Abstract:AIM: To assess the consistency of refractive errors measured by two autorefractors in myopia screening of school-age Chinese children.

METHODS: Topcon RM-8900 and Tianle RM-9000 autorefractors were utilized to measure refractive errors under noncycloplegic condition in students aged 6 to 16 years old who were cluster sampled from four primary and secondary schools in Dongli district, Tianjin. Sperman correlation analysis and Bland-Altman method were used to evaluate the consistency of spherical diopters, cylindrical diopters and spherical equivalents measured by the two methods, and the axial difference distribution of astigmatism measured by the two methods was analyzed.

RESULTS:A total of 2 276 eyes of 1 138 subjects with a mean age of 10.49±2.66 a were finally enrolled. Spearman correlation analysis showed that sphere(r=0.958, P<0.0001), cylinder(r=0.769, P<0.0001), and spherical equivalent(r=0.962, P<0.0001)measured by Tianle RM-9000 were highly correlated with those measured by Topcon RM-8900, respectively. Bland-Altman analysis showed spherical diopters measured by Tianle RM-9000 were significantly more hyperopic(P<0.0001)with a mean difference of 0.44 D(SD: 0.37; 95% CI: -0.27, 1.16)while the maximum absolute value(1.13 D)of the difference within the 95% CI was above the clinically acceptable range; however, no significant difference(P=0.83)was found between cylindrical diopters measured by the two methods with a mean difference of -0.01 D(SD: 0.31; 95% CI=-0.62, 0.61)while the maximum absolute value(0.62 D)of the difference within the 95% CI was clinically acceptable. The proportion of the axial deviation within ±20° was 84.6%(1 503/1 777)in eyes with cylinder ≤-0.25D while that rose to 96.4%(853/885)in eyes with cylinder ≤-0.75D.

CONCLUSION: Spherical diopters measured by Tianle RM-9000 have a significant hyperopia bias than those measured by Topcon RM-8900 while the consistency of cylindrical diopters and cylindrical axes is clinically acceptable.

Abstract:AIM: To compare the efficacy and safety of penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in the treatment of stromal corneal dystrophy.

METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity \〖best-corrected visual acuity(BCVA)(LogMAR)\〗 and corneal endothelial cell count(ECC)as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference(WMD)and risk ratios(RRs), respectively, along with their respective 95% confidence intervals(CIs).

RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy(59.71% males)were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively(WMD=401.62 cell/mm², 95% CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower(RR=0.30, 95% CI: 0.14-0.64, P=0.002; RR=0.09, 95% CI: 0.02-0.46, P=0.004, respectively)when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet's membrane perforations and postoperative double anterior chamber(All P<0.001).

CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

Abstract:AIM: To determine the vitamin D levels in vernal keratoconjunctivitis(VKC)patients in Indian population.

METHODS:A total of 30 non-atopic healthy children and 30 children having VKC were included in the study. The serum vitamin D levels and the time spent outside was compared between the two groups(P<0.05).

RESULTS: The mean serum vitamin D level in the VKC group was significantly lower(mean 19.17±10.76 ng/mL)compared to the control group(mean 31.19±9.09 ng/mL)(P=0.0003). The vitamin D levels were found to be deficient(10-20 ng/mL)in 43.33%, whereas severe deficiency(<10 ng/mL)was found in 20% of the VKC patients. The deficiency of vitamin D correlated with the level of severity of VKC(P<0.02). The time spent outside in the VKC group was 1.07±0.76h, whereas in the healthy subjects it was 2.08±0.72h(P<0.0001), and it showed a significant correlation with the serum 25(OH)D3 levels(r=0.478, P<0.001).

CONCLUSION:The study shows that children with VKC had a significantly lower serum vitamin D levels as compared to the healthy children which correlated with time spent outside. The severity of VKC also correlated with the severity of vitamin D deficiency which suggests that vitamin D plays an important role in maintaining ocular surface health.

Abstract:AIM: To investigate the protective effect and mechanism of quercetin on age-related macular degeneration in mice through Nrf2/Keap1/ARE pathway.

METHODS: Kunming mice were used as research objects, which were divided into control group, model group and quercetin group. Fundus examination was showed whether yellow-white like glassy sputum substances appeared in the fundus of each group of mice; OCT was used to examine the retinal thickness of each group of mice; HE staining was used to observe the changes of retinal morphology in each group of mice; FFA was observed the fundus vascular integrity of each group of mice. The activities of SOD, GSH-Px, CAT and the contents of ROS and MDA in serum were detected by ELISA; Western blot was used to detect the expression of Nrf2/Keap1/ARE related proteins in the retina of each group.

RESULTS: Quercetin can reduce the yellow and white glassy wart substance in the fundus of mice and increase the thickness of the retina(P<0.05), and the points of retinal vascular leakage is significantly reduced. Compared with the model group, the a-wave amplitude and b-wave amplitude of the quercetin group were significantly higher than those of the model group(P<0.01); Quercetin can make the retinal structure of mice clearer, necrosis and shed part of the outer nuclear layer, and reduce the content of ROS and MDA in mouse serum(all P<0.05), and increase the activities of SOD, GSH-Px, and CAT(all P<0.05). Compared with the model group, the expression of Nrf2 protein in the retinal cytoplasm of mice in the quercetin group was up-regulated(P<0.05), and the expression of Nrf2 protein in the nucleus was down-regulated(P<0.05), GCL protein expression was down-regulated(P<0.05).

CONCLUSION: Quercetin improved the oxidative stress state after retinal photodamage through the Nrf2/Keap1/ARE pathway, protected the retinal function, and protected against age-related macular degeneration.

Abstract:AIM: To invesgate the expression of epidermal growth factor-like domain7(EGFL7)protein in several lacrimal gland tumor types and normal lacrimal gland tissues by immunohistochemical staining. And discuss the correlation of EGFL7 expression with tumor cell proliferation activity and the MVD in lacrimal gland epithelial tumors.

METHODS: A total of 46 paraffin-embedded specimens of common lacrimal gland epithelial tumors and other lacrimal gland tumor types, including 20 cases of lacrimal gland pleomorphic adenoma, 12 cases of pleomorphic adenocarcinoma, and 14 cases of adenoid cystic carcinoma, as well as ten normal lacrimal glands were analyzed for the expression of EGFL7 protein. For all specimens, the tumor microvascular networks were also labeled with anti-CD34 antibody and the tumor MVD was calculated. The proliferative activity of tumor cells containing Ki67.

RESULTS: EGFL7 protein was scored as positive with the presence of brown color in the cytoplasm, and was mainly observed in cells of lacrimal gland pleomorphic adenocarcinomas and adenoid cystic carcinomas. Immunohistochemical staining showed that EGFL7 was not expressed in normal lacrimal gland tissue. The rates of expression of EGFL7 in lacrimal gland pleomorphic adenomas, lacrimal gland pleomorphic adenocarcinomas, and lacrimal adenoid cystic carcinomas were 5%(1/20), 83%(10/12), and 86%(12/14), respectively. The EGFL7 expression in both malignant tumor types was significantly higher than that in pleomorphic adenomas and normal lacrimal gland tissues(P<0.001). CD34 staining colored the tumor microvascular network brown-yellow in single cells or clustered cell populations. The expression of CD34 in lacrimal gland pleomorphic adenocarcinomas(32.58±14.46)and adenoid cystic carcinomas(43.43±4.60)was significantly higher than that in pleomorphic adenomas(4.20±1.19)(P<0.001). Ki67 staining appeared as a brownish color in cell nuclei, indicating proliferative activity. The expression of Ki67 in lacrimal gland pleomorphic adenocarcinomas(44.83±13.68)and adenoid cystic carcinomas(26.29±8.44)was significantly higher than that in pleomorphic adenomas(2.80±3.14)and normal tissues(0.40±0.70)(P<0.001). Furthermore, the expression of EGFL7 protein was positively correlated with high MVD and Ki67 expression in lacrimal epithelial tumors(r_s=0.897, P<0.001; r_s=0.837, P<0.001).

CONCLUSION: The correlation of EGFL7 expression with high MVD and Ki67 expression suggests that high EGFL7 expression plays an important role in promoting tumor angiogenesis and tumor proliferation.

Abstract:AIM: To evaluate the expression level of transforming growth factor β2(TGF-β2)in the aqueous humor and trabecular tissue of patients with primary angle-closure glaucoma(PACG)of Han and Kazakh ethnic groups and the formation of filter bleb after trabeculectomy.

METHODS: Prospective research. Between July 2018 to April 2019, 46 PAGG patients(49 eyes)underwent trabeculectomy in our hospital, including 25 Han nationality(26 eyes)and 21 Kazak nationality(23 eyes). Aqueous humor and trabecular tissue were obtained through trabeculectomy. ELISA method was used to detect the content of total aqueous TGF-β2(tTGF-β2)and activated TGF-β2(aTGF-β2). And the expression of TGF-β2 in trabecular tissue was detected by immunohistochemistry and immunofluorescence.

RESULTS:Immunohistochemical staining and immunofluorescence staining showed that the expression of TGF-β2 in the trabecular meshwork of Han patients was significantly higher than that of Kazakh patients. ELISA quantitative analysis showed that the aTGF-β2 content of Han and Kazak patients were 172.015±79.367pg/mL and 83.436±41.743pg/mL, respectively, the difference was statistically significant(t=4.794, P<0.001). In patients ≥70 years old, the content of tTGF-β2 in the aqueous humor of patients of the two nationalities was 480.124±152.997 and 338.858±72.497pg/mL, respectively, the difference was statistically significant(t=2.421, P=0.026). In the comparison between preoperative and postoperative, there were time differences and interaction effects in intraocular pressure between Han and Kazak patients. At 6mo postoperatively, the formation of type Ⅰ and Ⅱ filter blebs in Han and Kazak patients was different, and the difference was statistically significant(50% vs 78%; χ²=4.841, P=0.028).

CONCLUSION: The expression of TGF-β2 in the aqueous humor and trabecular meshwork of patients with PACG in the two ethnic groups is different. The expression of TGF-β2 in the aqueous humor and trabecular meshwork of Kazakh patients is significantly lower, which reduces the promotion of postoperative filtering scar Functional filtration filtration bleb.

Abstract:AIM: To observe the changes of microvascular structure of different patterns of macular edema(ME)secondary to branch retinal vein occlusion(BRVO)after intravitreal injection of conbercept.

METHODS: A total of 70 patients(70 eyes)with ME secondary to BRVO were classified as cystoid macular edema(CME group, 24 eyes), diffuse retinal thickening(DRT group, 22 eyes)and serous retinal detachment(SRD group, 24 eyes)according to features under OCT examination. After an initial intravitreal injection of 0.5mg(0.05mL)conbercept(IVIC). The changes of best corrected visual acuity(BCVA), central macular thickness(CMT), foveal avascular zone(FAZ), vascular density of superficial capillary plexus(SCP), vascular density of deep retinal capillary plexus(DCP)and the injection times were compared among three groups after 1, 6mo treatment.

RESULTS: After 6mo follow up, the BCVA(0.24±0.13、0.11±0.07、0.33±0.13)and the CMT(268.75±19.01、245.64±23.20、277.00±21.21μm)of the three groups showed a significant downward trend; The FAZ(0.37±0.09、0.30±0.08、0.36±0.03mm²)of the three groups showed a significant decreased trend; The SCP(46.18%±3.21%、47.49%±3.48%、42.76%±3.66%)and the DCP(43.50%±4.34%、47.69%±2.76%、43.88%±3.54%)of the three groups showed a significant increased trend(P<0.01). After 6mo treatment, DRT group was better than CME group and SRD group in improving BCVA, reducing CMT and FAZ area, increasing the density of SCP and DCP. The DRT group had the least injection numbers(2.55±0.69)(F=5.584, P<0.05).

CONCLUSION: The intravitreal injection of conbercept significantly improved the BCVA, reduced the CMT and the FAZ, increased the vascular density of SCP and DCP of different patterns of ME. Best outcomes were achieved in DRT group.

Abstract:AIM: To investigate the correlation between the concentrations of interleukin-23(IL-23)and interleukin-17(IL-17)in the ocular aqueous humor(AH)at the different degrees of diabetic retinopathy(DR)patients.

METHODS: From June 2016 to June 2019, 70 patients(70 eyes)for age related cataract surgery were enrolled in Hubei Yichang Central People's Hospital. All cases were graded into 4 groups, includingⅠ group(20 cases): the control group(patients without diabetes), Ⅱ group(18 cases): diabetic patients without retinopathy, Ⅲ group(17 cases): diabetic patients with non-proliferative diabetic retinopathy, Ⅳ group(15 cases): diabetic patients with proliferative diabetic retinopathy. The levels of IL-23 and IL-17 in AH of the four groups were tested by Enzyme-linked immunosorbent assay(ELISA)and statistically analyzed by ANOVA respectively. The correlations between IL-17 and IL-23 were calculated by Person correction analysis.

RESULTS: The concentration of IL-23 in Ⅰgroup was low(22.18±5.48pg/mL),while those in Ⅱ(37.63±4.52pg/mL), Ⅲ(45.06±4.64pg/mL), Ⅳ(68.89±6.11pg/mL)groups respectively were higher. The IL-17 level inⅠ, Ⅱ, Ⅲ, Ⅳ groups were 4.69±2.03, 6.83±1.02, 9.52±1.30, 10.89±1.26pg/mL respectively. Comparison of IL-23 and IL-17 within four groups revealed: both were increased in Ⅱ group initially, and raised along with the progression of DR. According to the correlation analysis, the expression level of IL-17 of DM was typical positively correlated with IL-23.

CONCLUSION:The over-expression of IL-23 and IL-17 may have a synergistic effect on the occurrence and development, and the IL-23/IL-17 pathway might be associated with the severity of DR by aggravating the inflammatory response of retina. These results indicated that IL-23-IL-17 axis could be a new target for the early diagnosis and treatment of DR.

Abstract:AIM:To observe the changes of vitreous concentrations of cytokines in eyes with proliferative diabetic retinopathy(PDR)after intravitreal injection of ranibizumab or triamcinolone acetonide.

METHODS:A total of 88 PDR patients(112 eyes)with PDR from May 2015 to February 2017 in our hospital were enrolled in this study. The patients were randomly divided into ranibizumab group(57 eyes)and triamcinolone acetonide group(55 eyes). Ranibizumab(0.5mg/0.05mL)or triamcinolone acetonide(4mg/0.1mL)were given intravitreal respectively, after vitreous samples(0.5mL)were collected before the injection. Vitreous samples(0.5mL)were collected again 7d after the injection right before the PPV operation. The concentration of placental growth factor(PIGF)was measured by enzyme-linked immunosorbent assays(ELISA); the concentrations of monocyte chemotactic protein 1(MCP-1)and monocyte chemotactic protein 3(MCP-3), interleukin 6(IL-6)and interleukin 8(IL-8), platelet-derived growth factor-AB/BB(PDGF-AB/BB)and vascular endothelial growth factor-A(VEGF-A)were detected by Luminex200.

RESULTS:Afterranibizumab injection, the concentrations of PlGF and VEGF decreased significantly(PIGF:65.36±15.16 vs 19.42±6.34pg/mL; VEGF-A:315.16±14.34 vs 21.32±2.54 pg/mL, P<0.001), whereas those of IL-6, IL-8 increased significantly(IL-6:37.32±4.04 vs 52.42±5.32 pg/mL; IL-8:111.723±21.32 vs 198.73±19.03 pg/mL,P<0.001). There were no remarkable changes in MCP-1, MCP-3, and PDGF-AB/BB levels after ranibizumab injection(P>0.05). In triamcinolone acetonide group, the concentration of PIGF increased significantly after injection(74.28±17.34 vs 136.12±15.34 pg/mL,P<0.05), while that of MCP-1 decreased significantly(2789.32±143.54 vs 2038.21±105.34 pg/mL,P<0.05). There were no remarkable changes in the expression of MCP-3, IL-6, IL-8, PDGF-AB/BB and VEGF-A(P>0.05). In addition, the concentrations are lower for PIGF and VEGF-A(P<0.01)and higher for IL-8 and MCP-1(P<0.05)in eyes treated with ranibizumab, compared with those treated with triamcinolone acetonide. The incidence of intraoperative bleeding was significantly lower for ranibizumab group than that for triamcinolone acetonide group(P<0.05).

CONCLUSION: The levels of PIGF and VEGF-A decreased, while those of IL-6 and IL-8 increased in eyes with PDR after ranibizumab injection. After triamcinolone acetonide injection, the concentration of MCP-1 decreased, while that of PIGF increased.

Abstract:Thyroid-associated ophthalmopathy(TAO)is the most common orbital disease in adults. Its ocular damage is becoming more and more serious, which causes great harm to the physical and mental health of patients. The pathogenesis of TAO is very complex and has not yet been fully elucidated. The classical theory is the theory of co-antigens. In view of the drawbacks of existing treatment schemes, it is of great significance to study the factors related to TAO and explore better treatment methods for TAO patients. In recent years, the relationship between inflammatory response and TAO has been found, therefore this article reviews the research on TAO-related inflammatory factors.

Abstract:Cataract surgery has become a refractive surgery, which has attracted much attention on postoperative functional vision and visual quality, and promoted the continuous development and improvement of intraocular lens(IOL)materials and design. The traditional presbyopia-correcting IOL has achieved distance and near visual acuity initially, while in recent years the new presbyopia-correcting IOL has further improved the visual experience of patients. This article reviews the progress to provide reference for clinical practice.

Abstract:At present, with the intensification of China's population aging, more and more cataract patients choose surgical treatment, and the incidence of postoperative dry eye is also increasing. Therefore, in addition to paying attention to the postoperative vision recovery of the patient, we should pay close attention to the ocular surface. In order to improve the understanding of dry eyes after cataract surgery, this article reviews the influencing factors of dry eyes after cataract surgery in order to provide a reference for clinical prevention and treatment of dry eyes after cataract surgery.

Abstract:Diabetic retinopathy is the most common disease of microvascular diseases caused by diabetes. It is harmful to vision in the late stage. If not treated in time, it can cause blindness. The diagnosis, treatment and follow-up of diabetic retinopathy were mainly based on fundus fluorescein angiography. There are some limitations in the clinical application because of the side effects of its operation, such as invasive, allergic and adverse reactions. Recently, optical coherence tomography has become more and more popular among ophthalmologists for its noninvasive, rapid and high resolution fundus angiography. It cannot only display the choroidal vascular network information in layers, but also quantitatively analyze the changes of blood flow in the macular region. For the first time, the blood flow analysis of optic disc and macular area in vivo has reached the level of tissue anatomy. It has wide application prospect and is more and more favored by ophthalmologists. In this paper, the clinical application of octa in diabetic retinopathy was reviewed.

Abstract:Alzheimer's disease(AD)is one of the most common causes of Dementia in the world, with symptoms often appearing years after the degenerative changes in the brain. Therefore, the early diagnosis of AD is difficult and the previous diagnostic methods are generally invasive. Considering that most patients with AD are accompanied by visual impairment, the retina can be regarded as a window into the brain. Recently, optical coherence tomography(OCTA)can be used for noninvasive and rapid assessment of structure within different vascular plexuses in the retina and choroid. This improves our understanding of neurological diseases, and more likely contributes to the early diagnosis of AD patients. This paper reviewed the relevant literatures on the application of OCTA in the study of neurological diseases, as well as the structure and function of the brain and retina in patients with AD.

Abstract:Amblyopia is a disease which is caused by abnormal visual experience during the critical period of the visual development, and it has no organic diseases of the eye. Visual examination is an important part of the screening and diagnosis of amblyopia. However, the vision test is limited for the young children who can't express verbally. Refraction error and anisometropia are most common risk factors for amblyopia. In recent years, the early screening of amblyopia has been extended to the early screening of amblyopia-related risk factors. Moreover, the screening methods and technologies for amblyopia have also been developed and updated. In this paper, the methods of vision examination and refractive screening for amblyopic patients are reviewed.

Abstract:Adenoid cystic carcinoma of lacrimal gland is the most common malignant epithelial tumor of the lacrimal gland, and surgical treatment alone shows unsatisfactory result. In recent years, as the application of radiotherapy and chemotherapy, changes have happened in the treatment modality for adenoid cystic carcinoma of lacrimal gland. On one hand, clinical staging is gradually refined, which promote the application of standardized comprehensive treatment. On the other hand, neoadjuvant therapies, such as proton radiotherapy, neutron radiotherapy and intra-arterial cytoreductive chemotherapy, can further improve the application of eye-sparing surgery, decrease the rate of local recurrence and metastasis, and prolong the disease-free survival. In this review, we attempt to arrive at some general insights regarding the progress of treatment in adenoid cystic carcinoma of lacrimal gland, in order to provide new reference basis.

Abstract:Contrast sensitivity(CS)has been widely studied in the research of ophthalmology and optometry. Compared with visual acuity(VA)test, CS assessment can fully and accurately reveal the state of visual function, which has become an important indicator for the prediction, diagnosis of eye diseases and for the evaluation of the disease progression and therapeutic effect. To improve the accuracy of CS measurement, CS detection methods have been constantly improved and innovated, mainly including objective examination and subjective psychophysical examination. Both methods have their advantages and limitations and the main target population is slightly different. With the development of the current Internet Plus, the CS detect software based on computer technology has been successively developed by many research institutions, which provide more convenient detection methods. Therefore, this paper reviews the visual standard design, measurement requirements and main applicable characteristics of common CS detection.

Abstract:With the development and prevalence of artificial intelligence(AI), the application of AI has become a global trend in medical field recent years. The combination of AI and clinical medicine is becoming a hot spot in medical research. It is remarkable that the AI based on deep learning(DL)has achieved great accomplishments in image recognition, speech recognition and natural language processing, especially the application of convolutional neural network(CNN)in image recognition. CNN has been applied to the detection and diagnosis of various of ophthalmological diseases such as diabetic retinopathy, retinopathy of prematurity, glaucoma and age-related macular degeneration. Meanwhile, there are many public databases on ocular including large amount of images of fundus photographs, optical coherence tomography and visual field for researchers to train and test the AI algorithms. However, training the algorithm based on AI technology is still costly and time-consuming. The medical ethic of AI is another challengefor its application. Although DL has bought revolutionary change in ophthalmology field, it still has a long way to go for its world wide application. The article aims to synthesize the researches on the applications of AI technology in ophthalmology, and give a review on the present situation, existing problems and future outlook.

Abstract:AIM: To investigate the clinical efficacy of intravitreal injection of Conbercept in the treatment of macular edema(ME)secondary to branch retinal vein occlusion(BRVO).

METHODS: From March 2016 to May 2018, 86 patients(86 eyes)with BRVO secondary macular edema were selected. 43 patients(43 eyes)were divided into the study group and the control group. Patients in the control group were treated with intravitreal injection of razumab, while patients in the study group were treated with intravitreal injection of conbercept. The patients were followed up for 6mo. The central macular thickness(CMT)and best corrected visual acuity(BCVA)were compared before treatment(T0), 1mo after treatment(T1), 3mo after treatment(T2), 6mo after treatment(T3). The number of injections and complications were recorded during the follow-up period.

RESULTS: At 1mo, 3mo and 6mo after treatment, the levels of LogMAR BCVA(0.57±0.29, 0.42±0.21, 0.38±0.12)and CMT(343.56±46.23, 316.68±38.25, 283.56±29.47μm)in the study group were compared with those in the control group(BCVA: 0.58±0.30, 0.43±0.23, 0.40±0.13). The comparison of CMT: 345.47±46.53, 317.83±38.46, 284.34±29.56μm showed no statistical difference(PSymbol～@@0.05); the average number of injections in the study group was(2.25±1.16)times, which was significantly lower than that in the control group \〖(4.37±1.58)times, P<0.05\〗; There was no persistent ocular hypertension, endophthalmitis, retinal detachment, vitreous hemorrhage and other complications in both groups.

CONCLUSION: Vitreous injection of conbercept is effective and safe in the treatment of ME secondary to BRVO, and can significantly reduce the number of injections.

Abstract:AIM: To research the correlation between the concentrations of interleukin-6(IL-6)and monocyte chemokine-1(MCP-1)in aqueous humor and the intravitreal ranibizumab injection was injected into the glass body cavity.

METHODS: Forty patients(40 eyes)diagnosed with RVO macular edema were selected as the treatment group, twenty patients(20 eyes)underwent cataract surgery were selected as the control group, anterior aqueous humor was collected before surgery in the treatment group and control group. Using the cytometric bead array methods detection the concentration of MCP-1 and IL-6. Comparison and analysis the concentration of MCP-1 and IL-6 before the operation treatment group and control group, comparison and analysis the concentration of MCP-1 and IL-6, BCVA, CMT before and after the operation in the treatment group.

RESULTS: The concentration of MCP-1(49.84±16.16、547.75±108.45pg/mL)and IL-6 in the treatment group was higher than the control group(10.71±7.26、235.65±34.45pg/mL,all P<0.001)before the operation. There was a positive correlation between the concentration of MCP-1, IL-6 and CMT before the operation in the treatment group(r=0.646, 0.912, all P<0.001). The concentration of IL-6 was significantly correlated with MCP-1(r=0.902, P<0.001). The treatment group underwent the intravitreal ranibizumab injection was injected into the glass body cavity, the concentration of IL-6, MCP-1(20.08±11.56、228.35±70.69pg/mL)was lower than before. BCVA was improved significantly compared with before operation, CMT decreased after surgery compared to before surgery(P<0.001).

CONCLUSION: There was a positive correlation between the concentration of MCP-1, IL-6 and CMT, with IVR treatment of secondary macular edema to RVO, to reduce the concentration of MCP-1 and IL-6, to reduce CMT, and reduce macular edema, improved patient's vision level.

Abstract:AIM: To explore the effect of vitreous macular adhesion(VMA)on the efficacy of anti-VEGF therapy in patients with branch retinal vein occlusion(BRVO).

METHODS: Retrospective case study. According to initially diagnosed OCT characteristics, 110 patients(110 eyes), selected from those who received intravitreal injection of Conbercept in the ophthalmology department of our hospital from January 2017 to May 2019,were divided into VMA-present group(VMA+ group, 34 eyes)and VMA-free group(VMA- group, 76 eyes). After the first injection, at least 6mo follow-up was ensured, to record the number of injection and to examine the best corrected visual acuity(BCVA)and central macular thickness(CMT). And it's via the OCT reports to evaluate status of the vitreous macular adhesion and the occurrence of posterior vitreous detachment(PVD).

RESULTS: During the 6mo follow-up after the first injection, there was no difference in the average number of intravitreal injections between patients in VMA+ group and VMA- group(2.91±1.05 times vs 3.08±1.22 times, P=0.915). At the 6mo after the first injection, BCVA and CMT were significantly improved in both groups, and BCVA gain in VMA+ group was more obvious than that in VMA- group \〖-0.20(-0.33, -0.10)LogMAR vs -0.20(-0.30, -0.10), P=0.041\〗, but there was no difference in CMT changes between the two groups(P=0.914). During this follow-up period, in the VMA+ group, 3 eyes, which were focal VMA at baseline, all developed into macular PVD(100.0%); and 5 of 31 eyes, which were extensive VMA at baseline, developed into macular PVD(16.1%). Compared with the extensive VMA, PVD was more likely to develop into focal VMA(P=0.009).

CONCLUSION: BRVO patients combined with VMA have greater potentiality in visual improvements under anti-VEGF treatments. Therefore, the presence of VMA does not prevent BRVO patients from receiving anti-VEGF therapy.

Abstract:AIM:To investigate the risk factors of diabetic retinopathy(DR)in diabetic patients and the influence on the biological structures of anterior segment.

METHODS: This was a cross-sectional study. Patients with type 2 diabetes who had been treated in ophthalmology department of Shanghai Tongren Hospital were invited to participate in this study during January 2018 to September 2018. To evaluate clinical characteristics, each subject completed diabetes related history questionnaire, laboratory examination(blood glucose, glycosylated hemoglobin, blood lipid), eye examination(vision, intraocular pressure, slit lamp examination, corneal topography, fundus photography, OCT). According to the severity of retinopathy, patients were classified to three groups: group 0: none DR, group 1: mild and moderate NPDR, group 2: severe NPDR and PDR. Chi-square test, t-test and variance analysis were used to analyze the differences between groups, and risk factors of DR were studied through Logistic regression analysis. Then analyzed whether these risk factors would affect the biological structures of the anterior segment, such as refractive index, corneal thickness, corneal curvature and anterior chamber depth.

RESULTS: Totally 219 diabetic patients participated in the survey, and 56 patients(25.6%)were diagnosed with DR. The age of DR patients \〖(66.84±15.13a)(group 1)/(65.45±12.83a)(group 2)\〗 was higher than that of patients without DR(59.59±14.61a)(P<0.05). The course of diabetes in DR patients \〖(13.69±10.22a)(group 1)/(15.23±8.22a)(group 2)\〗 was higher than that in patients without DR(9.21±7.92)a(P<0.05).The proportion of diabetic nephropathy in DR patients \〖(28.0%)(group 1)/(32.3%)(group 2)\〗 was higher than that those without DR(14.1%)(P<0.05).The proportion of DR patients treated with insulin \〖(64.0%)(group 1)/(83.9%)(group 2)\〗 was higher than those without DR(44.2%)(P<0.05). Logistic regression analysis showed that the course of diabetes, diabetic nephropathy and insulin were the risk factors of DR(OR>1, P<0.05). All of the above risk factors will significantly reduce the corrected vision of DR patients.The corneal thickness of patients with DR(550.82±34.73)μm was greater than those without DR(542.37±33.32)μm(P<0.05). The anterior chamber depth of patients with diabetes over 10a(2.49±0.43)mm was less than those with diabetes less than 10y(2.68±0.40)mm(P<0.05).

CONCLUSION: The course of diabetes, diabetic nephropathy and insulin use were the risk factors for DR. Patients with long duration of diabetes had a shallower anterior chamber depth.

Abstract:AIM: To compare the objective optical quality of high myopic patients between SMILE and V4c ICL implantation.

METHODS: This was a prospective control study. Thirty-eight patients underwent SMILE and thirty-two patients underwent V4c ICL implantation with high myopia were chosen for this study. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA)and refractive situation were evaluated preoperatively, at 1wk, 1mo, 3mo and 6mo postoperatively. The objective scattering index(OSI), strehl rate(SR)and modulation transfer function(MTF)cut off frequency were measured by the double-pass optical quality system at the same time.

RESULTS: No significant difference of spherical equivalent(SE), UCVA and BCVA was found between SMILE group and V4c ICL implantation group at all time points. At 1wk and 1mo after operation, the OSI values of two groups were significantly higher than pre-operation(P<0.01). OSI values of two groups returned to baseline at 3mo after operation. The MTF cut off frequency of both groups decreased significantly at 1wk after operation(P<0.05)and recovered to baseline at 1mo after operation, no significant difference was found between two group at all time points(P>0.05).

CONCLUSION: Both SMILE and V4c ICL implantation can obtain good visual acuity and objective optical quality.

Abstract:AIM: To compare differences and consistency of corneal curvatures in adolescent patients with low and moderate myopia measured by Pentacam, IOL Master and corneal topographic.

METHODS: A prospective clinical study. 291 adolescent patients(291 eyes)with low and moderate myopia who underwent orthokeratology in the Affiliated Eye Hospital of Nanjing Medical University from January 2019 to September 2019 were selected. Among them, 141 cases(141 eyes)were low myopia and 150 cases(150 eyes)were moderate myopia. Corneal curvature(K₁, k₂, K_m)and corneal Astigmatism(J₀, J₄₅)were examined by Pentacam, IOL Master, and corneal topography. And then the difference, correlation and consistency of the measurement results of three instruments were analyzed.

RESULTS: Differences analysis showed that in the measurement of J₄₅, there was no difference between Pentacam and corneal topography(P>0.05)in patients with low and moderate myopia; in the measurement of J₀,there was no difference between Pentacam and IOL Master(P>0.05)in patients with low myopia; in the measurement of K₂,there was no difference between Pentacam and corneal topography(P>0.05)in patients with low myopia; in the measurement of J₀,there was no difference between Pentacam and corneal topography(P>0.05)in patients with moderate myopia. But there were significant differences in other measurements among three instruments(P<0.05). Pearson correlation analysis showed that K₁, K₂, K_m, J₀, and J₄₅ were highly correlated among three instruments(r=0.545-0.997, all P<0.001). Bland-Altman consistency analysis showed that three instruments had good consistency.

CONCLUSION: Pentacam, IOL Master and corneal topographic have good consistency and can be used as a mutual reference before orthodontic fitting of low and moderate myopia patients. The measurement difference between Pentacam and corneal topography is the smallest among three instruments, but whether three instruments can be replaced by each other needs to be considered in combination in clinical application.

Abstract:AIM: To investigate the prevalence of poor vision and ametropia and main influencing factors of myopia of primary and secondary school students in Xiangtan, providing scientific basis for prevention and control of myopia among primary and secondary school students.

METHODS:Cluster random sampling was performed. 6 164 samples were randomly chosen to be tested for uncorrected visual acuity, corrected visual acuity and eye position, and among those whose uncorrected far visual acuity of either eyes below 5.0, refractive power of both eyes were further tested. Self-questionnaire was designed to understand the influencing factors of myopia.

RESULTS: Among 6 164 samples, the rate of presenting visual acuity below 5.0 is 40.3%(1 249/3 099)for male and 43.8%(1 343/3 065)for female respectively(P<0.01). The prevalence of myopia is 59.1% for male and 68.7% for female respectively(P<0.01). The prevalence of myopia is 44.1% for primary school students and 71.3% for secondary school students; the prevalence of hyperopia is 3% for primary school students and 1.7% for secondary school students. Multivariate regression analysis showed that, homework time(>2h), average sleeping time(≤8h)and myopic parents are independent risk factors(OR=1.48, 1.55, 1.26, 1.58, 2.13,all P<0.05)for myopia of primary and secondary school students.

CONCLUSION: The prevalence of visual impairment and myopia for primary and secondary school students in Xiangtan are high, which is influenced by many factors, by which should be intervened comprehensively.

Abstract:AIM: To understand the prevalence of refractive state of primary school students in Haicheng district, Beihai city.

METHODS: Cross-sectional study and cluster sampling were used. A total of 30 716 students aged 6 to 14 from 15 primary schools in Haicheng district, Beihai city, who had taken physical examination from October 2019 to January 2020, were selected for visual acuity and pupil diopter. SPSS17.0 statistical software was used for data analysis.

RESULTS: In the eyes of the 15 primary schools monitored in this study, 30 716 cases had mild myopia(29.62%), 0.50D < astigmatism < 2.00D(25.43%), metropia(21.05%)and mild hyperopia(15.85%). With the growth of age, the proportion of emmetropia and farsightedness declined as awhole. The proportion of myopia is on the rise. A total of 1 894 cases of wearing glasses 3 788 eyes. The rate of poor vision was 23.30%, and the rate of qualified correction of frame glasses was 64.57%. Compared with the left eye, the difference was statistically significant, and the P₅₀ of the right eye was more negative than that of the left eye. The equivalent spherical mirror was compared between boys and girls. The difference was statistically significant, and the P₅₀ of equivalent spherical mirror of girls was more negative than that of boys.

CONCLUSION: With the growth of age, the proportion of mild hyperopia and squarely eyes decreases year by year; The proportion of myopia increases year by year; Among the students with poor eyesight, the number of those who regularly wear glasses is small; However, after wearing glasses, there are still some students whose glasses are not up to standard. The refractive state of the right eye is more negative than that of the left eye; Female students tend to be more negative than male students in the refractive state.

Abstract:AIM: To compare and study the differences of eyeball biometric measurements among Han, Hani and Yi nationality in Honghe Hani and Yi Autonomous Prefecture(Honghe Prefecture), and prediction accuracy of the intraocular lens(IOL)degree by SRK-T and Haigis formulas in the different eye axes, to provide further objective clinical evidence for the majority of basic-level hospitals and the blind prevention and treatment projects in minority areas.

METHODS: Selected 186 cases(200 eyes)cataract patients in our department, divided them into three groups according to different nations, get their eyeball biometric measurements(ocular axial length, anterior chamber depth and corneal curvature)by A-ultrasound combined with corneal curvature meter and corneal topography, and then compared the differences. According to the different eye axes, they were divided into three groups and then randomly divided into two groups. SRK-T and Haigis formulas were used to predict the IOL degree, and collected postoperative optometry results, calculated the absolute prediction error, then conducted statistical analysis.

RESULTS: There were no difference in the mean axial length, mean anterior chamber depth and mean corneal curvature(measured respectively by corneal topography and corneal keratometer)in the different ethnic groups(P>0.05), and the mean corneal curvature measured by the two methods had no difference(P>0.05). There were no difference of the mean corneal curvature measured by the two methods in the three axial eye groups(P>0.05)and in the same axial eye group(P>0.05). There were no difference in the absolute error of the two IOL measurement formulas in the three eye axis groups(P>0.05). The absolute error calculated by SRK-T formula for the short and the middle eye axis groups were smaller, while it calculated by Haigis formula for long eye axis group was smaller.

CONCLUSION: In our department, there are no statistical difference in the eye biometrics of Han, Yi and Hani nationality. Corneal curvature measured by corneal topography and corneal keratometer have no significant difference. SRK-T and Haigis formula both have high predictive value for IOL degree, SRK-T formula has smaller predictive error for patients which with short and middle eye axis, and Haigis formula has better predictive value for the long ones.

Abstract:AIM: To analyze influencing factors of the curative effect of phacoemulsification(PHACO)combined with intraocular lens implantation in the treatment of high myopia with cataract.

METHODS: The clinical data of 80 cases patients(91 affected eyes)with cataract and high myopia who underwent phacoemulsification and intraocular lens implantation in the hospital from February 2016 to March 2019 were analyzed retrospectively. According to the best corrected visual acuity(BCVA)at 3mo after operation, the patients were divided into low vision group(BCVA<0.3)and normal group(BCVA≥0.3). The preoperative clinical data of the two groups were compared, and the factors affecting visual recovery were analyzed.

RESULTS: All patients completed surgery successfully, and there were statistically significant differences in BCVA before and after surgery(P<0.001). No serious complications such as corneal decompensation, secondary glaucoma and intraocular lens displacement were found. There were significant differences in age, myopia time, axial length, preoperative intraocular pressure, corneal astigmatism, anterior capsular opening area, central anterior chamber depth, grade of lens nucleus and incidence rates of diabetic retinopathy, posterior scleral staphyloma, macular degeneration and postoperative macular edema between the low vision group and the normal group(P<0.05). Multivariate Logistic regression analysis showed that axial length >30 mm, preoperative intraocular pressure ≥21mmHg, corneal astigmatism ≥1.30D, grade Ⅲ-Ⅳ lens nucleus, preoperative diabetic retinopathy and macular degeneration were the independent risk factors for postoperative visual recovery in patients with high myopia and cataract(P<0.05).

CONCLUSION: PHACO combined with intraocular lens implantation is markedly effective in the treatment of high myopia with cataract. However, the curative effect is affected by axial length, preoperative intraocular pressure, corneal astigmatism, grade of lens nucleus, preoperative diabetic retinopathy and macular degeneration, which deserves attention.

Abstract:AIM: To investigate the effect of combined application of fluorouracil and adjustable suture in trabeculectomy for acute attack of primary angle-closure glaucoma in middle-aged patients.

METHODS: This was a prospective study. 60 patients(60 eyes)with primary angle-closure glaucoma in middle-aged patients were selected in our hospital from October 2016 to March 2019. Patients were randomly divided into suture group, 5-FU group and combined group, with 20 cases(20 eyes)in each group. Followed up for 6mo postoperatively, the patient's vision, visual field, intraocular pressure, adjuvant therapy and quality of life were observed.

RESULTS:The best corrected visual acuity among the three groups in the first week after operation was higher than that before surgery(P<0.05). The intraocular pressure of the three groups at one week, one month and six months after operation were lower than that before operation(all P<0.05). The intraocular pressure in the combined group were significantly lower than that in the suture group and the 5-FU group at 1mo and 6mo after operation(all P<0.05). The number of eyes with anti-glaucoma drugs(2 eyes)and the number of anti-glaucoma drugs(0.20±0.016)in the combined group after operation were significantly lower than those in the suture group(11 eyes, 0.90±0.068)and the 5-FU group(12 eyes, 0.95±0.045)(all P<0.05). There was no significant differences in preoperative CLVQOL scores among the three groups(P>0.05). The CLVQOL scores of the combined group(110.60±2.44)was higher than that of the suture group(101.50±2.61)and the FU group(98.55±2.50)at 6mo after operation(P<0.05). The increase of CLVQOL scores(34.50±4.36)in the combined group before and after operation was significantly higher than that in the suture group(25.80±3.59)and the FU group(23.05±5.44)(P<0.05).

CONCLUSION: Combined use of 5-FU and adjustable suture in trabeculectomy for the treatment of acute attack of middle-aged primary acute angle-closure glaucoma patients is safe and effective, which can improve the quality of life.

Abstract:AIM: To observe the short-term efficacy of intravitreal injection of aflibercept on macular edema secondary to retinal vein occlusion(RVO).

METHODS: Totally 24 patients(24 eyes)with macular edema secondary to RVO confirmed by ophthalmic clinical examination received intravitreal injection of aflibercept from May to October in 2019 in hospital. Before and after the 1wk, 1mo treatment, all the eyes of the sick were examined with best corrected visual acuity(BCVA), optical coherence tomography angiography(3x3mm scanning range model)BCVA, central macular thickness(CMT), vascular density of superficial capillary plexus(SCP), vascular density of deep capillary plexus(DCP), and the area, perimeter and the roundness index in foveal avascular zone(FAZ)were observed.

RESULTS: Intravitreal injection of aflibercept for 1wk and 1mo, BCVA improved with the difference were statistically significant(P<0.05); The treatment for 1wk and 1mo, CMT decreased with the difference were statistically significant(P<0.001); There were no statistical difference for the vascular density of SCP,DCP and FD-300 before and after treatment 1wk, 1mo(P>0.05), and it revealed there was no obvious change for vascular density of SCP,DCP and FD-300(All P>0.05); The area and perimeter of FAZ after treatment increased obviously, and the roundness index of FAZ decreased than before with the difference were statistically significant(P<0.05).

CONCLUSION: For macular edema secondary to RVO, eyesight improved and edema absorbed obviously with the intravitreal injection of aflibercept in short-term clinical observation. At the same time, FAZ become regular and macular ischemia wasn't aggravated after treatment.

Abstract:AIM: To explore the prevalence of outer retinal tubulation(ORT)in nAMD patients treated with anti-VEGF and the frequency of anti-VEGF therapy before and after ORT appearance.

METHODS:Sixty eyes of 54 patients were included in the study(treated with ranibizumab by pro re nata regimen(PRN)and followed up for 24mo. At baseline, patients underwent fluorescein fundus angiography(FFA), fundus color photography(CFP), best corrected visual acuity(BCVA)and macular optical coherence tomography(OCT), and followed up monthly thereafter. The subretinal hyper reflective material(SHRM)and ORT was recorded at baseline, and the time of new appearance of outer retinal tubulation structure during followup also was noted. The average number of intravitreal injections before and after ORT was compared. The BCVA and central retinal thickness(CRT)were compared between ORT eyes and non-ORT eyes.

RESULTS: ORT was found in 15.0%, 21.7%, 25.0% and 46.7% of patients at baseline. After ORT appearance, the average number of injections of anti-VEGF per month decreased(Whitman U test, P=0.006), and the difference was statistically significant. At baseline, 78.3% of the eyes had SHRM, 66.0% of which eventually had ORT, while at baseline, there was only 23.1% of the eyes had ORT in no SHRM eyes, with a relative risk of 2.86(P<0.01). The BCVA and CRT were worse in ORT eyes than those in non-ORT eyes.

CONCLUSION: ORT increases gradually with the prolongation of the course of the disease, and the frequency of anti-VEGF retreatment decreases after the occurrence of ORT.

Abstract:AIM: To explore the correlation between urinary microalbumin creatinine ratio and diabetic retinopathy(DR)in type 2 diabetic patients in Hefei area.

METHODS: A retrospective case analysis. 281 patients with type 2 diabetes mellitus(T2DM)hospitalized in Hefei Second People's Hospital from November 2018 to September 2019 were conducted in this study. According to the digital fundus photography, the patients were divided into diabetic retinopathy group(DR group)and non-diabetic retinopathy group(NDR group). The patients' gender, age, course of diabetes, history of hypertension, body mass index(BMI), blood urea nitrogen(BNU), urinary microalbumin creatinine ratio(UACR),fasting blood glucose, HbA1c, total bilirubin(TB), total cholesterol(TC), triglyceride(TG)were collected and risk factors of DR were analyzed.

RESULTS: A total of 281 cases, 169(60.1%)were in the NDR group and 112(39.9%)in the DR group. Logistic regression analysis and ROC curve analysis showed that the risk factors related to DR were UACR(β=0.036, OR=1.037, 95% CI: 1.019-1.056, P<0.001), the best critical value was 10.15mg/g·Cr(AUC=0.717, P<0.001); the course of diabetes(β=0.061, OR=1.063, 95% CI: 1.008-1.120, P=0.023), the best critical value was 10.5a(AUC=0.666, P<0.001).

CONCLUSION: UACR and the course of diabetes are independent risk factors for DR in some of the patients with type 2 diabetes in Hefei.

Abstract:AIM: To study the changes of serum IL-6, ADPN, Apelin, hs-CRP and VEGF levels in patients with RVO, and to explore their association with the occurrence and development of RVO from a molecular perspective.

METHODS:Totally 72 cases of RVO, including 35 cases of central retinal vein occlusion(CRVO)and 37 cases of branch retinal vein occlusion(BRVO). They were divided into groups 1 and 2. 32 senile cataract patients were collected as control group. The time of onset, visual acuity, history of cardio cerebral vascular disease and Macular edema thickness were recorded. Enzyme linked immunosorbent assay was used to detect the expression of IL-6, ADPN, Apelin, hs-CRP and VEGF in blood serum, which were closely related to inflammation and arteriosclerosis.

RESULTS: The mean value of Apelin in group BRVO was 6.69(4.25, 10.52)ng/mL, and CRVO group was 7.12(3.78, 8.58)ng/mL, and the two groups were higher than those in control group 1.19(0.74, 1.49)ng/mL(P<0.05). The mean value of ADPN in group BRVO was 8.06(4.67, 10.81)μg/mL, while in group CRVO was 9.74(4.10, 11.67)μg/mL. The mean value of IL-6 in group BRVO was 35.89(17.63, 37.50)pg/mL, while in group CRVO was 37.16(11.52, 42.80))pg/mL. The mean value of hs-CRP in group BRVO was 161.10(54.51, 164.01)μg/mL. The mean value of VEGF in group BRVO was 158.25(82.24, 230.41)pg/mL, while in group CRVO was 174.14(76.04,243.98)pg/ml(P>0.05). There was no significant difference between the experimental group and the control group.

CONCLUSION:By comparing the levels of serum IL-6, ADPN, Apelin, hs-CRP and VEGF in 72 RVO patients and 32 senile cataract patients, Apelin was found to be higher than that in the control group. Apelin may be one of the related risk factors for RVO. The expression of ADPN, IL-6, hs-CRP, VEGF, RVO in acute stage no specificity.

Abstract:AIM: To explore the multimodal imaging features of choroidal osteoma.

METHODS:Retrospectively observational case series. Nine patients(15 eyes)with choroidal osteoma presented to Xi'an No.3 hospital from October 2015 to August 2019 were included in the study. Among them, there were 2 males and 7 females. All patients received the best corrected visual acuity, fundus color photography, short wavelength fundus autofluorescence(SW-AF), infrared fundus autofluorescence(IR-AF), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA), optical coherence tomography(OCT)and orbital X-ray computed tomography(CT).

RESULTS: In 15 affected eyes, lesions were involved in macula and optic disc in 5 eyes(33%), lesions were located in macula in 8 eyes(53%), peripapillar lesions in 2 eyes(13%). Choroidal osteomas presented as orange-red or yellow-white lesions with pigmentation on the surface in fundus color photographies. SW-AF images showed that choroidal osteomas presenting with mottled hypofluorescence and hyperfluorescence in 15 eyes(100%), while IR-AF images showed that all of the choroidal osteomas presenting punctate and patchy hypofluorescence and hyperfluorescence. FFA showed that 15 eyes(100%)of choroidal osteoma had gradually enhanced brightness, of which 6 eyes(40%)had severe leakage of fluorescence from sub-retinal neovascularization(SRNV). ICGA images revealed SRNV in 9 eyes(60%), all corresponding area of choroidal osteomas showed low fluorescence in the early stage of angiography, and the brightness of tumors increased during angiography gradually. OCT images showed that choroidal osteomas with inhomogeneous reflection in 10 eyes(67%); choroidal osteomas presented with hypo-reflectivity in 5 eyess(33%). All of the choroidal osteomas(100%)presented as high density bone mass on CT images.

CONCLUSION: Choroidal osteoma is orange-red or yellow-white, and expressed as bone mass on CT images, which is an important basis for diagnosis of choroidal osteoma. Damaged RPE leads to appearance of strong and weak mottled SW-AF and IR-AF in the location of choroidal osteomas. FFA and ICGA are helpful to clarify the abnormal circulation in the lesion area. The intensity of cross-sectional reflection in choroidal osteomas are different on OCT images, meanwhile, OCT was helpful to observe the condition of subretinal effusion and neovascularization.

Abstract:AIM: To evaluate the clinical efficacy and safety of oral propranolol for treatment of vision function-threaten infantile ocular hemangioma.

METHODS: This is a prospective observational study. A total of 54 infants with huge ocular hemangioma were treated with oral propranolol. The changes of tumor appearance, tumor size evaluated by color ultrasound or MRI were examined before treatment, 1mo, 3mo, 6mo and 1a after treatment. In addition, the astigmatism degree of hemangioma eyes were measured with cycloplegic refraction before treatment and at the stage of drug withdrawal, the local and general adverse reactions were recorded during the treatment.

RESULTS: One week after treatment, all of the cases had different degrees of tumor color or texture changes gradually. 1mo, 3mo and 6mo after treatment, the effective rates were 88%, 96% and 98%, the cure rates were 25%, 35% and 67% respectively. The patients with ocular dysfunction such as ptosis, ocular motility disorder or exophthalmos became better gradually during the treatment, and were fully recovered finally as the hemangioma shrinking. At the stage of drug withdrawal, the M(P₂₅, P₇₅)of the hemangioma average volume were 150.00(0.00, 378.00)mm³ which decreased from 3254.00(2016.00, 7600.00)mm³ before treatment; and the M(P₂₅, P₇₅)of astigmatism values were 0.75(0.50, 1.44)D compared with 2.25(1.00, 3.50)D measured pre-treatment. The difference of hemangioma volume and astigmatism values before and after treatment was statistically significant(P<0.001).

CONCLUSION: With the detailed assessment of the general condition of patients, oral propranolol of recommended dosage for treatment of vision function-threaten infantile ocular hemangioma was a safe and effective regimen.

Abstract:AIM: To evaluate the clinical significance of outer zona pellucid in tear ferning image in dry eye patients and explore a new method for evaluation tear lipid layer.

METHODS:Forty-seven patients were randomly selected from the outpatient department of ophthalmology, He Eye hospital, Shenyang from May 2018 to July 2019. The right eye was selected as the study object. All patients were investigated by the ocular surface disease index(OSDI)questionnaire and performed lipid layer classification by DR-1 tear interferometry, NIBUT and tear meniscus height examination by OCULUS Keratograph. Then tears were collected and tear ferning tests was performed. The whole tear crystallization images were observed and photographed by microscopy, then measured by Digimizer software and the area ratios of outer transparent belt were calculated. Pearson correlation analysis were performed between area ratios of outer transparent belt and OSDI scores, lipid layer levels, tear meniscus height values, NIBUT values.

RESULTS: The area ratios of outer transparent belt were negatively correlated with OSDI scores(r=-0.764, P<0.05), negatively correlated with lipid layer levels(r=-0.838, P<0.05), positively correlated with NIBUT values(r=0.575, P<0.05)and the correlation between tear meniscus height values was not significantly(r=-0.237, P=0.112).

CONCLUSION: The outer transparent belt in tear crystallization image can be used to evaluate the lipid layer of tear film; the larger area ratios of outer transparent belt, the thicker the lipid layer. This method has the advantages of quantified results, good repeatability, low requirement on equipment, and is worth popularizing.

Abstract:AIM: To investigate the cause and treatment of abnormal blinking in 225 children.

METHODS: A retrospective analysis was performed on the causes, examination results, treatment methods and efficacy of abnormal blinking in 225 children.

RESULTS: Among 225 children, 156 cases(69.3%)had corneal or conjunctival diseases, of which 68 cases(30.2%)were diagnosed with allergic conjunctivitis and 88 cases(39.1%)with other corneal or conjunctival diseases, 38 cases(16.9%)were found with eyelid disease, 65 cases(28.9%)with ametropia, 56 cases(24.9%)with dry eye, and 108 cases(48%)with video terminal syndrome. After 1wk to 2mo of treatment for the underlying causes, 175 cases were cured and 35 cases were improved, with no improvement observed in 15 cases.

CONCLUSION: The cause of abnormal blinking in children is relatively complex, which is closely related to allergic conjunctivitis, video terminal syndrome, dry eye and ametropia. It should be considered comprehensively in clinical practice and treatment should be given targeting different causes.

Abstract:AIM: To study the reliability of Pentacam, OCT, Tomey OA-2000, IOL Master700, and A ultrasound pachymetry in the measurement of central corneal thickness(CCT)in myopic eyes.

METHODS: CCTs of 56 myopic patients(112 eyes)were measured using Pentacam, RTVue OCT, Tomey OA-2000, IOL Master 700, and A ultrasound pachymetry(NIDEK US-500). The difference, correlation, and consistency were statistically analyzed using average values taken from the five devices and the measured values produced by each device.

RESULTS: CCTs of 112 eyes were determined using Pentacam(530.17±25.08)μm, OCT(519.79±26.90)μm, Tomey OA-2000(521.75±26.51)μm, IOL Master 700(519.53±28.15)μm, and A ultrasound pachymetry(542.23±26.88)μm. The average value across all five devices was 526.69±26.08μm. The results of root mean square error(RMSE)and theil inequality coefficient(TIC)showed that the degree of deviation from the average of the values measured using Pentacam was the smallest. The other four devices were, from least deviation to most, Tomey OA-2000, OCT, IOL Master 700, and A ultrasound pachymetry. Typical correlation analysis showed that the correlation coefficients between the measured values of Pentacam, OCT, Tomey OA-2000, IOL Master 700, and A ultrasound pachymetry and the average values were ρ=0.957, P=0.950, P=0.953, P=0.930, and ρ=0.949, respectively. The results of correlation coefficient showed that Pentacam and Tomey OA-2000 had the closest correlation with the average value. The other three were, in order of closest to furthest correlation, OCT, A ultrasound pachymetry and IOL master 700. The results also showed that the measurements of Pentacam and Tomey OA-2000 were more reliable, which was consistent with the clinical situation. The results of Bland-Altman analysis showed that the five groups of measurements were closely consistent with the average values, and the CCT measurements of Pentacam and Tomey OA-2000 were the most consistent with the average values.

CONCLUSION: Among the five instruments, Pentacam and Tomey OA-2000 produced results that were closest to the average value in CCT measurement, with the best correlation and consistency. Their measurement methods are more objective and safer than A-scan, so they may provide better reference data for clinical practice.

Abstract:“Chloroquine phosphate” was listed as a trial drug in diagnosis and treatment program of COVID-19(trial sixth edition), and the application of chloroquine and hydroxychloroquine treatment for COVID-19 in medical institutions also increased. Chloroquine and hydroxychloroquine have certain retinal toxicity, its mechanism is still unclear, due to different drug tolerance, the risk degree of retinal toxicity in COVID-19 treatment is unclear. Therefore, when using chloroquine and hydroxychloroquine in the treatment of COVID-19, it is recommended to choose the appropriate dosage according to patients' situation, and adopt necessary ophthalmic screening for patients with high risk to prevent the occurrence of retinopathy. In this paper, we described the risk factors, clinical manifestations and screening methods of retinal toxicity caused by chloroquine and hydroxychloroquine, in order to provide references for the safer use of chloroquine and hydroxychloroquine in the treatment of COVID-19.

Abstract:AIM: To analyze and study the corneal nerve invasion phenomenon of Bowman's membrane in patients with IIIA lattice corneal dystrophy by confocal laser scanning microscopy. Quantitative analysis of 10a continuous observation image data was performed, followed by self-control studies.

METHODS: A total of 10 patients(13 eyes)with IIIA Lattice corneal dystrophy were continuously examined by confocal laser scanning microscopy. The data were observed and analyzed.

RESULTS: The normal corneal nerve of Bowman's membrane(Grade 0)of IIIA LCD patients gradually decreased with the prolongation of observation time. The nerves of grade I to V involved(amyloid-wrapped nerve fibers)gradually increased correspondingly. So suggested that the corneal nerve invasion of Bowman's membrane(amyloid deposits)in patients with IIIA LCD were gradually increasing with time.

CONCLUSION: In patients with type ⅢA lattice corneal dystrophy, there is a neurotropic phenomenon in Bowman's membrane, which gradually worsens with the aggravation of the lesion. This lesion can explain the recurrent epithelial damage of the IIIA LCD from some degrees. Continuous observation of patients with type IIIA LCD by corneal laser confocal microscopy can well understand the development of the lesion and explain its clinical manifestations.