Abstract:AIM:To evaluate the repeatability and comparison of corneal visualization scheimpflug technology(Corvis ST)parameters in keratoconus eyes before and after accelerated transepithelial corneal cross-linking(ATE-CXL).

METHODS: Thirty eyes of 30 progressive keratoconus patients were included in the prospective study. Three repeated corneal biomechanical measurements were performed preoperatively and one month postoperatively by Corvis ST. The interclass correlation coefficient(ICC)and 95% confidence interval(CI), Cronbach'α, repeatability coefficient(RC), and coefficient of variation(CV)were used to evaluate the repeatability of Corvis ST parameters. Paired t-test or Wilcoxon rank test was used to evaluate the differences between preoperative and postoperative data.

RESULTS: At preoperative, 26 of 39(66.67%)parameters showed good to excellent repeatability, 6(15.38%)showed moderate, and 7(17.95%)showed poor repeatability. Similarly, 34(87.18%)parameters showed good to excellent repeatability, 3(7.69%)showed moderate, and 2(5.13%)showed poor repeatability after ATE-CXL. After ATE-CXL 1mo, the intraocular pressure(IOP), biomechanical corrected IOP(bIOP), first applanation time(A1T), Radius, deformation amplitude at the first applanation(A1DA), deflection length at the maximum deformation(HCDLL)and stiffness parameter at first applanation(SP A1)parameters increased, while the steep keratometry(Ks), flat keratometry(Kf), mean keratometry(Kmean), second applanation time(A2T), DA Ratio Max(2 mm)and integrated radius parameters decreased(all P<0.05).

CONCLUSION:The repeatability of the Corvis ST parameters before and 1mo ATE-CXL follow up were both acceptable, and the corneal stiffness was improved after 1mo ATE-CXL.

Abstract:AIM: To assess the effectiveness of low vision devices in visual rehabilitation of people with age-related macular degeneration(AMD).

METHODS: Forty-four consecutive people with AMD were assessed in low vision clinic. Data about uncorrected and best corrected visual acuity, refractive errors, types of low vision aids(LVAs)and reading speed prior and with low vision devices were collected and analyzed.

RESULTS: Among 44 people with mean age 73±10.8 years suffering from AMD, 36(82%)were male. 29(67%)participants had distance visual acuity(DVA)of 1.0-1.6 LogMAR in the better-seeing eyes while 36(82%)had near visual acuity(NVA)less than 3.2 m. Mean improvement in DVA with low vision devices was 0.67±0.27 LogMAR(P=0.000). With LVAs 42(95%)participants achieved NVA of 1 m or better whereas only two(4.5%)participants had NVA of 1 m without LVAs. With the provision of adequate LVAs, mean reading speed was improved from 2.9±4.78 words per minute(wpm)to 71.31±29.96 wpm among the group of participants who could read(P<0.001). Monocular telescopes were prescribed to 15 participants for distance vision and high plus monocular lenses in spectacle were the most common aid for reading.

CONCLUSION: LVAs can play an effective role in vision rehabilitation of people with AMD and in improvement of reading abilities. Referral to low vision care services must be considered for people with AMD.

Abstract:AIM: To investigate and discover whether different insertion areas for Baerveldt glaucoma implant(BGI)surgery produce different outcomes in terms of the reduction of intraocular pressure(IOP).

METHODS: This retrospective study involved the review of cases of patients admitted at Toho University Sakura Medical Center, who underwent BGI surgery via the pars plana route for the treatment of neovascular glaucoma. The patients were divided into two groups: the superotemporal insertion group \〖18 eyes in 16 subjects(13 males, 3 females; mean age 62.9±14.4a)\〗 and the inferonasal insertion group \〖17 eyes in 15 subjects(11 males, 4 females; mean age 56.9±10.7a)\〗. The patients were followed up and re-evaluated at 12mo. The IOP reduction rate 12mo after surgery relative to preoperative IOP was compared between the two groups.

RESULTS: The mean preoperative IOP was 31.1±10.0 mmHg and postoperative IOP was 14.4±4.5 mmHg in the superotemporal group, whereas for the inferonasal group, the mean preoperative IOP was 34.9±9.7 mmHg and postoperative IOP was 15.9±3.7 mmHg. The IOP reduction rate of the superotemporal group was(50.0±19.0)% and that of the inferonasal group was(51.2±16.3)%. There was no significant correlation between the two groups(Student's t-test, P=0.590).

CONCLUSION: There was no difference in the short-term clinical outcomes between superotemporal and inferonasal BGI performed via the pars plana route.

Abstract:AIM: To investigate the protective effect and mechanism of luteolin on H₂O₂-induced oxidative damage of retinal pigment epithelium(RPE)cells.

METHODS:ARPE-19 cells were divided into the control group, H₂O₂ group, different doses of luteolin groups and Nrf2 inhibitor group, and the oxidative damage model of RPE was prepared by 100μmol/L H₂O₂, except for the control group. Cell activity was detected by Methyl thiazolyl tetrazolium(MTT)assay and proper experimental concentration of luteolin was determined. The cell morphology and activity was observed in each group. Cell apoptosis rate and reactive oxygen species(ROS)were detected by flow cytometry, malondialdehyde(MDA)and superoxide dismutase(SOD)were detected by kit method, and the expression of caspase-3, poly adeno-sine diphosphate ribose polymerase(PARP), B cell lymphoma-2(Bcl-2), nuclear factor erythroid 2-related factor 2(Nrf2)and heme oxygenase-1(HO-1)proteins were detected by Western blot.

RESULTS: 100μmol/L luteolin has toxic effects on ARPE-19 cells, so 25μmol/L and 50μmol/L luteolin were selected for subsequent experiments. The cell activity, SOD activity and the protein expression levels of Bcl-2, Nrf2, HO-1 in 25μmol/L and 50μmol/L luteolin groups were significantly higher than the H₂O₂ group(P<0.05). The apoptosis rate, ROS, MDA content and the protein expression levels of Caspase-3 and PARP in 25μmol/L and 50μmol/L luteolin groups were significantly lower than the H₂O₂ group(P<0.05). The cell activity, SOD activity \〖(13.83±1.49)U/mL vs(22.69±1.83)U/mL\〗 and the protein expression levels of Bcl-2, Nrf2 and HO-1 protein expression in the Nrf2 inhibitor group were significantly lower than the 50μmol/L luteolin group(P<0.05). The apoptosis rate, ROS, MDA content \〖(654.96±26.99)vs(446.52±29.42),(3.89±0.29)nmol/mL vs(2.06±0.19)nmol/mL\〗 and the protein expression levels of Caspase-3 and PARP in the Nrf2 inhibitor group were significantly higher than the 50μmol/L luteolin group(P<0.05).

CONCLUSION: Luteolin can improve the oxidative damage of RPE cells induced by H₂O₂, and its mechanism may be related to the activation of the Nrf2/HO-1 pathway.

Abstract:AIM: To analyze the protective effect of resveratrol on the optic nerve of glaucoma rats and its effect on the phosphatidylinositol 3 kinase(PI3K)/protein kinase B(Akt)signal pathway and its related factors.

METHODS: SPF grade SD rats were used to cauterize the scleral surface veins to make a right eye glaucoma model. After successful modeling, different doses(10, 20, 40 mg/kg intraperitoneal injection)of resveratrol were used to intervene. Intraocular pressure was measured 2h after the last administration, and retinal slices were made to observe the survival of retinal ganglion cells(RGC). Retinal plaque to observe the survival of retinal ganglion cells(RGC). Real-time fluorescence quantitative PCR and Western blot were used to detect the mRNA and protein expression of retinal PI3K, Akt, basic fibroblast growth factor(bFGF), and brain-derived neurotrophic factor(BDNF).

RESULTS: The intraocular pressure(30.25±4.25)mmHg in the model group was higher than that in the low-dose group(26.30±4.05)mmHg, the middle dose group(22.31±3.68)mmHg and the high dose group(18.32±3.21)mmHg, and the model group RGC labeling rate(48.25±4.50)% was lower than the low dose group(56.32±5.05)%, middle dose group(66.03±6.68)% and high dose group(78.56±7.82)%(P<0.05). The intraocular pressure in the low, middle and high dose groups decreased in a dose-dependent manner, and the RGC labeling rate increased in a dose-dependent manner(P<0.05). The p-PI3K/PI3K, p-Akt/Akt protein ratio, bFGF, BDNF mRNA and protein relative expression in the model group were lower than those in the low dose group, middle dose group, and high dose group(P<0.05), and the low-dose group, middle dose group and high-dose group increased in a dose-dependent manner.

CONCLUSION: Resveratrol can inhibit the apoptosis of RGC in glaucoma rats and reduce optic nerve damage, which may be related to the up regulation expression of phosphorylated of related proteins in PI3K/Akt signal pathway and the expression of protective gene and protein of optic nerve.

Abstract:AIM: To explore the effect and mechanism of acyclovir(ACV)on the proliferation and apoptosis of human eye Tenon capsule fibroblasts(HTFs) in vitro.

METHODS: HTFs were divided into ACV treatment group and control group; CCK8 was used to detect cell proliferation rate under different concentration gradients, scratch assay was used to detect HTFs migration ability, and flow cytometry was used to detect HTFs apoptosis and cell cycle.

RESULTS: Compared with the control group, the proliferation rate of HTFs in the ACV-treated group(final concentrations were 1.125, 2.25, 3.375, 4.5mmol/L)was significantly reduced(P<0.05)and was concentration-dependent. The scratch closure rate in the ACV-treated group(final concentrations were 4.5mmol/L)was significantly reduced(P<0.05), the apoptosis rate was significantly increased(P=0.0005), the peak value of the cell cycle G0 / G1 increased(P=0.0011), and the S-phase decreased(P=0.0006). The cell cycle is blocked in the G0/G1 phase.

CONCLUSION: Acyclovir can promote cell apoptosis by blocking the cell cycle of HTFs, and inhibit the proliferation and migration of HTFs.

Abstract:AIM: To explore the clinical value of fundus retinal argon laser photocoagulation combined with calcium dobesilate in the treatment of diabetic retinopathy(DR).

METHODS:A prospective study from August 2017 to August 2019 was conducted. Totally 182 patients(326 eyes)with DR were divided into two groups. The observation group received fundus retinal argon laser photocoagulation combined with calcium dobesilate, and the control group received fundus retinal argon laser photocoagulation. Flash electroretinography was performed before treatment and after treatment, and changes in a and b waves were recorded. Changes in the best corrected visual acuity(BCVA), retinal neovascularization fluorescein leakage area, central macular thickness(CMT)and retinal microcirculation parameters were detected. The absorption time of retinal edema, bleeding and exudation was recorded, and the incidence of postoperative complications was counted.

RESULTS: At 6mo after treatment, a-wave and b-wave amplitudes of the two groups were decreased(P<0.001). The b-wave amplitude of observation group was larger than that of the control group(P<0.05). There were no statistically significant differences in a-wave and b-wave peak time and amplitudes between the two groups(P>0.05). The BCVA of the two groups was increased, and the macular leakage area and CMT were reduced(P<0.001). Compared with the control group, the BCVA of the observation group was higher, the macular leakage area and CMT were smaller, peak blood flow velocity and average blood flow velocity of the central retinal artery were higher, and the vascular resistance index and pulsatility index were lower(P<0.001). The absorption time of edema, bleeding and exudation was shorter in observation group than in the control group(P<0.001). There was no significant difference in the incidence of surgical complications between the two groups(P>0.05).

CONCLUSION: Fundus retinal argon laser photocoagulation combined with calcium dobesilate is superior to retinal photocoagulation alone in the treatment of DR. The former can promote the improvement of visual acuity, reduce fluorescein leakage, and promote the absorption of retinal edema, bleeding and exudation, which is conductive to improving retinal microcirculation and inhibiting neovascularization.

Abstract:AIM: To investigate the clinical value of microRNA(miRNA, miR)-27 expression in patients with diabetic retinopathy(DR).

METHODS: A total of DR 80 patients(DR group)treated between January 2019 and January 2020 were retrospectively reviewed. Meanwhile, 40 patients with simple type 2 diabetes mellitus(T2DM)(T2DM group)and 40 normal healthy persons(control group)were enrolled, and plasma RNA was extracted. Real time fluorescent quantitative reverse transcription polymerase chain reaction(RT-PCR)was adopted to determine plasma miR-27 expression, and enzyme-linked immunosorbent assay was performed to determine the vascular endothelial growth factor(VEGF)level. Plasma miR-27 and serum VEGF expression in different groups and in patients with different severities of DR was comparatively analyzed. Multivariate Logistic regression analysis was performed to screen factors influencing the expression of miR-27 in patients with DR, and Pearson correlation analysis of miR-27, serum VEGF and blood glucose indexes was conducted. Meanwhile, significance of miR-27 in pathogenesis of DR was summarized.

RESULTS: DR group had the highest plasma miR-27 and serum VEGF levels, followed by T2DM group, and then the control group(P<0.05). Proliferative diabetic retinopathy(PDR)patients had higher levels of plasma miR-27, serum VEGF, fasting blood glucose and glycated hemoglobin than those with non-proliferative diabetic retinopathy(NPDR)(P<0.05). It was found that course of disease(OR=3.206), fasting blood glucose(OR=2.570), glycated hemoglobin(OR=2.787), VEGF(OR=3.442)and severity of DR(OR=5.842)were influencing factors of plasma miR-27 expression in DR patients(P<0.05). In DR patients, relative expression of plasma miR-27 was positively correlated with serum VEGF, fasting blood glucose and glycated hemoglobin(r=0.548, 0.398, 0.522, all P<0.05).

CONCLUSION: DR patients have higher plasma miR-27 expression level than those with simple T2DM and normal healthy people. The duration of diabetes, fasting blood glucose, glycated hemoglobin and severity of DR all affect the expression of miR-27. Besides, miR-27 is positively correlated with serum VEGF, glycated hemoglobin and fasting blood glucose. It is speculated that miR-27 may mediate the pathogenesis and progression of DR by regulating glucose metabolism and promoting angiogenesis.

Abstract:AIM: To investigate the efficacy and safety of orthokeratology combined with 0.01% atropine in controlling low to moderate myopia in adolescents.

METHODS: A prospective non-randomized controlled study was conducted among 120 eyes of 120 adolescents with low to moderate myopia. 60 eyes in the control group were treated with orthokeratology, and 60 eyes in the combined group were treated with orthokeratology combined with 0.01% atropine. The best corrected distant visual acuity(BCDVA), best corrected near visual acuity(BCNVA), refraction, axial length, accommodative amplitude, photopic pupil diameter, mesopic pupil diameter, lipid layer thickness(LLT), tear film break up time(BUT)and complications were determined before treatment and at 1a after treatment.

RESULTS: There were no significant differences in BCDVA and BCNVA within and between the two groups before and after treatment(P>0.05). After treatment, the spherical equivalents of both groups progressed significantly(P<0.01), and the average changes of spherical equivalent refractive error in the combined group and the control group were 0.21(0.03, 0.53)D and 0.40(0.15, 0.74)D respectively(P<0.01). The axial lengths of both groups were increased significantly(P<0.01), and the axial length elongations of the combined group and the control group were(0.13±0.19)mm and(0.22±0.21)mm respectively(P<0.01). There were no significant differences in the accommodative amplitude, photopic and mesopic pupil diameters of the control group before and after treatment(P>0.05). After treatment, the accommodative amplitude of the combined group decreased significantly, while the photopic and mesopic pupil diameters significantly increased, respectively(P<0.01). The accommodative amplitude of the combined group was smaller than that of the control group, while the photopic and mesopic pupil diameters were larger than those of the control group at 1a after treatment(P<0.01). The LLT and BUT in both groups were significantly reduced from baseline(P<0.01), but both showed no significant differences between the two groups at baseline and at 1a after treatment(P>0.05). During the treatment period, there was no difference in the incidence of total adverse reactions between the combined group and the control group(26.7% vs 15.0%, P>0.05).

CONCLUSION: Combined treatment with 0.01% atropine and orthokeratology would be a safe and more effective choice of treatment to control the development of myopia in adolescents.

Abstract:Neuromyelitis optica(NMO)is an inflammatory central nervous system(CNS)astrocytic disease with high incidence, neuro-ophthalmic intercross, and humoral immune-dominated in Asian population. It has attracted much attention due to its high pathogenicity, high risk of recurrence, and poor prognosis. It is difficult for patients with NMO-associated optic neuritis(NMO-ON)to benefit from routine treatment, and they are often left with different degrees of optic nerve atrophy. One limitation of the study of NMO-ON is the deficiency of the experimental model. Therefore, the progress and application of NMO and NMO-ON experimental model are reviewed in this paper, aiming to explore the pathological mechanism and possible treatment of NMO visual impairment.

Abstract:With the development of science and the progress of society,a revolutionary breakthrough-optical coherence tomography angiography(OCTA), a non-invasive imaging-assisted examination method-has been achieved, in the study of hemodynamics of the fundus of primary glaucoma in recent years. This technology has many advantages compared with previous traditional inspection methods. It fully exercises split-spectrum amplitude decorrelation angiography(SSADA)to acquire three-dimensional blood flow images of the fundus. With characteristics of none invasion but fastness, repeatability, layered imaging and high resolution, it can stratify and quantify the fundus blood flow density, and is also used to monitor the early changes of glaucoma fundus blood flow, disease progression and evaluation of therapeutic effect. However, OCTA presents certain shortcomings in actual clinical applications. Before available to function more widely in the fields of glaucoma disease, this method demands further researches and development. This article gives an overview of the application and research progress of OCTA technology in primary glaucoma.

Abstract:Mesenchymal stem cells(MSCs)are multipotent cells with high proliferation ability that can differentiate into a variety of cell types. Thus great plasticity was provided for the regeneration of somatic cells in animal individual growth. Recently, MSCs have been applied to the treatment of traumatic and degenerative diseases on account of its distinct biologic peculiarity. The cells have tremendous potential in the clinical application. This article reviewed clinical treatment of ophthalmic diseases, administration route, methods of acquiring and security about two of MSCs derived from bone marrow and adipose tissue(BMSCs and ADSCs).

Abstract:Dry age-related macular degeneration(ARMD)is a degenerative fundus disease whose pathogenesis is not yet fully clear. Dry ARMD with macular pigmentation disorder, drusen and geographic atrophy as main manifestations can lead to irreversible loss of central vision. It's reported that immune and inflammatory reactions play a key role in the development of dry ARMD, in which complement system, pattern recognition receptors, inflammasomes, and various cytokines in immune molecules are closely related to the occurrence of dry ARMD. In this paper, the latest researches on these immune molecules and dry ARMD will be reviewed.

Abstract:As a newly discovered endogenous regulator, fibroblast growth factor 21(FGF21)becomes hot topic in recent professional research. It plays an important role in diabetic retinopathy recently. Moreover, FGF21 has attracted more and more attention in recent years. This paper discussed the molecular structure of FGF 21, biological function, relationship between FGF21 and inflammatory response and role in the pathological process of diabetic retinopathy.

Abstract:Refractive errors are a common ophthalmic disease, which can be corrected by wearing glasses, laser refractive surgery and so on. However, there are some limitations of these methods for treating high myopia, keratoconus, etc. The implantation of the posterior chamber implantable collamer lens(ICL)is one of the most common surgry for correcting refractive errors(mainly apply to high myopia and astigmatism). This study aim to explore the safety and effectiveness of implanting ICL to correct low to moderate and high myopia or hyperopia. This review will summarize the research progress of implanting ICL to correct refractive errors.

Abstract:In recent years, ocular biometers based on swept-source optical coherence tomography(SS-OCT)technology have emerged in ophthalmic practice. Compared with the earlier ocular biometers such as the partially coherent interference(PCI)based ones, the SS-OCT based devices have a higher signal-to-noise ratio, greater swept light wavelength, better tissue penetration, faster scanning speed, and better axial length(AL)detection rate for cataract patients. This review aims to summarize the advances of a widely used SS-OCT based device-IOL Master 700 in cataract.

Abstract:Vascular endothelial growth factor(VEGF)is a key factor of the angiogenesis during embryonic period, and it is also an important mediator of the pathological neovascularization and vascular permeability in various ophthalmic diseases. With the increasing use of anti-VEGF therapy in adults, more and more clinical studies are focused on the application of anti VEGF therapy in pediatric retinal and choroidal diseases, including retinopathy of prematurity, Coats disease, familial exudative vitreoretinopathy, incontinence pigmented related retinopathy, sickle cell retinopathy, retinoblastoma and choroidal neovascularization caused by various causes. In this article, the application of anti VEGF therapy in these pediatric retinal and choroidal diseases was reviewed.

Abstract:Respiratory virus infection remains a major cause of morbidity and mortality in patients with respiratory diseases. The respiratory virus is predominantly spread by air or droplet through the exposed mucosa. Meanwhile the ocular mucosa is also exposed to air, so more and more attention has been paid to the correlation between respiratory virus and human ocular diseases. In this paper, we will summarize the research progress of the relationship between some familiar respiratory viruses and human eyes.

Abstract:AIM:To evaluate the long-term efficacy and safety of retinal photocoagulation combined with intravitreal injection of Ranibizumab(IVR)and simple Ranibizumab in the treatment of branch retinal vein occlusion secondary macular edema(BRVO-ME).

METHODS: The literatures related to randomized controlled clinical studies on the treatment of BRVO-ME with laser and Ranibizumab in Embase, The Cochrane Library, PubMed, China National Knowledge Infrastructure(CNKI), Wanfang Database and China Science and Technology Journal Database(VIP)were systematically retrieved, and the risk assessment was carried out and data indicators were extracted for the included studies. RevMan 5.3 software was used for data analysis and funnel plot was used to evaluate publication bias.

RESULTS: Totally 7 studies were included, with 641 eyes. There was no significant difference in the best corrected visual acuity(BCVA)between the laser combined with Ranibizumab group and the simple Ranibizumab group at 12mo \ and 24mo \ after treatment. There was no significant difference in central foveal thickness between the two groups at 12mo \ and 24mo \. There were no statistically significant differences in the injection times of Ranibizumab and the incidence of final adverse events between the two groups at 12mo and 24mo after treatment.

CONCLUSION: Compared with the treatment of BRVO-ME with simple Ranibizumab, there was no significant difference in the long-term efficacy of vision and central foveal thickness for the laser combined with Ranibizumab, and there was no significant difference in the injection times and safety of Ranibizumab.

Abstract:AIM: To evaluate the clinical effects of using anti-VEGF drugs combined with Steroids to treat macular edema(ME)secondary to retinal vein occlusion.

METHODS: Chinese and English electronic databases(Pubmed, Embase, Cochrane, CNKI, Wanfang and Weipu)were searched to obtain qualified random controlled test(RCT)researches from their foundation to January 2020. According to inclusion and exclusion criteria, two researchers retrieved the literature independently, extracted data and evaluate methodological quality. Review Manager 5.3 was used for Meta-analysis.

RESULTS: A total of 5 RCTs were identified with 212 patients. There was no significant difference in patients' best correct visual acuity(BCVA)improvement in 1mo, 3mo and 6mo between anti-VEGF combined with steroids and anti-VEGF monopoly. Significant difference was found in the relieve of ME in 1mo and 3mo(1mo: MD=-20.89, 95% CI: -34.65 to -7.13, P=0.003; 3mo: MD=-22.83, 95% CI: -33.68 to -11.97, P<0.0001), but not in 6mo between two groups. As for side effects and complications, the combination group occurs more often than the monopoly group(P=0.02). Meanwhile, significant difference was found in the number of injections between two groups(P<0.001).

CONCLUSION: Compared with the single use of anti-VEGF drugs, anti-VEGF drugs combined with corticosteroids for the treatment of ME secondary to RVO have the characteristics of rapid onset, fewer injections, and more economical. The treatment process should closely follow the patient's intraocular pressure and lens status.

Abstract:AIM: To analyze the influence of trifocal lens(AT LISA tri 839MP), Lenstec SBL-3 intraocular lens(IOL)and T SPHERIS 209M monofocal IOL implantation on vision and visual quality of patients with age-related cataract(ARC).

METHODS: Totally 114 patients(114 eyes)with ARC undergoing elective surgical treatment in the hospital between October 2018 and April 2019 were enrolled in the prospective clinical study. They were divided into LISA tri group, SBL group and monofocal group with 38 cases(38 eyes)in each group. They were treated with trifocal IOL(AT LISA tri 839MP), Lenstec SBL-3 IOL and CT SPHERIS 209M monofocal IOL, respectively. The corneal endothelium, vision and visual quality before operation and 3mo after operation were compared.

RESULTS:Three months after operation, no significant changes in corneal endothelial cell density(ECD), central corneal thickness(CCT)and the proportion of hexagonal cells in the three groups compared with preoperation(P>0.05), while the uncorrected distance visual acuity(UCDVA), uncorrected intermediate visual acuity(UCIVA)and uncorrected near visual acuity(UCNVA)were significantly improved(P<0.001). UCDVA, UCIVA and UCNVA of LISA tri group were(0.11±0.03)LogMAR,(0.17±0.05)and(0.09±0.02), which of SBL group were(0.12±0.02, 0.19±0.05, 0.08±0.02), all significantly better than(0.21±0.04, 0.24±0.07, 0.15±0.03)in monofocal group(P<0.05). 3mo after operation, the near off-glasses rate and visual satisfaction in LISA tri group were 92% and 97%, which in SBL group were 95% and 92%, all significantly higher than 66% and 68% in monofocal group(P<0.017). Compared with preoperation, the visual function and quality of life(VF-QOL)scores of the three groups significantly increased(P<0.001), which were significantly higher in LISA tri group and SBL group than in monofocal group(P<0.05).

CONCLUSION: Trifocal IOL(AT LISA tri-839MP)and Lenstec SBL-3 multifocal IOL implantation is superior to monofocal IOL in the treatment of patients with ARC, which can effectively improve vision and visual quality.

Abstract:AIM: To investigate the ocular surface changes of diffuse diabetic macular edema(DDME)treated by intravitreal injection of Conbercept.

METHODS: Twenty patients(20 eyes, right eyes)diagnosed as DDME and requiring vitreous injection of conbercept in the Department of Ophthalmology, the First Affiliated Hospital of Nanchang University from January 2019 to June 2019, were selected as experiment group. Experiment goup was treated with three vitreous injections of Conbercept. The left eyes of the patients without macular edema were treated as control group without any treatment. Before operation and on the first day after operation, we used corrected visual acuity, superficial punctate epithelial erosion(SPEE), lacrimal river height, intraocular pressure, symptom and sign scores, Schirmer I test(S I t)and corneal fluorescein staining(CSF)to estimate eyes.

RESULTS: Before treatment, there was no difference in intraocular pressure, the height of lacrimal river, OSDI score, S I t, CSF score between the two groups(P>0.05), and there was no superficial punctate epithelial erosion in both groups, but the corrected visual acuity of the control group was significantly better than that of the experimental group(0.50±0.20 vs 1.65±0.35, P<0.05). After treatment, the corrected visual acuity, lacrimal river height and S I t in the experimental group were significantly lower than those in the control group, OSDI and CSF scores were significantly higher than those in the control group(all P<0.05), and the intraocular pressure increased more significantly than that in the control group, but there was no difference between the two groups(P>0.05). Compared with before treatment, the corrected visual acuity of the experimental group was significantly improved, the lacrimal river height and S I t were significantly decreased, OSDI and CSF scores were significantly increased(P<0.05), but the intraocular pressure had no significant change(P>0.05); the observation indexes of the control group had no significant changes(P>0.05).

CONCLUSION: Intravitreal injection of conbercept in the treatment of diffuse diabetic macular edema can damage the ocular surface.

Abstract:AIM: To investigate the clinical effectiveness of conbercept intravitreal injection combined with panretinal photocoagulation for ischemic central retinal vein occlusion.

METHODS: A retrospective study has been conducted on 80 patients(80 eyes)of ischemic central retinal vein occlusion diagnosed and treated at Dalian No.3 People's Hospital from January 2017 to January 2019. These 80 patients have been divided into two groups based on treatment methods. In Group A, 40 patients(40 eyes)were given 3+PRN intravitreal injection of conbercept combined with panretinal photocoagulation. In Group B, 40 patients(40 eyes)accepted the treatment of 3+PRN intravitreal injection with conbercept. The best corrected visual acuity(BCVA)and central macular thickness(CMT)before and after treatment were recorded respectively at 3mo, 6mo and 12mo, and the clinical effectiveness and adverse reactions were observed and documented.

RESULTS: After 12mo: In group A, BCVA improved from 1.05±0.58 to 0.41±0.37(P<0.01).In group B, BCVA improved from 0.98±0.51 to 0.63±0.53(P<0.01). There was no significant difference between the two groups(P>0.05). In group A, CMT changed from 592.30±79.75μm to 260.08±86.23μm(P<0.01). In group B, CMT changed from 604.98±81.73μm to 406.83±162.97μm(P<0.01).CMT was better in Group A than Group B(P<0.01). The mean number of injections in group A(3.15±0.43 times)and group B(3.83±1.06 times)was statistically significant(P<0.01). During follow-up, no adverse events happened in Group A. Two patients were neovascular glaucoma after central retinal vein occlusion in Group B.

CONCLUSION:It is safe and effective to use intravitreal injection of conbercept to treat central retinal vein occlusion. Combining intravitreal injection of conbercept with panretinal photocoagulation can significantly improve BCVA, lead to further regression of macular edema and a more stabilized positive effect. It proves to reduce recurrence rate of the central retinal vein occlusion and decrease the chances of any complications.

Abstract:AIM: To investigate the correlation between macular mierostructure changes and visual outcomes after scleral buckling for macular-off primary rhegmatogenous retinal detachment(RRD)by three-dimensional optical coherence tomography(3D-OCT).

METHODS: Retrospective case review, the clinical data of scleral buckling in 30 eyes of 30 cases of RRD involving macular area were analyzed retrospectively. The changes of ellipsoid zone(EZ), external 1imiting membrane(ELM), subretinal fluid(SRF)and central retinal thickness(CRT)were observed and the relationship between them and best corrected visual acuity(BCVA)was analyzed by 3D-OCT at 2d, 2wk, 1, 3 and 6mo after operation.

RESULTS: Postoperative SRFH and CRT showed a descended trend. Postoperative BCVA showed an ascendant trend. Multiple comparisons: there were significant difference in each groups except SRFH(2wk vs 1mo, P>0.05), CRT(2d vs 2wk, P>0.05), BCVA(2d vs preoperation, 2wk vs preoperation, P>0.05). There are four forms of EZ and ELM::9 eyes, intact ELM and EZ(EZ+ELM+); B: 7 eyes, intact ELM with disrupted EZ:(EZ-ELM+); AC: 6 eyes, intact EZ with disrupted ELM:(EZ+ELM-); D: 8 eyes, disrupted ELM and EZ:(EZ-ELM-), the BCVA of the above four types are 0.15±0.04, 0.50±0.06, 0.54±0.05 and 0.59±0.09, there were significant difference in each groups except(C vs B, P>0.05)and(C vs D, P>0.05). The incidence of SRF was 87% 2d after operation, 46.6% patients had persistent SRF at 6mo after operation. Postoperative CRT was positively correlated with postoperative SRFH.

CONCLUSION: After scleral buckling, the macular microstructure showed dynamic changes. The effect of SRF may be manifested as BCVA delayed recovery. With the slow absorption of SRF, CRT decreased and BCVA increased. The intact ELM or EZ shows better vision, but the disrupted ELM means worse vision.

Abstract:AIM: To compare short-term effectiveness of E-eye IPL combined with meibomian gland expression to simple meibomian gland expression in the treatment of meibomian gland dysfunction(MGD).

METHODS: Totally 40 patients with MGD(80 eyes)visiting the Department of Ophthalmology of West China Hospital of Sichuan University from October 2019 to January 2020 were randomly divided into experimental group and control group. Both eyes in the experimental group received IPL combined with meibomian gland expression, while those in the control group received meibomian gland expression only once every 2wk for 3 times. During the whole treatment, patients in the two groups received 0.3% sodium hyaluronate 4 times a day. Metrics were collected before each treatment and 2wk after the last treatment to evaluate the short-term efficacy of IPL combined with meibomian gland expression.

RESULTS: OSDI and SPEED scores of the two groups decreased with statistical significance(P<0.05), but there was no statistical significance between the two groups(P>0.05). MGE and LLT of both groups increased. The increase in the control group was slower than that in the experimental group. MGE of the experimental group was higher than that of the control group after the second and third treatment, with statistical significance(P<0.05). BUT of both groups increased. Corneal staining in both groups decreased, and it decreased more in the experimental group than in the control group, with no statistical significance between the two groups(P>0.05). The visual quality in the two groups improved, but in improving visual quality the experimental group was much better than the control group(P>0.05). There was no significant change in tear secretion, incomplete blink ratio and meibomian gland loss rate in the two groups(P>0.05). There were no skin and visual impairment, intraocular pressure change, anterior segment inflammation and other complications in all subjects.

CONCLUSION:IPL combined with meibomian gland expression and meibomian gland expression alone are both safe and effective. IPL, which has good, rapid effects and cumulative effects, works better after reaching a certain number of treatments.

Abstract:AIM: To investigate the diagnostic value of Keratograph 5M for the diagnosis of dry eye(dry eye)tear film grading.

METHODS: Totally 100 eyes diagnosed with dry eye by conventional means and 40 non-dry eye eyes with suspected dry eye at the same time were enrolled through OPC. The immediate ocular surface parameters of the above cases were collected by the K5M ocular surface analyzer, including the first tear film rupture time(NIBUTf), the average tear film rupture time(NIBUTav), and the tear river height(TMH)which were utilized to evaluated the diagnostic efficacy of K5M compared to routine ocular surface examination on the index of dry eye tear film.

RESULTS: The comparison of NIBUTf, NIBUTav and TMH between dry eye group and non-dry eye group by K5M eye surface comprehensive analyzer showed statistically significant differences(all P<0.05). The coincidence rate between the NIBUTf of K5M ocular surface analyzer and the BUT of routine diagnosis was 78.6%, and the area under the ROC curve as well as the standard error were 0.042 and 0.795(P<0.01)with 95% confidence interval(0.712, 0.878); The coincidence rate between NIBUTav of K5M and BUT of routine examination diagnosis was 73.6%, and the area under the ROC curve as well as the standard error were 0.853 and 0.033(P<0.01), with 95% confidence interval(0.788, 0.917).The coincidence rate between TMH of K5M and the SⅠt of conventional diagnosis was 87.9%, and the area under the ROC curve as well as the standard error were 0.795 and 0.044(P<0.01), with the 95% confidence interval(0.709, 0.880). The sensitivity, specificity, correctness index, positive likelihood ratio, negative likelihood ratio, and odds ratio of the exploratory diagnosis of dry eye by NIBUTf combined with TMH were 98, 40, 38, 1.63, 0.05, and 32.6%, respectively. The sensitivity, specificity, correctness index, positive likelihood ratio, negative likelihood ratio, and odds ratio of the exploratory diagnosis of dry eye by NIBUTav combined with TMH were 86, 75, 61, 3.44, 0.187, 18.39%, respectively.

CONCLUSION: K5M ocular surface analyzer can provide accurate and reliable diagnostic value for single tear film index grading diagnosis of dry eye; compared with TMH combined with NIBUTav, TMH combined with NIBUTf was more sensitive but less specific in diagnosing dry eye.

Abstract:AIM: To analyze the difference of the angle between the long axis of lacrimal sac and bony nasolacrimal duct(BNLD)in patients with chronic dacryocystitis and normal eyes, and discuss the relationship between the angle and chronic dacryocystitis.

METHODS:A total of 218 patients(248 diseased eyes)from Sichuan Province who visited the ophthalmology department of our hospital from January 2016 to March 2019 were collected retrospectively. All patients underwent computed tomography dacryocystography(CT-DCG)immediately after bilateral lacrimal duct irrigation, and three-dimensional reconstruction of the nasolacrimal duct structure was performed. The structures of the nasolacrimal duct, lacrimal sac and its surrounding tissues were observed in the coronal position, and the lacrimal sac-BNLD angles of the diseased eyes and the normal eyes were measured respectively.

RESULTS:The lacrimal sac-BNLD angle of the diseased eyes \〖23.55°(17.30°, 29.90°)\〗 was higher than that of the normal eyes \〖20.05°(15.40°, 28.35°)\〗(P<0.05). Among them, the angle of the diseased eyes in female patients \〖24.60°(17.75°, 31.00°)\〗 was significantly higher than that in normal eyes \〖21.15°(15.10°, 27.35°)\〗(P<0.05), while there was no significant difference in the angle between the diseased eyes and normal eyes in male patients(P>0.05). In addition, the angle of the diseased eyes in the age group of 41-60 a \〖25.20°(17.90°, 33.00°)\〗 was significantly higher than that in normal eyes \〖21.60°(15.25°, 29.05°)\〗(P<0.05).

CONCLUSION: The angle between the long axis of lacrimal sac and bony nasolacrimal duct increased in patients with chronic dacryocystitis, which may be one of the factors causing the onset of chronic dacryocystitis in middle-aged and elderly women.

Abstract:AIM: To analyze the problems faced by teachers and undergraduates online teaching.

METHODS:A self-designed questionnaire survey and result of examination comparison were used. The contents of the questionnaire include the time used before and after class, the confusion faced by online teaching and the self-evaluation of teaching effect. 63 students and all teachers were participants in the questionnaire survey. The survey is from May 2020 to June 2020.

RESULTS: The average time spent by students before class of online teaching had no difference with that of offline teaching, while the average time spent by teachers for online teaching before class was significantly longer than that for offline teaching. 63% of the undergraduates considered that online teaching takes much more time to review after class. 95% of the students admitted that online teaching was easier to lose concentration because of lack of interaction with teachers, and 73% of teachers though that for online teaching they had less passionate compared to off line teaching. Regarding to the questionnaire survey, 73% of the instructors expected that the effect of online teaching would be worse than that of offline teaching. Surprisingly, 95% of the students thought that there had no significant difference in knowledge mastering between online and offline teaching after reviewing of courseware. For the future teaching model, 91% of the teachers and 79% of the students preferred the combination of watching pre-recorded video and live broadcasting.

CONCLUSION: The lack of interaction is the primary issue of online teaching. Online teaching can achieve the same effect as offline teaching,whereas it needs more post-class time for students. The combination of watching pre-recorded video and live-broadcasting is the online teaching mode recommended by teachers and students.

Abstract:AIM: To evaluate the effect of pupil dilation on ocular biometry and IOL power in cataract patients with high myopia, and the difference between cataract patients with high myopia and cataract patients with normal axial length(AL).

METHODS:Measurements of AL, corneal curvature(K including K1 and K2), anterior chamber depth(ACD)were performed using IOLmaster in 22 cataract patients with high myopia(34 eyes)(group A)and 23 cataract patients with normal AL(39 eyes)(group B)before and after pupil dilation. SRK-T and Haigis were used to caculate pre- and post-cycloplegic IOL power.

RESULTS:ACD after dilation(3.84±0.58mm)significantly increased comparing with ACD before dilation(3.61±0.35mm)in group A(P<0.01). ACD after dilation(3.30±0.70mm)also significantly increased comparing with ACD before dilation(3.13±0.63mm)in group B(P<0.01). But the difference of pre- and post-cycloplegic ACD between the two groups was not statistically significant(P>0.05). Pre- and post-cycloplegic AL and K(including K1 and K2)were not significantly different in two groups(P>0.05). The differences between pre- and post-cycloplegic IOL power were not statistically significant using the SRK-T and Haigis formula(P>0.05), but the IOL power changed by over 1D after pupil dilation using the SRK-T and Haigis formula respectively in 15% and 27% of eyes in group A,in 3% and 5% in group B.

CONCLUSION:ACD increases after pupil dilation in cataract patients with high myopia, which is not different from cataract patients with normal AL. Pupil dilation does not affect AL, K and the IOL power(using SRK-T and Haigis)in cataract patients with high myopia. But the IOL power may change greater than in cataract patients with normal AL, so we suggest IOL power should be measured and calculated without mydriasis.

Abstract:AIM: To compare the consistency of IOL Master 700 with IOL Master 500 and A-mode ultrasound for biological measurements, and evaluate the measurements of IOL Master 700 in preoperative examinations of cataract patients.

METHODS:In this prospective study, a total of 52 patients(100 eyes)diagnosed as age-related cataract were selected at the Nanjing Medical University Eye Hospital. All the patients were examined in turn by IOL Master 700, IOL Master 500 and A-mode ultrasound. Measurements by these three instruments were compared for axial length(AL), corneal curvature(Km), central anterior chamber depth(ACD), white-to-white(W-W)and pupil diameter(P). The results were analyzed by one-way ANOVA, Pearson correlation and Bland-Altman.

RESULTS: The detection rates of AL and ACD with IOL Master 700, IOL Master 500 and A-mode ultrasound were 98%, 87%, 99% and 100%, 99%, 99%; respectively. The detection of Km with IOL Master 700 and IOL Master 500 were 100%, 99%. The detection of W-W and P were both 99%. Among them, 24 eyes had high myopia, posterior scleral grape swelling and axial length ≥26mm. The detection of AL with IOL Master 700, IOL Master 500 and A-mode ultrasound were 96%, 79%, 96%. There was a significant difference in AL and ACD between three instruments(F=11.58, P=0.03; F=12.46, P=0.02). There were no significant differences in Km, W-W and P parameters among three instruments(all P>0.05). The average difference between three instruments for AL measurement: IOL Master 700 and IOL Master 500 was 0.05±0.12mm, IOL Master 700 and A-mode ultrasound was 0.16±0.14mm; The average difference between three instruments for AL measurement in axial length≥26mm: IOL Master 700 and IOL Master 500 was 0.17±0.16mm, IOL Master 700 and A-mode ultrasound was 0.55±0.22mm. The Pearson's correlation analysis showed that there was a high correlation between the measured results of each equipment. The consistency of AL results using Bland-Altman analysis showed there was good consistency in the range of 95% consistency.

CONCLUSION: There was high consistency in ocular biological measurements between three instruments in cataract eyes. However, the detection rate of IOL Master 700 in AL was higher than that of IOL Master 500, and the accuracy of the IOL Master 700 measurement was higher in the AL measurement in high myopia with posterior staphyloma. Compared with traditional examination equipment, IOL Master 700 has better penetration and accuracy to provide more accurate measurement parameters.

Abstract:AIM: To compare the detection rate of axial length(AL)in cataract eyes by Tomey OA-2000 and IOL Master 500, and to evaluate the repeatability of OA-2000 in measuring ocular biometrics parameters.

METHODS: A cross-sectional study of 270 cataract eyes was implemented in the ophthalmic outpatient department from July to September 2018. Ocular biometric measurements including AL, keratometry readings(K), anterior chamber depth(ACD), lens thickness(LT), central corneal thickness(CCT), pupil diameter(PD)and white to white(WTW)were performed using OA-2000 and IOL Master 500. The detection rates of AL were calculated and compared between the two devices.

RESULTS: AL detection rates of 86.3%(233/270)and 97.0%(262/270)were found by IOL Master 500 and OA-2000 respectively. The mean difference in the measured AL by the two devices was(0.007±0.129)mm, and the 95% limits of agreement(95%LoA)of AL was 0.01(-0.24 to 0.26)mm. OA-2000 demonstrated good repeatability in measuring AL, ACD, K(2.5mm and 3mm pupil diameter), LT and CCT, but not in measuring PD and WTW.

CONCLUSION: Both OA-2000 and IOL Master 500 showed good agreement in AL measurement in cataract patients. However, compared with IOL Master 500, OA-2000 has a higher detection rate of AL. OA-2000 not only demonstrates excellent repeatability in ocular biometric measurements including AL, ACD, K, LT and CCT, but also more advantageous for the AL measurement of cataract with heavy lens opacity and subcapsular opacity.

Abstract:AIM:To investigate the function of Pentacam in accurately selecting the model and axial position of Toric artificial lens.

METHODS: Totally 53 eyes of 46 cataract patients who were scheduled to receive phacoemulsification from January 2018 to December 2018 were selected in our hospital. Before the operation, corneal astigmatism was greater than 1.0D according to the examination results by AL-Scan and automatic corneal curvature instrument, and Pentacam was used to evaluate the corneal astigmatism to guide the accurate selection of Toric IOL model and the axial position to be implanted. Surgery was done by the same doctor. After operation, the patients were traced and visited for 3mo to collect the uncorrected visual acuity(UCVA), the best corrected visual acuity(BCVA), the whole-eye astigmatism, the corneal curvature and target induced astigmatism(TIA)before and after the operation as well as the postoperative astigmatism, the rate not relying on the glasses, visual quality assessment and so on.

RESULTS: There was no obvious change on patients' corneal astigmatism before and after the operation. The whole-eye astigmatism was reduced and UCVA and BCVA were obviously improved. The difference was statistically meaningful(P<0.05). The postoperative residual astigmatism and TIA were statistically tested, and the results showed no statistical significance(P>0.05). The rate of distant vision defecation and visual quality were significantly improved.

CONCLUSION: Pentacam can evaluate the corneal astigmatism more comprehensively and accurately, which is helpful to guide the accurate selection of Toric artificial lens model, and to improve the postoperative expected effect.

Abstract:AIM: To study the changes of serum IL-35 and TGF-β₁ expression levels and the correlation between them in patients with acute anterior uveitis, and to explore the clinical significance of IL-35 and TGF-β₁ levels in patients with acute anterior uveitis.

METHODS: Thirty patients with acute anterior uveitis confirmed in the Department of Ophthalmology of Gansu Provincial Hospital into 2018-05/2019-05 were selected as the case group, and thirty healthy patients who received physical examination at the Gansu Provincial Hospital during the same period were selected as the control group. Serum IL-35 and TGF-β₁ expression levels between the two groups were detected by Elisa. Modified endotoxin-induced uveitis(EIU)clinical standard was used for the severity of acute anterior uveitis.

RESULTS: Serum IL-35 and TGF-β₁ expression levels in the acute anterior uveitis group were significantly higher than that in the healthy control group(all P<0.05), and there was no significant correlation between serum IL-35 and TGF-β₁ levels as well as the severity of acute anterior uveitis(r_s=0.087, 0.044, all P>0.05). There was a significant positive correlation between serum IL-35 and TGF-β₁ expression levels in patients with acute anterior uveitis(r_s=0.637, P<0.001).

CONCLUSION: The expression levels of IL-35 and TGF-β₁ in serum are closely related to the occurrence and development of acute anterior uveitis and may play a synergistic role in immunosuppression in acute anterior uveitis.

Abstract:AIM: To determine the clinical characteristics of intraretinal microvascular abnormality(IRMA)and associated neovascularization.

METHODS:This was a prospective, observational study. We recruited treatment-naive patients with diabetic retinopathy(DR)with IRMAs or retinal neovascularization, confirmed using fundus fluorescein angiography(FFA)between October 7, 2016 and December 10, 2017. Under the guidance of FFA, IRMAs and neovascularizations were scanned using optical coherence tomography angiography(OCTA). Origins, initial layers, morphologic features, retinal nonperfusion areas(NPAs), location with capillary nonperfusion(CNP)and leakages demonstrated by FFA of IRMAs and associated neovascularization were documented and compared. Retinal nonperfusion areas were measured using Image J software.

RESULTS: Thirty-nine eyes of 36 patients were enrolled in this prospective study. High quality images of twenty IRMAs and 22 IRMA-associated neovascularizations were identified using OCTA. All IRMAs originated from and drained into veins in pruned-tree-like shapes. IRMAs originated from the major retinal vessels at the margin of the CNP, extended into retina and were always confined within a single original nonperfused area. All IRMA-associated neovascularizations originated from IRMAs with a sea-fan-like appearance. The IRMA associated neovascularizations crossed retinal venous and extended to both sides. The main part of these structures was intraretinal, except some advancing tips that breached the internal limiting membrane(ILM)to form neovascularization, and were adhered firmly to the retina; 91%(20/22)of IRMA-associated neovascularizations were located in the CNPs, and 9%(2/22)were located at the margin of CNPs. The affiliated NPAs of IRMA-associated neovascularizations were 26.1mm²±4.2mm², significantly larger than the IRMAs(12.9mm²±4.7mm², P<0.05). The initial layers showed no statistic difference between the groups(P>0.05).

CONCLUSION: OCTA is an effective method for detecting both IRMA and neovascularization in DR. IRMA and associated neovascularization had significantly different clinical characteristics that can be differentiated by OCTA, and therefore may be useful to better understand pathophysiological mechanisms and to guide efficient therapeutic strategies for DR patients.

Abstract:AIM: To investigate the effect and safety of endoscopic-assisted RS silicone intubation for congenital nasolacrimal duct obstruction after failed probing in children, in order to guide the clinical application.

METHODS: Retrospective case series. Totally 158 children(158 eyes)with congenital nasolacrimal duct obstruction who were failed probing in our hospital from September 2016 to September 2019 were selected as the research subjects. All patients underwent endoscopic-assisted RS silicone intubation. Regular follow-up was performed 1, 3, and 6mo after surgery. Observe the children's gender, age, treatment history, presence or absence of discharge before surgery; treatment effect; complications; types of nasolacrimal duct obstruction. Spearman's correlation coefficient calculation and analysis of the relationship between ages, times of probing and operation efficiency, Fisher's exact probability test for the operation efficiency of different types of nasolacrimal duct obstruction, and chi square test for the operation efficiency of presence or absence of discharge.

RESULTS: The total effective rate was 89.9%(142/158). The effective rate of surgery tends to decrease with age(Spearman's correlation coefficient r_s= -1.000, P<0.01). The effective rate of surgery showed a downward trend with the increase of the times of probing(Spearman's correlation coefficient r_s= -1.000, P<0.01). The efficiency of membranous nasolacrimal duct obstruction surgery is higher than that of complex nasolacrimal duct obstruction, and the difference is statistically significant(P<0.05). It cannot be considered that there is a statistically significant difference in the effectiveness of the operation between the two symptoms with or without discharge(P>0.05). The main complications were: false passage formation(16 eyes, 10.1%), loss of tube(14 eyes, 8.9%), red eyes and irritated tears(18 eyes, 11.4%), punctums tissue adhesion(3 eyes, 1.9%), punctum granuloma formation(1 eye, 0.6%).

CONCLUSION: Endoscopic-assisted RS silicone intubation has a higher effective rate and better safety in the treatment of congenital nasolacrimal duct obstruction after failed probing in children. The effective rate of surgery decreases with age, and decreases with the increase of the times of probing. Membranous nasolacrimal duct obstruction is more effective than complicated nasolacrimal duct obstruction.

Abstract:AIM: To explore the effect of nasal septum deviation(NSD)on the curative effect of endonasal endoscopic dacryocystorhinostomy(EES-DCR).

METHODS: Totally 84 patients(84 eyes)who have been diagnosed with chronic dacryocystitis in our hospital from June 2017 to May 2019 were collected and then the patients were divided them into two groups according to whether NSD existed through the preoperative nasal endoscopy. Group A included 42 patients(42 eyes)who had no NSD while Group B included 42 patients(42 eyes)who had NSD(mild or moderate). The EES-DCR was performed under general anesthesia in both groups. The preoperative treatment indexes, evaluative efficacy after 6mo follow up and nasal adhesion were compared between the two groups after operation.

RESULTS: The operation time and intraoperative blood loss of group B(69.9±13.1min, 51.8±16.4mL)exceeded group A(53.4±11.7min, 24.9±12.0mL)respectively(P<0.05), while the hospitalization time between two groups showed no difference(P>0.05). Follow up for 6mo: the effective rate of group A was 86% while group B was 71%(P>0.05); No nasal adhesion was found in group A while 12% incidence existed in group B, with no difference between the two groups(P>0.05).

CONCLUSION: Patients who have chronic dacryocystitis combined with mild or moderate NSD do not need to perform a septoplasty simultaneously if the symptom does not accompany by nasal dysfunction. Only by performing the EES-DCR can achieve a quite good result.

Abstract:AIM: To investigate the therapeutic effect of optimal pulse technology combined with tea tree essential oil paste in the treatment of Demodex blepharitis.

METHODS: Prospective clinical study. Totally 283 patients(566 eyes)with Demodex blepharitis were selected and randomly divided into three groups. Group A(94 cases, 188 eyes)was treated with optimal pulse technology, group B(96 cases, 192 eyes)was treated with tea tree essential oil paste, and group C(93 cases, 186 eyes)was treated with optimal pulse technology combined with tea tree essential oil paste. After 6wk of treatment, the number of Demodex, subjective symptom score, clinical sign score, tear film rupture time and corneal fluorescein staining were analyzed.

RESULTS: There was no significant difference in Demodex count, symptom score, sign score, tear film rupture time and corneal fluorescein staining among the three groups before treatment(P>0.05). After treatment, the number of Demodex among the three groups were significantly reduced(P<0.05), and there were significant differences among group C, group A and group B(P<0.05). The scores of subjective symptoms and signs of the three groups were significantly improved after treatment(P<0.05), and the improvement of group C was more significant than that of group A and group B(P<0.05). After treatment, tear break-up time of the group B not significantly improved, tear break-up time that of group C was significantly longer than that of groups A and B(P<0.05); Fluorescent staining scores of three groups before and after treatment were significantly improved(P<0.05). The statistical results of group C were better than those of groups A and B, but there was no difference among the three groups. No obvious complications occurred in all patients.

CONCLUSION: The effect of optimal pulse technology combined with tea tree essential oil in the treatment of acariasis blepharitis is significant, which is significantly better than that of single optimal pulse technology therapy and single use of tea tree essential oil.

Abstract:AIM:To explore the clinical efficacy of probing lacrimal passage combined with tobramycin eye drops in the treatment of congenital dacryocystitis.

METHODS: A total of 228 children(250 eyes)aged from 6mo-3a with congenital dacryocystitis treated in our hospital from January 2017 to June 2019 were included. They were assigned into three groups by age: 133 patients(149 eyes)aged from 6mo-1a(Group A), 62 patients(64 eyes)aged from 1-2a(Group B), and 33 patients(37 eyes)aged from 2-3a(Group C). All patients received lacrimal duct probing in surface anesthesia combined with postoperative tobramycin eye drops.

RESULTS: The probing cure rates of congenital dacryocystitis among there groups were 97.3%(Group A), 92.2%(Group B)and 83.8%(Group C), respectively. No adverse events reported. Through comparison of these three groups, the cure rate of children from 6mo-1a was the highest. The difference was statistically significant(P=0.009).

CONCLUSION: Lacrimal duct probing is effective in the treatment of congenital dacryocystitis, and it is safe and reliable to combine tobramycin eye drops(TOBREX)after surgery. The best time for treatment is 6mo-1a. The operation is simple, less complication, with high clinical value.

Abstract:AIM:To evaluate the efficacy and safety of azithromycin aerosol fumigation combined with meibomian gland massage in the treatment of meibomian gland dysfunction(MGD).

METHODS: In this prospective study, 47 patients with moderate to severe MGD were treated with azithromycin aerosol fumigation combined with meibomian gland massage. The ocular surface disease index(OSDI)questionnaire, noninvasive tear breakup time(NI-BUT), tear meniscus height and atrophic rate of meibomian glands were recorded at baseline, at 1mo after treatment, and at 3mo after treatment.

RESULTS: The OSDI was 21.43±13.14, the first NI-BUT was 9.03±6.09s, the average NI-BUT was 9.72±4.05s, and the tear meniscus height was 0.24±0.09mm after 1mo of treatment. The OSDI was 23.02±11.41, the first NI-BUT was 7.80±4.82s, the average NI-BUT was 10.25±4.78s, and the tear meniscus height was 0.24±0.09mm after 3mo of treatment. Compared with the baseline, the difference was statistically significant(all P<0.05); There was no significant difference in OSDI, first NI-BUT, average NI-BUT and tear meniscus height between 1mo after treatment and 3mo after treatment(all P>0.05). Compared with baseline, there was no significant improvement in atrophic rate of meibomian glands after 1mo of treatment and 3mo after treatment(all P>0.05). In addition, azithromycin aerosol fumigation administration was well tolerated and no adverse reactions were observed during follow-up(all P>0.05).

CONCLUSION: Azithromycin aerosol fumigation combined with meibomian gland massage can effectively improve the clinical symptoms and increase first NI-BUT, average NI-BUT, tear meniscus height of patients with moderate to severe MGD.