Abstract:AIM: To evaluate the visual acuity, visual function, quality of life, and cost/effectiveness of cataract surgery in patients with low socioeconomic status(LSES)who received government subsidies for free cataract surgery.

METHODS: Retrospectively, 334 eyes of 334 patients were reviewed. Visual function and quality of life questionnaires were available in 83 patients. The cost/effectiveness of cataract surgery was analyzed in 225 patients with LSES and 120 patients who received standard cataract surgery. Multiple linear regression analysis and logistic regression analysis were used to assess the factors affecting the postoperative visual acuity.

RESULTS: At 1wk postoperatively, uncorrected visual acuity(UCVA)was improved significantly compared to these preoperatively(P<0.05), 235 eyes(70.4%)had UCVA of 20/40 or better, and 16 eyes(4.8%)had UCVA worse than 20/400. Multiple linear regression analysis revealed that other ocular diseases and cataract classification were factors contributing to postoperative UCVA. Logistic regression analysis showed that low preoperative visual acuity and other ocular diseases were risk factors of postoperative low vision, and the odds ratio(95% confidence interval)values were 6.5(2.8-14.8)and 1.3(1.0-1.6), respectively. Visual function and quality of life were significantly improved after the surgery. The cost/effectiveness of cataract surgery in patients with LSES was lower than that in standard cataract patients.

CONCLUSION: Visual acuity and visual function were significantly better after the surgery in cataract patients with LSES, and the operation cost was low. Quality of life in these patients was significantly improved.

Abstract:AIM: To determine the relation between each of the optical coherence tomography(OCT)patterns, etiologies and visual acuity in patients with cystoid macular edema(CME).

METHODS: Fifty-seven eyes with CME from 52 patients were included in our study. The data of this cross sectional study was collected from patients with CME assessed by OCT, who also underwent fundus photography and visual acuity test the same day. The best corrected visual acuity(BCVA)was assessed by using E chart and converted in logarithm of the minimum angle of resolution(logMAR). The visual acuity varied from 2.3 logMAR to 0 logMAR with a mean of 1.11±0.57. The etiology was determined from medical history and the fundus photograph of the patient. Four OCT grades established according to ratio between the vertical size of largest cyst and the maximum macular thickness(<30%, ≥30% <60%, ≥60% <90% and ≥90%)were considered. The correlation was established by calculating the Pearson's correlation coefficient “r” and the statistical significance was considered when P value was inferior to 0.05.

RESULTS: OCT grade IV was the most associated with very severe visual loss with the greatest mean VA of 1.96±0.23 logMAR and the correlation between OCT grades and visual acuity was strongly statistically significant(r=0.729, P<0.001). The central retinal vein occlusion(CRVO)was the most underlying disease associated with worse vision, with the greatest mean VA of 2 logMAR and the correlation was statistically significant(r=0.375, P=0.004). Another associated OCT pattern, the disruption of both inner segment/outer segment(IS/OS)and external limiting membrane(ELM), was inversely associated with severe visual loss(high mean VA=1.11±0.57 logMAR, with statistically significant correlation, r=-0.346, P=0.008). The presence of both vitreoretinal traction components and outer retinal layers disruption were significantly associated with OCT grade IV(r=0.390, P=0.003)and CRVO(r=0.362, P=0.006).

CONCLUSION: In this study, the OCT fourth grade and CRVO seem to be more significantly associated with the worse vision in patients with CME.

Abstract:AIM: To report the incidence of post-operative cystoid macular edema(pCME)in patients with or without diabetes and its correlation with cumulative dissipated energy(CDE)and phaco-time after uncomplicated phacoemulsification.

METHODS: In the study 116 nondiabetic(Group A)and 101 diabetic patients(Group B)underwent phacoemulsification. Preoperatively none of the groups(A+B)had signs of maculopathy or diabetic macular edema documented by spectral-domain optical coherence tomography(SD-OCT)and fundus fluorescein angiography(FFA). Phaco metrics were documented after surgery. FFA was performed two months after each operation. Patients with indications of pCME were reassessed with SD-OCT.

RESULTS: The incidence of pCME after uncomplicated phacoemulsification was statistically significant difference between the two groups(15.8% in Group B versus 6.9% in Group A, P=0.03<0.05). The subclinical pCME appeared in 19 out of 24 patients. There was a significant correlation between parametric values(CDE, phaco-time, hardness of the lens)and pCME occurrence. Glycosylated Hemoglobin(HbA1c)blood levels was statistically significant difference(P=0.005<0.05)between the patients who developed or not pCME. Cystoid macular edema did not correlate with the axial length of the eye.

CONCLUSION: There was statistically significant difference in the incidence of pCME after uneventful phacoemulsification between nondiabetic subjects and diabetics. Most of these patients with pCME had subclinical appearance. CDE and phaco-time data were important factors and predictors to pCME. Good glycemic controls prevent the incidence of pCME.

Abstract:AIM:To evaluate the relationship between color discrimination ability(CDA)and depth perception among university students with normal color vision.

METHODS:A total of 52 students, 33 males(63.46%)and 19 females(36.54%)from Baskent University Faculty of Medicine, aged 21.18±2.52y included in this study. Subject has normal visual acuity(20/20)and without congenital color vision deficiency(CCVD). They were evaluated by Ishihara Pseudoisochromatic Plate Test(IPPT). Dominant eye(DE)was determined using the Gundogan Method. The CDA was examined by Farnsworth-Munsell 100 Hue Test(FM100HT)test for detecting total error score(TES)and local error score(LES)for two eyes(TE)open, the right eye(RE)open and the left eye(LE)open. The error scores were divided into the three groups: for the TE, for the dominant eye(DE)and for the non-dominant eye(NDE). The presence of the binocularity and stereoscopic sensitivity(SS)were investigated by TNO test which were also divided into four groups according to the level of SS within a range of 480-15 arc/s.

RESULTS:The error scores of FM100HT without gender difference for TES, blue/yellow(b/y)LES and red/green(r/g)LES were found 61.22±30.32(58.50), 35.80±19.32(36.50)and 25.42±14.65(24.00)respectively. In male subjects(n=31)were found 67.45±29.95(61.00), 40.25±18.83(39.00)and 27.19±14.30(24.00)respectively. In female subjects(n=19)were found 51.05±28.84(47.00), 25.52±18.32(28.00)and 22.2±31.13(23.00)respectively. Females had higher CDA than males according FM100HT error scores. CDA classification according to FM100HT were found to be higher(6%, TES=0-20), medium(86%, TES=20-100), lower(8%, TES>100), the medium level was statistically more frequently observed(P<0.05). The r/g color LES for DE and NDE were 24.12±14.70 and 32.20±14.21, b/y color LES for DE and NDE were 34.68±1.95 and 36.24±17.56 respectively. In female(n=19)r/g color LES for DE and NDE were 21.89±15.06 and 31.00±22.42; in male(n=31)25.48±14.55 and 32.93±17.31. In female(n=19)b/y color LES for DE and NDE were 29.63±18.62 and 33.42±17.38; in male(n=31)37.77±18.78 and 37.96±17.73 respectively. All students' TES of TE, DE and NDE subgroups and stereopsis level of were compared, the differences were not statistically significant(P=1). According to our research CDA and binocular depth perception does not effect on each other.

CONCLUSION: In normal subjects TES of FM100HT showed that no difference in the subject with different stereopsis level and the depth perception evaluated by TNO test which is based on color dissociation and the ability to color discrimination was not correlated. Our previous study DE's CDA was found superior to the NDE's. But in the presenting study showed that DE was not superior to NDE in terms of depth perception.

Abstract:AIM: To investigate the effect of pupillary dilation on intraocular lens power calculation.

METHODS: This prospective study included 52 eyes of 45 patients diagnosed with cataract and indicated for phacoemulsification with intraocular lens(IOL)implantation at the Faculty of Medicine of Mersin University. For each patient, preoperative corneal topography, autokeratometric measurements and biometric measurements were performed before and after pupil dilation.

RESULTS: K_h(horizontal)values obtained through autokeratometry and anterior chamber depth measured by biometric ultrasonography were significantly greater when pupils were dilated compared with values obtained when pupils were undilated. Implanting IOLs with power calculated using measurements taken during pupillary dilation resulted in a significantly higher rate of emmetropia. Comparison of emmetropic eyes and ametropic eyes showed significantly larger anterior chamber depth in emmetropic eyes.

CONCLUSION: Keratometric and biometric measurements are more important in IOL power calculation than the formula used. If biometric ultrasonography is performed using contact technique, care must be taken to avoid corneal compression. Anterior chamber depth should be followed during measurement, and the margin of error can be minimized by using the highest value obtained in IOL power calculation.

Abstract:AIM: To evaluate the characteristic of choroidal thickness(CT)in highly myopic glaucoma eyes, and investigate the factors that affect the CT in various regions of the macula.

METHODS: Thirty-two highly myopic eyes of 18 patients with primary open angle glaucoma(POAG), 36 non-highly myopic eyes of 20 patients with POAG, and 33 non-glaucoma highly myopic eyes of 21 matched volunteers were enrolled. CT at subfoveal, and 1mm and 3mm nasal, temporal, superior, and inferior to the fovea was measured using enhanced depth imaging coherence tomography. Multiple linear regression analyses were performed to detect the effects of diagnosis, spherical equivalent(SE), age, intraocular pressure(IOP), central corneal thickness(CCT), and mean deviation(MD)of visual field defect on CT at all measured points.

RESULTS: The choroid of highly myopic glaucoma eyes was statistically thinner than non-highly myopic glaucoma eyes at various locations(all P<0.05), while there was no significant difference between highly myopic glaucoma and non-glaucoma high myopia eyes at all locations(all P>0.05). Multiple regression analysis showed that SE was the most influential factor on CT in all regions of the macula, and CT varied significantly with age in 3mm superior to fovea(S3CT), but not with diagnosis, MD of visual field defect, IOP, or CCT.

CONCLUSION: CT in highly myopic glaucoma is equivalent in comparison with non-glaucoma highly myopia, although it's thinner than that in glaucoma eyes without high myopia. This implies the lack of association between CT and progression of glaucomatous optic neuropathy.

Abstract:AIM: To investigate mechanism of bradykinin(BK)on inflammations of retinal pigment epithelium(RPE)cells.

METHODS: ARPE-19 cells were cultured in vitro, stimulated by 100nM BK for 24h. Cell morphology changes were observed by microscope, and BK receptor localization was detected through cell immunofluorescence. Changes of Ca²⁺ in BK and BR antagonist stimuli were detected by laser scanning confocal microscopy. The expressions of COX-1, COX-2, eNOS and iNOS protein in control group and BK group were detected by Western Blot.

RESULTS: After the stimulation of BK, there was no significant changes of ARPE-19 cells in morphology. Kinin B1 receptors(B1R)and B2 receptors(B2R)could be detected in ARPE-19 cells. Compared with control group, Ca²⁺ concentrations significantly increased in BK group; in B1R antagonist group and B2R antagonist group Ca²⁺ concentrations increased less than BK group; B1R and B2R antagonist group showed no obvious changes in Ca²⁺ concentrations. Compared with control group, COX-2 and iNOS protein concentrations were significantly increased in BK group(P<0.001).

CONCLUSION: BK induces the increasing expression of COX-2 and iNOS in the cultured ARPE cells through binding with either B1R or B2R.

Abstract:AIM: To investigate the influence on blood-retina barrier after intense light exposure in rats.

METHODS: The rats were randomly divided into light exposure group and control group. Rats in light exposure group were exposed in white light(10 000lux,12h on-off, continuing 1-14d). Rats in control group were only exposed in natural light. The eyes of the rats in the two groups were removed when the rats in light exposure group acceptted intense light after 1, 3, 7 and 14d. We observed the change of retinal structure using hematoxylin-eosin(HE)staining, and observed the change of retinal ultrastructure using electron microscope. We quantified the change of retinal vascular permeability using laser scanning confocal fluorescence microscope and spectrophotometry after perfusion of Evans-blue, to evaluate the change of blood-retinal barrier.

RESULTS: At 1d after intense light exposure, the retinal ultrastructure of rats changed, such as denaturation of photoreceptor cells and falling of membranous disc outer segment and thinning of the outer nuclear layer thickness, and so on; and the longer the rats exposure to intense light, the more serious change of the retinal ultrastructure were found. At 3d later, photoreceptor cells began apoptosis. At 14d later, the outer nuclear layer became thinner obviously, and the number of cells reduce obviously. At 1d after intense light exposure, EB leaked from the retinal vascular, and at 14d later the leaking of EB was more obvious.

CONCLUSION: The photoreceptor cell of the outer nuclear layer of retina will degenerate and apoptosis, and the outer nuclear layer will be thinner, and the structure and function of blood-retinal barrier will be destroied, if the eyes of rats exposed in intense light.

Abstract:AIM:Through the establishment of penetrating keratoplasty model of rats, to detect the role and its mechanism of immature dendritic cells with IL-10 gene modified.

METHODS:Allogeneic penetrating corneal transplantation in rat model was performed. SD rats were randomly divided into positive control group, GFP-DC group, 8-DC and IL-10-GFP-DC group. At 3d before keratoplasty, the rats were given tail intravenous injection with the same amount of PBS, bone marrow 8-DC(DC had cultured for 8d)from donor Wistar rats, GFP-DC after 48h transfection and IL-10-GFP-DC. Rats were observed under slit-lamp for corneal graft cases every day, and recorded rejection index and corneal graft survival time. At 14d after keratoplasty, pathologic and immunohistochemical examinations were performed.

RESULTS:Compared with GFP-DC group and 8-DC group, corneal graft survival time of IL-10-GFP-DC group was significantly longer(P<0.01); at 14d after keratoplasty, corneal opacity, edema, neovascularization and rejection index of IL-10-GFP-DC group were significantly lower(P<0.01). Pathological examination showed that in the three experimental groups corneal inflammation was lighter than the positive control group without significant central graft neovascularization. Immunohistochemistry showed: compared to the positive control group, GFP-DC group and 8-DC group, CD4⁺, CD8⁺, CD25⁺, IL-2⁺, NK⁺ and NF-κB⁺ positive cells in IL-10-GFP-DC group were lower(P<0.01).

CONCLUSION: After donor-derived immature dendritic cells pretreated, corneal graft survival was significantly prolonged, successfully induced corneal transplantation tolerance. CD4⁺, CD8⁺, CD25⁺, IL-2⁺, NK⁺ and NF-κB⁺ positive cells are involved in corneal allograft rejection regulation, IL-10-GFP-DC may reduce CD4⁺, CD8⁺, CD25⁺, IL-2⁺, NK⁺ and NF-κB⁺ positive cell infiltration, inhibit corneal transplant rejection.

Abstract:AIM: To investigate the influence of propylene glycol mannite sulfate(PGMS)on the expression of tumor necrosis factor -α(TNF-α)and interleukin-1β(IL-1β), in diabetic retinopathy by a rat model, to study the mechanism of PGMS against diabetic retinopathy, and provide a reliable theoretical and experimental evidence for the PGMS to be applied to clinical prevention and treatment of diabetic retinopathy.

METHODS: Male Wistar rats were randomized into 4 groups, normal control group, diabetic control group and PGMS in group, the PGMS in groups included the doses of 50mg/kg and 100mg/kg. 1% streptozotocin(STZ)of 60 mg/kg was intraperitoneally injected in rats to establish the diabetic models. The PGMS with the doses of 50mg/kg and 100mg/kg were used to gavage in different groups of models for 12wk. Twelve weeks later, the animals were sacrificed and retinas were isolated. The aqueous humors and serums were taken, expressions of TNF-α and IL-1β protein in retinas, aqueous humors and serums were detected by enzyme-linked immunosorbent assay(ELISA), respectively. The location and the expression of TNF-α and IL-1β protein in retina tissue was detected by immunohistochemistry.

RESULTS: Twelve weeks after the use of PGMS, the level of blood glucose was not changed. ELISA showed that the expression of TNF-α and IL-1β protein in serum and retina was significantly increased in diabetic control group than in normal control group(P<0.05), but in the groups which PGMS was given reduced, lower than those in diabetes mellitus(DM)group, especially as the concentration of PGMS increased(P<0.05). But the levels of aqueous humor's TNF-α and IL-1β proteins in PGMS group were not reduced. Immunohistochemistry showed that the TNF-α protein was almost not expressed in normal control group. But the TNF-α protein was highly expressed in diabetic control group. The expression mainly located in the ganglion cell layer, the inner plexiform layer, outer plexiform layer and pigment epithelium. The TNF-α protein was weakly expressed at the group of 50mg/kg PGMS, the TNF-α protein was almost not expressed at the group of 100mg/kg PGMS. When the normal control group was detected, the IL-1β protein was weakly expressed in the outer plexiform layer. But the IL-1β protein was also highly expressed in diabetic control group.The expression mainly located in the inner plexiform layer, outer plexiform layer and pigment epithelium. The IL-1β protein was weakly expressed at the group of 50mg/kg and 100mg/kg PGMS.

CONCLUSION: PGMS can treat the diabetic retinopathy by downregulating the expressions of TNF-α and IL-1β in early diabetic retinopathy. PGMS maybe have a good control effect on early diabetic retinopathy.

Abstract:AIM: To investigate the effects of Bevacizumab on the proliferation and the expression of E-Cadherin and fibronectin in human retinal pigment epithelial cell(ARPE-19)in vitro.

METHODS: Different concentrations(0, 0.625, 1.25, 2.5, 5.0mg/mL)of bevacizumab were exposed to ARPE-19 cells, then cell viability was analyzed by CCK-8, cell cycle was determined by flow cytometry, and the expression of E-Cadherin and fibornectin was detected by Western blot and RT-PCR.

RESULTS: The concentration as 2.5mg/mL or 5.0mg/mL of bevacizumab was shown to effectively suppress the proliferation and cell cycle of ARPE-19 cell(P<0.05). In addition, 2.5mg/mL or 5.0mg/mL of bevacizumab could downregulate the expression of E-cadherin and promote the transcription of fibronection gene(P<0.05).

CONCLUSION: High concentration of bevacizumab was able to inhibit ARPE-19 proliferation, downregulate E-Cadherin expression and promote fibronectin expression, indicating epithelial-mesenchymal transition induced by bevacizumab in ARPE-19 cell.

Abstract:AIM:To analysis the relation of severity of rhegmatogenous retinal detachment with the levels of amino acids and vascular endothelial growth factor(VEGF)in the serum and in subretinal fluid.

METHODS: Forty-eight patients(52 eyes)with rhegmatogenous retinal detachment treated in our hospital were selected. According to the degree of retinal detachment, patients were divided into <1/2 quadrant group, 1/2-3/4 quadrant group and >3/4 quadrant group. Fifty-five healthy objects for physical examination in our hospital were selected as the control group,to compare the differences of amino acids and VEGF levels in the serum. Correlation analysis on VEGF levels and amino acids in the serum and in subretinal fluid among patients with different grades of rhegmatogenous retinal detachment was conducted.

RESULTS: In patients with rhegmatogenous retinal detachment, the tryptophan in serum was 28.59±4.46mg/L, phenylalanine 8.95±2.55mg/L, methionine 8.15±2.17mg/L, valine 28.62±5.29mg/L, histidine 18.96±1.85mg/L and VEGF 589.92±185.34μg/L, which were higher than those in the control group, and the difference was statistically significant(P<0.05). The levels of phenylalanine was 9.85±1.21mg/L, histidine 20.63±2.07mg/L and VEGF 718.69±283.34μg/L in the subretinal fluid of >3/4 quadrant group, which were significantly higher than those in the <1/2 quadrant group and 1/2-3/4 quadrant group(P<0.05). VEGF in the subretinal fluid of VEGF in the rhegmatogenous retinal detachment group were positively correlated with phenylalanine(r=0.542, P<0.001), and histidine(r=0.782, P<0.001).

CONCLUSION: The levels of amino acids and VEGF in the subretinal fluid of patients with rhegmatogenous retinal detachment was higher than those in normals and increased with the severity of retinal detachment.

Abstract:AIM: To evaluate the efficacy of photocoagulation alone or combined with intravitreal Bevacizumab for radiation retinopathy(RR).

METHODS: There were 43 patients(43 eyes)with RR were collected at the Fifth Affiliated Hospital Sun Yet-Sen University between Jan. 2009 and Jan. 2014. Twenty-one patients received the photocoagulation treatment combined with intravitreal bevacizumab and 22 patients received the treatment of photocoagulation alone. All the patients would complete ophthalmologic examinations, including best-corrected visual acuity(BCVA), intraocular pressure, optical coherence tomography, fundus fluorescein angiography before and after the treatment.

RESULTS: BCVA: In monotherapy group, there were no statistically difference about BCVA before and after treatment(P>0.05). In combined therapy group, the BCVA had been increasing gradually in 2wk, 1, 3, 6mo after treatment(P<0.05). There was no significant difference about BCVA before and 1a after treatment(P>0.05). In the comparison of BCVA in these two groups in 2wk, 1, 3, 6mo after treatment, the combined therapy group were better than monotherapy group in each time point(P<0.05), but no statistically significant difference was observed in these two groups at 1a after treatment(P>0.05). Central macular thickness(CMT): in monotherapy group, the CMT had been decreasing gradually in 2wk, 1, 3, 6mo after treatment(P<0.05). There was no significant difference about CMT before and after 1a treatment(P>0.05). In combined therapy group, the CMT had been decreasing gradually in 2wk, 1, 3, 6mo after treatment(P<0.05). There was no significant difference about CMT before and 1a after treatment(P>0.05). In the comparison of CMT between these two groups in the 2wk, 1, 3, 6mo after treatment, those of combined therapy group were thinner and difference were statistically significant(P<0.05), but no statistically significant difference was observed in two groups at 1a after treatment(P>0.05).

CONCLUSION: Photocoagulation combined with intravitreal bevacizumab for the treatment of radiation retinopathy both have an effect on reducing the macular edema in a short time(6mo). But the long-term efficacy is poor.

Abstract:AIM: To observe the values and changing rules of angle Kappa in corneal refractive surgery under light and dark conditions.

METHODS:Two hundred and thirty-four eyes of 118 patients for corneal refractive surgery were enrolled for this study. Pupil diameters and angle Kappa values under light and dark conditions were measured by Keratron Scout corneal topography.

RESULTS: There were significant differences in pupil diameters between light and dark conditions(P<0.01). More angle Kappa of both eyes distributed in the superior nasal quadrant under light conditions, and more angle Kappa distributed in the superior temporal quadrant under dark conditions. The differences of horizontal and vertical offsets of angle Kappa under two conditions were statistically significant(P<0.01).

CONCLUSION: The changes of pupil diameters in light and dark conditions could affect angle Kappa and then affect the accuracy of corneal refractive surgery centered on angle Kappa.

Abstract:DJ-1 has been reported to act as aredox-activated chaperone and sensor of oxidative stress participated in a variety of activities in cellular, playing an important role in resisting oxidative stress, regulating signaling pathways and gene transcription, and maintaining mitochondria dynamic balance. DJ-1 is closely related to the occurrence and development of various diseases. Recently, the effect of DJ-1 in eye diseases has drawn more attention, and researchers have found its significant role of resistance to oxidative stress in the pathogenesis of Fuchs endothelial corneal dystrophy(FECD)and age-related macular degeneration(AMD).This review will state the mechanism of DJ-1 against oxidative stress and its role in the development of eye diseases.

Abstract:Advances in genome-wide analysis have revealed that up to 90% of the human genome is transcribed. However, only approximately 1% of RNA transcripts encode proteins, and the remaining transcripts are noncoding RNAs. Noncoding RNAs can be roughly divided into small noncoding RNAs(<200nt)and long noncoding RNAs(LncRNAs, >200nt). Small noncoding RNAs include microRNAs, transfer RNAs and small nucleolar RNAs, whereas the long noncoding RNAs comprise ribosomal RNA, natural antisense transcripts, etc. Although the biosynthesis and biological activities of microRNAs are well studied through bioinformatics and active biological molecules analysis, the understanding of LncRNAs on these aspects is still limited. LncRNAs play multiple roles in regulating gene transcription and translation, and epigenetics. Aberrant LncRNAs expression can occur in various pathological processes and significantly related to the pathogenesis or poor prognosis of ophthalmological diseases. In this review, we will focus on the characteristics and regulatory functions of LncRNAs that are commonly associated with ophthalmological diseases.

Abstract:Dry eye is a common eye disease around the world, which has highly incidence. Although there are many treatment measures for dry eye, the clinical effect is not satisfactory. There is a close relationship between inflammation and dry eye, so the researchers pay more attention on anti-inflammatory therapy, such as fluorometholone. To explore the effect of anti-inflammatory medicine on dry eye, put forward the problems and shortcomings as well, lay the foundation for further study, and provide a strong theoretical basis for the clinical use of anti-inflammatory drugs in the treatment of dry eye, the author summarizes the clinical and experimental research progress of fluorometholone on dry eye in China and abroad.

Abstract:Retinoblastoma is a common eye malignant tumor which has high degree of malignancy.The traditional treatment methods are destructive, and the prognosis is poor. Hypoxia-inducible factor-1α highly express in retinoblastoma and regulate the development and progression of retinoblastoma(by influencing the proliferation and differentiation of tumor cells and involving in the generation of vascular mimicry). This article reviewed the role of hypoxia inducible factor-1α in the development of retinoblastoma which will initiate a new avenue for the treatment of retinoblastoma.

Abstract:Diabetic retinopathy is one of those significant complications of diabetes. With the increasing number of diabetic patients, blind caused by diabetic retinopathy is a serious threat to human health which cannot be neglected, but there is no highly effective treatment for it. Consequently, early detection and preventive treatment for it are important. Currently, studies have found that urine microalbumin had a close relation with diabetic retinopathy and that urine microalbumin might play an important role in early predicting of diabetic retinopathy. The review is about the diagnostic significance of urine microalbumin test for early diabetic retinopathy.

Abstract:Since the introduction of 25-gauge/23-gauge(25G/23G)sutureless micro-incision vitrectomy surgery(MIVS)at the beginning of the 21 century, we have stepped into an era of micro-incision vitreoretinal surgery more than10a. The current 25/23G MIVS provide numerous advantages over the conventional 20G vitrectomy surgery including simplified surgical procedure, shortened operating time, decreased complications as well as smaller sclerotomy wound. As a result, vitreoretinal surgeons have been shifting gradually from 20-gauge to 25/23-gauge vitrectomy in the past decade. As the 25/23G MIVS adapted worldwide, however, its drawbacks were also increasingly reported. Most criticism regarding to current 25/23G MIVS are focusing on would sealing related complications. Based on stablished notion regarding vitrectomy -“the smaller the better”, researchers and doctors were keeping on exploring the next generation of vitrectomy system. Thanks to the innovation and development in new generation vitrectomy machines, high lumen output light source, more delicate manufacturing technology and clear wild angle fundus view system, Dr. Oshima from Japan launched the first 27-gauge vitrectomy surgery system. It provided us novel surgical experience with smaller sclerotomy wound and faster cut rate. Further development and refinement of vitrectomy with 27-gauge or more are still on its way and will continue in the future. Undoubtedly, MIVS would be heated debated regarding its pro/con, complications, indications and future development. Combined with our own experiences, here we briefly reviewed the 27-gauge vitrectomy surgery.

Abstract:Color vision has been an important part of the human visual function. It is determined by the phytochrome of cone. In many clinical cases of ocular fundus diseases, patients had color vision loss, which shows that color visions tests is necessary and meaningful. At present, doctors have not paid attention to it and adopt the tests rarely. The article summarizes the tests of color in common use and applications on the diagnosis and treatment for common ocular fundus diseases to be a theory basis.

Abstract:The small incision lenticule extraction(SMILE)with femtosecond laser is a new mode of corneal refractive surgeryrecently. The safety, efficacy, stability and predictability of SMILE lead the corneal refractive surgery to a new world that only use femtosecond laser to correct myopia. With the development and popularity of SMILE, the clinical effect has aroused much concern. But there remain exited disputes in refractive stability, visual quality and corneal biomechanical property, contrast sensitivity and glare symptoms, corneal sensitivity and dye eye, corneal endothelial cells and intraocular pressure. These will be summarized in this review.

Abstract:AIM: To observe the effect of acute angle closure glaucoma with cataract patients treated with glaucoma trabeculectomy combined two incision phacoemulsification and intraocular lens(IOL)implantation(two incision triple surgery).

METHODS: Patients admitted in our hospital during Jan. 2013 to Jan. 2016.The acute angle closure glaucoma with cataract patients in 40 cases(58 eyes)were randomly divided into two groups: the observation group of 20 cases(29 eyes)with two incision triple surgery treatment, and the control group of 20 cases(29 eyes)with single incision triple after treatment. Visual acuity, intraocular pressure, bleb, corneal endothelial cell density, the area at 1mo before and after surgery, and postoperative complications of two groups were analyzed.

RESULTS: Postoperative visual acuity of two groups were significantly improved, but there was no significant difference between groups(P>0.05); postoperative intraocular pressure, bleb formation rate of the observation group were 14.41±1.38mmHg, 90%, and the control group 14.40±1.40mmHg, 86% without statistical significance(P>0.05), corneal endothelial cell density and area of observation group after 1mo were 1696.6±300.8/mm², 540.8±71.6μm², and control group 1410.6±288.5/mm² and 594.3±72.8μm² with significant differences(P<0.05). The incidence rate of compli-cation was 17% in the observation group, and 21% in control group(P>0.05).

CONCLUSION: For patients with acute angle closure glaucoma and cataract given two incision triple surgery and single incision triple surgery treatment can get good outcomes, but the effect of double incision on corneal endothelial cell injury is less.

Abstract:AIM: To evaluate the pupil light reflex in patients with primary open angle glaucoma, and to investigate the relation between pupil and visual field defect.

METHODS: From July 2014 to October 2015, 115 eyes in 86 patients with primary open angle glaucoma and 23 eyes in 16 healthy individuals were continuously enrolled in this study. All the subjects received comprehensive eye examination, visual field examination(Humphrey, SITA Standard 24-2)and dynamic pupil measurement(MonCV3 Metrovision). According to the visual field and the Glaucoma Staging System, the patients with glaucoma were divided into 5 subgroups: stage 1, stage 2, stage 3, stage 4 and stage 5. The parameters of pupillary light reflex were as follows: pupil diameter(minimum, maximum), latency and duration of contraction, latency and duration of dilatation, contraction amplitude, contraction and dilatation speed, and percent of pupil contraction(PPC). SPSS 19.0 statistical software was used to analyze the measurement results.

RESULTS: The control group significantly differed from the stage 4 subgroup(P=0.032)and stage 5 subgroup(P=0.014)in terms of minimum pupil diameter; there was significant difference in the pupil contraction speed between groups(F=648.675, P<0.01), and the contraction speed in stage 5 subgroup was significantly lower than those in the other subgroups and control group(P<0.05); the control group significantly differed from the stage 3, stage 4, and stage 5 subgroup in terms of PPC(P<0.05). Pupil contraction speed, PPC and minimum diameter showed correlation with the stages of glaucoma.

CONCLUSION: Pupil contraction ability in patients with primary open angle glaucoma was impaired, and the degree of impairment is related with the degree of visual field defect.

Abstract:AIM: To evaluate efficacy of Ranibizumab and Conbercept for wet age-related macular degeneration(wAMD).

METHODS: This was a retrospective case series study. Thirty patients(30 eyes)with wAMD were enrolled to receive intravitreal injections of ranibizumab(0.5mg)on 3 consecutive monthly schedule and 28 patients(30 eyes)with wAMD were enrolled to receive intravitreal injections of conbercept(0.5mg)on 3 consecutive monthly schedule. Best corrected visual acuity(BCVA), optic coherence tomography(OCT)measurement were compared at 1mo after injections.

RESULTS: One month after every injection, the BCVA increased while the central macular thickness(CMT)decreased compared with those before treatment in group A and B(P<0.05). BCVA and CMT changes between two groups were no statistically different(P>0.05).

CONCLUSION:Ranibizumab and conbercept therapy can control the prognosis of wAMD and improve the vision effectively. There is no statistical difference on the curative effect between two drugs for 3mo.

Abstract:AIM:To compare the loss of peripapillary retinal nerve fiber layer(RNFL)thickness measurements by spectral-domain optical coherence tomography(SD-OCT)in healthy individuals and glaucoma patients with or without progression.

METHODS:A total of 60 eyes, comprising 36 glaucomatous eyes with primary open angle glaucoma(POAG)and 24 healthy controls, were included in the study over a 2-year period. All eyes underwent at least 4 serial RNFL measurements performed by Cirrus OCT every half a year over a period of 2a. Visual field(VF)testing was performed by using the Swedish interactive threshold algorithm(SITA)Standard 30-2 program of the Humphrey field analyzer within the same week as the optic disc/RNFL photography. By masked comparative analysis of VF test results and optic disc/RNFL photographs, the eyes were classified into non-progressive and progressive glaucoma cases. Longitudinal loss of RNFL thickness was compared.

RESULTS: The mean follow-up time was 2.1±0.3a. Seventeen from 36 subjects were identified as progressors. Mean rates of change in average RNFL thickness were significantly higher for progressors compared with nonprogressors(2.46μm/a vs.1.21μm/a; P<0.001). Inferior quadrant RNFL thickness were significantly correlated with MD reduction in glaucoma eyes with progression(r=0.423, P=0.03).

CONCLUSION:Longitudinal measurements of RNFL thickness using SD-OCT show a pronounced reduction in patients with progression compared with patients without progression. Inferior RNFL thickness parameters might be more important in discriminating eyes with progressive glaucomatous optic nerve damage.

Abstract:AIM: To evaluate the incidence and clinical properties of dry eye after phacoemulsification in age-related cataract patients.

METHODS: Samples were collected from 145 age-related cataract patients(145 eyes). Dry eye was analyzed at 0, 7, 30, 90 and 180d after phacoemulsification by 1)Ocular Surface Disease Index questionnaire(OSDI), 2)tear meniscus height(TMH), 3)corneal fluorescein staining, 4)tear film break-up time(BUT), 5)Schirmer Ⅰ test(SⅠt).

RESULTS: The symptoms and signs of dry eye, such as narrowing of TMH, shorting of BUT, decreasing of SⅠt, cornea staining by fluorescein, occurred as early as 7d post-phacoemulsification and were measured by OSDI questionnaire and 4 additional clinical tests. Over the six-month observation the severity of dry eye peaked at 30d and then gradually relieved.

CONCLUSION: The severity of dry eye after phacoemulsification peaked at 30d and gradually improved over time. Considering the characteristics of ocular surface for aged people ophthalmologists should pay more concern on evaluating the occurring of dry eye after phacoemulsification so as to improve the life quality of these people.

Abstract:AIM: To analyze the ocular manifestations of meningiomas in the trigone of the lateral ventricle, discuss the relevant factors of visual impairment in these patients and things need attention clinically.

METHODS: Retrospectively study on the clinical data of 90 eyes in 45 patients diagnosed of trigonal meningiomas treated at Beijing Tian Tan Hospital from October 2011 to October 2015. Preoperative examinations including visual acuity, optic disc findings, visual field, size of tumors and other change in MRI were analyzed.

RESULTS: Patients' age was 12-68 years old(mean 41.7±13.7 years). Male/female ratio was 1:4.6. Decreased visual acuity occurred in 18 eyes. Optic disc edema was found in 24 eyes and optic disc pale in 6 eyes. Fourty-seven eyes had visual field defect, mostly homonymous hemianopia or defect. The maximum diameter of tumors was 2.1-9.6cm(4.8±1.7cm). Range of tumor volume was 3.02-193.2cm³(48.3±47.8cm³). A positive correlation of preoperative visual field defect was found with tumor volume, tumor maximum diameter, and brain midline shift respectively. While the preoperative visual field defect was not found any correlation with age, gender, course, and the enlargement of the ventricle and the edema of the tissue around the tumors. After Mann-Whitney U test, the differences on tumor volume, the maximum diameter of tumors, and brain midline shift between the two groups were significant.

CONCLUSION: Patients with trigonal meningiomas often have ocular signs and symptoms. The major reason of visual field defect is the damage of optic radiation around the tumor. The specific position of injured optic radiation determines the type and extent of visual field defect. Both ophthalmologist and neurosurgeon should pay attention to tumors nearby posterior visual pathway. Doing neurophthalmology examinations for these patients and realizing the position between the tumor and posterior visual pathway will be helpful and necessary in surgical planning.

Abstract:AIM: To investigate changes of anterior chamber parameters after posterior chamber phakic implantable collamer lens(ICL)surgery and its correlation with intraocular pressure(IOP).

METHODS: This was a retrospective case series study. Seventy four eyes in 43 myopia patients were examined by Allegro Oculyzer anterior segment tomography to obtain the changes of anterior chamber volume(ACV), anterior chamber angle(ACA), central anterior chamber depth(ACD)and vault, meanwhile, to measure the IOP to analyze the correlation with anterior chamber parameters.

RESULTS: Compared with preoperative, ACV, ACA, ACD all decreased apparently(P<0.01)in the postoperative period of 1, 3, and 6mo. ACV, ACA and ACD showed their stability in each period after the surgery. There were changes of vault in 1 and 6mo(t=27.66, P=0.01). IOP had not altered when compared with the preoperative. This research revealed that IOP had no relation with ACV, ACA, ACD and vault in every phase(all P>0.05).

CONCLUSION: For patients underwent ICL, the anterior chamber parameters all decreased which included ACV, ACA, ACD, and had stabilized since early postoperative period. Correspondingly,IOP was stable and had not correlate with ACV, ACA, ACD and vault, however the long-term observation is still necessary.

Abstract:AIM: To compare the changes in epithelial thickness profile following TransPRK and Epi-LASIK for myopia.

METHODS: In this prospective non-randomized controlled study, 76 right eyes of 76 myopic patients with the spherical equivalent refraction -1.25 to -6.00D were included under the informed consent. The eyes were divided into TransPRK group for 43 eyes and Epi-LASIK group for 33 eyes. Epithelial thickness was measured using spectral-domain optical coherence tomography at different corneal zones(central, 2mm; paracentral, 2-5mm; and mid-peripheral, 5-6mm)preoperatively and at 1, 3, and 6mo postoperatively. The results were compared between the two groups.

RESULTS: The epithelium were thicker at 3 and 6mo after surgery compared to preoperative measurements in the two groups(all P<0.05). In TransPRK group, the epithelial thickness at 3 and 6mo demonstrated a negative meniscus-like lenticular pattern with lesser thickening centrally and progressively great thickening centrifugally(F_3mo=-2.687,P=0.027; F_6mo=-2.908,P=0.000). No statistically significant change was detected among the three zones in Epi-LASIK group(F=1.365, P=0.237). The epithelial thickness was thicker in the TransPRK group compared to the Epi-LASIK group mid-peripherally(P<0.05).

CONCLUSION: Significant epithelial thickening was observed after TransPRK and Epi-LASIK. It was showed a lenticular change with more thickening mid-peripherally after TransPRK than Epi-LASIK. Wound healing and inflammation may account for differences in the effect on epithelial thickness change by both surgeries.

Abstract:AIM: To compare postoperative anti-inflammation effect and safety between bromfenac sodium eye drops and pranoprofen eye drops in patients after laser epithelial keratomileusis(LASEK).

METHODS: In the prospective, randomized and controlled study, 100 patients(200 eyes)undergoing LASEK were randomized into the bromfenac sodium group(100 eyes)and control group(100 eyes). Patients in bromfenac sodium group received bromfenac sodium hydrate ophthalmic solution eye drops twice a day in 3d before surgery and 2wk after surgery, while the patients from the control group were given proanoprofen eye drops 4 times a day in the same period. At 1, 3, 5d, 1 and 3mo after surgery, irritative symptoms grade, duration of irritation, time for corneal epithelial healing, cornel haze, uncorrected visual acuity and intraocular pressure(IOP)were observed and compared between the two groups. Quantitative data were analyzed using independent samples t-test and ranked data were statistically analyzed using the Mann-Whiteney rank sun test.

RESULTS: There was no significant difference between two groups in irritative symptoms grade(P=0.317), neither was existed between two groups in uncorrected visual acuity after surgery(P>0.05). There was no statistical significance in the time for corneal epithelial healing between two groups(P=0.551).

CONCLUSION: Bromfenac sodium eye drops(1g/L)can achieve the same therapeutic effect as pranoprofen eye drops after LASEK.

Abstract:AIM: To investigate the clinical effect of orthokeratology for 400 juvenile with myopia astigmatism and its effects on corneal endothelial cells.

METHODS: Four hundred patients(800 eyes), of whom the average age was 11.5±2.3 years old, 239 male, 161 female, were divided into two groups: orthokeratology group and spectacles group. Parameters including efficacy data(uncorrected visual acuity, corneal curvature, axial length and diopter)and corneal endothelial cell data(count of endothelial cell, endothelial cell density, fluorescein staining and central corneal thickness)were observed at 1d, 1, 6, 12 and 24mo after wearing.

RESULTS: The visual acuity of spectacles group recovered to normal after wearing, that of orthokeratology group recovered to normal at 1mo after wearing. At 2a after wearing, the corneal curvature, diopter of orthokeratology group decreased significantly(40.09±0.31D, 0.23±0.06D respectively); while those of spectacles group increased, the differences between the two groups were significant(P<0.05). The axial length of the two groups increased slightly at 1mo after wearing(P>0.05)compared to those before wearing. At 2a after wearing, the axial length of the two groups were 23.96±0.38mm, 26.49±0.88mm respectively(P<0.05). At 2a after wearing, central corneal thickness was 527.33±27.69mm, 526.98±26.89μm(P>0.05). The count of endothelial cell and endothelial cell density both decreased after wearing without significant differences(P>0.05).

CONCLUSION: Orthokeratology has less effect on the corneal endothelial cells, no obvious adverse reactions and can control the prognosis of myopia.

Abstract:AIM: To discuss clinical efficacy and safety of 10g/L atropine with short covering for children with amblyopia.

METHODS: Eighty-eight children(88 eyes)with amblyopia, staying in hospital from February 2011 to February 2014 for treatment, were divided into control group(n=44)and observation group(n=44). The control group only given short covering therapy was observed. Observation group was given 10g/L atropine treatment besides covering. Clinical efficacy, treatment compliance, visual acuity, corrected spherical degree of amblyopia eye and adverse events were observed and compared.

RESULTS: 1)After treatment, total effective rate of the observation group was 95%(42/44), significantly higher than that of control group(80%, 35/44, P<0.05); 2)excellent compliance rate of the observation group was 95%(42/44), significantly higher than that of control group(82%, 36/44, P<0.05); 3)visual acuity of the two groups when the disease was first diagnosed was not significantly different(P>0.05), but increased number of lines of vision and corrected spherical degree of amblyopia eye in the observation group were significantly higher(P<0.05); 4)in the observation group total rate of adverse events was 9%(4/44), significantly lower than that in the control group(23%, 10/44, P<0.05).

CONCLUSION: The combined therapy, 1% atropine with short covering, is effective and safe for amblyopia in children.

Abstract:AIM:To study the Influence and outcomes of eye healthcare information teaching for the visual development of children under “combination of medicine and education” in kindergartens.

METHODS:The children(5-6 years old)were randomly selected from 6 kindergartens in Nanjing,3 in Yuhua District as the experimental group,and the other 3 in Jianye District as the control group.A one-year follow-up was conducted to evaluate the difference of visual development, including the rate of low vision, rate of referral caused by refractive abnormality, rate of astigmatism, the average of the equivalent spherical lens and the rate of lacking physiological hypermetropia, between the experimental group and the control group children.

RESULTS: One school year later,the rate of low vision, rate of referral caused by refractive abnormality and the rate of astigmatism, were significantly lower(P<0.05)in the experimental group under the mode of “combination of medicine and education”, which were also lower than those before experiment(P<0.05). The average of the equivalent spherical lens of experimental group increased and the rate of lacking physiological hypermetropia decreased significantly, compared with the control group(P<0.05)and with those before experiment(P<0.05).

CONCLUSION:Using “combination of medicine and education” eye health care model,is good for children's visual development,so as to reduce the rate of low vision and delay the occurrence of myopia.

Abstract:AIM: To assess the current situation of trachoma in Shaanxi Province and analyze its epidemiology and clinical features.

METHODS: The World Health Organization(WHO)simplified trachoma grading system was used for the recognition and registration of cases of trachoma. Trachoma rapid assessment(TRA)was conducted and 30.3687 million people from Shaanxi province were screened. Eyelids, eyelashes, conjunctiva and cornea were examined. The prevalence of trachoma trichiasis(TT)in Shaanxi Province was estimated.

RESULTS: Totally 987 cases with TT were collected in Shaanxi province, in which 395 cases were male and 592 cases were female. The overall TT prevalence was 0.0325‰.The age of TT cases ranged from 25-86 years old, and concentrated in the 60-80 years old, only 58 cases were <50 years old. There were 12 cases of TT combined corneal opacity(CO)and the ratio was 1.2%. Sixty-four patients were cured by electrolysis trichiasis, the remaining 923 patients corrected by surgery interventions.

CONCLUSION: Based on the results of this study, trachoma blind is no longer estimated as a public health problem in Shaanxi province, as the detection rate of TT was less than 1‰ which is the goal of “elimination of trachoma” worldwide.

Abstract:AIM:To investigate the effective treatment methods of corneal injury caused by chestnut thorns and the factors affecting the disease progression.

METHODS: From Jul. 2014 to Oct. 2015, the clinical data of 15 patients(15 eyes)with corneal injury caused by chestnut thorns in Ophthalmology Inpatient Department of Wuhan Tongji Hospital was retrospective analyzed. The patients without fungal keratitis were treated with the surgery of removing chestnut thorn from cornea and antifungal drugs. For the patients complicated with fungal keratitis, besides surgery of removing chestnut thorn and antifungal drugs, anterior chamber irrigation and corneal stroma injection with fluconazole solution were given to treat the disease. If necessary, amniotic membrane transplantation or keratoplasty was also given to the patients complicated with fungal keratitis. After that, the effectiveness of those methods and the factors affecting progression were analyzed.

RESULTS:For 11 patients without fungal keratitis, the average time between corneal injury and receiving treatment at Tongji Hospital was 1-7(2.42±2.15)d and for 4 patients complicated with fungal keratitis, the average time was 3-30(18.25±4.35)d. Among 15 cases, statistics suggested that the average number of chestnut thorn in patients complicated with fungal keratitis was 4.5, and all the chestnut thorn penetrated the cornea into the anterior chamber. The average number of chestnut thorn in patients without fungal keratitis was 3.5, and the proportion of chestnut thorn penetrated the cornea into the anterior chamber was 28.5%. After treatment, all patients had no new fungal keratitis or other complications. Those results indicated that the different treatments for the patients with or without fungal keratitis were all effective.

CONCLUSION:The factors affecting the progression of cornea foreign body injury caused by chestnut thorn are the number of chestnut thorn, whether chestnut thorn penetrate the cornea into the anterior chamber, time since injury, active anti-fungal therapy. If patients complicated with fungal keratitis could be treated with antifungal agents and anterior chamber irrigation or corneal stroma injection using fluconazole solution without delay, the progress of fungal keratitis could be effectively controlled, and favorable conditions for further therapy such as amniotic membrane transplantation or keratoplasty could be provided.

Abstract:AIM: To observe the effects of different antidiabetic therapies on macular thickness in diabetes patients without fundus complication.

METHODS: The macular thickness was measured by optical coherence tomography(OCT). The retina volume on the center of macula was scanned, and it generated automatically the average thickness data of three rings and nine areas of 1mm, 3mm and 6mm. The data were statistically analyzed.

RESULTS: Healthy control group, oral hypoglycemic drug group and insulin treatment group were enrolled. Each group included 22 cases 22 eyes. The macular retinal thickness of healthy control group is 268.09±17.97μm(the 1^st ring), 340.41±22.25μm(the 2^nd ring)and 298.14±12.90μm(the 3^rd ring), respectively. The macular thickness of oral hypoglycemic drug group is 260.00±18.17μm(the 1^st ring), 335.44±21.12μm(the 2^nd ring)and 295.63±15.92μm(the 3^rd ring), respectively. The macular thickness of insulin therapy group is 271.01±26.09μm(the 1^st ring), 340.86±17.10μm(the 2^nd ring)and 298.57±12.14μm(the 3^rd ring), respectively. Comparison of the macular thickness of the 1^st ring among 3 groups was insignificant(F=1.21, P=0.31), neither the comparison of the 2^nd ring(F=0.35, P=0.71), neither the comparison of the 3^rd ring(F=0.22, P=0.81).

CONCLUSION: Compared with healthy individuals, both oral antidiabetic medicines and insulin therapy don't alter the macular thickness of patients with diabetes while without fundus complication.

Abstract:AIM: To compare the coherence and difference on the fundus examination made with two kinds of optical coherence tomography(OCT): Angio-OCT and fourier domain-optical coherence tomography(FD-OCT).

METHODS: Using Angio-OCT and FD-OCT to measure the retinal nerve fiber layer(RNFL)thickness, optic parameters, and ganglion cell complexes(GCC)thickness from 20 subjects respectively. The coherence was tested with Pearson's correlation coefficient, the difference was tested with paired Student t testing.

RESULTS: The total correlation of the RNFL thickness, optic parameters, GCC thickness made with two kinds of OCT was between 0.7-0.8; the RNFL thickness, optic disk area etc. made with the Angio-OCT were lower than those made with FD-OCT except for the GCC thickness.

CONCLUSION: The results made with two kinds of OCT from the same subject has certain coherence, but cannot be compared directly.

Abstract:AIM:To analyze the clinical features of Terrien marginal degeneration(TMD).

METHODS:Fifty-six patients(90 eyes)admitted in our hospital from January 2013 to January 2015 were selected as observation group. At the same period, 56 healthy(88 eyes)for corneal examination were as control group to analyze the clinical features of TMD. With immunohistochemistry and enzyme linked immunoassay method(ELISA), the levels of HLA-DR, HLA-DQ and tumor necrosis factor-α(TNF-α)in blood samples of TMD patients were tested.

RESULTS:The transparent degree of the eye, lipid deposition in TMD patients with early, advanced, swelling and hole-wearing period were significantly different(χ²=10.85, χ²=65.32, P<0.05). Astigmatism in TMD patients with early and advanced, swelling and hole-wearing period were significantly different(P<0.05). The levels of HLA-DR, HLA-DQ and TNF-α in blood samples between the two groups were significantly different(t=45.326, t=23.564, t=19.86, P<0.05).

CONCLUSION: Terrien's marginal degenerative is an inflammatory disease characterized by increased levels of TNF-α, HLA-DQ, and HLA-DR in peripheral blood, decreased corneal transparency, astigmatism and lipid deposition. This research provides experiment evidence for the mechanism of TMD.

Abstract:AIM: To observe the efficacy of 25G vitrectomy for traumatic cataract.

METHODS: Retrospective analysis of 70 cases(70 eyes)of traumatic cataract treated by 25G vitrectomy with lensectomy from February 2013 to February 2015 in our hospital was made for the study. In the patients, there were 43 males(43 eyes), 27 females(27 eyes), aged from 22-51 years old with an average of 35.23±2.54 years, mean visual acuity was 0.10±0.03. They were all followed up for 6-12mo postoperatively. Anterior segment, fundus, complications, best corrected visual acuity(BCVA)and intraocular pressure were observed during the follow-up. BCVA preoperatively, 1wk postoperatively, 1mo postoperatively, 6mo postoperatively were compared.

RESULTS: All the patients underwent the surgery successfully, and visual acuity improved at different degrees. The differences of BCVA preoperatively compared with 1 and 6m postoperatively were all statistically significant(P<0.05). Postoperative complications: 5 cases with corneal edema, 10 cases with ocular hypertension, 4 cases with ocular hypotension, 5 cases with retinal spotting. The symptoms improved after symptomatic and supportive treatment.

CONCLUSION: 25G vitrectomy with lensectomy is effective on treating traumatic cataract, with decreased operation risk, complications and improved visual acuity.

Abstract:AIM: To investigate the risk factors and prognosis of posterior capsular rupture in phacoemulsification cataract surgery through analyzing the cataract patients in our hospital.

METHODS: Totally 1 825 patients(1 912 eyes)treated in our hospital were selected from November 2012 to November 2015. The patients with posterior capsular rupture were as observation group. Control group was randomly selected with a 1: 4 ratio in patients without posterior capsular rupture. All the patient's age, gender, type of cataract, ocular disease history, other medical history, surgical history, preoperative intraocular pressure, the eyes affected, the health situation, visual acuity at 1d before and after surgery and other factors were recorded and analyzed for risk factors and prognosis.

RESULTS: Statistical results showed gender, type of cataract, preoperative intraocular pressure, history of tobacco and alcohol, eyes affected and other factors did not impact on the rupture rate(P>0.05); and type of nucleus, preoperative visual acuity, some eye diseases were the risk factors for posterior capsule rupture(P<0.05). Postoperative visual acuity of the two groups was all improved, but visual acuity of patients with posterior capsule rupture significantly decreased.

CONCLUSION: With eye disease history(a history of vitreous hemorrhage, retinal detachment before surgery and preoperative visual acuity <20/200)are more likely to result in intraoperative posterior capsular rupture. Nuclear hardness over grade Ⅳ is also an important risk factor. Before one surgery, it is needed to learn more about the medical history of cataract patients, to conduct a reasonable comprehensive assessment for risk factors, to decrease the risk in the surgery, which are to increase the success rate and to improve the prognosis.

Abstract:AIM: To analyze the effects of femtosecond laser assisted cataract surgery(FLACS)in the treatment of cataract and its effect on prognosis.

METHODS: Forty-two cases(42 eyes)of patients with cataract who were treated in the Department of Ophthalmology in our hospital between January 2012 and December 2014 were selected as the study objects. According to the order of treatment, they were divided into control group and observation group, 21 cases in each. The control group was treated with traditional phacoemulsification cataract surgery(PCS). On the basis, the observation group was treated with femtosecond laser. The effective phacoemulsification time(EPT), cumulative dissipated energy(CDE), fluid flow and monitored pressure of the two groups were recorded. The rate of corneal endothelial loss and the situation of Tyndall phenomenon were statistically analyzed. The two groups were followed up for 1a. The long-term visual acuity recovery was observed. The best corrected visual acuity(BCVA)was recorded, and the long-term complications were statistically analyzed.

RESULTS: 1)The total response rate in observation group was 95% while in control group was 90%(P>0.05); 2)the surgery time of the observation group was longer than that of the control group(P<0.05)but EPT was shorter than that of the control group. CDM and liquid flow were less than those of the control group(P<0.05); 3)at 1d after surgery, there was no significant difference in intraocular pressure between the two groups(P>0.05); the rates of Tyndall phenomenon and corneal endothelial loss in the observation group were lower than those in the control group(P<0.05); 4)BCVA of the two groups at different time after surgery were significantly higher than that before surgery(P<0.05). However, at 1d, 3mo, 6mo and 1a after surgery, BCVA of the observation group was better than that of the control group(P<0.05); 5)the incidence of complications in the observation group after surgery(14%)was lower than that in the control group(43%)(P<0.05).

CONCLUSION: The surgical effects of FLACS in the treatment of cataract are good. After surgery, the visual acuity of patients is improved significantly and the incidence of postoperative complications is low. However, the surgery time is long and cost is high, so it is difficult to popularize.

Abstract:AIM:To observe the clinical efficacy of intravitreal Lucentis injection combined with panretinal photocoagulation(PPR)and compound trabeculectomy for neovascular glaucoma(NVG).

METHODS:A total of 14 cases(14 eyes)with NVG were collected from January to November 2015. All cases were treated with intravitreal lucentis injection, PPR and compound trabeculectomy by turns. Intraocular pressure(IOP), visual acuity and the complications at pre-or post-surgery were recorded, respectively.

RESULTS: Followed up for 3-6mo, the average IOP preoperatively was significantly decreased than that detected at post-operation(18.00±6.70 vs 41.65±4.07mmHg, t=11.288, P<0.05). IOP less than 21mmHg with or without the usage of anti-intraocular pressure drugs was defined as the sign of successful or effective surgery, respectively. At the ultimate follow-up, 11 cases were successful, 2 cases were effective, and the success rate was 79%, effective rate was 14%. Only 1 case was applied cyclocryotherapy due to the uncontrolled IOP. Moreover, the results of visual acuity detection demonstrated that 6 eyes got a better visual acuity, 7 eyes remained the same condition and 1 case got no light perception. Meanwhile, 13 cases showed none iris neovascularization during the follow-up; 1 case got a reappearance of iris neovascularization on the third month, which was then dissolved subjected to the intravitreal lucentis injection in combination with PPR. One case developed post-operative hyphema and absorbed after 1wk. No shallow anterior chamber and eyeball atrophy happened.

CONCLUSION:Intravitreal lucentis injection combined with PPR and compound trabeculectomy is an effective and safe therapeutic strategy for the treatment of NVG.

Abstract:AIM: To observe the clinical curative effect of the intravitreal injection of anti-VEGF antibody combined with the implantation of Ex-press glaucoma drainage device for neovascular glaucoma(NG).

METHODS:A retrospective analysis of 20 patients with NG, who got the intravitreal injection of anti-VEGF antibody combined with the implantation of Ex-press. The visual acuity, intraocular pressure(IOP), iris neovascularization fade and intraoperative and postoperative complications were observed at 1wk, 1, 3 and 6mo postoperatively.

RESULTS:The average IOPs of 20 patients were 47±5.6mmHg, 13.4±3.6mmHg, 15.3±4.2mmHg, 16.9±5.3mmHg and 18.7±6.9mmHg preoperatively and postoperatively 1wk, 1mo, 3mo and 6mo with statistical difference(P<0.05). The intraoperative and postoperative complications of the implantation of Ex-press mainly included early shallow anterior chamber, drainage tube obstruction, filtering bleb scarring. There were 8 eyes with filtering bleb scarring with normal IOP.

CONCLUSION: The intravitreal injection of anti-VEGF antibody combined with implantation of Ex-press is effective for NG, which can significantly reduce the IOP.

Abstract:AIM: To study the association of the single nucleotide polymorphism(SNP)rs1157699 in the calcitonin receptor-like receptor(CRLR)gene with primary angle closure(PAC)in a Han Chinese population.

METHODS: All samples, involved 232 PAC cases and 306 controls, were obtained from an epidemiologic survey conducted in Funing, Jiangsu Province, China. Genotyping were carried out by TaqMan-MGB probe using the real time quantitative polymerase chain reaction system to study the relationship between SNP of rs1157699 in CRLR gene and PAC.

RESULTS: The prevalence of CRLRrs1157699 genotype was 67.4%, 30.0%, 2.6% for CC, CT, TT in cases, and 71.3%, 27.0%, 1.7% in controls respectively. There was no difference between the two groups in the distribution of genotype and allele frequencies of rs1157699(P>0.05).

CONCLUSION: Our results do not support a significant role for rs1157699 in CRLR with PAC.

Abstract:AIM: To investigate the therapeutic effect of Lucentis in the treatment of anterior segment neovascularization(ASNV)induced by central retinal vein occlusion(CRVO).

METHODS: This was a retrospective case series study for patients with ASNV secondary to CRVO from January 2013 to December 2014 and treated with intravitreal injection of lucentis. Best visual acuity(BCVA), intraocular pressure(IOP), iris examination and gonioscopy, and if necessary, fluorescein angiography and optical coherence tomography, were recorded. The follow-up time was 6-13mo, the average was 9.1±2.9mo.

RESULTS: Eighteen patients(18 eyes)were treated with intravitreal injection of lucentis; 15 patients(15 eyes)of the 18 were treated with panretinal photocoagulation; the other 3 patients 3 eyes were not received the photocoagulation because of vitreous opacity. One patient was treated with glaucoma valve implantation. Six patients with only neovascularization and without glaucoma were improved in visual acuity whose intraocular pressure was controlled after combined treatment. Of the patients with neovascular glaucoma(n=12), after intravitreal injection of lucentis and panretinal photocoagulation, the IOP was controlled in 4 patients(4 eyes); the IOP of another 7 cases reduced but glaucoma drugs were still needed. One patient(1 eye)received glaucoma valve implantation because of bad control on IOP with worse vision after implantation.The rubeosis disappeared in all patients.

CONCLUSION:Intravitreal injection of lucentis can stop neovascularization and help to control IOP. In the early stage without neovascular glaucoma, lucentis has better effects, which means early detection and intervention are important.

Abstract:AIM:To investigate the causes and characteristics of retinal detachment after vitrectomy.

METHODS: Retrospective analysis of patients in our hospital in recent 4a who underwent primary, standard, three-port pars plana vitrectomy(PPV). Retinal detachment occurred in 24 eyes(23 cases), 24-67 years old, average 49.0±12.0 years old. There were male in 17 cases, female in 6 cases, 6 right eyes, 18 left eyes.

RESULTS: Eighteen(75%)eyes without any symptoms were found during a routine check, 6 eyes(25%)with decreased visual acuity or in front of shadow. It took 1-223d from PPV to retinal detachment, average 40.7±54.2d, of which retinal detachment occurred in 10(42%)eyes within 1wk, 14(58%)eyes within 1mo. The direct cause of retinal detachment was new retinal break(a total of 27 holes)in 19 eyes, proliferative vitreoretinopathy(PVR)in 4 eyes, 1 eyes with primary hole not closed. All retinal detachment were ultimately completely reset.

CONCLUSION: The occurrence of new retinal breaks is the main cause of retinal detachment after vitrectomy, attention should be paid to the early postoperative peripheral retinal examination; after a timely surgery, the retina can be reset.

Abstract:AIM: To evaluate the efficiency of two different operation ways, vitrectomy and vitrectomy combined with inferior scleral buckling, for a complex kind of retinal detachment.

METHODS:The complex kind of retinal detachment were diagnosed in 100 cases(100 eyes), with the common features: 1)the course of more than 1mo; 2)at least one retinal hole located in the inferior marginal retina; 3)the detachment of retina was found proliferated, there was at least 1 retinal fold in retinal detachment area. The patients were randomly divided into two groups: the treatment group(50 eyes)who received vitrectomy combined with inferior scleral buckling; the control group(50 eyes)who received vitrectomy without scleral buckling. The retinal anatomic reattachment, visual function recovery, macular central fovea thickness and complications in two groups were observed.

RESULTS: There were 49 eyes(98%)with retinal anatomic reattachment in the treatment group while 42 eyes(84%)in control group(χ²=4.2605, P<0.05); the best corrected visual acuity(BCVA)was 0.254±0.238 in the treatment group while it was 0.219±0.229 in control group(t=1.8879,P>0.05); the macular central fovea thickness was 272±32.21μm in the treat group while it was 316±33.46μm(t=12.597,P<0.01). Intraocular pressure in 12 eyes(24%)was more than 30mmHg in the treatment group while 4 eyes(8%)in control group within 1wk postoperation(χ²=4.7619,P<0.05); intraocular pressure in 100 eyes were controlled below 21mmHg 1mo postoperatively.

CONCLUSION: It is a more effective method to vitrectomy combined with inferior scleral buckling than the single vitrectomy for the special kind of retinal detachment. It can increase the rate of retinal anatomic reattachment and reduce macular edema.

Abstract:AIM: To evaluate the effects on recovering of corneal wound and postoperative discomfort of different methods for primary pterygium.

METHODS: Forty-seven cases(60 eyes)of primary pterygium were excised under microscope with limbal epithelial transplantation, with sharp dissection(24 cases, 30 eyes, Group A)and blunt dissection(23 cases, 30 eyes, Group B). All cases were followed up for 1d to 1mo.

RESULTS: The recovering of corneal wound was better in Group B on 1st day and 3rd day after surgery. Pain, photophobia and tears, foreign body sensation were more serious in group A on 1st day after surgery with a statistically significant difference(P=0.005,0.015,0.012). Pain, photophobia and tears, foreign body sensation were more serious in Group A on 3rd day after surgery with a statistically significant difference(P=0.019,0.018,0.015). There was no statistically significant difference on 1wk and 1mo after surgery(P>0.05).

CONCLUSION: Compared with sharp dissection, primary pterygium excised with blunt dissection can significantly improve recovering of corneal wound and postoperative discomfort.

Abstract:AIM:To evaluate the effect of combined glaucoma and cataract surgery on the function of eye surface and tear film.

METHODS:This clinical trial involved 75 patients(75 eyes)with glaucoma complicated with cataract undergoing combined glaucoma and cataract surgery. All the eyes were divided into surgical group(the eyes undergoing operation)and control group(the other eyes).The symptoms and signs of dry eye disease, Schirmer's I test, break-up time(BUT), corneal fluorescein staining were tested and marked 1mo after operation. Comparison of the results was made between two groups.

RESULTS: The average intraocular pressure was 16.25±0.46mmHg at 1mo after operation, compared with 45.29±4.39mmHg at 3d before surgery, the difference was statistically significant(P<0.05). Preoperative average visual acuity was 0.08±0.06, corrected visual acuity was <0.05 in 23 eyes, ≥0.05 to <0.1 in 16 eyes, ≥0.1 to <0.3 in 36 eyes. Postoperatively 1mo, corrected visual acuity: <0.05 for 7 eyes(9%), ≥0.05 to <0.1 for 11 eyes(15%), ≥0.1 to <0.3 for 38 eyes(51%), ≥0.3 to <0.5 for 11 eyes(15%), ≥0.5 for 8 eyes(11%), postoperative visual acuity was 0.15±0.1, which was significantly higher than before surgeries(P<0.05). The postoperative dry eye symptoms of surgical group was higher, compared with that of control group, and the differences of diagnosis of dry eye test indicators between the two groups were statistically significant(P<0.05).

CONCLUSION: Combined cataract and glaucoma surgery may affect postoperative ocular surface and tear film function, make the tear film stability damaged and lead to dry eye disease.

Abstract:AIM: To assess the efficacy and adverse reactions of two concentrations of diluted botulism toxin A(BTX-A)for blepharospasm.

METHODS: Totally 220 patients(440 eyes)confirmedas blepharospasm in our department(from January 2013 to January 2015), were divided randomly into two groups: 110 in high concentration group and 110 in low concentration group. The two groups were given local injections with 25 U/mL or 40 U/mL concentration of botulism toxin type A to the upper and lower eyelids orbicular muscle, corrugator, reducing eyebrow muscle and procerus respectively. We observed dosage of two groups, the treatment effect, the duration of the effect and the incidence of adverse reactions.

RESULTS: The high concentration group was given the BTX-A with 48.33±4.02U,the low concentration group was given the BTX-A with 28.51±3.42U,the differences were statistically significant(P<0.05). The differences of post-operative evaluation of curative effect, onset time and duration of the effect between the groups were not statistically significant(P >0.05). Sixteen cases had ptosis in different levels in the high concentration group, and 2 in the low concentration group, the differences were statistically significant(P<0.01). There were no serious complications such as intoxication, drug allergy in both groups. Ptosis relieved after using naphcon-A and disappeared in 2-3 wk.

CONCLUSION: The efficacy of local injection with two concentrations of diluted botulinum toxin A for blepharospasm was positive. Considering the high incidence of ptosis in high concentration group, we recommended the 25U/mL botulism toxin A for blepharospasm.

Abstract:AIM: To comparatively analyze the efficacy and clinical value of cutting frontal muscular slap or not during frontalis aponeurosis flap suspension in treating congenital severe ptosis.

METHODS: Clinical data of 44 children(54 eyes)with congenital severe ptosis treated in our hospital from May 2013 to October 2015 was retrospectively analyzed. Children included were divided into two groups according to the different ways of operation, observation group(cutting frontal muscular slap)and control group(without cutting frontal muscular slap), 22 cases(27 eyes)in each group. The general information, postoperative follow-up, eyelid closure and complication occurrence in two groups were compared.

RESULTS: The general information of the two groups had no statistical difference(P>0.05). After 1, 6mo, the cosmetic correction rate, the rate of overcorrection, and the rate of under correction in two groups had no statistical difference(P>0.05), but the activity of upper eyelid in observation group was bigger than that in control group(P<0.05). After 1, 6mo, the incomplete closure in two groups had no statistical difference(P>0.05), but eyelid fissure height in natural closed eyelids in control group was higher than that in observe group(P<0.05). After 1mo, 2 eyes in control group were with abnormal feelings in frontal part, and 3 eyes in observation group. After 6mo, 2 eyes in control group were with abnormal feelings in frontal part, and 3 eyes in observation group. There were no complications such as exposure keratitis, eyelid margin deformity, infection, hematoma, and diplopia in two groups.

CONCLUSION: The total therapeutic effects of two different surgery procedures in treating severe congenital ptosis are quite similar. The surgery with cutting frontal muscular slap could improve the activity of upper eyelid and postoperative eyelid closure.

Abstract:AIM: To compare the corrected vision and improvement of visual quality after wearing rigid gas permeable corneal lens(RGPCL)or spectacles in aphakic patients.

METHODS: We selected 29 aphakic patients(29 eyes)caused by different reasons wearing RGPCL and spectacle. The corrected vision, eye condition and visual quality were observed and all patients were followed up for 6mo.

RESULTS: RGPCL was better than spectacle on corrected vision(P<0.05). The patients who wore RGPCL for long had no corneal complications reported. The patients who wore RGPCL had better subjective visual quality than those wore spectacle.

CONCLUSION: RGPCL is a good choice for correcting high myopia and astigmatism for aphakic patients. The patients' compliance is good. Wearing RGPL long has high safety for patients' ocular surface.

Abstract:AIM: To analyze the clinical effects of partial rectus muscle transportation procedure for paralytic strabismus due to single rectus muscle paralysis.

METHODS: The conditions of 22 patients(25 eyes)who underwent partial rectus muscle transportation procedure for paralytic strabismus due to single rectus muscle paralysis were retrospectively reviewed. The following data were analyzed: 1)the angle of deviation of primary position; 2)the presence of diploma in the primary position; 3)the presence of compensatory head posture; 4)the motility of the affected eye. All of the patients attended 6mo postoperative follow-up examinations.

RESULTS: According to the results of examinations before and during operation, different operations were performed: 2 eyes were treated with partial rectus muscle transportation, 20 eyes were treated with recession of antagonistic muscle of paralytic rectus muscle combined with partial rectus muscle transportation, 3 eyes were treated with recession of antagonistic muscle, partial rectus muscle transportation and recession of yoke muscle. Twenty patients were orthotropia in the primary position, the diploma and abnormal head posture were eliminated. Two patients with binocular lateral rectus muscles paralysis were in mild undercorrection which were resolved by wearing 8^△ and 10^△ prisms respectively. The procedure improved strabismus of 25 eyes from 100.23^△±42.61^△ preoperatively to 0.82^△±2.67^△ postoperatively(t=10.797,P<0.001). Ocular movement was improved from -4.52±0.51 preoperatively to -2.68±0.63 postoperatively(t=-19.468, P<0.001).

CONCLUSION: Partial rectus muscle transportation procedure for paralytic strabismus due to single rectus muscle paralysis can effectively correct the primary position in paralytic strabismus, eliminate the presence of diploma in primary position and abnormal head posture, and improve the ocular motility, which provides content clinical effects.