Abstract:AIM: To evaluate the differences of macular vascular network measured by optical coherence tomography angiography(OCTA)between severe non-proliferative diabetic retinopathy(S-NPDR)eyes and health eyes, and explore the changes of these OCTA characteristics in patients with S-NPDR before and after panretinal photocoagulation(PRP).

METHODS: This was a prospective study including 31 eyes from 18 consecutive patients with S-NPDR and 31 eyes of healthy subjects. We measured macular vascular density and foveal avascular zone(FAZ)area and volume by an OCTA device.

RESULTS: Compared to the normal control group, in superficial retinal capillary plexus(SCP), macular vascular density decreased in S-NPDR group, except foveal vascular density unchanged. Consistently, in deep retinal capillary plexus(DCP), macular vascular density was also lower in S-NPDR group. In addition, FAZ area and volume expanded in S-NPDR eyes. At 6mo post-PRP in S-NPDR eyes, foveal SCP and DCP densities increased significantly, while FAZ area and volume decreased. At 3mo post-PRP, only foveal vascular density in DCP increased. The changes of foveal SCP and DCP densities as well as FAZ area and volume were not statically significant at 1mo post-PRP.

CONCLUSION: Macular vascular network was impaired in S-NPDR assessed by OCTA. Although OCTA parameters were not significantly affected by PRP in 1 and 3mo period, at 6mo follow-up parameters became significant after PRP.

Abstract:AIM:To figure out the sequence of vessel density(VD)changes in the retina and deformation induced by mechanical force in the optic nerve head(ONH)tissue during intraocular pressure(IOP)elevation.

METHODS: This prospective study tested 34 eyes from 34 healthy volunteers. Group A had 23 subjects. Their testing protocol included a baseline phase, two elevated IOP phases(15 mmHg and 30 mmHg respectively for 2min), and a recovery phase. Group B had 11 subjects, and their protocol included an IOP elevation of 15 mmHg for 10min. In each phase the deformation in the ONH and macular region were scanned by optical coherence tomography(OCT), and Bruch's membrane opening(BMO)distance, the optic nerve head surface depth(ONHSD), the subfoveal choroidal thickness(SFCT)were measured, the VD was measured by OCTA.

RESULTS: After the first IOP elevation in group A, the VD in the ONH decreased(superficial capillary plexuses, from 67.39±7.65% to 43.78±5.89%, P<0.05), the BMO distance, the ONHSD, the VD in the macula and the SFCT did not change. After the second IOP elevation, the VD in the ONH and in the macular region both decreased, the BMO distance and ONHSD increased(all P<0.05). After the IOP elevation in group B, the VD in the ONH and in the macular region decreased significantly, the BMO distance increased, the SFCT did not change. ONH VD reduction is not associated with BMO distance increment(r=0.050, P>0.05).

CONCLUSION:The ONH tissue is more sensitive to hemodynamics than to morphological change. Hemodynamics during IOP elevation differs in the ONH and the macular tissue.

Abstract:AIM:To study the effect of vitamin E on the injury of human retinal pigment epithelial(hRPE)cells induced by high-dose blue light, and provide experimental evidence for intercepting blue light damaged hRPE cells.

METHODS: The hRPE cell injury model was established with 3000±150Lx blue light. The apoptosis rate and reactive oxygen species(ROS)of the six groups of hRPE cells were detected by flow cytometry at 0, 3, 6, 9, 12 and 24h respectively. Apoptosis and ROS in hRPE cells were detected by cytometry in 0h-irradiation group, 6h-irradiation group, and vitamin E added groups(vitamin E concentration 10, 50, 100μmol/L)before or after 6h-irradiation. The fluorescence intensity of hRPE cells was observed under a fluorescence microscope using Hoechst 33258 staining reagent.

RESULTS: Compared with the 0h-irradiation group, the relative amount of reactive oxygen species increased significantly in 3, 6, 9, 12 and 24h groups(all P<0.01), the apoptosis rate of hRPE cells increased significantly in 6, 9, 12 and 24h groups(all P<0.01), the apoptosis rate of the 3h-irradiation group was not statistically significantly increased(P=0.46). Compared with the 6h-irradiation group, the relative amounts of ROS and apoptotic rate of the six groups of hRPE cells added vitamin E were significantly decreased, and the blue fluorescence of Hoechst 33258 released in the cells gradually decreased, which was concentration dependent(all P<0.01),except for apoptosis rate of hRPE cells in the 10 μmol/L vitamin E group before irradiation(P=0.66). Compared with the 0h-irradiation group, the difference in the relative amount of ROS and apoptosis rate of hRPE cells in added groups were statistically significant(all P<0.01). At the same concentration of vitamin E, the relative amount of ROS and apoptosis rate of hRPE cells added vitamin E after irradiation were significantly lower than those added vitamin E before irradiation(all P<0.01), except for apoptosis rate of hRPE cells in the 10 μmol/L vitamin E group, which had no difference between added before and after irradiation(P=0.08).

CONCLUSION: After hRPE cells had been irradiated by blue light, the increase in the relative amount of intracellular ROS was earlier than that of apoptosis. Elimination of intracellular ROS is the idea of intercepting high doses of blue light induced hRPE cell injury. Vitamin E protects RPE cell against damage induced by high doses of blue light, and the effect becomes stronger as the concentration of vitamin E increases, which is better when added after irradiating. However, it doesn't take effect until the concentration reaches a certain level. And the damage can't be completely repaired.

Abstract:AIM: To investigate the potential toxic effects of paclitaxel(PTX)on the proliferation, apoptosis, cell cycle, morphology, and blood-retinal barrier(BRB)of human retinal pigment epithelial cells(ARPE-19).

METHODS: ARPE-19 cells were cultured in vitro and divided into two groups: Control group(Control)and drug plus group(PTX). ARPE-19 cells were treated with different concentrations of PTX(0.005, 0.05, 0.5, 5mg/L)for a certain period of time(12, 24, 36, 48, 72h), and CCK8 assay and flow cytometry were used to detect the effects of drug on proliferation and apoptosis of ARPE-19 cells at different concentrations and time points. The same time, the cell cycle was detected by flow cytometry. Morphological changes of cells were observed by immunofluorescence. Expressions of apoptosis-related proteins and barrier function-related proteins were detected by Western blot. The effect of the drug on the cell barrier was measured by measuring the transepithelial resistance of the cells.

RESULTS: PTX reduced the proliferation ability of ARPE-19 cells. After 36h of treatment with low concentration of 0.005mg/L paclitaxel, cell proliferation began to be affected. At the same time, PTX accelerated cell apoptosis was dependent on drug concentration and time. Flow cytometry showed that the cells were arrested in the G2-M phase. In addition, PTX causes significant morphological changes in cells, with normal cells fusiform or irregular. In the PTX group, the number of cells decreased and the cell shape tended to be round. PTX affected retinal barrier function, and the transepithelial resistance of cells was significantly decreased after treatment, and the expression of tight junction proteins ZO-1 and Occludin were significantly decreased compared with the control group(P<0.05). The expression levels of Cleaved-caspase-3 and Bax were significantly increased compared with the control group, while the expression levels of Bcl-2 were significantly decreased(P<0.05)and was dependent on drug concentration and time.

CONCLUSION: PTX can affect the proliferation and apoptosis of ARPE-19 cells, and it depends on time and concentration. In addition, PTX affected the cell cycle and morphology of ARPE-19 cell. At the same time PTX can destroy the barrier function of the retina,suggesting that anti-tumor drugs have a potential toxic effect on the retina.

Abstract:AIM: To explore the value of corneal epithelial thickness parameters in the diagnosis of early keratoconus by Fourier domain optical coherence tomography(FD-OCT).

METHODS: Retrospective control study. Patients with early keratoconus who were admitted to the Department of Ophthalmology of the First Affiliated Hospital of Soochow University from January 2015 to October 2020 and patients who received laser refractive surgery for myopia during the same period were included in this study. Using FD-OCT to measure the cornea in circle centralized by the pupil and with diameter of 9mm in the early-keratoconus group and the control group. This was to obtain the thickness parameter of corneal epithelium with diameter of 7mm, the respective averaged thickness value of corneal epithelium and the respective averaged thickness value of the full corneal layer on each of the 25 divisions. The parameter value differences between the early-keratoconus group and the control group were compared, and the diagnosis value of parameters that hold difference was analyzed.

RESULTS: The Min_-e value in early-keratoconus group was significantly lower than that of the control group. On contrary, the value of Std.Dev, Max-Min_-e, and Max_-e were significantly higher in early-keratoconus group than that in latter one(all P<0.001). The value of Std.Dev and Max-Min_-e hold a greater diagnostic efficiency on diagnosis of early keratoconus(AUC=0.937, 0.928), while Max _-e value and Min_-e value performed a medium diagnostic efficiency(AUC=0.871, 0.797). Analysis on thickness of corneal epithelium on the 25 divisions found that the thickness of corneal epithelium at infratemporal region of inner ring(EIT₁)became thinner most obviously in early-keratoconus group, with greatest diagnostic efficiency(AUC=0.827). The average corneal thickness of the 25 zones of the early keratoconus group was significantly thinner than that in the normal control group. Averaged corneal thickness at infratemporal region of inner ring(CIT₁)hold a relatively high diagnostic efficiency among the 25 divisions(AUC=0.903).

CONCLUSION: The parameter values of corneal epithelium thickness including Std.Dev, Max-Min_-e, Max_-e, Min_-e, the averaged thickness value of corneal epithelium at infratemporal region of inner ring, and the thickness value of full corneal layer at infratemporal region of inner ring can all be used for diagnosis of early keratoconus.

Abstract:AIM: To discuss the measurement of retinal thickness in each macular region, fixation property, best corrected visual acuity(BCVA), eye axis and equivalent spherical power and treatment time for the children with hyperopia anisometropic amblyopia before and after treatment.

METHODS: This study was a prospective longitudinal controlled trial. The subjects were 40 hyperopia anisometropia children aged 4-8 years with monocular amblyopia who had not been treated with amblyopia before diagnosis in our hospital(20 cases of central fixation and 20 cases of paracentral fixation)from August 2018 to August 2019. Atropine mydriatic optometry, fundus macular fixation quality, ocular axis and optical coherence tomography(OCT)retinal thickness were used in the initial diagnosis and 6mo and 1a follow-up. Statistical analysis was used to analyze whether the macular retinal thickness of hyperopia amblyopia had changed in the treatment and the related factors, and whether had differences between different fixation properties.

RESULTS: There were significant differences in foveal retinal thickness and nasal retinal thickness of inner ring between central fixation group and paracentral fixation group at different measurement times(before treatment, 6 and 12mo after treatment)(P<0.01). There were no significant changes in the other retinas in macular area(P >0.05). With the extension of treatment time, the foveal retinal thickness and the nasal retinal thickness of the inner ring in the central fixation group and the paracentral fixation group became thinner(all P<0.05). At the same measurement time, the thickness of fovea and inner ring nasal retina in the central fixation group was thinner than that in the paracentral fixation group(all P<0.05), and there were no significant differences in the thickness of other retinas in the macular region(all P>0.05). There were significant differences in ocular axis, BCVA and equivalent spherical power of amblyopia before and after treatment(all P<0.05); With the extension of treatment time, the length of ocular axis and BCVA had increased and the degree of equivalent spherical mirror had decreased. The macular retinal thickness of hyperopia amblyopia was thicker than that of contralateral normal eyes, and the length of ocular axis was shorter than that of contralateral normal eyes(all P<0.01). The axial length of amblyopia and normal eyes had changed significantly before and after treatment(all P<0.01). The axial length of amblyopia was shorter than that of normal eyes. With the extension of treatment time, the axial length of amblyopia and normal eyes had become longer.

CONCLUSION:The thickness of macular retina in moderate and high amblyopic eyes was greater than that in contralateral normal eyes, and the ocular axis was shorter than that in contralateral normal eyes. After treatment, with the improvement of best corrected visual acuity, the retinal thickness of fovea and nasal side of inner ring in central fixation group and paracentral fixation group had decreased.

Abstract:AIM:To compare the effect of comprehensive treatment in children with anisometropia and strabismus amblyopia.

METHODS: Prospective study. Forty-six individuals(mean age 9±3 years old, 26 males, 20 females)with previously untreated monocular amblyopia were recruited in our hospital from July 2018 to January 2020. There were 23 patients with strabismus monocular amblyopia(mean age 9±3 years old, 12 males, 11 females)and 23 patients with anisometropia monocular amblyopia(mean age 9±3 years old, 14 males, 9 females). The best corrected visual acuity(Tumbling E Chart)and stereopsis(Titmus)were measured before and after a 6mo period of comprehensive treatment(refractive correction, patching and precision eyesight training). The differences of monocular visual benefits(visual acuity)and binocular visual benefits(stereopsis)between two groups before and after treatment were compared.

RESULTS: Before treatment, there was no significant difference of best corrected visual acuity between anisometropia amblyopia and strabismus amblyopia(t= -0.475, P>0.05), but the stereopsis of strabismus amblyopia was significantly lower than that of anisometropia amblyopia(t= -3.919, P<0.001). After 2mo treatment, there was a significant difference in best corrected visual acuity benefits between anisometropia amblyopia and strabismus amblyopia(t= -2.946, P<0.01), but there was no significant difference in stereopsis benefits between anisometropia amblyopia and strabismus amblyopia(t=1.305, P>0.05). After 6mo treatment, there was a significant difference in visual acuity benefits between anisometropia amblyopia and strabismus amblyopia(t= -2.353, P<0.05), and there was also a significant difference in stereopsis benefits between anisometropia amblyopia and strabismus amblyopia(t=2.218, P<0.05). However, the stereopsis of strabismus amblyopia was still lower than that of anisometropia amblyopia at 6mo(t=-2.760, P<0.01).

CONCLUSION: We conclude that the stereopsis of patients with strabismus amblyopia is more severe than those with anisometropic amblyopia before treatment under the same visual acuity. The visual acuity of patients with anisometropic amblyopia recovers faster than patients with strabismus amblyopia through treatment. While the stereopsis of patients with strabismus amblyopia recovers faster than patients with anisometropic amblyopia, but the level of stereopsis with strabismus amblyopia is still lower than that of patients with anisometropic amblyopia.

Abstract:Circular RNA(circRNA)is a single-stranded covalently closed RNA molecule produced by reverse splicing, which is an evolutionarily conserved and stable transcript, and widely exists in various eukaryotic cells. CircRNA is more stable and conserved than linear transcripts because of the absence of 5'cap and 3'polyadenylation tail in circRNA. A variety of bioactive processes are regulated by circRNA, such as cell differentiation, proliferation, angiogenesis and cell apoptosis. CircRNAs were shown to be key regulators of various diseases, especially cancers, neurodegenerative and cardiovascular. Recently, with the rapid development of RNA high-throughput sequencing technology, accumulating evidence shows that there are multiple differentially expressed circRNAs in ocular tissues and they play important roles in initiation, progression, and prognosis of diverse ocular diseases, such as glaucoma, cataract, retinopathy, ocular tumors and ocular immunologic diseases. In this article, the research on the relationship between circRNA and ophthalmic diseases in the recent years is briefly reviewed, and the purpose is to provide reference for its clinical treatment and prognosis.

Abstract:Metastasis-associated lung adenocarcinoma transcript 1(MALAT1)is one of the first identified LncRNA associated with human diseases. Unlike most members of the LncRNA family, MALAT1 is found in almost all human tissues and expressed at a relatively high level. At present, MALAT1 is known to play a vital role in the pathophysiological process of many diseases such as tumors, cardiovascular diseases, and nervous system diseases. In recent years, studies have found that MALAT1 may be involved in many ocular diseases(such as diabetic retinopathy, cataracts, glaucoma, retinoblastoma, neonatal retinopathy, etc.)play an important role in the pathological development process, and it is expected to become an effective target for the diagnosis and treatment of eye diseases. This article summarizes the research progress of eye diseases in which MALAT1 has participated in recent years.

Abstract:Brain-derived neurotrophic factor(BDNF)is a basic protein, and a member of neurotrophic factor family, which plays an important role in the development, differentiation and maintenance of neurons. A large number of studies have confirmed that BDNF is involved in the occurrence and development of neurodegenerative diseases such as Parkinson's disease and Alheimer's disease, and has a neuroprotective effect. In the retina, BDNF is mainly produced by retinal ganglion cells, amacrine cells, astrocytes, retinal glial cells(Müller cells)and photoreceptors. In recent years, related studies have found that BDNF is involved in the occurrence and development of glaucoma, diabetic retinopathy(DR)and other ocular diseases, and may have a diagnostic role, which will be beneficial to early intervention of patients to avoid the development of advanced glaucoma or DR. On the other hand, BDNF-based therapies have achieved good results in in vitro and in vivo experiments of glaucoma, DR and amblyopia, which may provide more choices for the treatment of these ocular diseases. In this manuscript, the research progresses of BDNF in ocular diseases in recent years were reviewed.

Abstract:Microbial mixed infectious keratitis is an ocular surface disease caused by corneal infection, which has an acute onset and rapid progression and can lead to blindness in severe cases. Establishing an animal model of microbial mixed infectious keratitis is conducive to exploring its pathogenesis, prevention, clinical diagnosis and treatment. This article reviews the methods of making animal models of mixed infectious keratitis with microorganisms and the diagnostic methods after successful modelling infections, aiming to provide references for the further development and research of animal models of the disease.

Abstract:Diagnosis of early keratoconus(KC)contributes to identifying potential patients before typical clinical symptoms. It also contributes to timely intervention of the progress of disease and improvement of long-term prognosis. Hence, it is crucial to prevent iatrogenic corneal ectasia and reduce the burden of keratoplasty. There are diverse kinds of early KC diagnosis techniques, including corneal topography, corneal aberrations, epithelial and corneal thickness measurement, corneal confocal microscopy, corneal biomechanics, and genetic examination. Since it is often difficult to ensure sufficient sensitivity and specificity with single technique, multiple techniques are beneficial to evaluate the cornea comprehensively, which may become the development tendency of early KC diagnosis in the future.

Abstract:Primary angle-closure glaucoma(PACG)is an irreversible disease-causing blindness, the damage of optic nerve is caused by elevated intraocular pressure(IOP)as a result of angle-closure. Angle-closure is a fundamental pathologic process in PACG. In addition, PACG is characterized by elevated IOP as a result of mechanical obstruction of the trabecular meshwork by either apposition of the peripheral iris to the trabecular meshwork or by a synechial closed angle. In recent years, with the development of ophthalmic imaging technology, the iris has been recognized as necessary to complement anatomical risk factors in assessing the risk of PACG. In this review, we intend to describe the potential role of the iris in the pathogenesis of PACG, so as to provide new ideas and directions for prevention and treatment of such disease.

Abstract:Age-related macular degeneration(ARMD)is a main cause of irreversible visual impairment in the elderly. The major pathological features are drusen formation, macular pigment disorder, geographic atrophy and abnormal neovascularization. Retinal pigment epithelium(RPE)function is impaired in ARMD. Endoplasmic reticulum(ER)is an organelle in eukaryotes responsible for protein synthesis, modification, integration and quality control. ER also participates in the maintenance of calcium homeostasis and lipid biosynthesis. Stimuli from the external and internal environment may trigger ER stress and therefore activate the intracellular signal transduction pathway-the unfolded protein response(UPR), to restore cell homeostasis. However, prolonged ER stress may lead to apoptosis. The pathogenesis of ARMD has not been fully elucidated, nevertheless, compelling evidence demonstrates that ER stress is involved. In this article, we summarize recent advances in UPR pathways, as well as the role of ER stress in the physiological function of RPE and in the pathogenesis of ARMD.

Abstract:Diabetic retinopathy(DR), one of the most common diabetes-specific microvascular complications, is classically described by intraretinal microvascular abnormalities and neovascularization. It is the main reason why visual impairment and blindness in people aged 20-65 years worldwide. Glycolysis can provide energy by converting glucose into pyruvate. Endothelial cells mainly utilize glycolysis to produce ATP to maintain the function, including forming tight junctions and barrier functions. Pyruvate kinase(PK)M2(M2 isoform of pyruvate kinase)is a key enzyme of glycolysis and is widely expressed in most tissues. As major cellular components in the retina, endothelial cells and photoreceptor cells play a crucial role in the occurrence and development of DR. Studies have shown that PKM2 takes part in the development of DR by regulating the function of endothelial cells and photoreceptors in metabolic and non-metabolic ways. Therefore, this article overviews the role of PKM2 in DR from the direction of endothelial cells and photoreceptor cells and provides new insight into the diagnosis and treatment of DR.

Abstract:Nonarterial anterior ischemic optic neuropathy(NAION)is a group of common optic nerve diseases that seriously endanger visual function. It is resulted from insufficient perfusion of the posterior ciliary artery, which causes acute ischemia, structural and functional disorders of the optic nerve, and ultimately leads to hypopsia and even vision loss. The etiology and pathogenesis of this disease is complex. It is nowadays considered that multiple factors including local anatomy, risk of systemic vascular cause this disease together, which result in no clear, unified and recognized treatment. Early detection, diagnosis and treatment are of great significance in the prognosis of NAION. Possible therapeutic methods include etiological treatment, drug therapy, traditional Chinese medicine(TCM)treatment, combined medication, optic nerve sheath decompression, adjuvant treatments and exosomes. With the continuous development and application of various anti-NAION drugs in recent years, a variety of therapeutic methods have been proposed, especially with the exosomes as the research focus. In order to better treat NAION with improvement of the cure rate and guidance for clinical work, this paper mainly reviews the progress in the treatment of NAION in recent years.

Abstract:Myopia is a common ocular disorder. In recent years, the incidence of myopia presents an increasing trend year by year. Patients with high myopia are at an increased risk for severe visual impairment. The economic and societal impacts of complication associated with myopia are enormous. Therefore, it is essential and imminent for implementing effective myopia control strategies. The results of the current study suggest that uncontrolled axial elongation produced by periphral hyperopic defocus could be one of the possible mechanisms for myopia development, multiple strategies especially optical defocus technology based on this are increasingly becoming part of the mainstream clinical practice in myopia management. This article reviews the principle of optical defocus on myopia control, experimental research on defocus myopia animals, and the latest clinical applications of different optical defocus technologies on myopia control, summarizes the clinical research results of myopia control using progressive addition spectacle lenses, peripheral defocus spectacle lenses, defocus incorporated multiple segments spectacle lenses, orthokeratology contact lenses and multifocal soft contact lenses. It is proposed to provide a new option for the treatment plan to delay the progression of myopia.

Abstract:AIM: To compare the clinical efficacy and safety of gatifloxacin eye drops and levofloxacin eye drops in the treatment of acute bacterial conjunctivitis using Meta-analysis.

METHODS: According to the Cochrane systematic evaluation method, “gatifloxacin” “levofloxacin” and “acute bacterial conjunctivitis” were used as keywords for literature search in Embase, Cochrane library, Pubmed, Medline, CNKI, Wanfang, VIP and CBMdisc from the establishment of the database to March 1, 2021. Randomized controlled trials(RCTs)gatifloxacin eye drops and levofloxacin eye drops in the treatment of acute bacterial conjunctivitis were included. Cochrane bias risk assessment tool was used to evaluate the quality of the included studies. RevMan5.3 software was used for combined analysis. Egger's test in Stata12 was used to assess publication bias, and the level of evidence was evaluated according to the GRADE system.

RESULTS: A total of 10 RCTs were included in this study with 1 149 patients. The control group was treated with levofloxacin and the experimental group was treated with gatifloxacin. The results of Meta-analysis showed that the clinical effective rate of acute bacterial conjunctivitis in gatifloxacin group was higher than that in levofloxacin group(OR=3.75, 95%CI: 2.52-5.58, P<0.00001). Egger's test suggested there was publication bias among studies. And GRADE rating results indicated, the level of evidence was VERY LOW. The incidence of adverse drug reactions in the gatifloxacin group was lower than that in levofloxacin group(OR=0.37, 95%CI: 0.19-0.71, P=0.003). No publication bias was observed in Egger's test and GRADE showed the level of evidence was LOW.

CONCLUSION: Gatifloxacin eye drops is more effective than levofloxacin eye drops in the treatment of acute bacterial conjunctivitis, and has lower adverse effect rates. And due to the low levels of evidence included, more multicenter, randomized double-blind clinical trials are needed to improve the strength of evidence for the clinical efficacy of gatifloxacin eye drops in the treatment of acute bacterial conjunctivitis.

Abstract:AIM: To compare the therapeutic effects of high-intensity focused ultrasound cycloplasty(UCP)and cyclocryotherapy on refractory glaucoma.

METHODS:This retrospective study included 45 patients(81 eyes)with refractory glaucoma admitted to the hospital between January 2017 and December 2020. According to the treatment method, patients enrolled were divided into cyclocryotherapy group(22 patients, 40 eyes)and high-intensity UCP group(23 patients, 41 eyes). Changes in intraocular pressure at 1d, 1wk, 1 and 3mo after operation were compared between the two groups. The Numerical Rating Scale(NRS)was used to evaluate eyeball pain. Surgical results and complications in the two groups were compared.

RESULTS:The total effective rate of operation in the high-intensity UCP group was significantly higher than that in the control group(P<0.05). Generalized estimation equation analysis showed that there were statistically significant differences in intraocular pressure and eyeball pain between the two groups before and after operation(all P<0.05). There were statistically significant differences in intraocular pressure and eyeball pain between the two groups at different time points after operation(all P<0.05). The incidence rates of complications such as conjunctival hyperemia, corneal edema, anterior chamber inflammatory exudation, reactive intraocular hypertension and hyphema in the high-intensity UCP group were significantly lower than those in the cyclocryotherapy group(P<0.05).

CONCLUSION: High-intensity UCP is effective in the treatment of refractory glaucoma, with obvious advantages in reducing intraocular pressure, eyeball pain and complications as compared with cyclocryotherapy.

Abstract:AIM:To profile gene expression changes induced by dexamethasone in human trabecular meshwork using bioinformatics analysis, and to elucidate the possible mechanisms involved in the pathogenesis of glucocorticoid-induced glaucoma(GIG).

METHODS:The gene expression dataset GSE37474 was obtained from the Gene Expression Omnibus(GEO). GEO2R was utilized to identify differentially expressed genes(DEGs)in trabecular meshwork between the dexamethasone group and the control group. Gene Ontology(GO)function annotation and the Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment were constructed using the DAVID database. STRING database and Cytoscape software were used to construct protein-protein interaction(PPI). The hub genes were screened by CytoHubba plug-in. Finally, the mRNA expression of key hub genes was verified by RT-PCR.

RESULTS:Compared to normal trabecular meshwork, dexamethasone-treated trabecular meshwork had a total of 252 DEGs, with 141 genes up-regulated and 111 genes down-regulated. GO function annotation showed that DEGs were mostly located in the extracellular matrix, where they engaged in the biological processes of positive regulation of inflammation and extracellular matrix remodeling. KEGG pathway enrichment showed that DEGs were largely involved in vascular smooth muscle contraction, arachidonic acid metabolism, ether lipid metabolism and choline metabolism. The PPI network yielded seven hub genes, three of which were up-regulated(EDN1, FOS, and LPL)and four of which were down-regulated(CCL2, IGF1, PTGS2, CCL5). In RT-PCR, the mRNA expression levels of the seven hub genes matched those in the gene expression profile.

CONCLUSION:Dexamethasone can cause dramatic changes in the gene expression profile in trabecular meshwork. The enriched pathways of DEGs and certain hub genes play an important role in the remodeling of the extracellular matrix and the regulation of aqueous humor outflow, providing a full knowledge of the molecular mechanism of GIG.

Abstract:AIM: To quantitatively analyze the microcircular and structural changes of the macular and peripapillary area in patients with diabetic kidney disease(DKD), exploring non-invasive effective monitoring indexes that can predict the occurrence and development of diabetic kidney disease used optical coherence tomography angiography(OCTA).

METHODS: A cross-sectional study. The diabetic patients(52 cases)and healthy subjects(20 cases)who came to Shanxi Provincial People's Hospital from January 2020 to January 2021 were collected, and the diabetes mellitus(DM)patients were further divided into DKD group(23 cases)(complicated with diabetic kidney disease)and non-DKD group(29 cases)(not complicated with diabetic kidney disease). All patients underwent slit-lamp microscopy, best corrected visual acuity(BCVA), OCTA and fundus color photography. OCTA was used to scan the macula and peripapillary area of all participants, measuring the shallow and deep blood flow density, the area and circumference of the fovea(FAZ), vascular density in the 300μm area around FAZ(FD300), retinal thickness, peripapillary-VD, retinal nerve fiber layer(RNFL)thickness, and ganglion cell complex(GCC)thickness. The correlation between the changes of these parameters in OCTA, DR staging and DKD staging was analyzed.

RESULTS: Parafoveal SCP-VD, perifoveal DCP-VD, peripapillary-VD, and FD300 showed a decreasing trend among the healthy group, non-DKD group, and DKD group(P<0.05). The foveal DCP-VD was decreased only in the DKD group(P<0.05), and there was no significant difference in the SCP-VD of fovea among the three groups(P>0.05). FAZ area and GCC thickness were gradually increased among healthy group, non-DKD group and DKD group(P<0.05). DR staging was positively correlated with DKD staging(r_s=0.648, P<0.05). Parafoveal SCP-VD, parafoveal DCP-VD, and perifoveal DCP-VD were negatively correlated with DKD staging(r_s= -0.535, P=0.009; r_s= -0.712, P<0.001; r_s= -0.641, P=0.001). Compared with non-DKD group, DKD group had higher SBP, lower eGFR, and higher UACR(P<0.05).

CONCLUSION: OCTA can detect retinal microcirculation and structural changes in patients with DKD, including decreased vessel density in the macular and peripapillary area, increased FAZ area and GCC thickness. More importantly, we found that retinal vessel density decreased with renal function impairment, suggesting that retinal vessel density may be a noninvasive and effective predictor in the severity of DKD.

Abstract:AIM:To quantitatively evaluate the macular microvasculature and visual function in patients with macular edema secondary to retinal vein occlusion(RVO)by optical coherence tomography angiography(OCTA)combined with microperimetry.

METHODS: Totally 36 patients(36 eyes)with monocular RVO complicated with macular edema were enrolled, including 15 patients(15 eyes)in central retinal vein occlusion(CRVO)group and 21 patients(21 eyes)in branch retinal vein occlusion(BRVO)group(all with superior temporal vein occlusion), 15 age-matched healthy subjects(24 eyes)were included as controls. OCTA was used to scan macular retina in the range of 3mm×3mm in all three groups and measure the vascular density(VD)of superficial capillary plexus(SCP)and deep capillary plexus(DCP), the area of foveal avascular zone(FAZ)and the central retinal thicknes(CRT); the retinal mean sensitivity(RMS)at 10°was measured by MP-3 microperimetry. VD and RMS in BRVO group were further divided into lesion area(superior), non-lesion area(inferior)VD and RMS. The lesion area and non-lesion area of the control group were divided according to corresponding regions of the BRVO group. The changes of above indexes in CRVO group and BRVO group were compared with control group respectively, and the correlation between RMS and VD, CRT and FAZ areas in CRVO group and BRVO group was analyzed.

RESULTS:The overall VD(SCP and DCP)in CRVO group were lower than those in control group(t= -2.536, P=0.016; t= -8.834, P<0.001); the area of FAZ was larger than that in control group(t=3.354, P=0.002); the CRT was thicker than that in control group(t=13.888, P<0.001); the overall RMS was significantly lower than that in control group(t= -6.250, P<0.001). The overall VD(SCP and DCP)in BRVO group were decreased compared to those in control group(t= -5.186, P<0.001; t= -5.238, P<0.001); the VD of SCP and DCP in the affected sector were decreased compared to those in the corresponding sector of the control group(t= -5.611, P<0.001; t= -6.940, P<0.001); the VD in the unaffected sector was significantly less than that in the corresponding sector of the control group only in DCP, but not in SCP(t= -3.047, P=0.004; t= -1.459, P=0.156); the area of FAZ was larger than that in control group(t=2.722, P=0.011); the CRT was thicker than that in control group(t=7.764, P<0.001); the overall RMS was significantly lower than that in control group(t= -10.931, P<0.001); the RMS in both the affected sector and the unaffected sector were lower than those in the corresponding sector of the control group(t= -13.183, P<0.001; t= -8.074, P<0.001). In CRVO group,the overall VD of SCP and DCP was positively correlated with the overall RMS(r=0.571, P=0.026; r=0.813, P<0.001)and the area of FAZ and CRT was negatively correlated with the overall RMS(r= -0.621, P=0.014; r= -0.533, P=0.041). In BRVO group,the overall VD of SCP and DCP was positively correlated with the overall RMS(r=0.465, P=0.034; r=0.611, P=0.003), and the CRT was negatively correlated with the overall RMS(r= -0.547, P=0.01), while there was no correlation between the area of FAZ and the overall RMS(r= -0.421, P=0.057).

CONCLUSION: The combined application of OCTA and microperimetry can corresponding quantitatively evaluate the structure and function of macular area in patients with macular edema secondary to retinal vein occlusion, providing more detailed information for clinical decision makers to explain the disease well.

Abstract:AIM: To evaluate the changes of amplitude of accommodation(AA)and axial length(AL)undergoing overnight orthokeratology treatment. And to explore the mechanism of orthokeratology on controlling the development of myopia in pre-adolescent.

METHODS: Prospective study, 215 pre-adolescent myopia aged 7-14 years old were enrolled in the study from May 2018 to August 2019. Every subject was measured for comprehensive eye examination. And according to the above measurements and the compliance of children and their parents, 113 patients who matched the inclusion criteria accepted treatment of orthokeratology(ortho-k group)and the other 102 subjects were selected to wear spectacle(spectacle group). During regular follow-up visits, AA was measured respectively at pre-wear, 1, 3, 6mo and 1a after orthokeratology. AL was measured at baseline and after 1a. The changes were evaluated and compared between the orthokeratology and spectacle group.

RESULTS: After 1a follow-up, 100 eyes of 100 subjects in the ortho-k group completed the follow-up, and 13 eyes of 13 subjects were withdrawn from the study. In the spectacle group, 77 eyes of 77 subjects completed the study, and 25 eyes of 25 subjects were withdrawn. At baseline, the AA of myopia was 13.57±2.47D, the AA after 1, 3 and 6mo, 1a was significantly higher than before(all P<0.005). It reached its peak after 6mo treatment(15.74±2.32 D), and it slightly decreased at 1a treatment(15.44±2.35 D), compared with 6mo treatment. The axial elongation in orthokeratology group was significant smaller than in spectacle group during the 1a study period(0.13±0.15mm vs 0.50±0.28mm, P<0.001).

CONCLUSION: AA was improved after orthokeratology in pre-adolescents. Orthokeratology suppressed axial elongation in myopic, suggesting that it is one of the effective treatments in slowing the progression of myopia in pre-adolescents.

Abstract:AIM: To investigate the status of astigmatism in children and adolescents aged 7-19 years in some areas of Xinjiang, and to analyze the distribution of astigmatism in children and adolescents in Xinjiang.

METHODS: Cross-sectional study. This study took a purposive sampling survey of 41 schools in some areas of Xinjiang, including 20 primary schools and 21 middle schools, from May 2019 to December 2019. A total of 71 838 children and adolescents were included as the survey objects for relevant eye examinations.

RESULTS: Among 71 838 students, 35 888 were found to have astigmatism(column ≤ -0.50D), and the astigmatism detection rate was 49.96%. The differences of astigmatism detection rate among different ages, genders, education levels, regions and ethnic groups were statistically significant(all P<0.001). The detection rate of astigmatism increased with age from 7-16 years old, and reached the highest rate of 57.60% at 16 years old. The detection rate of astigmatism decreased from 16-19 years old, and the overall detection rate of astigmatism increased with age. With the increase of education level, the detection rate of astigmatism increases, and the detection rate of male astigmatism(51.25%)is higher than that of female astigmatism(48.62%). The detection rate of astigmatism in provincial capital cities(50.99%)is higher than that in non-provincial capital cities(48.05%); the detection rate of astigmatism in Han(53.41%)was higher than that in Uyghur(40.17%), Kazakhs(48.23%), Kyrgys(45.56%)and Hui(48.87%). The astigmatism type was mainly with-the-rule astigmatism(74.53%), and with the increase of age, the composition ratio of with-the-rule astigmatism decreased, while the composition ratio of against-the-rule astigmatism and oblique astigmatism increased. The final results of Logistic regression analysis showed that age, gender, nationality, region and education level were all influential factors of astigmatism.

CONCLUSION: The prevalence of astigmatism in children and adolescents aged 7-19 years in some areas of Xinjiang is 49.96%, and the astigmatism is mainly with-the-rule astigmatism(74.53%). Age, gender, nationality, region and education level are the influential factors of astigmatism.

Abstract:AIM: To investigate the effects of long-term orthokeratology lens wearing on corneal morphology, corneal biomechanics and objective visual quality.

METHODS: A retrospective study was conducted to collect 33 myopic patients(60 eyes), including 19 males(35 eyes)and 14 females(25 eyes), mean age 11.80±1.51 years old, with an average equivalent spherical lens of -3.25±0.69D, who had been wearing orthokeratology lens for 2a from October 2019 to December 2020 in our hospital. Relevant data were collected before wearing and 2a after wearing. The radius of curvature(ARC and PRC), the thickness of the thinnest cornea(THP)and the index of comprehensive deviation analysis of corneal dilation(BADD)were measured by Pentacam anterior segment analysis system. Corvis ST biomechanical analyzer measured non-contact biomechanical corrected intraocular pressure(blOP), maximum deformation amplitude(DA), maximum reverse radius(HCR), ratio of deformation amplitude between apex and 1mm(DR), hardness parameters(SPA1), and corneal biomechanical parameters(CBI). The biomechanical index(TBI)of CT scan was obtained by the combined diagnosis system of Pentacam and Corvis ST. OQAS-II objective visual quality analysis system measured modulation transfer function cutoff frequency(MTF cutoff), Stryl ratio(SR), objective scattering coefficient(OSI)and OV value(OV100%, OV20% and OV9%). The above parameters were compared before and continuously wearing orthokeratoscope for 2a.

RESULTS: After 2a of wearing orthokeratology, ARC increased, THP decreased, and BADD increased(t=-9.38, 2.85, -13.08; all P<0.05), while there was no significant difference between PRC and before wearing(t=1.49, P>0.05). DA increased and HCR decreased compared with before wearing orthokeratology lens(t=-2.37, 2.28; all P<0.05), but bIOP, DR, SPA1, CBI and TBI showed no difference(t=1.36, -1.87, 1.27, -0.95, -1.49; all P>0.05). SR was higher than before, OV20% and OV9% were lower than before(t=-5.31, 8.37, 2.34; all P<0.05), MTF cutoff, OSI and OV100% had no difference compared with before(t=-1.57, -1.35, 1.11; all P>0.05).

CONCLUSION: Long-term wearing of orthokeratology lens changed the morphology of the anterior corneal surface, but had no significant effect on the corneal biomechanics, and the objective visual quality of patients was improved during the day, but decreased at night.

Abstract:AIM:To investigate the correlation among corneal densitometry, corneal topographic parameters, and corneal biomechanical properties in keratoconus.

METHODS: Retrospective case study. A total of 70 eyes of 48 keratoconus patients were enrolled in this study. Corneal topography were measured using Pentacam, inclding the flat keratometry of anterior cornea(K₁), the steep keratometry of anterior cornea(K₂), the mean keratometry of anterior cornea(K_m), the maximum keratometry of anterior cornea(K_max), anterior corneal elevation(ACE), posterior corneal elevation(PCE), thinnest corneal thickness(TCT), and the distance from cone to apex(DCA). Corneal optical density of different corneal layers and zones were measured with the Scheimpflug-based Pentacam corneal densitometry module. Corneal biomechanical properties were measured using CorVis ST, inclding time of the first applanation(AT₁), length of the first applanation(AL₁), velocity of the first applanation(V₁), time of the second applanation(AT₂), length of the second applanation(AL₂), velocity of the second applanation(V₂), the highest concavity time(HCT), the highest concavity deformation amplitude(HCDA), the highest concavity radius(HCR), the highest concavity peak distance(HCPD), stiffness parameter applanation 1(SPA1), Ambrósio's relational thickness horizontal(ARTh).

RESULTS: Correlation between corneal densitometry and topographic parameters: The corneal densitometry values of the anterior ≤2mm layer correlated with the K₁, K₂, K_m and K_max values positively(r=0.291, 0.315, 0.315, 0.387; P=0.015, 0.008, 0.008, 0.001). The corneal densitometry values of the anterior ≤2mm, anterior >2 and ≤6mm, total ≤2mm, total >2 and ≤6mm, and posterior >2 and ≤6mm layers correlated with the anterior corneal elevation positively(r=0.465, 0.302, 0.317, 0.291, 0.335; P<0.01, P=0.011, 0.008, 0.014, 0.005), and also with the posterior corneal elevation(r=0.565, 0.369, 0.348, 0.306, 0.284; P<0.01, P=0.002, 0.003, 0.010, 0.017). Correlation between corneal densitometry and biomechanical properties: the corneal densitometry values of all ≤2mm, central >2 and≤6mm, posterior >2 and ≤6mm, and total >2 and ≤6mm layers all correlated with AL₁ negatively(r= -0.284, -0.290, -0.245, -0.326, -0.282, -0.395, -0.310; P=0.017, 0.015, 0.041, 0.006, 0.018, 0.001, 0.009). The corneal densitometry values of central ≤2mm, central >2 and ≤6mm, and posterior >2 and ≤6mm layers all correlated with AL₂ negatively(r= -0.246, -0.256, -0.256; P =0.041, 0.032, 0.032). The corneal densitometry values of anterior ≤2mm layer correlated with HCR negatively(r= -0.308, P=0.010). The corneal densitometry values of central ≤2mm, posterior ≤2mm, and certral >2 and ≤6mm layers all correlated with HCT negatively(r= -0.292, -0.340, -0.262; P=0.014, 0.004, 0.028). The corneal densitometry values of anterior ≤2mm, total ≤2mm, and posterior >2 and ≤6mm layers all correlated with ARTh negatively(r= -0.430, -0.293, -0.319; P<0.01, P = 0.014, 0.007).

CONCLUSION: The corneal densitometry values correlated with the severity of keratoconus and the biomechanical properties, and may became a potential diagnostic index of keratoconus.

Abstract:AIM:To investigate the clinical efficacy and safety of trans-epithelial accelerated corneal collagen cross-linking in the treatment of progressive keratoconus.

METHODS: A prospective before-after self-control study. A total of 47 eyes of 37 patients with progressive keratoconus who underwent trans-epithelial accelerated corneal collagen cross-linking in our hospital from August 2016 to November 2019 were collected. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refractive status, corneal transparency, maximum keratometry value of the anterior corneal surface, thinnest corneal thickness, corneal endothelial cell counts and intraocular pressure(IOP)were analysed preoperatively and at 1, 3, 6 and 12mo postoperative.

RESULTS: UCVA of patients 1, 3, 6 and 12mo after surgery was higher than that before surgery, but there was no difference(F=1.372, P=0.261). BCVA at 1, 3, 6 and 12mo after surgery was higher than that before surgery, the difference was statistically significant(F=3.308, P=0.019). There were no differences in the spherical and cylindrical power, Kmax and thickness of the thinnest point of cornea at 1, 3, 6 and 12mo postoperatively compared with those before surgery(F=0.293, 1.378, 2.448, 1.970; P=0.881, 0.258, 0.061, 0.116). There was no difference in corneal endothelial cell counts between 1mo after surgery and before surgery(t=1.156, P=0.25). There was no difference in IOP at all postoperative time points compared with that before surgery(F=1.221, P=0.321). The corneal Haze(grade 1-2)appeared in 7 eyes after surgery, and subsided in 5 eyes from 3-6mo after surgery, and the corneal transparency recovered. The corneal nebula remained in 1 eye, and the corneal central stroma linear opacity existed in 1 eye, but the visual acuity of both eyes was not affected.

CONCLUSION: Trans-epithelial accelerated corneal collagen cross-linking can significantly improve BCVA, stabilize refractive status, corneal morphology and thickness, prevent or delay the progression of keratoconus, and enable patients to obtain better visual function. At the same time, the operation time is short, postoperative complications are less, and the operation has good safety.

Abstract:AIM: To evaluate the visual quality of patients with high myopia complicated with cataract after implantation of trifocal intraocular lens by OPD-Scan Ⅲ aberration analyzer.

METHODS: Totally 32 patients(38 eyes)with high myopia complicated with cataract who underwent femtosecond laser assisted cataract phacoemulsification combined with trifocal intraocular lens implantation in Foshan Aier Eye Hospital from June 2018 to December 2020 were selected. Uncorrected distance visual acuity(UCDVA), uncorrected intermediate visual acuity(UCIVA)and uncorrected near visual acuity(UCNVA)were compared before, and 1wk, 3mo after surgery; OPD-Scan Ⅲ aberration analyzer measured objective visual quality before, and 1wk and 3mo after surgery.

RESULTS: There were significant differences in UCDVA, UCIVA and UCNVA before, and 1wk, 3mo after operation(P<0.05). The average orientation and centration distance was 0.12(0.08-0.15)mm and the average axial was(212.68±90.45)°in 3mo postoperative. There were significant differences in spherical aberration(P<0.05), Strehl ratio(SR)and area ratio(AR)before, and 1wk, 3mo after operation(P<0.001). In comparison, SR at 1wk and 3mo postoperative was higher than that before operation, whereas AR in 1wk and 3mo postoperative were both higher than that before operation(all P<0.001). There was a negative correlation between SR and spherical aberration at 3mo postoperative(r_s=-0.420, P<0.01); There was a negative correlation between SR and trefoil at 3mo postoperative(r_s= -0.418, P<0.01); There was a negative correlation between AR and trefoil at 3mo postoperative(r_s=-0.400, P<0.05).

CONCLUSION: Femtosecond laser assisted cataract surgery combined with trifocal intraocular lens implantation can provide a comfortable and natural full-range vision. The orientation and centricity of trifocal intraocular lens using OPD-Scan Ⅲ has shown that there was a good reliability and consistency. The vision quality using OPD-Scan Ⅲ is satisfactory.

Abstract:AIM: To assess the association of vascular endothelial growth factor(VEGF)gene polymorphisms(rs2010963 and rs3025039)with diabetic retinopathy(DR)in Li nationality type 2 diabetic(T2DM)patients in Hainan.

METHODS: Prospective study. A total of 89 patients with T2DM in the Li nationality in Hainan were randomly categorized(between 09/2016 to 10/2019)into three groups, 30 patients in nonproliferative diabetic retinopathy(NPDR)group, 33 patients in proliferative diabetic retinopathy(PDR)group, and 26 patients in T2DM without retinopathy(DWR)group as control. Polymerase chain reaction-restriction fragment length polymorphism method was used to determine the polymorphism in the VEGF gene. Differences in allele frequencies and genotype frequencies between cases and controls were compared.

RESULTS: Compared with the DWR group, the CC genotype of rs2010963 polymorphic site was significantly increased(P<0.016667), and CG genotype was significantly decreased in PDR group(P<0.016667). No significant differences were detected in the frequencies of genotype GG and C, G allele distribution among the three groups(P>0.05). Meanwhile, no significant differences were detected in the frequencies of genotype CC, CT, C, and T in rs3025039 among the three groups(all P>0.05). Plasma levels of serum urea and creatinine were significantly increased in PDR group compared to DWR and NPDR groups in Li nationality group in Hainan(all P<0.05).

CONCLUSION: The polymorphism of the VEGF gene(rs2010963)is associated with DR. CC genotype may be a genetic risk factor for the development of DR, increasing susceptibility to PDR. The rs2010963 related genotype is conferred risk and associated with higher susceptibilities of PDR.

Abstract:AIM: To investigate the application value of optical coherence tomography angiography(OCTA)in observing retinal microvasculature in patients with diabetic retinopathy(DR).

METHODS: Prospective research. The 84 patients(98 eyes)with DR admitted to our hospital during 2017-06/2019-12 were selected as the study group, and were further divided into non-proliferative DR group and proliferative DR group according to the degree of DR. Another 60 cases(68 eyes)with simple diabetes mellitus who underwent physical examination in our hospital during the same period were selected as the control group. The OCTA was used to quantitatively analyze the microvessels in the retinal macular area of the subject, and the built-in analysis software was used to obtain the blood flow density(SCP, DCP)of the superficial and deep parafoveal retina, the area and circumference of the foveal avascular zone(FAZ), the roundness index, full-thickness retinal blood flow density(FD-300). The differences of quantitative indexes, the correlation between OCTA parameters and DR severity and the diagnostic value of DR were compared.

RESULTS: The study group's FD-300, SCP and DCP were lower than those of the control group(t=6.476, 8.907, 5.078; all P<0.05), while the FAZ circumference and the roundness index were higher than those of the control group(t=4.380, 10.542; all P<0.05). The FD-300, SCP and DCP of the proliferative DR group were lower than those of the non-proliferative DR group(t=2.668, 3.408, 3.103; all P<0.05), while the FAZ circumference and the roundness index were higher than those of the non-proliferative DR group(t=2.550, 5.563; all P<0.05). Pearson correlation analysis shows that FD-300, SCP, DCP were negatively correlated with disease severity(r= -0.485, -0.546, -0.522; all P<0.05), FAZ circumference and morphological index were positively correlated with disease severity(r=0.426, 0.443; all P<0.05). ROC curve analysis showed that the area under the curve for FD-300, SCP, DCP, FAZ circumference, and FAZ morphological index to diagnose DR were 0.835(95%CI: 0.722-0.947), 0.806(95%CI: 0.701-0.911), 0.849(95%CI: 0.770-0.928), 0.768(95%CI: 0.641-0.896), 0.742(95%CI: 0.633-0.850), respectively.

CONCLUSION: OCTA can clearly monitor the morphology of superficial and deep capillaries in the macular area of patients with DR. The quantitative index of blood flow density is negatively correlated with the severity of the disease, which has high clinical value for the diagnosis of DR.

Abstract:AIM: To investigate the proportional distribution of the size of lacrimal sac in recurrent dacryocystitis after the removal of artificial nasolacrimal duct and the clinical effect of dacryocystorhinostomy under nasal endoscope on patients with recurrent dacryocystitis.

METHODS: Totally 73 patients(73 eyes)with recurrent dacryocystitis after removal of artificial nasolacrimal duct in our hospital from January 2018 to November 2019 were retrospectively studied. All patients underwent dacryocystography after hospitalization, and then performed dacryocystorhinostomy combined with intubation of double- artificial nasolacrimal duct under nasal endoscope and general anesthesia. The size of lacrimal sac was measured, and the area and effective rate of fistula were analyzed respectively at 2wk, 1, 3 and 6mo after operation.

RESULTS: There were 13 eyes with large dacryocyst(Transverse diameter > 5mm, 18%), 26 eyes with middle dacryocyst(Transverse diameter between 2-5mm, 36%), and 34 eyes with small dacryocyst(Transverse diameter <2mm, 47%); There was significant difference in the stoma area of dacryocystostomy at 2wk, 1, 3, 6mo respectively(P<0.05); Compared with 2wk, 1, 3mo after operation, the stoma area at 6mo after operation significantly decreased by 14.08±0.68, 10.49±0.75, 0.31±0.23mm²(all P<0.05); The curative rates were 100%, 93%, 88% and 85% at 2wk, 1, 3, 6mo after operation, respectively.

CONCLUSION: After the removal of the artificial nasolacrimal duct, the majority of the patients with recurrent dacryocystitis typically featured medium and small lacrimal sac. The curative effect of this type of recurrent dacryocystitis by dacryocystorhinostomy and intubation under nasal endoscope was proved to be effective, which could serve as a proper and better choice in clinic practice.

Abstract:AIM: To investigate the changes of tear film function and symptoms of dry eye in patients with diabetic peripheral neuropathy(DPN).

METHODS: Retrospective case-control study was conducted. A total of 59 patients(59 eyes)with tear film abnormalities who were diagnosed with type 2 diabetes mellitus(T2DM)were divided into group T2DM(31 cases, 31 eyes)and group DPN(28 cases, 28 eyes)depending on the presence or absence of diabetic peripheral neuropathy. Patients at the Department of Ophthalmology who met the criteria of tear film abnormalities and without diabetes were selected as the non-T2DM group(33 cases, 33 eyes). All subjects were completed the Ocular Surface Disease Index(OSDI), and underwent fluorescein breakup time test(BUT), fluorescein staining(FL), Schirmer Ⅰ test(SchirmerⅠ)and infrared meibomian gland photography.

RESULTS: A statistically significant difference was observed among the three groups for the BUT values(F=9.43, P<0.01), and differences still existed between any two of the three groups(P<0.05). There were no statistically differences among the three groups for the Schirmer Ⅰ and the positive rates of fluorescein staining(P>0.05). There was statistically difference among the three groups for meibomian gland loss scores(χ²=8.433, P<0.05). Statistically differences only were observed between DPN group with non-T2DM group or T2DM group(P<0.05). Difference of OSDI scores of three groups was statistically significant(P<0.05). There was no significant difference between T2DM group and non-T2DM group(P>0.05), meanwhile between DPN group with non-T2DM group or T2DM group, the differences were statistically significant(P<0.05).

CONCLUSION: T2DM patients with DPN are more likely to have shorter BUT and more meibomian gland loss than T2DM patients without DPN and patients without T2DM, but the symptoms of dry eye are less obvious. Ocular surface abnormalities should be followed up closely in DPN patients.

Abstract:AIM: To observe the location characteristics of the earliest tear film breakup in elderly patients with dry eyes.

METHODS: Cross-sectional study. The 154 elderly patients with dry eyes in our hospital from July 2019 to December 2019 were included, with 143 right eyes, 124 left eyes, and 71 patients were males, 83 patients were females, aged 68-90(mean: 73.40±4.13)years old. The location of the earliest tear film breakup was investigated by using corneal topographer. The cornea was separated to four sectors to record the earliest tear film breakup location by anticlockwise order. The sector corresponding to the right eye was nasal superior, temporal superior, temporal inferior and nasal inferior respectively. And it corresponding to the left eye was temporal superior, nasal superior, nasal inferior and temporal inferior respectively. Then the sector which was the earliest tear film breakup location was recorded. At the same time, the distance which was from the earliest tear film breakup location to the centre of cornea was recorded too.

RESULTS: The highest constituent ratio of area of right eye was nasal inferior(28.7%), then was temporal inferior(27.3%), nasal superior(20.3%), temporal superior(11.2%), and the constituent ratio of earliest tear film breakup occurred in 2-3 areas at the same time was 12.6%. The constituent ratio of the earliest tear film breakup area of left eye also was nasal inferior(31.5%), then was temporal inferior(25.0%), nasal superior(23.4%), temporal superior(11.3%), the constituent ratio of earliest tear film breakup occurred in 2-3 areas at the same time was 8.9%. There was no difference in the constituent ratio of tear film breakup area between two eyes(χ²=1.443, P=0.837). The distance from the earliest tear film breakup area of the nasal inferior quadrant to the centre of cornea was mostly the zone from 1.5-2mm and 2-2.5mm in both eyes.

CONCLUSION: There is a certain regularity in the characteristics of tear film breakup area in elderly patients with dry eyes, and the earliest tear film breakup area of both eyes is mainly occurred in nasal inferior, and there is no significant difference between two eyes.

Abstract:AIM:To observe the curative effect of take oral and cold-wet compress on eyes with Tiaoti Tuomin Decoction and the changes of immunologic function in patients with allergic conjunctivitis.

METHODS:Totally 160 patients 320 eyes with allergic conjunctivitis were randomly divided into observation group and control group. The 80 patients(160 eyes)in the observation group were treated with Tiaoti Tuomin Decoction take oral and cold-wet compress on eyes. The 80 patients(160 eyes)in the control group were treated with 0.05% Azelastine Hydrochloride Eye Drops. After 14d of continuous treatment, the symptom and sign scores, quality of life questionnaire scores of allergic conjunctivitis, and the levels of serum immunoglobulin IgG, IgA, IgE of the two groups were compared and analyzed.

RESULTS:After treatment, the scores of symptom and sign, quality of life questionnaire of allergic conjunctivitis in both groups were better than those before treatment(P<0.05), and the improvement degree of which in the observation group was better than that in the control group(P<0.05). After treatment, the levels of serum immunoglobulin IgG, IgA in the two groups were not significant improvement than before treatment(P >0.05), the level of serum immunoglobulin IgE in the observation group were significantly improved than before treatment(P<0.05).

CONCLUSION: Treatment of take oral and cold-wet compress on eyes with Tiaoti Tuomin Decoction can improve clinical symptoms of allergic conjunctivitis patients, help relieve allergic reaction and improve the quality of life.

Abstract:AIM: To investigate the prevalence and risk factors of pterygium in Zhuang and Miao nationality adults aged 40 and over in Wenshan prefecture, Yunnan Province.

METHODS: An epidemiological survey of Zhuang and Miao nationality in Yunnan Province was conducted by using the portable slit-lamp and Keratograph-D eye surface analyzer. The Logistic regression analysis was operated to determine the impact of gender, age, occupation, outdoor activities and nationality on pterygium.

RESULTS: Totally 1 239 participants were included from March to November 2019, 437 people had pterygium in one or both eyes, and the total prevalence was 35.27%. Pterygium of both eyes accounted for 59.27% while pterygium of single eye accounted for 40.73%. The prevalence of pterygium was 34.84%(224 people)in Zhuang population and 35.74%(213 people)in Miao population, there was no significant difference between the two groups(P=0.740). According to the result of Logistic regression analysis, opening of meibomian is the influencing factor of pterygium(P=0.019), with OR=1.348. Gender, age, education, outdoor activities, hypertension and eating habits were not the influencing factors of pterygium. Logistic regression was used to analyze the invasion degree of pterygium. The results showed that the height of lacrimal river was the influencing factor of pterygium(P=0.048). The lower the lacrimal river height, the greater the degree of invasion.

CONCLUSION: The prevalence of pterygium in Zhuang and Miao nationality aged 40 and over in Wenshan prefecture, Yunnan Province is high, with no significant difference between the two nationalities. The function of meibomian gland, the quality and quantity of tears are related to pterygium.

Abstract:AIM: To analysis the epidemiological and clinical characteristics of ocular trauma in Shaanxi and surrounding areas, and provide research support for the formulation of prevention and treatment measures for ocular trauma.

METHODS: Retrospective study. The general data and clinical data of 1 723 unilateral ocular trauma patients(1 723 eyes)admitted to our hospital from January 2 018 to April 2 020 were collected to establish the ocular trauma database and analyzed.

RESULTS: Among the 1 723 cases(1 723 eyes)of ocular trauma patients, young and middle-aged patients(20-59 years old)accounted for the majority(1 149 eyes, 66.69%)and mainly were male patients(1 392 eyes, 80.79%), and the vast majority of patients came from rural areas(1 270 eyes, 73.71%)and engaged in manual labor(1 288 eyes, 74.75%). The main causes of ocular trauma were blunt tools(511 eyes, 29.66%), sharp objects(423 eyes, 24.55%), splashing metal(non-metal)foreign bodies(299 eyes, 17.35%), falling(183 eyes, 10.62%), etc. The main places of injury were workplaces(633 eyes, 36.74%), farming places(474 eyes, 27.51%), residential homes(302 eyes, 17.53%), public places(248 eyes, 14.39%), etc. The main type of ocular trauma was open globe injury(1 311 eyes, 76.09%), and the main therapy was surgical treatment(1 638 eyes, 95.07%). Logistic analysis found that age, post-injury visit time, types of ocular trauma, complications of ocular trauma, history of ocular trauma were all important factors influencing prognosis of ocular trauma patients(P<0.05).

CONCLUSION: Ocular trauma in Shaanxi and surrounding areas has characteristics of age, sex, place of residence, and occupation. For special occupations and special populations, timely targeted health education and prevention measures should be taken to reduce the incidence of ocular trauma. In addition, the timely treatment of ocular trauma can help improve the prognosis of patients.