results After 3 consecutive days, the tear film rupture time in the observation group was significantly prolonged (5.90±2.27 s vs. 8.93±5.22 s, P=0.02), the Schirmer II tear test was increased [5.0mm(2.0-10.0 mm)vs 9.0 mm (6.0-15.0 mm, P=0.02), and the ocular comfort score was significantly improved (72.10±4.72 vs. 77.36±4.98, P=0.015). The number of punctate epithelial erosions  [4 (2-5) vs. 1(0-2) points, P=0.001]  and pain scores  [1(0-1) vs.0 (0-0), P=0.01] in the observation group were significantly reduced after using the novel eye dressing compared with control group. Conclusions Short-term use of the novel type eye dressing with central window improved tear film stability, promoted recovery of corneal epithelial damage, and improved ocular comfort in patients with thyroid-related ophthalmopathy patients with lagophthalmos. (Ophthalmol CHN, 2023, 32: 45-48)

    Clinical and multimodal imaging characteristics of perifoveal exudative vascular anomalous complex
    Mo Bin, Yang Xiaohan, Ji Haixia, Jiao Xuan, Zhou Haiying, Liu Wu
    2023, 32(1):  49-54.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.009
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     Objective To observe the clinical characteristics and multimodal imaging characteristics of perifoveal exudative vascular anomalous complex (PEVAC). Design Retrospective case series. Participants 14 patients (14 eyes) with PEVAC in Beijing Tongren Eye Center during January 2011 to June 2022 were included. Methods The medical records data of all patients were reviewed. Main Outcome Measures The characteristics of color fundus image, FFA and OCTA; the blood flow density in different sections including whole image, fovea, parafovea, perifovea and 2 mm diameter. Results 14 patients (14 eyes) with PEVAC lesion included 9 females, with an average age of (63.21±6.69) years. There were 2 cases with diabetes and 4 cases with hypertension. On the color image, small red spots beside the fovea of the macula were seen in 7 cases, yellow white hard exudation changes were seen in 9 cases. FFA and ICGA showed punctate high fluorescence lesion with an average of (1.47±0.74); among them, 18 lesions were located at the temporal side of fovea and 4 lesions were at nasal side. The average distance from fovea to lesion was (690.68±168.68) μm. OCTA was performed in 8 cases. Blood flow signals were detected in the superficial retinal vascular layer in 1 case and in the deep retinal vascular layer in 7 cases. The blood flow density in different section of the superficial and deep layers was not statistically significant between the affected eye and the healthy eye (all P>0.05). Conclusion PEVAC often occurs in the elderly. It is manifested as a single or multiple large aneurysmal abnormality located in the inner layer of the retina that often occur in the temporal side of parafovea. It is often accompanied by exudative changes and rarely accompanied by bleeding. Abnormal blood flow signals can be detected in the deep or superficial retinal vascular layer. (Ophthalmol CHN, 2023, 32: 49-54)

    Measurement of the distance between lacrimal sac and axillary plane of middle turbinate in patients with chronic dacryocystitis based on CT lacrimal duct radiography
    Liu Xin, Mo Ya
    2023, 32(1):  55-57.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.010
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     Objective To measure the distance from the top and bottom of the lacrimal sac(LS) to the middle turbinate axillary plane (MTAP) on computed tomographic dacryocystography (CT-DCG ) to clarify the relative positional relationship between LS and MTAP in patients with chronic dacryocystitis(CD). Design experimental study. Participants CT lacrimal angiography images of 191 patients (216 eyes) with CD in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. Methods CT-DCG was performed in the patients. CT post-processing technology was used to carry out three-dimensional reconstruction of CT images, and to measure the distance from the top and bottom of the LS to the MTAP on the CT image. Main Outcome Measures The distance from the top and bottom of the LS to the MTAP. Results 153 cases (173 eyes) in all 191 patients (216 eyes) with CD are females. There is statistically significant difference in the distance between the top and the bottom of the LS to the MTAP in patients both in different genders and in different diseased eyes (P<0.05). There is no statistically significant difference in the 20-year-old age group (P>0.05), and the other age groups are statistically significant (P<0.05). The distance from the bottom to the LS to the MTAP is larger than that from the top of the LS to the MTAP. There is statistically significant difference in the bottom distance between the 41-60-year-old group and the 61-80-year-old group (P=0.003). The distance from the bottom of the LS to the MTAP is larger in the patients aged 61-80 years than that in patients aged 61-80 years. There is no significant difference both the top distance and the bottom distance of the other groups (P>0.05). Conclusions The distance from the bottom of the LS to the MTAP is larger than that from the top of the LS to the MTAP in patients with CD. Most of the LS are located below the MTAP. (Ophthalmol CHN, 2023, 32: 55-57)

    XEN gel stent implantation as a treatment option for glaucoma
    Qin Jiayin, Liu Yan, Jia Hongyan, Wang Tao
    2023, 32(1):  58-63.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.011
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    This article summarized the indications, surgical procedures, postoperative efficacy and safety of XEN gel stent implantation, and compared it with traditional trabeculectomy and other minimally invasive glaucoma surgery (MIGS). (Ophthalmol CHN, 2023, 32: 58-63)
    Deeply mourning for professor Jin Xiuying, founder of ophthalmology microbiology in China
    Liang Qingfeng, Jin Zibing
    2023, 32(1):  78-81.  doi:10.13281/j.cnki.issn.1004-4469.2023.01.020
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    Professor Jin Xiuying, the third director of the Beijing Institute of Ophthalmology, died on January 19, 2023 at the age of 99. This paper briefly reviews professor Jin Xiuying's life and his major contributions to the ophthalmic microbiology in China. (Ophthalmol CHN, 2023, 32: 78-cover III)