Abstract:Retinal vein occlusion(RVO)is divided into branch retinal vein occlusion and central retinal vein occlusion. It is characterized by retinal vein dilatation and tortuosity, blood flow stasis, bleeding and edema. It is often accompanied by macular edema(ME)and neovascularization. Neovascular glaucoma is the most serious complications. RVO is the second most common cause of visual loss classified under retinal vascular disorders after diabetic retinopathy. So far, the number of patients suffering from retinal vein occlusion has increased, but the pathogenesis of retinal vein occlusion has not been fully understood and there are no treatments that are very long-lasting. The research of animal models on the pathogenesis and treatment of the RVO is very important. Therefore, this article gives a briefly review to the animals and model making methods used in retinal vein occlusion experiments, and discusses the advantages and disadvantages of various RVO animal models.

Abstract:AIM: To evaluate the influence of pars plana vitrectomy(PPV)on ocular surface using Keratograph 5M.

METHODS: Totally 30 consecutive patients(30 eyes)undergoing primary 23G PPV were recruited in the study. Ocular Surface Disease Index(OSDI)questionnaire was performed. Ocular surface parameters, including tear meniscus height(TMH), noninvasive tear break up time(NITBUT)and bulbar redness score were obtained preoperatively, in 2, 4, 8 and 12wk postoperatively by Keratograph 5M. Correlations between all the clinical parameters were analyzed further.

RESULTS: The percentages of both photophobia and gritty within 4wk after PPV were significantly higher than preoperation, while they decreased to the preoperative levels in both 8wk and 12wk postoperatively. The percentage of sore eyes in the first week postoperatively was significantly higher than preoperation, but there were no significant differences between the percentages of preoperation and 2, 4, 8 and 12wk postoperatively. OSDI score increased significantly within 4wk postoperatively, but it returned to the preoperative level in 8 and 12wk. TMH increased with 2wk postoperatively, but there were no significant differences compared with preoperation. Both NITBUT-first and NITBUT-average shortened significantly within 8wk postoperatively, but they gradually improved to the preoperative levels in 12wk. Bulbar redness score was significantly higher than the preoperative level within 4wk postoperatively, but it returned to the preoperative level in 8wk. NITBUT-first and NITBUT-average had a significant positive correlation at each visit. TMH had a significant positive correlation with NITBUT-average in the first week postoperatively.

CONCLUSION: Keratograph 5M can provide a reliable noninvasive method to assess the influence of PPV on the ocular surface. PPV may cause various changes in both symptoms and signs of ocular surface damages at the early stage, while all these changes will return to preoperative levels gradually in 12wk postoperatively.

Abstract:AIM: To explore the influence of various related factors on ocular surface dysfunction in patients with type 2 diabetes mellitus.

METHODS: A total of 60 patients(60 eyes)with type 2 diabetes diagnosed in our hospital were chosen as diabetes group, 60 patients(60 eyes)without diabetes were chosen as control group. The subjects were tested including ocular surface disease index(OSDI), tear secretion(SⅠt)and the tear film break-up time(TBUT), tear meniscus height(TMH), corneal fluorescein staining(CFS).

RESULTS: All 65.94% of participants emerged dry eye(77.45% diabetics and 54.43% controls). In the diabetic group,OSDI and CFS were significantly higher(P<0.01), and BUT,SⅠt and TMH were significantly lower(P<0.05). Related analysis showed that duration of diabetes, glycemia and Hb1Ac were the influencing factors of symptoms in diabetic patients(P<0.05).

CONCLUSION: Diabetes patients are inclined to dysfunction in tear secretion and tear film, the longer of diabetes,and the higher of the glycemia and Hb1Ac, the worse the tear film stability were.

Abstract:AIM: To study clinical profile of amblyopia and also the outcomes of occlusion therapy among the amblyopes.

METHODS: This was a hospital-based longitudinal study by design. Data were collected from April 2015 to April 2016 in Ophthalmology Department of Dhulikhel Hospital. Presenting visual acuity, chief complaint at presentation, age at presentation, refractive status, binocularity and fixation patterns were assessed in all the children with amblyopia. Improvement in visual acuity was also noted in all the subjects after occlusion therapy, which is a most commonly used modality of treatment for amblyopia.

RESULTS: Among 1 092 children examined during the study period, 60(5.49%)were amblyopic. Among them, 35(58.30%)were females and 25(41.70%)were males. The mean age at presentation was 8.87±3.29 years. Meridional amblyopia was the most prevalent subtype seen in 43.3%(n=26)of children followed by anisohypermetropic amblyopia(20%, n=12). The most common refractive error was astigmatism accounting for 58.30% of the total cases followed by hypermetropia(22.50%)and myopia(7.50%). Compliance with spectacle wear combined with occlusion therapy and active vision therapy was 73.30%(n=44). There was a statistically significant improvement in visual acuity of the amblyopic eyes after the different treatment strategies after 3mo(P=0.002).

CONCLUSION: Prevalence of amblyopia and associated visual impairment is still a public health issue in developing countries like Nepal. Lack of awareness and lack of community or preschool vision screening for children lead to late presentation and significant visual impairment associated with the condition. The burden can easily be reduced with screening camps, timely referrals and proper interventions.

Abstract:AIM:To investigate the neuroprotective effect of vitreous cavity transplantation of bone marrow mesenchymal stem cells on rat glaucoma model.

METHODS: Rat primary bone marrow mesenchymal stem cells were extracted and identified; Lewis rats were randomly divided into 3 groups: Control group, Glaucoma group and bone marrow mesenchymal stem cell group(BMMSCs group), and rat glaucoma model were made: the left eye was the experimental eye(glaucoma), the right eye is the control eye, and identified them. Then vitreous cavity transplantation of bone marrow mesenchymal stem cells were performed; HE staining was used to observe the morphology of the retina; The number of retinal ganglion cells was detected by immunofluorescence; TUNEL staining was used to observe the apoptosis of retinal ganglion cells; The expression of IGF1 and BDNF protein in retinal tissue was detected by Western blot.

RESULTS: The intraocular pressure of the experimental eyes of the rats was significantly higher than that of the control eyes(P<0.01), indicating that the glaucoma rat models were successfully constructed; In the Glaucoma group, the retinal nerve fibers were irregularly arranged, the number of retinal ganglion cells and retinal thickness were significantly lower than that of the control group(P<0.01), and the number of apoptosis of retinal ganglion cells was significantly higher than that of the control group(P<0.001); The retinal nerve fiber cells in the BMMSCs group were arranged neatly. The number of retinal ganglion cells and retinal thickness were significantly higher than those in the Glaucoma group(P<0.05), and the number apoptosis of retinal ganglion cells was significantly lower than that of Glaucoma group(P<0.01); The expression of IGF1 and BDNF in the retina of the Glaucoma group was significantly lower than that in the control group(P<0.01), the expression of IGF1 and BDNF in the retina of the BMMSCs group was higher than that in the Glaucoma group(P<0.05).

CONCLUSION:Bone marrow mesenchymal stem cell vitreous cavity transplantation can improve glaucoma in rats and protect retinal ganglion cells.

Abstract:AIM:To investigate the effect of silencing glial fibrillary acidic protein gene(GFAP)on proliferation and apoptosis of high glucose-induced human retinal microvascular endothelial cells(hRMECs)and its mechanism.

METHODS: Expression of GFAP in hRMECs treated with high sugar(30mmol/mL)and low sugar(5mmol/mL)was detected by qRT-PCR. The high glucose-induced hRMECs cells of silencing GFAP gene was established by lentiviral-mediated method. High glucose-induced hRMECs cells were treated with SRI-011381(TGF-β signaling pathway activator)and dimethyl sulfoxide(DMSO); Expression of GFAP, transforming growth factor-1(TGF-β1), activating transcription factor2(Smad2), Smad3 proteins were measured by Western blot, and cell proliferation and apoptosis were detected by CCK-8 and flow cytometry, respectively.

RESULTS: Expression of GFAP was significantly increased in high glucose treated hRMECs. The high glucose induced hRMECs cell model of GFAP gene silencing was successfully constructed by lentivirus mediation, and the cell proliferation ability was significantly improved, the apoptosis rate is significantly inhibited, and expression of TGF-1, Smad2 and Smad3 proteins in the TGF-β signaling pathway was significantly inhibited after silencing GFAP, while activation of TGF-β signaling pathway could reverse the inhibitory effect of silencing GFAP on the proliferation and apoptosis in high glucose hRMECs.

CONCLUSION: Silencing GFAP gene can promote the proliferation of high glucoseinducedhuman retinal microvascular endothelial cells and inhibit cell apoptosis,the mechanism may be related to the inactivation of TGF-β signaling pathway.

Abstract:AIM: To build up prediction model of corneal edema after cataract surgery in patients with diabetic.

METHODS: During January 2017 to December 2019, 312 patients with diabetic cataract underwent elective phacoemulsification cataract extraction combined with intraocular lens(IOL)implantation were enrolled. The patients were divided into corneal edema group(n=62)and non-corneal edema group(n=250)according to corneal edema status within 1wk after surgery. The gender, age, smoking history, drinking history, diabetes history, hypertension history, glaucoma history, corneal dystrophy, chronic uveitis, lens core hardness Emery classification, preoperative anterior chamber depth, intraoperative ultrasound energy and effective ultrasound time, IOL material and implant location, number of corneal endothelium after surgery were compared between the two groups. Stepwise Logistic regression analysis was used to determine the risk factors and a risk scoring system was constructed base on the determined risk factors. The ROC curve was drawn to analyze the predictive value of the risk score model for postoperative corneal edema.

RESULTS: Of the 312 diabetic cataract patients included, 62 cases(19.9%)had postoperative corneal edema. According to stepwise Logistic regression analysis, age >60 years(OR=2.657, 95% CI: 1.135-6.220), duration of diabetes >10 years(OR=6.932, 95% CI: 1.911-25.145), hypertension history(OR=2.783, 95% CI: 1.037-14.510),glaucoma history(OR=3.679, 95% CI: 1.128-11.999), chronic uveitis(OR=2.601, 95% CI: 1.099-6.156), lens nucleus hardness grade IV to V(OR=8.658, 95% CI: 2.595-28.887), preoperative shallow anterior chamber(OR=3.431, 95% CI:1.679-7.011), postoperative corneal endothelial cell count(OR=3.026, 95% CI: 1.137-8.053)were the risk factor for postoperative corneal edema in patients with diabetic cataract. The risk scoring system was constructed according to the above risk factors: age >60 years old, history of hypertension, history of glaucoma, chronic uveitis, corneal endothelial cell number loss≥10%, shallow anterior chamber corresponding to 1 point, duration of diabetes >10 years and lens hardness Ⅳ-V corresponds to 2 points, with a total score of 0-10 points. The risk score model predicts that the area under the ROC curve of postoperative corneal edema in diabetic cataract patients was 0.848(95% CI: 0.772-0.934)at cut-off value of 8.94, and the sensitivity and specificity were 85.3% and 80.2%, respectively.

CONCLUSION: Age>60 years old, course of diabetes >10 years, history of hypertension, history of glaucoma, chronic uveitis, lens nucleus hardness Ⅳ-Ⅴ, preoperative shallow anterior chamber, postoperative corneal endothelial cell loss is the postoperative occurrence of diabetic cataract patients. The risk factors of corneal edema, the risk scoring model constructed based on the above risk factors has good predictive value for postoperative corneal edema.

Abstract:AIM: To evaluate the relationship between obstructive sleep apnea syndrome(OSAS)and branch retinal vein occlusion(BRVO).

METHODS:Seventy consecutive patients with BRVO and 70 age- and sex-matched controls were evaluated retrospectively. All participants underwent Berlin questionnaire and full-night respiratory polysomnography(PSG)for estimating risk of OSAS and monitoring apnea-hypopnea index(AHI), minimal oxygen saturation(MOS).

RESULTS: Of the 70 BRVO patients, 49(70%)had OSAS,average AHI was(19.74±7.59), MOS was(82.45±9.17)%. For controls, only 23(33%)of 70 subjects had OSAS, average AHI was(13.69±6.35), average MOS was(88.44±8.72)% in controls. Incidence of OSAS, AHI and MOS between BRVO patients and controls were different significantly(χ²=19.331, t=5.115, 3.954, all P<0.01). There was a positive correlation between OSAS and BRVO(r_s=0.319, P=0.033). Of the 39 patients with acute BRVO, average AHI was(16.905±6.31), average MOS was(85.14±8.22)%. For the 31 patients with chronic BRVO, average AHI was(17.84±5.47), average MOS was(83.81±7.87)%. There were no significantly differences between acute BRVO patients and chronic BRVO patients in average AHI or MOS(t=0.653, 0.685, P=0.516, 0.496).

CONCLUSION: OSAS could be a trigger in the pathogenesis of BRVO or an important risk factor of CRVO development.

Abstract:Corneal disease is a common disease that causes blindness, and keratoplasty is the main method for the treatment of corneal blindness. Visual function examination alone cannot fully evaluate the impact of surgery on patients, while the vision-related quality of life scale covers all aspects of visual indicators, which can more comprehensively reflect the feelings of patients. In recent years, it has gradually become a common method to evaluate the therapeutic effect of keratoplasty. This paper briefly reviews the research progress of NEI-VFQ-25 scale in corneal transplantation in recent years.

Abstract:Keratopathy is closely related to diabetes, and severe cases pose a threat to vision. At present, the treatment of diabetic keratopathy focuses on preventing infection and promoting the optical healing environment. A comprehensive understanding of disease progression from the cellular level is essential for identifying and developing potential therapeutic agents. This article reviews the phenomenon of diabetic corneal epithelium disorder and its subsequent maintenance of homeostasis, and discusses its rationality.

Abstract:Retinopathy of prematurity(ROP)is an immature proliferative retinal vascular disease that may lead to permanent blindness in preterm infant. Retinal laser photocoagulation is used for ablation of peripheral retina and treatment of ROP, however, it is destructive. Especially for the cases with lesions in Zone I region, retinal laser photocoagulation may cause severe complications. Recently, studies have demonstrated that vascular endothelial growth factor(VEGF)plays a causal role in the pathogenesis of ROP, and intravitreal injection of anti-VEGF agents can not only effectively impede ROP progression, but also gain timing for revascularization of a vascular retinal region. This article reviews the treatment indications, drug selection, injection site, dosage recommendation, follow-up of efficacy and complications of intravitreal injection of anti-VEGF agents in the treatment of ROP.

Abstract:Various eye diseases, especially retinal disease, can change the retinal microvascular. In addition, the disease such as cardiovascular disease that involves systemic vascular change also exist the change of retinal microcirculation. Therefore, the change of retinal microvascular system is important diseases index which not only an auxiliary diagnostic index for ocular diseases, but also an important index for the evaluation of systemic diseases. This paper briefly reviews the detection methods of retinal microcirculation examination and the clinical application of these methods.

Abstract:The blood-retinal barrier(BRB)plays an important role in maintaining the homeostasis of the retinal microenvironment. Many diseases can lead to the damage of BRB, such as diabetic retinopathy, acute glaucoma and retinopathy of prematurity. At present, the molecular mechanism of BRB injury has not been fully explained. This paper briefly reviews the structure and function of blood-retina barrier, the damage mechanism of blood-retina barrier caused by various ocular diseases, and the therapeutic countermeasures of drug therapy, laser therapy and surgical treatment.

Abstract:Idiopathic macular hole(IMH)refers to a full-thickness tissue defect of the retinal neuroepithelial layer in the macular region without obvious etiology. At present, with the gradual deepening of the understanding of IMH and the continuous innovation and improvement of its treatment methods, its treatment technology has also matured and diversified. Studies have shown that early IMH with small diameter can be observed and followed up. The Ocriplasmin has been approved for use in patients with small to medium sized macular holes and vitreomacular adhesion(VMA); internal limiting membrane(ILM)removal can improve anatomical closure rate. However, for IMH with a diameter of less than 250μm, it is uncertain whether ILM removal is always required. This paper discusses the pathogenesis, stages, classification and current treatment of IMH. Based on the characteristics of IMH and patient differences, an evidence-based medicine method is proposed to select the best and most practical treatment plan for individual patients.

Abstract:At present, gene detection technology has become increasingly mature and integrated with multi-disciplinary, which provides help for clinicians to diagnose, treat andprognosis of the disease. In recent years, gene detection technology in diabetic retinopathy(DR)has made some progress, mainly applied to the risk factors of diabetic retinopathy and follow-up personalized treatment plan. Therefore, we summarize and analyze the gene loci related to diabetic retinopathy that can be detected by gene detection technology.

Abstract:Pseudomonas aeruginosa keratitis can be described as one of the most common keratitis in clinical practice. It is characterized by an acute onset, fast development and hard to be treated entirely. Once failed to get prompt treatment, it would cause corneal ulcer, in an extreme case, blindness. In order to enhance the probability of treatment, it is meaningful to study the pathogenesis of pseudomonas aeruginosa keratitis further. The article reviews the pathogenicity of pseudomonas aeruginosa, and how the immunoreaction of host works in the pathogenesis of pseudomonas aeruginosa keratitis, thereby to provide theoretical basis of new methods for the treatment of pseudomonas aeruginosa keratitis.

Abstract:The incidence of dry eye is increasing worldwidely, and its pathogenesis is unclear yet. Studies have shown that oxidative stress is an important factor leading to many acute and chronic diseases and aging. The ocular surface contribute the first line of defense to the eye from oxidative stress, which is caused by the imbalance between the production of reactive oxygen species and anti-oxidative system. This review focuses on the evaluation of the influence of inflammation and oxidative stress emphasizing their relation with the pathogenesis of dry eye and anti-inflammation strategy.

Abstract:A systematic review of visual snow syndrome(VSS)was introduced in this article. Scientists don't know what caused visual snow syndrome for sure, but studies have shown that patients with VSS experience continuous television-static-like tiny flickering dots in the entire visual field and additional visual symptoms such as palinopsia, entoptic phenomena or photophobia or nyctalopia. Literature in recent years on the clinical and pathophysiological researches of VSS was reported, and in the latest literature, the VSS was more inclined to be seen as a visual processing disorder. It should be distinguished from the migraine and other diseases. In terms of treatment, current studies focused on experimental studies. Some case reports showed that anti-Seizure medications, antidepressants, or acetazolamide and colored filter-sheet may be effective in eliminating symptoms.

Abstract:Amblyopia is a common ophthalmic disease in the critical periodof children's visual development, and its pathogenesis is complicated. The traditional idea is that amblyopia does not cause obvious changes in the organic structure of the eyeball. However, with the deepening of research in recent years, researchers have found that amblyopia patients not only have different brain anatomy, but also have different eye structure from normal people, which provides a new way to explore the pathogenesis of amblyopia. This paper summarized the pathogenesis and ocular structural changes of amblyopia patients, and summarized the pathogenesis, choroidal thickness(CT), ocular vascular area and density, retinal nerve fiber layer thickness(RNFL), and ocular structural changes after occlusion therapy in amblyopia patients.

Abstract:AIM: To evaluate the effectiveness and safety of intravitreal injection of ranibizumab combined with Ahmed drainage valve implantation compared to pure Ahmed drainage valve implantation in the treatment of NVG.

METHODS: Computers were used to search PubMed, EMbase, Cochrane Library, American Scientific Citation Index Database(SCI), China Knowledge Network(CNKI), Chinese Science and Technology Journal Database(VIP), Wanfang Database, China Biomedical Document Service System(CBM), and to find literature about ranibizumab and Ahmed drainage valve implantation in the treatment of NVG. At the same time, relevant references were consulted. The search time limit was establishment until March 20, 2020. Quality evaluation and data extraction on the included studies were performed. RevMan 5.3 and STATA 12.0 software were used for Meta-analysis.

RESULTS: The included 7 clinical studies included 346 patients(349 eyes), and the quality was evaluated as medium to high quality. The homogeneity of the basic characteristics of various studies was better. Compared with the pure Ahmed drainage valve implantation group(the control group), the ranibizumab combined with Ahmed drainage valve implantation group(the experimental group)had lower intraocular pressure at 1wk and 1mo after surgery. There was no statistical difference at 6mo after surgery. The BCVA of the experimental group was better than that of the control group at 1mo and 3mo, and there was no significant difference at 6mo after surgery. There was no significant difference in the rate of anterior chamber bleeding and the number of anti-glaucoma drugs used between the two groups.

CONCLUSION: Compared with pure Ahmed drainage valve implantation, ranibizumab combined with Ahmed drainage valve implantation has better postoperative intraocular pressure and best corrected visual acuity in the early stage in the treatment of NVG, and the difference in the late postoperative period is not significant. It cannot reduce the rate of postoperative anterior chamber bleeding, and cannot reduce the use of anti-glaucoma drugs. This conclusion needs to be further confirmed by more high-quality clinical randomized controlled studies.

Abstract:AIM: To evaluate the practical teaching effect of the doctor-patient communication ability training combined with Simulation-based Medical Education(SBME)pedagogy in the standardized training for ophthalmology residents through Mini-Clinical Evaluation Exercise(Mini-CEX).

METHODS: From September 2015 to July 2017, sixteen residents from the Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University were selected as research subjects. Before and after the conventional teaching or SBME teaching with standardized patients(SP), real doctor-patient communications were completed respectively, which were evaluated through Mini-CEX.

RESULTS: As to the Mini-CEX assessment of the standard training residents for the pre-intervention doctor-patient communication about the three common diseases of age-related cataract, primary open-angle glaucoma, and acute bacterial conjunctivitis, there was no significant difference in the average score of the seven items between the trainees in the control group and the experimental group(P>0.05). After the demonstration teaching and comment revision, the control group directly performed the post-intervention doctor-patient communication and Mini-CEX evaluation, and the experimental group performed the further SBME teaching and then the post-intervention doctor-patient communication and Mini-CEX evaluation. The scores of the seven items in the two groups after the intervention were significantly higher than those before the intervention(P<0.05). The excellent rates of the trainees in the control group and the experimental group with an average score of 7 or more increased from 37.5%(3/8)and 37.5%(3/8)to 87.5%(7/8)and 100%(8/8), respectively. After the intervention, in addition to physical examination skills and clinical judgment, the scores of other five items such as medical interview skills, humanistic care and professionalism, psychological counseling skills, organizational effectiveness and overall clinical competence, were significantly higher in the experimental group than the ones in the control group(P<0.05).

CONCLUSION: SBME pedagogy with SP can improve the effectiveness of the doctor-patient communication training for ophthalmology residents. Mini-CEX can be used to evaluate the teaching efficiency easily, quickly and standardly. The combination of Mini-CEX and SBME can be widely used in the practice of the doctor-patient communication training for ophthalmology residents.

Abstract:AIM: To summarize the implementation effect of comprehensive prevention and treatment service model for diabetic ophthalmopathy in Pudong New Area, and provide practical reference for the establishment and improvement of the community-based comprehensive prevention and treatment service model of diabetic ophthalmopathy.

METHODS: From 2018-08 to 2019-08, diabetes patients with chronic disease management were selected for screening in the 45 community of Pudong New Area, stratified sampling by age and sex. The eye health data of long-distance screening were analyzed, and master the degree of satisfaction and participation willingness through the questionnaire survey.

RESULTS: The screening included 39 055 patients with DM, all of whom established eye health files for the first time. 15.870%(6 198/39 055)was made a definite diagnosis preliminarily of diabetic retinopathy, the prevalence of mild, moderate, severe NPDR and PDR were 3.974%, 9.904%, 1.746% and 0.246% respectively. The rate of needing referral was 44.325%(17 311/39 055); the rate of actual follow-up was 5.846%(1 012/17 311); the satisfaction of DR screening and willingness to participate were over 85%.

CONCLUSION: The service mode of comprehensive prevention and treatment for diabetic ophthalmopathy based on remote screening system was feasible for early detection, early diagnosis and early intervention of diabetic ophthalmopathy, but it needs further optimization and improvement in practice application.

Abstract:AIM: To analyze the changes in serum and aqueous humor of patients with diabetic cataracts in vitamin C, oxidative stress products, inflammatory factors and vascular endothelial growth factor(VEGF)levels.

METHODS: From January 2018 to December 2019, 40 patients with diabetic cataract(40 eyes)were selected as the observation group, and 40 patients with simple cataract(40 eyes)were selected as the control group. The differences in the levels of vitamin C, oxidative stress products(malondialdehyde), inflammatory factors(IL-6 and IL-8)and VEGF in blood and aqueous humor samples of the two groups of patients were analyzed.

RESULTS: There was no difference in serum vitamin C levels between the two groups(P>0.05), but the aqueous vitamin C levels in the observation group were significantly lower than those in the control group(20.6±13.6mg/L vs 27.2±9.9mg/L, P<0.05); There was no difference in the serum malondialdehyde level of patients(P>0.05), but the aqueous malondialdehyde level of the observation group was significantly higher than that of the control group(12.6±4.6nmol/mL vs 8.0±3.1nmol/mL, P<0.001); Serum and aqueous humor IL-6 and IL-8 levels were significantly higher than those of the control group(P<0.001); there was no difference in serum VEGF levels between the two groups(P>0.05), but the observation group's aqueous humor VEGF levels were significantly higher than the control group(45.6±20.6pg/mL vs 16.5±4.5pg/mL, P<0.001).

CONCLUSION: Compared with patients with simple cataract, patients with diabetic cataract have similar serum vitamin C, oxidative stress products and VEGF levels, but there are greater differences in the levels of vitamin C, oxidative stress products and VEGF in their aqueous humor. At the same time, patients with diabetic cataracts serum and aqueous humor inflammatory factor levels are higher than those of patients with simple cataract.

Abstract:AIM: To investigate the timing of using anti-VEGF drugs in severe non-proliferative diabetic retinopathy(SNPDR)patients with diabetic macular edema(DME)treated with intravitreal injection of Conbercept(IVC)combined with panretinal photocoagulation(PRP).

METHODS: Totally 85 SNPDR patients(85 eyes)with DME diagnosed in our hospital from May 2017 to October 2018 were randomly divided into control group(n=29 cases), IVC group(n=28 cases), PRP group(n=28 cases). The control group was treated with PRP only; the IVC group was given PRP 1wk after IVC; the PRP group was given IVC 1wk after PRP. The follow-up time was 12mo. Changes of the best corrected visual acuity(BCVA)and central macular thickness(CMT)were observed before and 1, 3, 6, 12mo after treatment, and the frequency of IVC were recorded.

RESULTS: Compared with before treatment, the BCVA of the three groups after treatment improved, and the CMT decreased(P<0.05). after treatment, the BCVA of the IVC group and the PRP group was better than the control group, and the CMT was lower than the control group(P<0.05). 3mo after treatment, BCVA(0.24±0.18, LogMAR)in the ICV group decreased more than that in the PRP group(0.38±0.29, LogMAR)(P<0.05). At 1 and 3mo after treatment, CMT in the ICV group(1mo 313.89±61.69um, 3mo 287.64±43.94μm)decreased more than that in the PRP group(1mo 347.50±56.55μm, 3mo 318.04±49.334μm), and the difference was significant difference(P<0.05). The frequency of IVC was(3.07±1.33)times in the IVC group and(3.93±1.60)times in the PRP group(P<0.05).

CONCLUSION: In SNPDR patients with DME, IVC combined with PRP is better than PRP alone. Anti-VEGF drugs before PRP can obtain better BCVA, reduce macular edema in the short-term observation. In long-term observation, it can also reduce the frequency of IVC, the risk of infection and the financial burden.

Abstract:AIM:To analyze the postoperative refractive error(RE)and its related factors of patients with age-related cataract(ARC)and idiopathic macular epiretinal membrane(IMEM)after phacoemulsification and intraocular lens(IOL)implantation combined with 23G vitrectomy(PPV).

METHODS: From February 2017 to September 2019,25 cases(25 eyes)of arc patients with IMEM who underwent phacoemulsification and IOL implantation combined with vitrectomy were selected as the observation group, and 25 cases(25 eyes)of simple arc patients treated with cataract phacoemulsification and IOL implantation were selected as the control group. The best corrected visual acuity(BCVA ), spherical equivalent(SEQ), corneal refractive power(CRP), anterior chamber depth(ACD), axial length(AL)and macular central foveal thickness(CFT)of the two groups before and after the operation were compared.

RESULTS:At 3mo after operation, BCVA(0.284±0.177, 0.016±0.085)in observation group and control group were significantly improved compared with those before operation(0.572±0.199, 0.568±0.191), ACD was significantly increased(all P<0.001), but CRP and AL had no significant changes in both groups(P>0.05), and there was no difference in ACD, CRP and AL between the two groups(P>0.05). At 3mo after operation, the actual SEQ value in the observation group(-0.426±0.146D)was significantly higher than that before operation(-0.122±0.037D)and that of the control group(-0.127±0.050D)(all P<0.001). The refractive error of the observation group was -0.304±0.142D; the CFT value of the observation group(331.1±67.2μm)was significantly lower than that before operation(444.8±72.1μm), but higher than that of the control group(224.7±16.6μm)The change of CFT in observation group was 113.7±32.2μm. Correlation analysis showed that the refractive error was positively correlated with the change of CFT at 3mo after operation in the observation group(r=0.447, P=0.025).

CONCLUSION: There was a positive correlation between myopic RE and CFT after Phacoemulsification and intraocular lens(IOL)implantation combined with 23G vitrectomy(PPV).

Abstract:AIM:To study the effect of EX-PRESS miniature glaucoma device implantation on corneal endothelial cell density and intraocular pressure for primary open angle glaucoma(POAG).

METHODS:This was a prospective clinical study of 38 eyes in 32 POAG patients who underwent EX-PRESS miniature glaucoma device implantation in our hospital from May 2016 to December 2017. The central, nasal, temporal,superior, inferior endothelium cell density, intraocular pressure(IOP), best corrected visual acuity(BCVA)were observed at 24mo after operation. Anterior chamber depth and the position of drainage nail with iris and cornea were also observed.

RESULTS: There was no significant difference of the corneal endothelium density in five sites and BCVA between preoperation and postoperation(P>0.05). There was significant difference in IOP between pre-operation and postoperation(P<0.05). The complete success rate was 66% and conditional success rate was 21%, the failure rate was 13%. The main cause of failure was filtering bleb scarring. There was no complete disappearance of anterior chamber during the operation and follow-up period. There were 1 eye of shallow anterior chamber, 5 eyes of EX-PRESS contact with iris surface. The position of drainage nail with iris and cornea endothelium was good in the other 32 eyes.

CONCLUSION: The EX-PRESS miniature glaucoma device implantation has no effect on corneal endothelial cells in five directions and can effectively control intraocular pressure. It is a safe and effective method for primary open-angle glaucoma.

Abstract:AIM: To determine the factors associated with primary angle-closure(PAC)progression to glaucoma(PACG)after laser peripheral iridotomy(LPI)at baseline.

METHODS: This was a prospective cohort study. Subjects were consecutively enrolled among the patients with PAC at the ophthalmology clinic of our Hospital between January 2017 and December 2017. Among these 86 eyes of 86 PAC patients who fulfilled the inclusion criteria, 65 eyes of 65 patients who fulfilled the inclusion criteria of 5 or more VFs and 2 years or more of follow-up were selected. The mean follow-up period was 2.65±0.27 years. According to the occurrence of visual field defects and corresponding glaucomatous optic nerve damage, the patients were divided into the progressive group and the non-progressive group, and the correlative factors of PAC progression after LPI were analyzed in PAC patients.

RESULTS: PAC progression after LPI was observed in 9 of 65 eyes(14%). There were significant differences in age and inter-visit IOP fluctuations between the progressive group(68.67±7.03 years, 10.11±4.17mmHg)and the non-progressive group(61.95±8.03 years, 5.54±2.73mmHg)(P<0.05). The frequency of PAC progressing into PACG with VCDR≥0.6, PAS≥1 quadrants, all angle-closure>2 quadrants was significantly higher in the progressing eyes than in the non- progressing eyes(P<0.05). PAC progression was significantly positively correlated with age, inter-visit IOP fluctuations, VCDR≥0.6, PAS≥1 quadrants, and all angle-closure >2 quadrants(r_s=0.304, 0.396, 0.495, 0.268, 0.309).

CONCLUSION:PAC patients after LPI with PAS≥1 quadrants and all angle-closure >2 quadrants, VCDR≥0.6, older age,higher inter-visit IOP fluctuations were more likely to progress to glaucoma.

Abstract:AIM: To observe the efficacy of Conbercept for different types of macular edema after cataract surgery with diabetes.

METHODS: Totally 52 cases(52 eyes)of macular edema(ME)patients after cataract surgery with diabetes were selected between Jan 2017 and Dec 2018. According to the morphologies of ME through optical coherence tomography(OCT), patients were divided into 3 groups, diffuse retinal thickening(DRT group)with 18 cases(18 eyes), cystoid macular edema(CME group)with 20 cases(20 eyes)and serous retinal detachment(SRD group)with 14 cases(14 eyes). All the patients received intravitreal injection of Conbercept by using 1+PRN method and followed up for 12mo after treatment. The best corrected visual acuity(BCVA)and central macular thickness(CMT)and injection times were recorded and compared.

RESULTS: Before treatment, the differences of BCVA and CMT among 3 groups were not statistically significant, while the course of ME in DRT group was shorter than CME group and SRD group(P<0.05). 1mo after treatment, the BCVA and CMT in 3 groups were improved significant, and beginning at 3mo, the BCVA and CMT in 3 groups were continue to improve and stabilize, they were improved significant compared with before treatment(P<0.05). 1mo, 3mo, 6mo and 12mo after treatment, the BCVA and CMT in DRT group and CME group is better than SRD group(P<0.05), while the BCVA and CMT among DRT group and CME group were not statistically significant(P>0.05). The injection times in 3 groups was 3.2±0.9, 2.9±0.8 and 4.1±1.1, the injection times in SRD group was the most frequent in 3 groups(P<0.05).

CONCLUSION: ME after cataract surgery with diabetes should be treated early. Conbercept could improve BCVA and CMT in different types of ME after cataract surgery with diabetes effectively.

Abstract:AIM:To evaluate the clinical effect of the auxiliary application of posterior scleral reinforcement(PSR)in the vitrectomy of macular hole retinal detachment with over-long axial length.

METHODS:A clinical randomized controlled trial was conducted. Patients of macular hole retinal detachment with over-long axial length ≥29mm were randomly divided into two groups. Group A accepted PSR + PPV + silicone oil injection, group B accepted PPV + silicone oil injection. After followed-up one year, the BCVA, the percentage of macular hole closure, cure rate of retinal detachment and reoperation rate were analyzed.

RESULTS:Totally 46 eyes were included in the study. The average BCVA of the two groups after treatment was improved. The BCVA of group A changed from 1.61±0.02 to 0.85±0.22(t=10.36, P<0.01), and that of group B increased from 1.59±0.04 to 1.08±0.16(t=7.92, P<0.01). The improvement of group A was greater than that of group B(t= -2.38, P=0.03). There was no significant change of the axial length before and after operation in both groups(P>0.05). In group A, the healing rate of macular hole was 91%(21/23), and the reoperation rate was 4%(1/23)before silicone oil removal. After silicone oil removal, no patients recurred to retinal detachment. During the follow-up period, silicone oil removal was completed in all eyes. In group B, the closure rate of macular hole was 65%(15/23), the rate of reoperation before silicone oil removal was 35%(8/23), the redetachment rate after silicone oil removal was 26%(6/23), and the rate of the silicone oil removal throughout the follow-up period was 74%(17/23).

CONCLUSION: PSR can effectively improve the successful rate of pathological myopic macular holes with retinal detachment and reduce the recurrence and reoperation.

Abstract:AIM: To discuss the surgical method of foldable capsular vitreous body(FCVB)implantation and evaluate its therapeutic effect.

METHODS: We retrospectively analysis of 73 cases with severe ocular rupture injury after FCVB implanted and silicone oil dependence after vitrectomy in our Hospital from April 2018 to March 2020. The visual acuity, corneal, anterior chamber depth, intraocular pressure, retina, FCVB status, their satisfaction with appearance is observed after treated from 1-20mo.

RESULTS: All the 73 patients in this group were successfully operated. The amount of silicone oil injected into the FCVB during the operation was 2.4-4.2mL, with an average of 3.5±0.36mL. There were 22 eyes with light perception, 46 eyes with manual perception and 5 cases with immediate index; 19 eyes during postoperative follow-up. Corneal clarity or basic clarity was observed in 19 eyes, corneal local opacity in 31 eyes, and corneal grayish white opacity in 23 eyes. There were 32 eyes with normal anterior chamber, 23 eyes with shallow anterior chamber, and 18 eyes with completely disappeared anterior chamber. The intraocular pressure(IOP)could not be tested in 22 eyes due to cornea, 17 eyes with IOP less than 8mmHg, and 34 eyes with IOP between 8 and 21mmHg. Slit-lamp microscope examination showed no obvious deviation of the position of FCVB. The postoperative appearances were satisfactory and basically satisfactory in 52 eyes(71%). No balloon rejection, sympathetic ophthalmitis or other obvious surgical complications were observed in all cases.

CONCLUSION: For the patients with severe eyeball rupture and silicone-oil-dependent eyes, the FCVB implantation can prevent from eyeball extraction. The operation is safe and effective, and the eyeball shape and intraocular pressure can be well maintained.

Abstract:AIM: To analyse the curative effect and influencing factors of Nd:YAG laser lacrimal duct angioplasty combined with lacrimal duct stent implantation on the treatment of lacrimal duct obstruction.

METHODS: Totally 150 eyes of 150 patients with lacrimal duct obstruction admitted to our hospital from June 2017 to June 2019 were selected and treated with Nd:YAG laser lacrimal duct plasty combined with lacrimal duct stent placement. Follow-up 6mo after extubation, the patients were divided into effective group(135 cases, 135 eyes)and ineffective group(15 cases, 15 eyes)according to the clinical efficacy. General information, complications, causes of lacrimal duct blockage, postoperative lacrimal duct flushing frequency and clinical data such as the condition of bony lacrimal duct, analysis of related factors affecting the therapeutic effect.

RESULTS: Follow-up 6mo after extubation, the effective rate and recurrence rate were 90.0%(135 eyes)and 1.3%(2 eyes)respectively. The course of the disease in the effective group was significantly shorter than that of the ineffective group, and the incidence of complications was significantly lower than in the ineffective group, the length of osseous lacrimal duct obstruction was significantly shorter than that of the ineffective group, the minimum diameter of the obstruction was significantly longer than that of the ineffective group, there was a significant difference in the frequency of tract flushing(all P<0.05). Logistic regression analysis showed that the course of disease(OR=4.600; 95%CI: 3.448-6.136), complications(OR=2.524; 95% CI: 1.481-4.302),the length of osseous lacrimal duct obstruction(OR=3.785; 95% CI: 1.844-7.770)and the minimum diameter of the obstruction(OR=2.330; 95% CI 1.464-3.708), as well as flushing frequency(OR=4.773; 95% CI: 2.227-10.231)were related factors affecting the therapeutic effect of Nd:YAG laser lacrimal duct plasty combined with lacrimal duct stent implantation.

CONCLUSION: Nd:YAG laser lacrimal duct angioplasty combined with lacrimal duct stent implantation is effective in the treatment of lacrimal duct obstruction, with the lower incidence of complications and recurrence rate. The course of disease, complications, postoperative lacrimal passage irrigation frequency and the condition of bone lacrimal passage are all influencing factors, among which the effective rate can be improved by properly increasing the number of lacrimal duct expansion irrigation.

Abstract:AIM: To detect the thickness of tear film lipid layer(LLT)in children with abnormal blink, to explore the relationship between abnormal blink and LLT, and to find out the diagnostic value of LLT in children with abnormal blink.

METHODS: Prospective comparative study. Selecting 46 cases of children with "frequent blink" as the first reason in our ophthalmic outpatient clinic in 2016-11/2017-02 as abnormal blink group. In the same period, 46 children with non-anomalous blink were selected as control group. The history collection, slit lamp examination, refractive examination, Schirmer I test(SⅠt), tear film break-up time(BUT), and the number of times of LLT and incomplete blink(PB)were measured and compared surface light interferometer were compared.

RESULTS: The LLT of the abnormal blink group was 72.17(22.13, 91.00)nm, which was lower than that of the control group 81.97(30.25,95.27)nm,(U=674.5, P=0.028); The mean equivalent spherical degrees(-0.98±3.09D)and SⅠt(11.39±2.46mm/5min)in the abnormal blink group were not different from those in the control group(-0.24±3.06D, 11.74±2.10mm/5min)(P>0.05). Mean PB(0.58±0.28)and mean BUT in the eyes of blink group There was a difference(18.27±5.51s)from the control group(0.43±0.17, 21.01±6.14s)(P<0.05).

CONCLUSION: Children's abnormal blinks are associated with many factors, and the LLT decline may be an important factor in children's abnormal blink.

Abstract:AIM: To study the effect of ocular surface and meibomian gland dysfunction of adolescents before and after wearing overnight orthokeratology, and to explore its effects on adolescent tear film.

METHODS: A prospective clinical study was conducted. 55 cases of 8 to 16-year-old adolescents who met the selection criteria from January 2017 to November 2017 were selected for orthokeratology. Before lens wear and after lens wear 1wk, 1mo, 3mo, 6mo, and 12mo were followed up for Ocular Surface Disease Index(OSDI)questionnaire, slit-lamp examination, and Keratograph 5M.

RESULTS: During the study period, no patients developed infectious keratitis. The OSDI scores were 7.38±1.71 points, 9.21±1.39 points, 10.19±1.02 points, 10.28±1.18 points, 10.29±1.85 points after wearing at 1wk, 1, 3, 6, and 12mo respectively, which were higher than those before wearing(4.80±1.63 points)were increased, and the difference was statistically significant at different times before and after wearing(P<0.05). 1wk, 1, 3, 6, 12mo NIBUT(f)values were 12.39±4.76s, 9.95±5.23s, 11.30±4.58s, 11.21±4.34s, 11.63±5.32s, and NIBUT(av)values were respectively 11.26±6.77s, 11.16±6.48s, 13.09±5.79s, 13.13±5.41s, 13.19±5.21s, NIBUT(f)1mo after wearing compared with before wearing, the difference was statistically significant(P<0.05), NIBUT(av)at 1wk and 1mo after wearing was compared with before wearing, the difference was statistically significant(all P<0.05), and the difference was both at 3, 6, 12mo after wearing and before wearing No statistical significance(all P>0.05).There was no significant change in TMH at 1wk, 1, 3, 6, 12mo after wearing, and the difference was not statistically significant(F=2.168, P>0.05). Corneal fluorescein staining scores were 3.51±1.67 points, 3.54±1.62 points, 4.05±1.52 points, 4.14±1.32 points, 4.50±1.43 points, respectively, 1wk after wearing, 1, 3, 6, and 12mo, which were higher than those before wearing(P<0.05). The meibomian gland lipid secretion score and the meibomian gland loss score did not change significantly at different times before and after wearing(P>0.05).

CONCLUSION: The tear film function in the early period of wearing the orthokeratology is reduced, but it gradually returns to the level before wearing the lens after 6mo, and tends to increase steadily. After wearing the orthokerato-scope, the symptoms of eye discomfort increase and corneal fluorescein stain increased after wearing, no effect on meibomian gland function.

Abstract:AIM: To observe the clinical effect of Toric intraocular lens(Toric IOL)implantation in the correction of corneal astigmatism, and vector analysis of residual astigmatism and corneal astigmatism.

METHODS: A retrospective case observation study. A total of 63 patients with 77 eyes who underwent phacoemulsification combined with Toric IOL implantation in our hospital from September 2018 to October 2019 were selected. LogMAR uncorrected distance visual acuity(UCDVA), best corrected distance visual acuity(BCDVA), residual astigmatism of subjective refraction were observed after operation in 1wk, 1mo, and 3mo. And after dilated pupil, the Toric IOL axis position was measured by OPD-scanⅢ, and compared with the target axis position(LAD).

RESULTS: The median(interquartile range)of UCDVA at 1wk, 1mo, and 3mo after operation were 0.22(0.15, 0.40), 0.30(0.15,0.40),and 0.30(0.15, 0.40), which were better than those of UCDVA \〖0.82(0.60, 1.22)\〗 and BCDVA \〖0.52(0.30, 0.70)\〗 before operation(P<0.008). The residual astigmatism was 0.75(0.50, 1.00), 0.75(0.38, 1.00), 0.50(0.25, 1.00)D, respectively, which was significantly lower than that of preoperative corneal astigmatism \〖2.19(1.73, 2.69)D\〗(P<0.008). At 3mo after surgery, the proportion of UCDVA(LogMAR)≤0.301 was 69%; the proportion of residual astigmatism ≤0.75D was 73%. The median LAD at 1wk, 1mo, and 3mo after surgery were 2.0°, 2.0°, and 3.0°; 81%, 82%, 77% were less than 5°. The maximum LAD value is 11°. Astigmatism vector analysis: preoperative corneal astigmatism was 2.31±0.80D, centroid value was 1.44D@177°±1.99D; Predicted postoperative residual astigmatism was 0.14±0.17D, centroid value was 0.02D@58°±0.22D; residual astigmatism at 3mo after operation was 0.69±0.53D, centroid value was 0.05D@142°±0.88D.

CONCLUSION: Toric IOL can effectively correct corneal astigmatism in patients with cataract and has good rotational stability. Astigmatism vector analysis can directly show the difference between predicting postoperative astigmatism and actual residual astigmatism, which is helpful to analyze and optimize the measurement of corneal astigmatism, calculation of IOL degree, surgical design, postoperative observation.

Abstract:AIM: To analyze the demands, consultation patterns and contributing factors of the patients involved in the ophthalmic on-line consultation during the COVID-19 epidemic to provide reference for the optimization of the ophthalmic online health care system.

METHODS: Prospective observational study. The patients using “expert online consultation” provided by the Zhongshan Ophthalmic Center from February 1 to March 15, 2020 were enrolled. The baseline characteristics were analyzed. For the patients with repeated consultation, we randomly selected the same amount of patients with single consultation as comparison. The baseline characteristics, consultation purposes, disease types, and number of combined eye diseases between the patients with single and repeated consultation were compared, and the contributing factors of patients'consultation pattern were analyzed with statistical test and regression model.

RESULTS: The “expert online consultation” provided 9 831 consultations during the study, 3 919 of which were single consultation while 5 912 of which came from the repeated consultations of 1 967 patients. 1 967 patients with single consultation were randomly selected and compared with the repeated inquirers. The main consultation purposes in the both groups were “return visit”(59.7%, 64.9%). There was no significant difference in age and gender distribution between the patients with single online visit and repeated online visits(P=0.897, 0.482). Compared with the patients with single visit, the patients with repeated visit were less with the purpose of “new-onset discomfort”, more with the purpose of “return visit” and “follow-up after surgery”, more with ocular surface, fundus and uveal diseases, and more with two or more combined eye diseases. Regression analysis showed that the patients with ocular refractive issues tended to have a single consultation, while the patients inquired on previous eye disease and surgery, with fundus or uveal disease tended to have repeated consultations. The number of repeated visits for the patients with diagnosed ophthalmopathy and ophthalmic surgery was higher than that for the patients with new-onset discomfort; the number of repeated visits was lower for the patients with lens and anterior segment diseases, and was higher for the patients with ocular surface diseases.

CONCLUSION: During the COVID-19 epidemic, the main purpose of on-line ophthalmic consultation was return visit for the diagnosed eye diseases. Type of eye disease, consultation purpose and number of combined ophthalmopathies all affected whether the patients repeated the consultation and the repeated times. The arrangement of ophthalmologists in different sub-specialties should be adjusted according to the patients' needs and their consultation patterns.

Abstract:The pneumonia caused by Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)abbreviated as Coronavirus Disease 2019(COVID-19)has been classified as a Class B infectious disease under the management of Class A infectious diseases in China. COVID-19 caused by hospital-related transmission is not uncommon and poses a serious threat to clinical medical staff and inpatients. This article introduces that ophthalmologists should master the epidemiological characteristics and clinical manifestations of COVID-19, how ophthalmologists cope with the emergency patients in ophthalmology, focus on the key points of infection prevention and control in ophthalmology emergency and surgery, and strengthen specific prevention and control measures, so as to provide reference for infection prevention and control in ophthalmology medical care in the front line of war epidemics.

Abstract:AIM:To evaluate the clinical efficacy of EX-PRESS aqueous humor drainage nail implantation combined with intravitreous injection of conbercept universal panretinal photocoagulation(PRP)in the treatment of neovascular glaucoma.

METHODS: Totally 21 patients(21 eyes)with neovascular glaucoma who met the inclusion criteria in our hospital from January 2015 to May 2018 were analyzed retrospectively. They were treated with intravitreal injection of conbercept before operation, EX-PRESS aqueous humor drainage nail was implanted after iris neovascularization disappeared 5-10d, and panretinal photocoagulation 2-3wk later. Intraocular pressure(IOP), visual acuity, recurrence rate of iris neovascularization and postoperative complications were observed after 12mo follow-up.

RESULTS: There were significant differences in intraocular pressure at different time before and after EX-PRESS aqueous drainage nail implantation(F=18.513,P<0.05). There was significant difference between preoperative and postoperative visual acuity of EX-PRESS(P=0.008). At the last follow-up, the operation was completely successful in 18 eyes(86%), the condition was successful in 2 eyes(9%), and the total success rate of operation was 95%. Recurrence of iris neovascularization occurred in 1 eye(5%), shallow anterior chamber in 1 eye(5%)and high IOP in 5 eyes(24%).

CONCLUSION: Implantation of EX-PRESS aqueous humor drainage nail combined with PRP can effectively reduce the intraocular pressure of neovascular glaucoma and can be widely used in clinical treatment.

Abstract:AIM: To explore changes of choroidal blood flow post vitrectomy in idiopathic macular hole(IMH), and to discuss the role of choroidal microstructure changes abnormality in macular hole formation.

METHODS: Totally 56 eyes of 56 patients diagnosed with unilateral IMH were included(2014-05/2015-12). All patients received pars planar vitrectomy, indocyanine green assisted inner limiting membrane peeling combined with intraocular +12%C₃F₈ tamponade. Patients with cataract received phacoemulsification and intraocular lens implantation. Choroidal thicknesses were measured at 9 points before and at 1, 3 and 6mo after the surgery, namely the fovea, 1mm and, 3mm above, below, nasal and temporal to the fovea.

RESULTS: Preoperative SFCT value was 233.43±84.638μm, and at 1, 3, 6mo follow-up SFCT were 242.46±88.199μm, 238.97±89.252μm, and 236.71±88.661μm, respectively. SFCT at 1mo after surgery was significantly increased compared to preoperative thickness(P<0.05). 1, 3, and 6mo after the surgery the choroidal thickness at 3mm below the fovea(ICT_3mm)(179.63±62.941μm, 179.74±65.981μm, 180.80±58.379μm)gradually increased compared with those before the surgery(170.89±57.040μm). However, there was no significant difference between ICT_3mm values at each time point. 1, 3, and 6mo after the surgery the choroidal thickness at 1mm below the fovea(ICT_1mm)(216.31±80.297μm, 214.54±75.693μm, 205.69±68.697μm)compared with those before the surgery(207.37±67.502μm)have statistical significance. Compared 6mo after the surgery with 1mo after the surgery have statistical significance with ICT_1mm values at each time point(P<0.05).

CONCLUSION: SFCT of the study eyes showed a transient increase at 1mo follow up, then gradually returned to the base line. As the macular hole successfully closed, the choroidal thickness didn't not show difference compared with baseline, indicating that the decreasing in choroidal thickness is possibly the cause to the formation of the macular hole, not the results. IMH postoperative choroidal thickness values change by location, which may be due to the oppression by the injected gas in the macular hole surgery.

Abstract:AIM: To observe the effect of modified minimally invasive 23G combined with standard 20G three-channel vitrectomy for silicone oil removal.

METHODS: The objects of study were 32 patients with silicone oil eyes hospitalized in Jingliang Eye Hospital from March 2018 to September 2019. Enrolled patients were provided with standard three-channel incision for vitrectomy, with 23G perfusion and lighting as well as 20G suction incision at 10 o'clock. Silicone oil removal was then conducted by using minimally invasive 23G vitrectomy instrument and modified 18G needle. Further examination was performed to observe the best corrected visual acuity(BCVA), intraocular pressure, pain comfort, silicone oil residue, choroidal detachment, retinal detachment 1d, 1wk, 1mo and 3mo after operation.

RESULTS: All the 32 patients underwent operation successfully, and there was stable intraocular pressure and no fluctuation during operation. The removal time of silicone oil was about 10-15min, and no complications occurred intraoperatively. Postoperative 3-month follow-up 3 revealed no vitreous hemorrhage, choroidal detachment and retinal reattachment.

CONCLUSION: The modified minimally invasive 23G combined with standard 20G three-channel vitrectomy is simple, safe, stable and effective for silicone oil removal.