Table of Content

25 November 2023, Volume 32 Issue 6

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The impact of swept-source optical coherence tomography (SS-OCT) development on clinical practice of fundus diseases

Peng Xiaoyan, Zhang Zhihan

2023, 32(6):  451-453.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.001

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Swept-source optical coherence tomography (SS-OCT) and Swept-source optical coherence tomography angiography (SS-OCTA), compared to traditional spectral-Domain OCT/OCTA, have several technical advantages such as longer wavelength, deeper scanning depth, faster scanning speed, and shorter image acquisition time. These advancements allow clear imaging of various layers of tissues from the vitreous to the sclera, and enable wide-angle imaging of retinal and choroidal vasculature. Clinical practitioners need to focus on harnessing the rich information provided by SS-OCT/SS-OCTA technology (including more accurate choroidal thickness measurements, clearer observation of choroidal vascular and stromal-dominant lesions, and easier differentiation between choroidal and scleral diseases) to improve the clinical diagnostic and treatment processes, thus effectively enhancing clinical service capabilities. It is crucial to move beyond solely observing imaging features and actively integrate these advancements into clinical practice. (Ophthalmol CHN, 2023, 32: 451-453)

Re-illuminating photophobia

Huang Houbin

2023, 32(6):  454-461.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.002

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As a common symptom, photophobia is usually refereed to ocular surface diseases. In fact, it is also manifested in ocular fundus diseases, neuropathy and a certain of systemic disorders. This review re-illuminates in detail the history, definition, etiology of photophobia, especially pays attention to the up-to-date pathogenesis of photophobia resulted from various diseases and the neural circuits. If a patient complains photophobia without evident causes, retinopathies and optic neuropathies should be considered, especially when vision decrease is associated. (Ophthalmol CHN, 2023, 32: 454-461)

Experimental study of rabbit on reducing intraocular pressure by drainage of aqueous humor through lamina cribrosa 

Tao Yan, Wen Liang, Guo Chaoqun, Zhang Shaodan, Liang Yuanbo, Wu Wencan, Wang Ningli

2023, 32(6):  462-468.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.003

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 Objective To determine the feasibility of lamina cribrosa puncture in intraocular pressure (IOP) reduction in rabbit eyes. Design Experiment study. Participants 4 healthy adult New Zealand rabbits (4 eyes). Methods Four healthy adult New Zealand rabbits were selected and 3 randomly for the experimental group to puncture lamina cribrosa and implant drainage tube. A sham rabbit eye with vitrectomy was used as a control. All surgeries were performed on the right eye only, with no treatment gived to the left eye. Intraocular pressure (IOP) was measured at pre-operative and postoperative 7 consecutive days, 18th day, 20th day, 21st day, 22nd day, 24th day, 25th day. Ophthalmic Ultrasound B was obtained at the 2nd day, 3rd day, and 7th day after the operation. All 4 rabbits were sacrificed 1 month postoperatively, and the eyeballs were enucleated for histopathological examination and hematoxylin-eosin (HE) staining and one of the experimental eyes was injected 100 μL of Japanese ink filtered by 0.2 μm filter membrane to vitreous cavity half an hour before death. Main Outcome Measures IOP and histopathological result. Results IOP measurements of all animals decreased 1 week after the operation, and the control rabbit eye increased gradually to the baseline at the 18th day postoperatively. IOP measurements of 2 experimental eyes in the experimental group during the observation period of the past month were (9.77±1.30) mmHg and (10.08±0.76) mmHg respectively, and were always lower than the pre-operative intraocular pressure (16.00 mmHg and 14.00 mmHg) and the contralateral untreated eyes (14.85±1.46) mmHg and (15.65±1.93) mmHg. The HE staining showed an accumulation of Japanese ink in para-vascular spaces around blood vessel walls in the one experimental eye. Conclusion Experimental study in rabbit preliminarily shows it is possible to drainage aqueous humor through a hole of lamina cribrosa to subarachnoid space. (Ophthalmol CHN, 2023, 32: 462-468)

Clinical comparative study on the treatment of juvenile open-angle glaucoma with gonioscopy-assisted transluminal trabeculotomy and microcatheter-assisted circumferential trabeculotomy 

Di Haohao, Chen Xuhao, Zhang Weijia, Gao Chuanwen, Qian Lifeng, Wang Huaizhou

2023, 32(6):  471-476.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.004

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Objective To systematically compare the long-term postoperative efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) and microcatheter-assisted circumferential trabeculotomy (MAT) and to provide a reference for the treatment of juvenile open-angle glaucoma (JOAG). Design Retrospective case series. Participants From January 2018 to June 2021, a total of JOAG patients who visited the Glaucoma Department of the Second People's Hospital of Zhengzhou and underwent trabeculotomy surgery were included in the study. Among them, there were 22 cases (30 eyes) in the GATT group and 19 cases (24 eyes) in the MAT group. Methods The patients were divided into the GATT group and the MAT group according to the surgical procedure. The preoperative and postoperative (at 1 day, 1 week, 1, 3, 6, 9 months, and 1 year) intraocular pressure (IOP) were recorded, as well as the types of antiglaucoma medications used during the 1-year follow-up. Complete success of the surgery was defined as achieving an IOP between 6~18 mmHg or a reduction in IOP by more than 20% from baseline without the use of antiglaucoma medications. Qualified success was defined as an IOP ＜21 mmHg or a reduction in IOP by more than 20% from baseline, along with a decrease in the use of antiglaucoma medications. Compare the IOP levels, medication use, and surgical success rates at different time points. Main Outcome Measures IOP, medications, success rate. Results The IOP in both groups was significantly lower than before surgery in 1 day, 1 week, 1 month, 3 months, 6 months, 9 months, and 1 year after surgery (all P<0.05). Compared to preoperative levels, the decrease in IOP at 1 day after surgery was greater in the MAT group (21.1±14.8) mmHg compared to the GATT group (13.4±12.2) mmHg (t=-2.105, P=0.040). However, there was no statistically significant difference in the change of IOP between the two groups at the various follow-up time points from 1 week to 1 year after surgery. One year after surgery, the median number of drugs in both the GATT and MAT groups decreased by three, which was significant compared to before surgery (both P<0.001). One year after surgery, the complete success rate was 60.0% in the GATT group and 70.8% in the MAT group, while the qualified success rate was 90.0% in the GATT group and 95.8% in the MAT group, with no significant difference between the two groups. The two groups had no significant difference in the abnormal IOP events. Conclusion For JOAG population, MAT demonstrates a greater reduction in IOP in the early stage, while GATT and MAT have the same long-term IOP lowering effect and success rate, and there is no difference in the abnormal IOP events between both surgeries. (Ophthalmol CHN, 2023, 32: 471-476)

Short-term effects of intravitreous Conbercept injection on choroid thickness in neovascular age-related macular degeneration eyes

She Chongyang, Jiao Jian, Wang Jing, Lu Hong, Hua Wen

2023, 32(6):  478-482.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.005

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Objective To evaluate the short-term effects of intravitreal Conbercept injection (ICI) on intraocular pressure (IOP), retinal thickness, and choroidal thickness. Design Prospective cohort study. Participants A total of 42 patients with neovascular age-related macular degeneration treated with 0.05 ml intravitreal Conbercept injection (ICI) by the same physician between October 2020 and May 2021 were collected. Methods All subjects underwent general physical and ophthalmic examinations. Eye axial length (AL) was measured using IOL Master before ICI. To observe the changes of central subfoveal thickness (CFT), retinal nerve fibre layer (RNFL) thickness, subfoveal choroidal thickness (SFCT) and parafoveal choroidal thickness (PFCT) within 1 hour before ICI, 1 hour after ICI, and 24 hours after ICI. Factors associated with SFCT and PFCT measured within 1 hour before ICI were analyzed by multiple linear regression. Main Outcome Measures CFT, RNFL thickness, SFCT, PFCT. Results The IOP was 15.8±3.6 mmHg before the injection, 17.8±4.3 mmHg at 1 hour after the injection, and 13.8±2.6 mmHg at 24 hours after the injection, with a significant increase followed by a significant decrease after ICI (F=5.43, P=0.006). The PFCT was 244.2±78.8 μm before the injection, 197.3±84.1 μm at 1 hour after ICI, and 307.9±74.2 μm at 24 hours after ICI, with a significant decrease followed by a significant increase after ICI (F=3.48, P=0.04). There were no significant differences in CFT (F=0.19, P=0.83), RNFL (F=0.45, P=0.64) and SFCT (F=1.53, P=0.23) among the different time point before and after ICI. Both SFCT [B (95% CI): -7.77 (-12.25, -3.29), P=0.002] and PFCT [B (95% CI): -6.87 (-10.51, -3.23), P=0.005] were negatively associated with age. Conclusion ICI has an immediate effect on choroidal thickness in the short term, which may lead to transient choroidal ischemia that recovers 24 hours after ICI. (Ophthalmol CHN, 2023, 32: 478-482)

The effect of shallow chamber depth on the prediction error of different intraocular lens calculation formulas 

Xian Jinzhui, Guo Juan, Zou Yanhong

2023, 32(6):  483-487.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.006

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Objective To investigate the effect of shallow aqueous depth (AD) on the prediction error of four different intraocular lens (IOL) calculation formulas. Design Retrospective observational study. Participants A total of 176 cataract patients (176 eyes) who had cataract surgery with single focus IOL in-the-bag implantation from the First Hospital of Tsinghua University from Jan 1st, 2019 to Dec. 31th, 2021. Methods Axial length (AL), corneal curvature and AD were measured before operation. Patients were divided into shallow AD group (AD<2.5 mm) and non-shallow AD group (AD≥2.5 mm) according to AD. And the shallow AD group was further divided into short AL (AL<22.0 mm) and normal AL (AL≥22.0 mm) subgroups. Manifest refraction results were collected 1 to 3 months after operation to calculate the postoperative prediction errors of SRK/T, Hoffer Q, Haigis and Barrett formulas. Main Outcome Measures The prediction error (PE) and absolute prediction error (AE) of IOL values after operation. Results The difference of PE of 4 formulas was statistically significant (P<0.001) in the shallow AD group, while not in the non-shallow AD group (P=0.438). In the shallow AD group，the PE of Haigis (0.00±0.41) D and Barrett (0.04±0.41) D were smaller than that of SRK/T (-0.18±0.45) D and Hoffer Q (-0.21±0.41) D (P<0.05), there were no significant difference in the PE between Haigis and Barrett (P=0.614). In the shallow AD short AL group, the PE of SRK/T (-0.41±0.56) D and Hoffer Q (-0.45±0.44) D tended towards nearly a 0.50 D myopic shift which was statistically different from Haigis [(0.05±0.42) D, P<0.05]. Compared with itself, the PE of SRK/T and Hoffer Q tended towards a myopic shift under the influence of shallow AD [P(SRK/T) =0.031, P(Hoffer Q) <0.001]. There was no significant difference in the AE of different formulas within the group (the shallow AD group, P=0.393, and non-shallow AD group, P=0.369) nor between (P>0.05). In the shallow AD group, AE of SRK/T (P=0.044) and Hoffer Q (P=0.02) was statistically bigger in the short AL group. In the shallow AD short AL group, the percentage of AE within 0.50 D was 90% of Haigis, and only 50% of Hoffer Q without statistically difference (P=0.098). Through Logistic regression analysis, only SRK/T was found a greater possibility to get a >0.50 D AE with a steeper cornea (OR 1.71), a longer AL (OR 2.03) and a shallower AD (OR 0.327). Conclusions In patients with shallow AD, Haigis and Barrett formulas had more accurate predictions than SRK/T and Hoffer Q formulas. These two formulas were recommended in clinical practice. (Ophthalmol CHN, 2023, 32: 483-487)

Effect of different refractive correction therapy on the treatment of high AC/A ratio accommodative esotropia

Wang Yachen, Cheng Luyao, Chang Di, Liu Zhihan, Zhang Weijia, Fu Tao

2023, 32(6):  488-491.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.007

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Objective To compare the effect of bifocal lenses, progressive addition lenses and single vision lenses on stereoscopic vision recovery in patients with high AC/A ratio esotropia. Design Prospective study. Participants A total of 57 cases were enrolled, including 18 cases with progressive addition lenses, 23 cases with bifocal lenses, and 16 cases with single vision lenses. Methods All patients in the three groups had full orthoptic correction and were in the orthoptic position when viewing the distance. The additional diopter of progressive addition lenses and bifocal lenses was +2.50~+3.00 D. After 3~5 years’ follow-up, the differences of deviation at distance and near, AC/A ratio and near stereoscopic vision in each group after the treatment were statistically analyzed. Main Outcome Measures Orthotropic rate at near, AC/A ratio, near stereoscopic vision. Results There were no significant differences of the baseline data of age, gender, refractive status, AC/A before treatment among the three groups (all P>0.05), the stereoscopic vision of the three groups was all lost before treatment. After follow-up of 3~5 years, the orthotropic rate at near of the bifocal lenses, progressive addition lenses and single vision lenses groups was 10/23(43%), 10/18(56%), and 6/16(38%), respectively (χ2=0.71，P=0.70). The stereoscopic vision of patients in the three groups was improved to (6.79±1.67) lnArcsec, (7.43±1.50) lnArcsec, and (7.41±1.48) lnArcsec, but there was no statistically significant difference among the three groups (F=1.12, P=0.33). Conclusion Bifocal lenses, progressive addition lenses, and single vision lenses have a similar therapeutic effect on high AC/A ratio esotropia. (Ophthalmol CHN, 2023, 32: 488-491)

Comparison of corneal thickness and diopter stability after SMILE, FS-LASIK and Trans-PRK for correcting myopia  

Xu Lingling, You Changtao, Li Shuaifei, Chen Dongdong

2023, 32(6):  496-501.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.009

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Objective To compare the corneal thickness and diopter stability after SMILE、FS-LASIK and T-PRK for correcting myopia. Design Retrospective cases series. Participants From January 2021 to July 2021,108 patients(108 right eyes) who underwent corneal refractive surgery in Zhengzhou Aier Eye Hospital. According to the accepted surgery, the patients were divided into SMILE（36 eyes）, FS-LASIK （36 eyes） and T-PRK（36 eyes）. Methods Apical corneal thickness (ACT) and spherical equivalent (SE) were reviewed preoperative, 2 weeks, 1 month, 3 months, 6 months and 1 year after surgery. The ACT and SE of one kind of surgery at different time and each time point were analyzed. Main Outcome Measures ACT, SE. Results Comparison of postoperative ACT: After SMILE the thinnest was 2 weeks, and the second was 1 month (all P＜0.05). After FS-LASIK, there were no significant differences between 1 month, 6 months with 3 months, but the thickness were gradually increased at other times(all P＜0.001). There were significant differences between 1 month and 3 months with other times after Trans-PRK (all P＜0.05) . The ACT became thicker in the early period after Trans-PRK, then became thinner, until stablily. Statistically significant differences of SMILE and Trans-PRK were thicker than FS-LASIK at any time (P＜0.05). Comparison of postoperative SE: Statistically significant differences of 2 weeks after SMILE was higher than 1 year (P=0.037). The diopter was unstable in the 1 month after FS-LASIK (all P＜0.05). There were significant differences between 1 month, 6 months with 1 year after Trans-PRK (all P=0.002). Statistically significant differences of SMILE was lower than FS-LASIK at 2 weeks (P=0.002). There was no statistical significance between the three surgery at other time. At 1 year after surgery,  SE within range ±0.50 D at SMILE, FS-LASIK and Trans-PRK group was 61%, 53% and 64%, respectively, and SE within range ±1.00 D was 93%, 89% and 89%, respectively. Conclusion The ACT all tended to be stable and slightly thickened after 3~6 months of the three refractive surgery. The corneal thickness of SMILE and Trans-PRK were thicker than FS-LASIK. The three refractive surgery all had a slight regression with time. Trans-PRK was preferred for low-moderate myopia or thin cornea, SMILE was preferred for moderate-high myopia, while FS-LASIK for high myopia or thin cornea should pay more attention to regression. (Ophthalmol CHN, 2023, 32: 496-501)

Comparative study on the measurements of biological parameters of anterior segment by two anterior segment  analyzers: Scansys and Pentacam

Liu Yin, Jiang Wenshan

2023, 32(6):  502-508.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.010

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 Objective To evaluate the difference and consistency of biological parameters of anterior segment measured by two anterior segment analyzers: Scansys and Pentacam. Design Consistency evaluation study. Participants Randomly select 158 initial visit patients (158 eyes) who received myopia surgery at General Hospital of Central Theater Command in August 2022. The comparison will be based on the right eye. Methods The  anterior segment biometric parameters were measured using both Scansys and Pentacam anterior segment analyzers by the same physician. The differences and agreements in the anterior segment biometric parameters were evaluated using the Bland-Altman method, while the comparison of corneal astigmatism (CA) was performed using vector analysis. Main Outcome Measures Parameters of anterior segment, including K1, K2, Km, Rm, CA, central corneal thickness (CCT), anterior chamber depth (ACD), corneal diameter (WTW), pupil diameter (PD), anterior chamber volume (ACV), anterior chamber angle (ACA). Results Compared to Pentacam, Scansys measured smaller values for K1, K2, Km, CCT, ACD, WTW, and ACV, while Rm, PD, and ACA were  larger. The differences between the two instruments in measuring K1, K2, Km, Rm, CCT, ACD, WTW, PD, ACV, and ACA were (-0.12±0.19)D, (-0.15±0.20)D, (-0.13±0.16)D, (0.03±0.03)mm, (-17±7.0)μm, (-0.04±0.18)mm, (-0.36±0.14)mm, (0.36±0.45)mm, (-21±20)mm3, and (3.5±4.8)°, respectively. The 95% limits of agreement (95% LoA) were (-0.48~0.25)D , (-0.54~0.24) D, (-0.45~0.18) D, (-0.03~0.08)mm, (-31~-3.5)μm, (-0.38~0.30)mm, (-0.64~-0.08)mm, (-0.52~1.2)mm, (-61~19)mm3, and (-6~13)°, with 94.3%, 95.6%, 95.6%, 93.0%, 98.1%, 94.9%, 96.2%, 96.2%, 95.6% and 98.1% of the data falling within the confidence intervals. There were some differences in CA measurements between the two instruments, with a 95% LoA ranging from -0.51~0.44 D, and the Bland-Altman plot showing that 94.9% of the data fell within the confidence interval. The vector analysis results showed that on the anterior corneal surface, the horizontal and vertical astigmatism values measured by Pentacam were approximately 0.04 D higher than those measured by Scansys, while the 45° axis astigmatism value measured by Pentacam was approximately 0.10 D lower than that measured by Scansys. The total refractive power measured by Pentacam was approximately 0.30 D higher than that measured by Scansys. Conclusion Scansys has a good consistency with Pentacam on the measurement of K2, Km, CCT, WTW, PD, ACV and ACA. However, in the measurement of K1, Rm, ACD and CA, there are significantly differences between Scansys and Pentacam, which should be comprehensively analyzed combined with more examination results in the application of different refractive surgeries. (Ophthalmol CHN, 2023, 32: 502-508)

A study on histocompatibility between a new type of endotamponade hydrogel substitute and Müller cells of human retina in vitro

Gou Yueqin, Ran Ruijin, Tao Mengying, Zhang Ming

2023, 32(6):  509-515.  doi:10.13281/j.cnki.issn.1004-4469.2023.06.011

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Objective To investigate the histocompatibility between a new type of endotamponade hydrogel substitute and human retinal Müller cells in vitro. Design Experiment study. Participants Human retinal Müller cell line (MIO-M1). Methods Human retinal Müller cells were passaged and cultured until stable growth, and then divided into three groups, which were respectively treated with a certain concentration of balanced salt solution (BSS), new type of Hydrogel extract, and perfluorocarbon liquid (PFCL) for cultivation. The morphology of cells in each group was observed after 24 h. The cells were cultured for 1 h, 4 h, 12 h, 24 h, 48 h, and 72 h, respectively. The cell viability was measured using MTT assay at different time points. Flow cytometry was used to detect the cell apoptosis, and the concentration of IL (interleukin)-6 in the supernatant was measured using ELISA at different time points. Meanwhile, expression of intracellular reactive oxygen species (ROS) was identified by immunofluorescence after 24 h of culture. Main Outcomes Measures Cell morphology, cell viability, IL-6 concentration, cell apoptosis rate, ROS concentration. Results After co-culturing the new hydrogel extract and Müller cells for 72 h, compared with the group of BSS, there was no decrease in cell viability or cell survival rate, no significant change in cell morphology, no significant increase in the secretion level of IL-6 and intracellular ROS after 24 h. In addition, compared with the group of BSS, after co-culturing PFCL and Müller cells for 12 h, the secretion level of IL-6 was increased (P=0.0105), the cell viability started to decrease after 24 h (P=0.0147), and the cells in contact with PFCL shrank, the number of the cells decreased, and the arrangement of cells was loose. Meanwhile, the analysis of apoptosis at different time points showed that the late apoptosis and necrosis rate of Müller cells increased after 24 h (P=0.0201). The level of intracellular ROS significantly increased after 24 h（P<0.0001）. Conclusions The new type of endotamponade hydrogel substitute has good histocompatibility with human retinal Müller cells in 72 h. Exposing Müller cells to PFCL for 12 h can increase the secretion level of IL-6. After 24 hours, the cell viability decreased and the level of apoptosis increased, which may be related to the oxidative stress mechanism activated by ROS in cells. (Ophthalmol CHN, 2023, 32: 509-515)