Table of Content

25 July 2023, Volume 32 Issue 4

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Structures of vitreoretinal interface and their clinical significance

Huang Houbin

2023, 32(4):  265-274.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.001

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 Vitreoretinal interface consists of posterior vitreous cortex, retina internal limiting membrane, and extracellular matrix. Basement membrane-like complex is formed in the interface, especially in some special locations, such as vitreous base, optic disc margin, retinal vessels, macular foveola, and some pathologic lesions. With aging, the posterior margin of vitreous base extends posteriorly, internal limiting membrane thickens and its elasticity decreases, the adhesion in vitreoretinal interface weakens, and posterior vitreous detachment develops. To fully recognize the interface and its age-related changes is of much importance for understanding the pathophysiology and treatment strategy of some diseases. (Ophthalmol CHN, 2023, 32: 265-274)

A survey on distant visual acuity test performed by nurses in ophthalmic specialized training of China

Xing Jingyu, Luo Mingyue, Zhang Dingding, Kang Weijuan, Zhao Jialiang

2023, 32(4):  275-280.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.002

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 Objective To investigate the current status of distance visual acuity testing among ophthalmic nurses in China, and to provide a reference for further standardization of distance visual acuity testing and training of clinical nurses. Design A cross-sectional questionnaire survey. Participants 34 directors and 781 ophthalmic clinical nurses from 34 ophthalmic nursing training bases nationwide. Methods A survey questionnaire was designed based on the Chinese National Standard for the Standard Logarithmic Visual Acuity Chart (GB11533-2011). The survey was conducted using the questionnaire Star App and the collected data was analyzed. Main Outcome Measures The training and assessment of distance visual acuity testing, the knowledge of ophthalmic nurses on the National Standard for the Standard Logarithmic Visual Acuity Chart, and the distance, height, and illumination for distance visual acuity measurement. Results 21 hospitals (61.8%) had training materials and qualification test, 5 hospitals (14.7%) had no training materials and test, 8 hospitals (23.5%) had qualification test, but no relevant training materials. 31 hospitals (91.2%) had operating standards for distant visual acuity test, and the remaining 3 hospitals (8.8%) had no operating standards. 24 hospitals (70.6%) departments were equipped with standard logarithmic vision charts, 8 hospitals (23.5%) departments did not have standard logarithmic vision charts, and 2 hospitals (5.9%) did not know the National Standard. 84.6% of the nurses knew the National Standard and 15.4% did not. Operation without certification (OR=3.93, 95%CI: 1.77~8.73, P=0.0022) and only one remote vision chart (OR=1.84, 95%CI: 1.18~2.87, P=0.0072) were independent risk factors for the nurses not knowing the National Standard. Conclusion The standardized management level of distant visual acuity test of nurses needs to be improved, and the standardized training of distant visual acuity test by nurses needs to be strengthened. At present, it is urgent to standardize the operation procedures of distant visual acuity test nationwide. (Ophthalmol CHN, 2023, 32: 275-280)

Study on the synergistic effect of 0.05 D precision full correction technique and defocus incorporated multiple segments technique in delaying the progress of myopia

Zhen Yi, Cao Kai, Gao Jie, Wang Ningli

2023, 32(4):  282-286.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.003

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 Objective To observe whether there is a synergistic effect between 0.05 D precise full correction technology and defocus incorporated multiple segments technology in delaying myopia progression. Design Pretrospective comparative case series. Participants 241 children who underwent frame glasses fitting at Optometry Center of Beijing Tongren Hospital from 2020 to 2022. Method According to the lens chosen by the parents, 241 children were fitted with 0.05 D spherical interval single vision group (63 cases), 0.25 D spherical interval single vision group (57 cases), 0.25 D spherical interval defocus group (61 cases), and 0.05 D spherical interval defocus group(60 cases). The fitting data including age, gender, refractive error, interval time between the two refractions, lens type of the above children in the electronic medical record system was retrospective analyzed. The refraction methods and environment of the four groups of patients were consistent, and the only difference was whether 0.05 D precise full correction technology was used in the central area of the frame eyeglasses and whether defocus incorporated multiple segments technology was used in the periphery of the lens. The data of the right eye were analyzed statistically. Main Outcome Measures Equivalent spherical change. Results The ages of the 0.25 D spherical interval single vision group, the 0.05 D interval single vision lens group, the 0.25 D spherical interval defocus group, and the 0.05 D interval defocus group were not significantly different (F=0.996, P=0.320). The mean equivalent spherical degrees at the first visit were (-2.10±1.77) D, (-2.00±1.34) D, (-1.97±0.89) D, and (-2.03±0.88) D, respectively (F=0.118, P=0.949). After 6 months of wearing glasses, the equivalent spherical changes in the four groups of patients were (-0.51±0.52) D, (-0.31±0.35) D, (-0.31±0.27) D, and (-0.15±0.26) D, respectively (F=9.503, P<0.001). The equivalent spherical changes in the 0.05 D interval single vision group (P=0.003), the 0.25 D interval defocus group (P=0.004), and the 0.05 D interval defocus group (P<0.001) were significantly smaller than those in the 0.25 D spherical interval single vision group. There was no significant difference in equivalent spherical changes between the 0.05 D interval single vision group and the 0.25 D interval defocus group (P=0.932). The equivalent spherical change in the 0.05 D interval defocus group was significantly smaller than that in the 0.05 D interval single vision group (P=0.018) and the 0.25 D interval defocus group (P=0.015). Conclusion 0.05 D precise full correction technology and defocus incorporated multiple segments technology showed a synergistic effect in delaying myopia progression due to different mechanisms of action. (Ophthalmol CHN, 2023, 32: 282-286)

Clinical efficacy after FS-LASIK myopia correction guided by 0.05 D optometry

Jia Yong, Zhang Baike, Liao Sha, Shen Jiafan, Guo Lisha, Tian Xuemin, Li Qiaoyun

2023, 32(4):  289-293.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.004

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 Objective To evaluate clinical efficacy after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) myopia correction guided by 0.05 D optometry. Design Retrospective case series. Participants From July 2021 to March 2022, a total of 355 eyes of 178 myopic patients who underwent FS-LASIK surgery were collected in No.988 Hospital of Joint Logistic Support Force of PLA. Methods The medical records of patients were reviewed. The optometry test modality was determined by patients, and all patients were divided into the 0.05 D group (89 cases 177 eyes) and the 0.25 D group (89 cases 178 eyes) according to the method of optometry. The 0.05 D group used 0.05 D optometry method to measure preoperative diopter; meanwhile, the 0.25 D group used 0.25 D optometry method to measure preoperative diopter. All patients underwent FS-LASIK with Zeimer LDV-Z2 and Zeiss Mel-80. The actual corneal ablation depth of the both groups and the corneal ablation depth simulated by 0.25 D optometry of the 0.05 D group were recorded. The patients were followed up for 6 months. And the visual quality questionnaire was conducted at 6 months postoperatively. Main Outcome Measures Visual acuity (LogMAR), diopter, corneal ablation depth, central corneal thickness (CCT), and visual quality questionnaire score. Results The actual corneal ablation depth of the 0.05 D group was (84.98±15.60) μm, which was slightly higher than (78.14±17.68) μm simulated by 0.25 D optometry of the 0.05 D group and (75.42±17.14) μm of the 0.25 D group (all P<0.001). There was no significant difference in the corneal ablation depth between simulated by 0.25 D optometry of the 0.05 D group and the 0.25 D group (P=0.129). The CCT of the both groups after surgery was significantly lower than that preoperative (t=72.459, P<0.001, t=58.693, P<0.001), and there was no significant difference in the CCT between the both groups after surgery (t=-1.890, P=0.060). At 3 months and 6 months after surgery, the uncorrected visual acuity (UCVA) of the 0.05 D group were -0.056±0.498, -0.061±0.479, which were better than 0.003±0.566, -0.002±0.530 of the 0.25 D group (all P<0.001). At 6 months after surgery, the percentage of UCVA better than preoperative best corrected visual acuity (BCVA) of the 0.05 D group was 67.80%, which was higher than 17.42% of the 0.25 D group (P<0.001). Among the adverse visual symptoms, the incidence of glare was the highest and the incidence of distortion was the lowest in the both groups. The incidence of asthenopia of the 0.05 D group was 1.7%, which was less than 6.7% of the 0.25 D group (P=0.018). There was no significant difference in the incidence of other symptoms. The asthenopia and total score of the 0.05 D group were significantly lower than those of the 0.25 D group (U=-2.032, P=0.042, U=-2.247, P=0.025). There was no significant difference in the scores of the questionnaire of other symptoms. Conclusion Compared with 0.25 D optometry, 0.05 D optometry can significantly improve visual acuity and subjective visual quality after FS-LASIK, and has the same surgical safety. (Ophthalmol CHN, 2023, 32: 289-293)

Study of myopic animal model induced by illuminance under constrained visual range

Zhang Kaixue, Fang Wenqing, Chen Juan, Zhang Youming, Yang Chaopu, Jin Han, Chen Taiyang, Huang Sanxiao, Zhou Penghui

2023, 32(4):  294-298.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.005

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Objective To study the effect of different illumination on the development of axial length in chicks with visual distance restriction. Design Experiment study.  Participants Sixty 10-day-old chicks.  Methods Chicks were randomly divided into 5 groups with 12 chicks in each group. One group was the control group and the others were the experimental groups. Using the greedy and phototaxis of the chicken to food, the visual distance of the chicken was more naturally restricted. Four groups of chickens were raised in four sets of self-made myopia induction devices, which could keep the visual distance within about 5 cm with the growth of chicks. The illuminances of the experimental groups were set at 0.5 Lx, 5 Lx, 50 Lx, and 500 Lx, respectively. The control group was reared in the natural light environment near the window without restricting the visual distance. When the chickens were 50 days old, the axial length of the eyes was measured by A-scan. The refraction was measured by retinoscope in the dark room and under non-local anesthesia. The weight was measured by electronic scale and the abnormal growth of axial length was calculated. The relationship between this value and diopter was analyzed. Main Outcome Measured Axial length, axial increase, diopter. Results There was a linear relationship between axial length and body weight in the control group (R2=0.89). When the chicken were 50 days old, the abnormal axial growth of 0.5 Lx, 5 Lx, 50 Lx and 500 Lx groups were 0.60 mm, 0.30 mm, 0.75 mm and 0.80 mm, respectively. There were significant differences in the increase of axial length among 5 Lx group and 0.5 Lx group, 50 Lx group, 500 Lx group (P=0.033, 0.001, 0.003). There was a linear proportional relationship between diopter and abnormal axial growth (R2=0.74). Conclusion The model can significantly induce axial myopia in chicks. Illumination had a significant effect on the increase of abnormal axial growth. The increase of abnormal axial growth was the smallest at 5 Lx and the largest at 500 Lx.  (Ophthalmol CHN, 2023, 32: 294-298)

Effect of blue-blocking display mode screen on digital eye fatigue

Zhang Wei, Zhen Yi, Du Lihua, Wang Ningli

2023, 32(4):  299-304.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.006

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 Objective To compare the difference of digital eye strain between blue-blocking mode and normal mode screen when using for reading task. Design A two-stage cross-designed clinical trial. Participants 74 healthy subjects aged 18~36 years old. Methods The subjects were randomly divided into two groups. 38 subjects (group 1) used normal mode first, and then used blue-blocking mode (400-500 nm 33.9% attenuated) to perform a 40-minute text reading. The second group (36 subjects) performed the task in the reverse order. The corrected visual acuity of the subjects was examined using a standard visual acuity chart. An open-field auto refractor was used to measure the refraction and accommodative lag. The subject's critical flicker frequency (CFF) was measured using a flash fusion frequency meter. These data were recorded within 3 minutes before and after reading. Likert scale was used to record subjective eye strain 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, critical flicker frequency, eye strain scale score, reading efficiency. Results Using normal mode, the diopter before and after reading was (-0.26±0.47) D and (-0.26±0.49) D, respectively (P=0.742); The accommodative lag before and after reading was (0.94±0.36) D and (1.05±0.42) D, respectively (P=0.002); The corrected visual acuity was 1.04 (1.0, 1.2), 1.03 (1.0, 1.2), respectively (P=0.058); The CFF was (29.03±2.84) Hz and (29.07±3.03) Hz, respectively (P=0.731). The subjective score of eye strain before and after reading was 0.73 (0, 1.00) and 2.04(1.00, 3.00), respectively (P<0.001). The mean value of eye strain score increased after reading, and the difference was statistically significant. Using blue-blocking mode, the diopter before and after reading was (-0.21±0.49) D and (-0.25±0.48) D, respectively (P=0.144), the accommodative lag was (0.98±0.39) D and (1.03±0.43) D, respectively (P=0.109), and the corrected visual acuity was 1.05 (1.0, 1.2), 1.04 (1.0, 1.2), respectively (P=0.096). The critical flicker frequency was (29.06±2.91) Hz and (29.15±3.08) Hz, respectively (P=0.432). The subjective score of eye strain before and after reading was 0.81 (0, 1.00), 1.64 (1.00, 2.00), respectively (P<0.001). The mean value of eye strain score increased after reading, and the difference was statistically significant. Cross analysis were applied for comparing the variation of ocular parameters caused by these two modes and the reading efficiency difference. There were no significant differences in the variations of refraction variation (P=0.447), accommodative lag (P=0.124), corrected visual acuity (P=0.356), CFF (P=0.687), reading efficiency (P=0.817). There was a significant difference for eye strain score (P=0.015) between these two groups. Conclusion Compared with reading using normal mode screen，blue-blocking mode did not cause obvious changes in objective refractive parameters of the human eye, and the subjective digital eye strain is lower for 40 minutes intense concentration text reading. (Ophthalmol CHN, 2023, 32: 299-304)

Evaluation of orthokeratology fitting status using deep learning algorithm

Song Hongxin, Cao Jingwen, Niu Kai, He Zhiqiang

2023, 32(4):  305-309.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.007

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 Objective To develop an automatic and objective quantification algorithm based on fluorescein patterns to evaluate the fitting status of orthokeratology. Design Diagnose test. Participants Ortho-k lens fitting video with fluorescein patterns from 360 subjects during 2022 from Beijing Tongren Hospital. Methods A deep learning algorithm based on an attention mechanism to analyze the fluorescein patterns video was used. The algorithm used key frames of the fluorescein patterns video to capture static morphological information of the ortho-K lens, while the video as a whole was considered comprehensively to obtain dynamic information such as ortho-K lens mobility. The algorithm adopted a two-stage structure, first classifying the tight fitting samples, and based on this result, further classifying the fit and loose fitting samples, the results were compared with the evaluation standard agreed by the 5 experienced optometrists. Main Outcome Measures Sensitivity, diagnosis accuracy, consistency with ophthalmologists’ results. Results In the validation set, our proposed algorithm achieved a classification accuracy of 82%, a sensitivity of 80%, and a specificity of 85% in the first stage of the classification task of fitting tight samples. In the second stage, the model can classify the remaining two types of samples with a correct rate of 88%, a sensitivity of 85% and a specificity of 93%. In the end, the correct rate of classification results for each category could reached more than 80%, which was highly consistent with the judgment given by optometrists. Compared with the results of human evaluation, the results of computer algorithms had a high degree of matching and better repeatability. Conclusions Using the deep learning algorithm based on the attention mechanism, we developed automatic algorithm for automatic analysis of the fluorescein patterns video of orthokeratology, which can make objective judgments about the fitting status of orthokeratology. (Ophthalmol CHN, 2023, 32: 305-309)

Study on fixation stability of intermittent exotropia in children

Huang Weidong, Yang Xubo

2023, 32(4):  310-315.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.008

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 Objective To compare the differences in fixative eye movements and saccadic eye movements between children with intermittent exotropia and normal children. Design Case-control study. Participants Children attending the strabismus and amblyopia outpatient clinic at West China Hospital, including 31 cases of intermittent exotropia and 22 normal children. Methods All subjects watched the screen at a distance of 80 cm from the computer display screen, and used the visual biological information stimulation technology-enhanced vision eye tracker software, and used its augmented reality technology to collect and analyze binocular fixation and saccadic eye movements. Tobii Eye Tracker 5 4C eye tracking device captures the orientation and trajectory of eyeball movement, and it was performed under corrected state for those with ametropia. Main Outcome Measures Corrected visual acuity, refractive error, prism diopters of strabismus, horizontal deviation of fixation point, vertical deviation of fixation point. Results In terms fixation eye movement, significant differences were observed between the intermittent exotropia group and the normal group in the directions of upper-right, straight-right, and lower-left gaze. The deviations of fixation points were significant in the horizontal direction for straight-right (Z=-2.764, P=0.006) and in the vertical direction for lower-left (Z=-2.112, P=0.035), while both horizontal (Z=-2.266, P=0.023) and vertical deviations (Z=-2.113, P=0.035) were significant for upper-right gaze points. In terms of saccadic eye movement, the intermittent exotropia group glanced at the beginning of the first line (Z=-2.140, P=0.032) and the end of the line (Z=-2.573, P=0.010), the beginning of the second line (Z=- 2.907, P=0.004) and the end of the line (Z=-2.365, P=0.018), the end of the third line (Z=-3.268, P=0.001), the beginning of the fourth line (Z=-2.022, P=0.043), there was an obvious offset in the horizontal direction; when scanning the first line (Z=-2.527, P=0.011) and the end of the line (Z=-2.031, P=0.042), the third line end (Z=-2.257, P=0.024), and the fourth row head (Z=-2.826, P=0.005), the intermittent exotropia group had a significant shift in the vertical direction. In the third row, there were significant differences in the vertical deviation of fixation positions at the beginning and end of the row (Z=-2.858, P=0.004). Conclusion Children with intermittent exotropia have different degrees of impairment in both fixation eye movement and saccadic eye movement compared to normal children. (Ophthalmol CHN, 2023, 32: 310-315)

Measurement of tarsal plate width and characteristic analysis of tarsal development in Chinese Han children with epiblepharon#br#

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Wang Yue, Du Baopu, Hou Zhijia, Li Lei, Zhang Zheng

2023, 32(4):  316-319.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.009

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 Objective To measure the width of the upper and lower tarsal plates of China Han children with epiblepharon, and analyze their growth and development characteristics. Design Prospective case series. Participants From 2018 to 2022, 258 cases (516 eyes) of children with lower epiblepharon aged 2~13 years in Beijing Tongren Hospital were included. Methods Before the general anesthesia operation, the width of the upper and lower tarsal plates was measured by a steel ruler with an accuracy of 0.5 mm under the operating microscope. Upper eyelid medial tarsal plate width, upper eyelid central tarsal plate width, upper eyelid pupil temporal margin tarsal plate width, upper eyelid lateral tarsal plate width, lower eyelid medial tarsal width, lower eyelid central tarsal width, lower eyelid lateral tarsal width were included. Main Outcome Measures  Tarsal plate width.  Results The average width of the upper tarsal plate of 258 children was (4.76±0.74) mm for the medial tarsal plate, (8.05±0.70) mm for the central tarsal plate, (8.47±0.74) mm for the pupil temporal margin tarsal plate and (7.07±0.78) mm for the lateral tarsal plate. The average width of the lower tarsal plate was (3.18±0.49) mm for the medial tarsal plate, (3.87±0.51) mm for the central tarsal plate and (3.84±0.54) mm for the lateral tarsal plate respectively. There was no significant difference between male and female in children's upper and lower tarsal plate width. The width of central tarsal plate of the upper eyelid was (7.71± 0.46) mm in the 0~3 years group (n=21), (7.95±0.65) mm in the 4~6 years group (n=147), (8.25±0.70) mm in the 7~9 years group (n=72) and (8.59±0.94) mm in the 10~13 years group (n=17). The width of the tarsal plate in the center of the lower eyelid was (3.74±0.44) mm in 0~3 years old group, (3.84±0.52) mm in 4~6 years old group, (3.94±0.52) mm in 7~9 years old group and (4.06±0.46) mm in 10~13 years old group. Conclusions The growth and development speed of the upper eyelid tarsal plate is faster in China Han children with epiblepharon, reaching the widest at the age of 10~13, while the development of the lower eyelid tarsal plate is relatively slow. The tarsal plate at the temporal edge of the pupil is the widest, followed by the central tarsal plate of the upper eyelid, and the medial tarsal plate of the upper eyelid is the narrowest. This difference should be taken into account during eyelid surgery in children. (Ophthalmol CHN, 2023, 32: 316-319)

12 months efficacy of adalimumab for the treatment of refractory juvenile idiopathic arthritis associated uveitis

Shen Zhijun, Shen Lin, Cao Xusheng, Li Lin, Wang Hong

2023, 32(4):  320-325.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.010

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 Objective To evaluate the efficacy and safety of adalimumab (ADA) for the treatment of juvenile idiopathic arthritis (JIA) associated uveitis. Design Retrospective case series. Participants 16 patients (28 eyes) with refractory JIA related uveitis who were treated with ADA in Beijing Tongren Hospital from June 2020 to September 2021. 10 cases (18 eyes) presented anterior uveitis, and 6 cases (10 eyes) presented panuveitis. Methods The outpatient medical records of patients were analyzed. All patients underwent ADA subcutaneous injection treatment. For individuals with weight ≥30 kg, the initial dose was 80 mg, and thereafter every 2 weeks, with a dose of 40 mg each time, and the dose was half for those with weight <30 kg. After inflammation was controlled, the dosage of glucocorticoids and immunosuppressants were gradually decreased. Main Outcome Measures Cells and flare in anterior chamber, and vitreous haze, visual acuity, changes of glucocorticoid and immunosuppressant dosage, and side effects of ADA. Results The inflammation of uveitis in all suffered eyes was controlled within 3~6 months after ADA treatment, and the inflammatory cells and flare in anterior chamber, and vitreous haze were all reduced from 2+~3+ to 0~1+. No recurrence was observed after follow-up for ≥12 months. After uveitis was controlled stably with ADA treatment, 8 of 10 patients with anterior uveitis completely stopped all medicines, and the other 2 patients stopped taking immunosuppressants. 4 of 6 patients with panuveitis stopped taking glucocorticoid, only taking immunosuppressants and ADA, and the other 2 patients had reduced the dosage of glucocorticoid and immunosuppressants. After ADA treatment, the visual acuity of 20/28 eyes improved by≥2 lines, and the visual acuity of 8/28 eyes improved by ≥1 line. No serious eye or systemic side effects were observed. Conclusion ADA is effective and safe for the treatment of refractory JIA associated uveitis and can reduce the dosage of systemic glucocorticoids and immunosuppressants. (Ophthalmol CHN, 2023, 32: 320-325)

Fundus characteristics in patients with acquired immune deficiency syndrome complicated with cytomegalovirus retinitis at different periods

Ye Hongli, Jiao Kangwei, Yan Pingjing, Zhang Qihang, Zhao Jie, Feng Xiaoxiao, Liu Jun, Xiao Libo

2023, 32(4):  326-331.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.011

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Objective To observe ultra-wide angle fundus photography and optical coherence tomography (OCT) characteristics in patients with acquired immune deficiency syndrome(AIDS) complicated with cytomegalovirus retinitis (CMVR) at different periods. Design Retrospective case series. Participants 14 patients (22 eyes) diagnosed with AIDS complicated with CMVR from the Affiliated Hospital of Yunnan University and the Third People's Hospital of Kunming from January 2019 to June 2022. Methods The patient's medical records were reviewed. The characteristics of fundus and OCT images at different stages of CMVR, as well as the CD4+T lymphocytes (CD4) and blood CMV-DNA levels at corresponding stages were analyzed. Follow up was for 6~30 months. Main Outcome Measures CD4 value, fundus photography and OCT image features. Results All patients were in the acute stage of CMVR at the time of initial diagnosis, including 2 cases (3 eyes) in the initial stage of CMVR and 12 cases (19 eyes) in the active stage. The mean CD4 value in acute stage was (32.26±25.7)/μL at first diagnosis, and the manifestations of CMVR in initial stage were <1 DD yellow-white granular lesions. OCT showed no thickening of retina but full layer destruction. During the active stage, the fundus showed large yellow and white cheesy exudation accompanied by bleeding, and OCT showed significant thickening of retina at all levels and high reflexes. In 12 cases (19 eyes), there were 9 cases (15 eyes) of interlayer punctuated strong reflexes, 4 cases (6 eyes) of outer layer punctuated strong reflexes, 12 cases (15 eyes) of lesions involved the macular region, and 3 cases (3 eyes) of macular edema. Epiretinal membrane in 12 cases (18 eyes), vitreous inflammatory cells in 11 cases (16 eyes). During follow-up, the mean CD4 in remission period was (380.4±85.2)/μL. Grey and white scars of fundus were in 13 cases (20 eyes). Retinal atrophy and thinning in the lesion area were observed on OCT, and retinal detachment was observed in 1 case (2 eyes). Conclusion The fundus of AIDS patients with CMVR showed different manifestations at different periods, such as yellow and white granular lesions, tomato and cheese lesions, and gray-white cicatricial lesions. OCT showed significant hyperreflective thickening, thinning and atrophy of retina. (Ophthalmol CHN, 2023, 32: 326-331)

Clinical characteristics of central retinal artery occlusion in 35 patients with internal carotid artery stenosis

Li Jiebin, Li Songfeng, Gui Yu, Zhang Jing, Ding Ning

2023, 32(4):  332-337.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.012

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Objective To compare the clinical characteristics of central retinal artery occlusion (CRAO) in patients with or without internal carotid artery stenosis (ICAS). Design Retrospective case series． Participants 92 patients with CRAO treated in Beijing Tongren Hospital from 2014 to 2021. Methods Thirty five patients (35 eyes) who had CRAO with ICAS formed CRAO-ICAS group and the other 57 patients (57 eyes) who only had CRAO formed CRAO-NICAS group. Demographic factors, clinical symptoms, vascular risk factors, internal medicine comorbidities, laboratory parameters and imaging examinations, treatment, 1-week and 1-year visual acuity improvement after treatment, and 1-year follow-up vascular events (e.g., ischemic stroke, acute myocardial infarction, death) were analyzed by comparing the two groups. Main Outcome Measures Clinical features, visual acuity improvement, 1-year follow-up vascular events. Results There was no statistically difference between CRAO-ICAS group and CRAO-NICAS group in affected eye, visual field defect, increased intraocular pressure, history of smoking, history of family cardiovascular and cerebrovascular disease, history of coronary artery disease, diabetes and atrial fibrillation (all P>0.05). Male (OR=5.765, P=0.003), hyperlipidemia (OR=3.638, P=0.028), hypertension (OR=3.769, P=0.020) were the independent risk factors for CRAO with ICAS. Compared with the CRAO-NICAS group, the CRAO-ICAS group was characterized by the higher rates of transient amaurosis before the onset, and acute cerebral infarction, and the difference were statistically significant (?字2=5.845, P=0.016; ?字2=9.563, P=0.004). The visual acuity was significantly improved in 12 cases (44.4%) of the 27 patients with CRAO-ICAS at 1 week after thrombolysis via super-selective ophthalmic artery catheterization, partially improved in 5 cases above 0.1, 1 case above 0.5 at 1 year of follow-up, furthermore improved in 2 new cases. The visual acuity was significantly improved in 19 cases(47.5%) of the 40 patients with CRAO-NICAS at 1 week after thrombolysis, partially improved in 7 cases above 0.5 at 1 year of follow-up. The visual acuity was significantly improved by early thrombolytic therapy (<24 h) in patients with CRAO-ICAS (?字2=9.258, P=0.002) and CRAO-NICAS (?字2=10.639, P=0.001). One year follow-up after treatment, there were 9 cases (25.7%) of vascular events (8 cases of cerebral infarction and 1 case of myocardial infarction) in CRAO-ICAS group, and 5 cases (8.8%) of cerebral infarction in CRAO-NICAS group, and the difference were statistically significant (?字2=4.825, P=0.038). Conclusions The visual recovery is relatively better by the thrombolysis via super-selective ophthalmic cartery catheterization within 24 hours of symptom onset both CRAO with ICAS and CRAO without ICAS. The patients of CRAO-ICAS have the higher rates of acute cerebral infarction at symptom onset and cerebrovascular and cardiovascular events at 1 year of follow-up. (Ophthalmol CHN, 2023, 32: 332-337)

Efficacy of phototherapeutic keratectomy combined with ocular surface intervention for recurrent corneal erosion

Luo Jiajing, Duan Hucheng, Chen Rui, Lv Yiyang, Lv Hongling, Yan Shigang, Kong Xiangbin

2023, 32(4):  339-343.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.013

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 Objective To observe the clinical efficacy of laser therapeutic keratectomy combined with ocular surface intervention in recurrent corneal epithelial erosion (RCE). Design  Retrospective case series. Participants 52 cases (52 eyes) with RCE diagnosed in the Second People's Hospital of Foshan from November 2018 to June 2021. Methods RCE patients were divided into two groups based on their treatment methods. 26 patients (26 eyes) were treated with phototherapeutic keratectomy alone as group A, and 26 patients (26 eyes) were treated with phototherapeutic keratectomy combined with perioperative dry eye treatment as group B. All patients completed 1 year follow-up. Corneal repair refers to complete and transparent corneal epithelium checked and negative fluorescein staining by slit lamp examination. On the 7th day after surgery, the stimulation score was questionnaired, and 3 months later, the tear lipid, meibomian gland, BUT, and tear river height were examined with ocular surface comprehensive analyzer. Main Outcome Measures Eye stimulation response score, subjective stimulation symptom score, repair duration, eye surface condition, and postoperative complication rate. Results Eye stimulation response score was 5.38±1.30 in group A and 4.35±1.23 in group B and the subjective stimulation symptom score was 5.77±1.42 in group A and 4.5±1.45 in group B at 7th day after surgery. The repair duration of group A was 8.19±1.86 days, and that of group B was 6.19±1.23 days (P=0.001). At 3 months after surgery, the lipid score of group A was 2.23±0.59, and that of group B was 1.46±0.51. BUT of group A was 7.50±2.29 s, and that of group B was 10.66±2.28 s. The tear river height of group A was 0.30±0.09 mm and that of group B was 0.47±0.08 mm (all P<0.05). The meibomian gland loss score was 2.08±0.48 in group A and 1.85±0.46 in group B (P=0.08). The incidence of postoperative complications was 34.6 % in group A and 7.7 % in group B (P=0.038). Conclusions Phototherapeutic keratectomy combined with ocular surface intervention is effective in the treatment of recurrent corneal erosion, improving ocular surface status and reducing postoperative complications. (Ophthalmol CHN, 2023, 32: 339-343)

Hypoxia protects human lens epithelial cells from senescence induced by oxidative stress

Hou Fang, Huang Qiming, Wan Xiuhua

2023, 32(4):  344-350.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.014

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 Objective To analyze the protection of hypoxia on the aging of human lens epithelial cells (hLECs) induced by 4-hydroxynonaenoic acid (4-HNE). Design Experimental research. Participants  Hypoxia and hLECs. Methods hLECs were treated with 4-HNE at different O2 concentrations and their proliferative activity were detected by CCK-8. The apoptosis levels, reactive oxygen species (ROS) and senescence of hLECs in hypoxic and normoxic condition were analyzed by Annexin-V/PI staining, fluorescent probe (DCFH-DA), β-galactosidase staining and BrdU combined assay respectively. Main Outcome Measures Proliferation activity, apoptosis, senescence and expression level of related proteins of hLECs. Results By compared with normal oxygen concentration, the cell viability of 1% hypoxia was significantly higher than that of 21% normoxia at 48 h, 72 h and 96 h, especially at 50 μM 4-HNE concentration at 96 h (4.75±0.45% and 2.17±0.52%, P=0.008). The survival rate of hLECs under hypoxia was significantly higher than that under normoxia (39.92±5.31% and 10.67±3.22% at 50 μM 4-HNE, P=0.003) detected by flow cytometry. The early and late apoptosis rates were significantly lower than those of normoxia (33.83±4.32% and 48.81±4.99% at 50 μM 4-HNE, P=0.015; 13.85±2.47% and 21.52±3.62% at 50 μM 4-HNE, P=0.007). The level of reactive oxygen species decreased significantly under hypoxia, which was significantly lower than that of normal oxygen (63.44±8.73% and 28.85±5.77% at 50 μM 4-HNE, P=0.009). Aging related β-galactosidase positive rate was significantly lower than those of normoxia (35.31±4.13% and 76.4±4.21% at 50 μM 4-HNE, P=0.004) and the positive of BrdU incorporation significantly higher than those of normoxia (6.55±1.74% and 3.20±0.93% at 50 μM 4-HNE, P=0.021). Western blot results showed that 4-HNE treatment could activate the expression of P53 and P16, the main regulators of aging. However, compared with the hypoxia group, the relative expression of P16 and P53 protein in the normoxia group was significantly higher than that in the hypoxia group (P=0.031, 0.005). Conclusion Hypoxia can promote the proliferation of hLECs, inhibit the apoptosis. ROS and aging level of hLECs caused by oxidative stress, and protect hLECs. (Ophthalmol CHN, 2023, 32: 344-350)

Application of BOPPPS mode in ophthalmic ultrasound diagnosis teaching of ophthalmology postgraduates

Zhao Qi, Yang Wenli, Li Dongjun, Wang Ziyang, Chen Wei, Li Yifeng, Cui Rui, Shen Lin, Liu Qian

2023, 32(4):  355-358.  doi:10.13281/j.cnki.issn.1004-4469.2023.04.017

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 Objective To evaluate the efficiency of BOPPPS mode in ophthalmic ultrasound diagnosis teaching of ophthalmology postgraduates. Design Teaching research. Participants Ten ophthalmology postgraduate students in Beijing Tongren Hospital. Methods The PACS loaded images of color Doppler flow imaging (CDFI) and ultrasound biomicroscopy (UBM), which were classified and labeled by two specialists. The BOPPPS model was used for teaching, and the scores of pretest and posttest were compared to evaluate the teaching efficiency. Students were divided into "5+3" long-duration group and full-time group according to the length of schooling, and the differences between the two groups were compared before and after six rounds training. Main Outcome Measures Kappa scores. Results The average Kappa score was elevated from 0.61±0.10 before training to 0.79±0.08 after training. The Kappa score of CDFI was elevated from 0.62±0.09 before training to 0.76±0.08 after training. The Kappa score of UBM was elevated from 0.61±0.11 before training to 0.83±0.07 after training. There were not obviously different between "5+3" long-duration group students and full-time group students before and after training. Conclusion BOPPPS mode is a valuable tool for ophthalmology postgraduates in ophthalmic ultrasound diagnosis teaching. (Ophthalmol CHN, 2023, 32: 355-358)