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Table of Content

    25 March 2023, Volume 32 Issue 2
    Combine medicine with industry, and overcome difficulties through cooperation-the innovative path of minimally invasive glaucoma surgery in China
    Sang Qing, Wang Jin, Xin Chen, Liu Xuyang, Pan Xiaojing, Wang Ningli
    2023, 32(2):  81-83.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.001
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    Minimally invasive glaucoma surgery (MIGS) has less trauma, less postoperative complications and rapid recovery. This article reviews the reform of MIGS in China, as well as the innovation and scientific research achievements of domestic experts on the theoretical mechanism, surgical technology and surgical equipment of MIGS. The current challenges, existing problems and future development direction of MIGS are proposed. (Ophthalmol CHN, 2023, 32: 81-83)
    The influence of biorhythms on refractive development and the development of myopia
    Li Congying, Huang Ying, Li Shiming
    2023, 32(2):  84-88.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.002
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    Rhythm is one of the essential basic features of nature, which enables organisms to better adapt to the environment and maintain the coordination of life processes through the appropriate phase relationship, seasonal changes, cloudy and sunny days, and night alternation are all rhythms. Biological rhythm is a regular change in the phenomenon of life, which plays an important role in the process of organ development and physiological regulation. In the change of external rhythm, light plays an important role, and there is also a rhythm in the change of light itself. The eye is the most important organ of natural light perception, and external and internal rhythms regulate its development and internal structure. Light signals are projected to the suprachiasmatic nucleus (SCN), the "master biological clock", by the intrinsically photosensitive retinal ganglion cells of the eye, resulting in daily rhythmic photo synchronization. When abnormal light exposure leads to biorhythmic dysregulation, the body may alter the balance of developmental hormones such as dopamine and melatonin by regulating the synchronization between the retinal biological clock and the SCN, disrupting eye growth and development and producing abnormal refractive status. In this paper, we analyze the effects of biorhythms on refractive development and myopia in recent studies to provide new ideas for the prevention and treatment of myopia. (Ophthalmol CHN, 2023, 32: 84-88)
    Extracellular matrix and associated congenital vitreous abnormalities
    Huang Houbin
    2023, 32(2):  89-97.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.003
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    Vitreous is a kind of extracellular matrix in nature, consisting of collagen, hyaluronan, proteoglycan, etc. Mutations of the genes coding the protein components would result in various congenital vitreous abnormalities including membrane, beaded or hypoplastic phenotype. High myopia and retinal detachment are commonly associated. Comprehensively knowing the extracellular matrix components composing the vitreous is really helpful to understand deeply the congenital inherited vitreoretinopathies. (Ophthalmol CHN, 2023, 32: 89-97)
    Analysis of the implementation characteristics of industry-sponsored drug clinical trials for eye diseases in China 
    Hu Jianping, Xin Chen, Zhang Lin, Peng Chuzhi, Jiao Yonghong
    2023, 32(2):  98-102.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.004
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    Objective To understand the implementation characteristics of industry-sponsored drug clinical trials for eye diseases in China. Design Retrospective observational study. Participants 201 drug clinical trials for eye diseases registered in the drug clinical trials registration and information disclosure platform of National Medical Products Administration from 2014 to 2021 were included. Methods The database and the related indexes were described and analyzed. Main Outcome Measures The completion rate of trials, the time-consuming for the starting-up and completion of trials. Results By the end of December 2021, the completion rate of 201 trials was 50.75%. The completion rate of bioequivalence studies (BE), phase I, phase II, phase III, phase IV trials was 85.71%, 58.21%, 39.39%, 43.06%, 71.43% respectively. The completion rate targeting age-related macular degeneration, macular edema and diabetes retinopathy was 57.45% (27/47), 46.88% (15/32), 63.16% (12/19) respectively. There were 12 trials in suspension/termination status. The main reasons were the clinical trial approval permission expired (4/12), protocol related issue (3/12), and adverse events (3/12). The median time-consuming for the starting-up of all trials was 4.28 (3.00, 6.02) months, wherein the BE, phase I, phase II, phase III, phase IV trials was 4.07 (0.30, 5.17), 3.87(3.00, 6.30), 4.90(2.10, 6.50), 4.63(3.20, 5.87), 3.50(0.93, 4.90) months respectively. 65.17% trials completed the first subject enrollment within 6 months after approved. The median time-consuming for the completion of all trials was 14.80 (4.07, 23.83) months wherein the BE, phase I, phase II, phase III, phase IV trials was 2.80(1.33, 4.73), 8.27(2.03, 16.53), 24.08(6.81, 49.18), 20.57(12.87, 27.95) and 31.73(24.51, 35.33) months respectively. Conclusions From 2014 to 2021, the drug clinical trials targeting fundus diseases were well implemented among industry-sponsored drug clinical trials for eye diseases in China.  The main reasons of trials suspension/termination were the clinical trial approval permission expired, protocol related issue (3/12), and adverse events. More than half of the trials have completed the first subject enrollment within six months after approval. The time-consuming for the staring-up and completion of trials was about 4 and 15 months respectively. (Ophthalmol CHN, 2023, 32: 98-102)
    Analysis of ocular biological parameters in cataract patients with long axial lengths measured by OA-2000
    Diao Lili, Yang Wenli, Yao Ning, Zhang Cong
    2023, 32(2):  103-107.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.005
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    Objective To analyze the characteristics of ocular biological parameters of cataract patients with long axial lengths (AL) . Design Retrospective cases series. Participants From June 2021 to April 2022, 1000 cataract patients (1000 eyes) who received medical treatment in Beijing Tongren Eye Center. Methods On basis of the axial length measured by OA-2000, the patients were divided into normal control group (22 mm≤AL<26 mm) and long axial group (AL≥26 mm). And the long axial group was further divided into 4 groups according to the axial length, namely, Group A (26 mm≤AL<28 mm) 187 cases (187 eyes), Group B (28 mm≤AL<30 mm) 140 cases (140 eyes), Group C (30 mm≤AL<32 mm) 130 cases, (130 eyes), Group D (AL≥32 mm) 93 cases (93 eyes). The ocular biological parameters were compared between eyes with normal axial and long axial group and each subgroup in the long axial group, and the correlation between axial length and ocular biological parameters, age and ocular biological parameters were analyzed. Main Outcome Measures AL, keratometry (Kf, Ks, Km), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW). Results The Kf, Ks, Km, corneal astigmatism, ACD, LT, and WTW of patients in the long axial group was (43.07±1.61) D, (44.65±1.71) D, (43.91±1.62) D, (1.52±0.77) D, (3.28±0.47) mm, (4.55±0.41) mm, (11.52±0.45) mm, respectively. Which was (44.51±1.42) D, (45.47±1.52) D, (44.98±1.51) D, (0.92±0.66) D, (3.01±0.41) mm, (4.63±0.46) mm, (11.40±0.48) mm, respectively in the normal control group (all P<0.05). There were statistically significant differences in Kf, Ks, Km, corneal astigmatism, ACD, LT and WTW among the four sub groups in the long axial group with different axial lengths (all P<0.05). Through Pearson correlation analysis, in the long axial group, AL was positively correlated with LT and WTW (r=0.249, P<0.0001) and (r=0.182, P=0.002) respectively; it was negatively correlated with Kf, Ks, Km, ACD (r=-0.219, P<0.0001), (r=-0.183, P<0.0001), (r=-0.194, P<0.0001), (r=-0.328, P<0.0001) respectively. There was no correlation between age and Kf, Ks, Km, WTW (all P>0.05); it was positively correlated with LT (r=0.299, P<0.0001); it was negatively correlated with AL and ACD (r=-0.245, P<0.0001) and (r=-0.228, P<0.0001) respectively. Conclusion Compared with patients in the normal control group, patients in the long axial group had smaller Kf, Ks, Km, deeper ACD, thinner LT, and longer WTW. The AL of patients in the long axial group was positively correlated with LT and WTW, but negatively correlated with Kf, Ks, Km, and ACD. The age was positively correlated with LT but negatively correlated with AL and ACD. (Ophthalmol CHN, 2023, 32: 103-107)
    Meta-analysis of the latest randomized controlled trials of clinical treatments for dry eye disease
    2023, 32(2):  108-119.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.006
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    Objective To summarize and analyze the curative effect, advantages and disadvantages of cyclosporine, glucocorticoids, non-steroidal eye drops and combination therapy in dry eye disease. Design Meta-analysis. Participants Random controlled trial (RCT) researches that were conducted for dry eye treatment. Methods The RCT researches on cyclosporine, glucocorticoids and non-steroidal eye drops in the treatment of dry eye up to August 7, 2022 were searched. The included literature data were analyzed using the R Meta (5.2.0) software package. Main Outcome Measures Schirmer test (SIT), tear film breakup time (TBUT), corneal fluorescein staining (FL), symptom score, effective rate and incidence of adverse reactions. Results A total of 5850 cases (7945 eyes) from 57 randomized controlled trials were included. There were 3008 cases (4056 eyes) in the test group and 2842 cases (3889 eyes) in the control group. The results showed that there was no significant difference in the adverse event rate of glucocorticoids and non-steroidal drugs compared with the control group, but the adverse event rate of cyclosporine was higher than that of the control group, and the dry eye scores of the three drugs were significantly better than those of the control group. All three classes of drugs significantly improved the outcomes of TBUT and FL. SIT (without anesthesia) was significantly higher in the cyclosporine eye drop test group than in the control group. There were no significant differences between the combined drug group and the single drug group in SIT (no anesthesia), TBUT, and FL. Conclusion Based on the data of this Meta-analysis, cyclosporine, glucocorticoids, and non-steroidal eye drops can all effectively improve and treat dry eye. Cyclosporin and glucocorticoid eye drops have advantages and disadvantages in improving various indicators, and both are better than non-steroidal eye drops. The combination of glucocorticoid and cyclosporine has no significant advantage over glucocorticoid or cyclosporine alone, but the combination did not lead to a significant increase in the rate of adverse reactions. (Ophthalmol CHN, 2023, 32: 108-119)
    Application of anterior segment optical coherence tomography in the evaluation and treatment of ocular surface squamous epithelioma
    Yu Haozhe, Wu Wenyu, Zeng Weizhen, Chan Szyyann, Gao Shuang, Feng Yun,
    2023, 32(2):  120-126.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.007
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    Objective To explore the imaging, analysis ability and consistency of HR-OCT and AS-OCTA in ocular surface squamous epithelioma (OSSN) patients. Design Retrospective case series. Participants Seven OSSN patients who were admitted to Peking University Third Hospital from September 2017 to January 2021 were enrolled. Methods HR-OCT and AS-OCTA images were collected before and after treatment. HR-OCT and AS-OCTA results were interpreted by 3 senior ophthalmologists back-to-back under the same display and the intraclass correlation coefficient (ICC) was calculated to evaluate the reliability of measurement. Main Outcome Measures The characteristics of local lesions and their consistency measured by OCT and AS-OCTA before and after treatment. Results The clear boundary between the normal and abnormal epithelium, thickened hyperreflective epithelium, and the cutting plane between the lesion and the underlying tissue can be observed through HR-OCT. The inter-rater agreement coefficient for hyperreflective epithelial was 0.942 (95% CI: 0.805-0.989, P<0.001). After surgical resection of the tumor and local chemotherapy, the abnormal high reflection area in OCT can be found to disappear. AS-OCTA could clearly identify abnormal vessels, showing focal or scallop-like vessels at the lesion, part of the vessel branches into vein or terminal expansion to form a loop-like structure with an inter-rater agreement coefficient of 0.824 (P<0.001). After treatment, the abnormal vascular branches may be resolved or partially resolved, and patchy avascular areas may remain. In addition, HR-OCT and AS-OCTA are able to assess corneoconjunctival vascular abnormalities in patients with extensive invasion. Conclusions HR-OCT and AS-OCTA can be used to visualize OSSN lesions and vascular structural features with good agreement and are also suitable for patients with extensive invasion, which also the potentially powerful tools for non-invasive comprehensive assessment and objective monitoring of related vascular ocular surface diseases. (Ophthalmol CHN, 2023, 32: 120-126)
    Clinical characteristics of uveitis glaucoma hyphema syndrome
    2023, 32(2):  127-132.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.008
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    Objective To analyze the clinical features of uveitis-glaucoma-hyphema (UGH) syndrome. Design Retrospective case series. Participants 8 patients (8 eyes) diagnosed with UGH syndrome in the Eye Hospital affiliated to Shandong University of Traditional Chinese Medicine from 2018 to 2022. Methods The clinical data of 8 patients with UGH syndrome were reviewed and the clinical characteristics, treatment and prognosis were sumarized. Main Outcome Measures Clinical characteristics and imaging findings. Results 8 UGH syndrome patients were attack from 1 to 6 months after IOL implantation. The average IOP was (42.91±11.54) mmHg, and there were different degrees of anterior chamber flare in all patients, 4 cases had hyphema and 4 cases had red blood cells on the aqueous smear. All cases had IOL deviation and contaction with iris and ciliary body. 2 cases of posterior concave of iris demenstrate IOL contactiont with posterior surface of iris. 4 cases exist IOL deviation and contact with posterior surface of iris. 1 case exists contact with ciliary body. One case was treated with drugs, two cases with posterior fovea of iris were treated with YAG laser iridotomy. One case each was treated with IOL repositioning, IOL replacement, IOL removal, glaucoma valve implantation, and ciliary body photocoagulation. All patients were followed up for 6 to 46 months after treatment. The anterior chamber flare and red blood cells in the anterior chamber disappeared, and the IOL contacting with the iris and ciliary body disappeared. Conclusion The clinical features of UGH syndrome are IOL contacting with iris or ciliary body after cataract surgery, high IOP, anterior chamber flare and red blood cells existing in the anterior chamber. Its treatment is to relieve the friction between IOL and iris or ciliary body. (Ophthalmol CHN, 2023, 32: 127-132)
    Establishment and evaluation of a murine model of autoimmune retinopathy
    Liu Qian, Zhou Jian, Wu Shen, Zhang Zijun, Zhang Jingxue, Zeng Huiyang
    2023, 32(2):  142-147. 
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    Objective To establish and evaluate a murine model of autoimmune retinopathy. Design Animal experiment. Participants Eighteen C57BL/6J mice of 7~9 weeks old as experimental group and another six age-matched C57BL/6J mice as control group. Methods Mice in experimental group were immunized with recombinant mouse recoverin (200 μg/mouse) in complete Freund’s adjuvant (CFA), while mice in control group were immunized with CFA-PBS. All of them were injected with 200 ng of pertussis toxin (PTX) day 0 and day 2 after immunization to facilitate cellular infiltration of the retina. The main indexes of the model were evaluated by western blotting, multi-modality imaging and pathological methods. Main Outcome Measures Presence of serum recoverin antibody, retinal findings and pathology were shown by slit-lamp examination, fundus photography, OCT, FFA, ERG, as well as HE staining of retinal cryosection at weeks 3, 6 and 8 after immunization. Results Presence of yellow fleck lesions in the deep retina was observed from 6 weeks and significantly progressed at weeks 8 post-immunization of recoverin. Damage of outer retinal elements on OCT, reduced amplitude of ERG response and leakage of fluorescent dyes were shown at weeks 6 or/and 8 post-immunization. Intrusion of inflammatory cells into retinal tissue with various degree were also found on the cryo-section of weeks 6 and 8 AIR model. The AIR model was tested positive for serum recoverin antibody from weeks 3 post-immunization and keep high level at weeks 6 and 8 after immunization. Conclusions A murine AIR model immunized with recoverin protein was successfully established and evaluated in terms of retinal features, pathological changes and presence of serum recoverin antibody. Its similarity with AIR patients made it a good tool for investigating the pathogenesis of the disease. (Ophthalmol CHN, 2023, 32: 142-147)
    Changes in subfoveal choroidal thickness before and after surgery of macular hole
    An Hongbang, Wang Shuna, Yu Tengfei, Wang Yixuan, Fan Shanshan, Cao Yongliang
    2023, 32(2):  148-153.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.011
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    Objective To exploring the changes of subfoveal choroidal thickness (SFCT) of two different types of macular holes before and after surgery to investigate the correlation between SFCT and their postoperative recovery. Design Retrospective cohort study. Participants From August 2021 to January 2022, 50 patients diagnosed with macular hole and treated with vitreo retinal surgery in the Ophthalmology Center of Weifang Medical College Affiliated Hospital were included. Methods The study subjects were divided into three groups: idiopathic macular hole (IMH) group, highly myopic macular hole (HMMH) group, and normal control group. The follow-up time points for the IMH and HMMH groups were preoperative, postoperative of 1 week, 1 month, and 3 months. Changes in SFCT were observed and the differences and similarities in SFCT value changes between the IMH and HMMH groups were compared. Main Outcome Measures SFCT and the closure status of the macular hole. Results The SFCT values of the normal control group, preoperative IMH group, and HMMH group decreased sequentially (F=71.33, P<0.001). The closure rate of macular holes in the IMH group after surgery was 91.4%, which was better than the 53.3% in the HMMH group. There were significant differences in SFCT values between the macular hole closure group and the non-closure group at each follow-up time point in both groups (P=0.001, P<0.001, P<0.001, P<0.001). In the IMH group, the SFCT values decreased sequentially 1 week, 1 month, and 3 months after surgery compared to preoperative values, with significant differences (F=37.89, P<0.001). In the HMMH group, the SFCT values decreased sequentially 1 week, 1 month, and 3 months after surgery, and were smaller 1 week after surgery than preoperative values (F=7.828, P=0.002). During the 1-week to 1-month postoperative period, the change in SFCT values was greater in the HMMH group than in the IMH group (P=0.001). In the IMH group, the base diameter of the macular hole was correlated with choroidal thickness 1 month after surgery (r=-0.345, P=0.043). In both the IMH and HMMH groups, the base diameter of the macular hole was correlated with the height of the macular hole (P≤0.001, 0.004). The base diameter of the macular hole was smaller in the IMH group than in the HMMH group (P=0.045). Conclusion After MH surgery, SFCT values will temporarily increase and then gradually decrease. Within 2-4 weeks postoperatively, the SFCT value in the fellow eye with HMMH decreases more significantly than in the fellow eye with IMH. SFCT may be an important factor that affects postoperative healing of macular holes. (Ophthalmol CHN, 2023, 32: 148-153)
    The effects of rigid gas permeable contact lens on aphakic infants with nystagmus and strabismus after congenital cataract surgery
    Liu Lizhou, Jiao Yonghong, Tang Ping, Lv Yanyun, Wu Jingjing, Peng Li
    2023, 32(2):  154-159.  doi:10.13281/j.cnki.issn.1004-4469.2023.02.012
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    Objective To evaluate the effects of rigid gas permeable contact lens (RGPCL) on aphakic infants with nystagmus and strabismus after congenital cataract surgery. Design Retrospective cohort study. Participants 120 cases (176 eyes) of aphakic infants with nystagmus and strabismus after congenital cataract surgery were enrolled. Methods The treatment modality was determined by parents.67 cases (108 eyes) were fitted with spectacles and 53 cases (68 eyes) were fitted with RGPCL. Best corrected visual acuity, eye position, strabismus degree, and nystagmus of the two groups were reviewed at baseline and every 6 months for up to 3 years. Main Outcome Measures Best corrected visual acuity (LogMAR), with nystagmus or not, strabismus degree. Results The LogMAR visual acuity of the spectacles group and RGPCL group was (1.345±0.339) and (1.406±0.361) at the baseline, and improved to (1.106±0.342) and (0.547±0.270) at 3 years respectively. Best corrected visual acuity in RGPCL group at 3 years was better than the spectacles group (z=5.155, P<0.001).There were 67 cases with nystagmus in the spectacles group at the baseline, and 67 patients remained after 3 years. In RGPCL group, there were 53 cases at the first time and 42 cases after 3 years. There was significant difference in the number of cases with nystagmus between the two groups at 3 years (P<0.001). In addition, the strabismus degree at 33 cm was also examined. In the spectacles group, 60(89.6%) cases had strabismus with degree < 15°, 7(10.4%) cases had 15°~30°strabismus degree and no cases had strabismus >30°. After 3 years, the cases with different strabismus degree were reviewed 37(55.2%), 26(38.8%) and 4(6.0%) respectively.  In RGPCL group, 49(92.5%) cases had strabismus with degree <15° and 4(7.5%) cases had 15°~30° strabismus degree. After 3 years, the cases became to 51(96.2%) and 2(3.8%) respectively. No cases had strabismus >30° before and after RGPCL  treatment. There was significant difference in the improvement of strabismus degree between the two groups (P<0.001). Conclusions Best corrected visual acuity (LogMAR) of the patients with RGPCL treatment for 36 months was better than those with spectacles. After wearing RGPCL for 3 years, nystagmus disappeared in about 20% patients, and the ratio of strabismus with degree <15° increased. The mechanism needs to be further studied. (Ophthalmol CHN, 2023, 32: 154-159)