Abstract:AIM: To investigate the effects of simvastatin(Sim)on human retinal pigment epithelial cells(RPE-19)and the possible mechanisms in vitro under hypoxia.

METHODS: RPE-19 cells were divided into three group: control group, hypoxia group(the final concentration of CoCl₂ in the medium was 125 μmol/L), and Sim treatment group(3 μmol/L Sim was added in the RPE cells' medium which contain 125 μmol/L CoCl₂). After 24h, the morphology of RPE-19 cells were observed, the proliferation of cells were calculated by MTT, the secretion levels and protein expression of hypoxia-inducible factor 1-Alpha(HIF-1α)and vascular endothelial growth factor(VEGF)were detected by enzyme-linked immunosorbent assay(ELISA)and Western blotting. The expression level of autophagy protein was detected by Western blot and apoptosis was detected by TUNEL.

RESULTS: The morphology and activity of RPE-19 cells showed an apparent change under hypoxia. The expression of HIF-1α and VEGF protein were increased obviously in the hypoxia group and then significantly decreased after Sim treatment. Beclin1, and LC3B proteins were decreased in the CoCl₂+Sim group, and the expression levels were lower than the control and CoCl₂ group. Under hypoxia, Sim inhibited RPE cells' proliferation and promoted the apoptosis.

CONCLUSION:Sim inhibits RPE cells' proliferation, decreases HIF-1α and VEGF protein, and promotes apoptosis under hypoxia. Our results suggested that the mechanism by which Sim promoted apoptosis in RPE cells may be related to its inhibition of autophagy.

Abstract:AIM: To investigate if mitomycin reduces or not the probability of developing synechiae and granulomas in transcanalicular diode laser dacryocystorhinostomy. Also, we want to clarify the usefulness of mitomycin in that procedure by searching in PubMed between 2011 and 2021.

METHODS: A retrospective case series study of 120 transcanalicular diode laser dacryocystorhinostomy was performed from January 2008 to July 2019. Patients were divided into two groups: one group was operated on with mitomycin and the other group was operated on without mitomycin.

RESULTS: The success rate was 71.9% in the mitomycin group and 71.0% in the non- mitomycin group.

CONCLUSION: No statistically significant differences in the outcomes of the two groups were found. Only two opposing articles regarding the use of mitomycin in transcanalicular diode laser dacryocystorhinostomy were found in PubMed between 2011 and 2021, so the use of mitomycin is still unclear.

Abstract:AIM: To investigate the effect of modulated autophagy activity on subepithelial haze after photorefractive keratectomy(PRK)in rabbits.

METHODS: Totally 64 New Zealand white rabbits were randomly divided into 4 groups according to different postoperative medication after PRK operation, including simple PRK group, 14μmol/L DMSO group, 50μmol/L rapamycin group and 100μmol/L rapamycin group. According to the group situation, two hours after the operation, eye drops were given, 3 times a day for 7d. Another 16 rabbits were selected as normal control group. The postoperative inflammatory response and corneal epithelial healing were observed with slit-lamp microscope every day. Haze formation of each group at 1 and 4wk after PRK was collected by slit-lamp microscopy system. Eight rabbits in each group were killed by air embolization 1 and 4wk after PRK, and corneal tissue was extracted and frozen for later use. Immunohistochemistry was used to detect the expression levels of transforming growth factor-β1(TGF-β1), α-smooth muscle actin(α-SMA), and matrix metalloproteinase-2(MMP-2). Real-time PCR was used to detect the relative expression levels of autophage-5(ATG5), autophage-12(ATG12), B lymphocytoma gene-2(Bcl-2)and cysteine aspartic proteinase-3(Caspase3)genes.

RESULTS: Corneal epithelium of all operative rabbits healed completely at 3-4d and no significant difference in healing time between the groups after operation(F=0.745, P=0.530). During the observation period, haze was the most obvious at 4wk after operation in all groups. The haze symptoms were more serious in the simple operation group and the 14μmol/L DMSO group, followed by the 50μmol/L rapamycin group. The haze symptoms in the 100μmol/L rapamycin group were significantly relieved than those in other groups. There was no significant difference in the haze grading with different time points after operation among all groups(all P<0.05). Immunohistochemistry showed that the expression of TGF-β1, MMP-2 and α-SMA was stronger in the operation group and 14μmol/L DMSO group, followed by 50μmol/L rapamycin group, and weakest in 100μmol/L rapamycin group than other groups at 1 and 4wk after operation(all P<0.05). The results of PCR showed that the relative expression of ATG5, ATG12 and Bcl-2 mRNA in 50μmol/L rapamycin group and 100μmol/L rapamycin group were significantly higher than those in simple operation group and 14μmol/L DMSO group at 1 and 4wk after operation(all P<0.05); The relative expression of Caspase3 mRNA in 50μmol/L rapamycin group and 100μmol/L rapamycin group was significantly lower than that in simple operation group and 14μmol/L DMSO group(all P<0.05).

CONCLUSION: Rapamycin can enhance autophagy level and inhibit apoptosis level, thus reducing haze formation after PRK in rabbits.

Abstract:AIM: To investigate the synthesis method of curcumin nanoparticles grafted with deoxycholic acid and the effect of curcumin nanoparticles on human retinal pigment epithelial(hRPE)cells.

METHODS: The synthesis and performance analysis of Cur/Chit-DC. The relationship between FITC/Chit-DC and hRPE cells was observed under an inverted fluorescence microscope after treating hRPE cells with FITC(FITC/Chit-DC)and Cur/Chit-DC(FITC/Cur/Chit-DC)for 24h, keeping them in dark for 1, 3 and 5d respectively.

RESULTS: By mixing Cur and Chit-DC, the nanoparticles containing chitosan derivatives were light yellow. The drug release from the nanoparticles reached equilibrium after 96h, and the cumulative drug release amount was 31.6%. After FITC/Chit-DC was treated with hRPE cells for 1d, most of Chit-DC nanoparticles were still located near the cell membrane. After 3d, the nanoparticles gradually converged towards the nucleus and most of them were located around the nucleus. After 5d, it was observed that Chit-DC nanoparticles had entered the nucleus and were partially degraded under the action of intracellular lysosomes. The relationship between Cur/Chit-DC and cellular action is roughly the same as the relationship between Chit-DC and cellular action.

CONCLUSION: Cur can be continuously released from Cur/Chit-DC nanoparticle, which has long-lasting sustained-release function.

Abstract:AIM: To explore the effect of dapagliflozin on the apoptosis and oxidative stress of high glucose-induced human retinal vascular endothelial cells and its regulatory effect on forkhead FOXO4.

METHODS: High glucose-induced human retinal vascular endothelial cells(HRVECs)were used to establish a cell injury model(high glucose group). Experimental groups include high glucose+dapagliflozin low-dose group(1ng/L dapagliflozin), high glucose+dapagliflozin medium-dose group(5ng/L dapagliflozin), high glucose+dapagliflozin high-dose group(10ng/L dapagliflozin), high glucose+dapagliflozin high-dose+pcDNA group, high glucose+dapagliflozin high-dose+pcDNA-FOXO4 group, and normal sugar group(5.5mmol/L D-glucose). Flow cytometry was used to detect the apoptosis rate. The levels of superoxide dismutase(SOD)and malondialdehyde(MDA)were tested with corresponding kits. Western blot assay was used to detect the protein level of FOXO4.

RESULTS: Compared with the normal sugar group, the apoptosis rate(P<0.05), the level of MDA(P<0.05)and FOXO4(P<0.05)were increased, but the level of SOD was decreased(P<0.05)in high-glucose group. Compared with the high glucose group, cell apoptosis rate(P<0.05), the level of MDA(P<0.05)and the protein level of FOXO4 were decreased(P<0.05), but the level of SOD was increased(P<0.05)in high glucose+medium-dose dapagliflozin group and high glucose+high-dose dapagliflozin group. Compared with high glucose+dapagliflozin high-dose+pcDNA group, the apoptosis rate(P<0.05)and the level of MDA(P<0.05)were increased, but the level of SOD was decreased(P<0.05)in high glucose+dapagliflozin high-dose+pcDNA-FOXO4 group(P<0.05).

CONCLUSION: Dapagliflozin could inhibit oxidative stress and cell apoptosis in high glucose-induced HRVECs by down-regulating FOXO4, thereby reducing cell damage.

Abstract:AIM: To explore the therapeutic effects and safety of dexamethasone intravitreal implant(DEX)on non-arteritic anterior ischemic optic neuropathy(NAION), and responses to the different course of disease.

METHODS: Totally 70 patients(70 eyes)in the First Affiliated Hospital of Zhengzhou University diagnosed with NAION from January 2018 to December 2020 were obtained retrospectively as combination treatment group and routine treatment group. 35 patients(35 eyes)in each group received usual care(methylprednisolne pluse therapy, microcirculation improvement and neurotrophic treatment), and combination treatment group also received a dexamethasone intravitreal implant. The best corrected visual acuity(BCVA), mean damage(MD)and pattern standard deviation(PSD)of the visual field, mean thickness of the retinal nerve fiber layer(RNFL)and intraocular pressure(IOP)were compared between the two groups, and two groups with a different course of disease before and 3mo after treatment.

RESULTS: BCVA and MD improved in both groups at 3mo after treatment(P<0.05). The PSD in the combination treatment group was not significantly different before and after treatment(P>0.05). The PSD at 3mo after treatment in the routine treatment group was worse than before treatment(P<0.05). BCVA, MD, and PSD in the combination treatment group had better improvement than in the routine treatment group at 3mo after treatment(P<0.05). Visual acuity improvement rate in the combination treatment group was higher than in the routine treatment group at 3mo after treatment(P<0.05). There was no obvious difference in RNFL thickness between the two groups(P>0.05). BCVA, PSD and effective rate in the combination treatment group had better improvement than in the routine treatment group in disease course ≤ 15d at 3mo after treatment(P<0.05), and no apparent difference in the group of disease course > 15d(P>0.05). There was a mild and controllable increase in IOP in the combination treatment group compared to routine treatment group.

CONCLUSION: Dexamethasone intravitreal implant can promote BCVA and the recovery of visual function for the long term. It is deemed safe and effective in treating NAION, with better therapeutic effects within 2wk after onset.

Abstract:AIM:To evaluate the safety and efficacy of 0.005% atropine eye drops on myopia control in children with low myopia.

METHODS: Prospective one-year controlled study. One hundred and sixteen children with low myopia were divided into two groups(0.005% atropine group and control group)according to the requirements of children and their guardians. The children(n=58)in the 0.005% atropine group wore single-vision(SV)spectacles, with one drop of 0.005% atropine eye drop applied to both eyes once nightly. The children(n=58)in the control group only wore SV spectacles. Repeated measurements of spherical equivalent refractive errors(SERs), axial length(AL), pupil diameter and accommodative amplitude were performed at baseline, and 4, 8 and 12mo after treatment. The discomfort symptoms were also observed.

RESULTS: There were no significant increase shown in change in SERs and AL from baseline to 12mo in the 0.005% atropine group and control group(P<0.05). There were differences in the change in SERs and AL between two groups, but either the change in SERs or change in AL failed to reach statistical significance(P>0.05). Statistically significant differences were all found in pupil diameter increase and accommodative amplitude decrease between two groups( P<0.01). Six eyes(10.3%)were mild photophobic in the early stage in the 0.005% atropine group. Photophobia disappeared in 4 and 2 eyes after using 0.005% eye drops 2 and 4wk, respectively. No children showed any other discomfort symptoms such as blurred vision or allergy in the two groups.

CONCLUSION: Compared to wear SV spectacles alone, regular application of 0.005% atropine could somewhat control the progression of myopia in children with low myopia. However, its clinical effect was not obvious.

Abstract:AIM:To observe the therapeutic effects of standard laser in situ keratomileusis(LASIK), wavefront-guided LASIK(WF-LASIK)and small incision lenticule extraction(SMILE)on refractive errors.

METHODS: This study retrospectively analyzed 97 patients(194 eyes)with refractive errors admitted to the hospital between March 2020 and March 2021. They were divided into LASIK group(28 cases, 56 eyes), WF-LASIK group(32 cases, 64 eyes)and SMILE group(37 cases, 74 eyes)according to the surgical method. The uncorrected visual acuity(UCVA), diopter, high-order aberrations, tear film break-up time(BUT)and tear secretion function(SⅠt)were observed before and after operation, and related complications were recorded.

RESULTS: The UCVA, spherical diopter, cylindrical lens diopter and spherical equivalent were similar in the 3 groups at 1 and 3mo after operation(all P>0.05). The spherical aberrations of LASIK group, WF-LASIK group, and SMILE group at 1 and 3mo after operation decreased in order(all P<0.05). The horizontal coma and vertical coma of LASIK group and SMILE group at 1 and 3mo after operation were greater than those of WF-LASIK group(all P<0.05). The total high order aberrations of LASIK group at 1 and 3mo after operation were significantly greater than those of the other two groups(all P<0.05). BUT and SⅠt of SMILE group at 1 and 3mo after operation were significantly better than those of the other two groups(all P<0.05), without significant difference between WF-LASIK group and LASIK group(all P>0.05). The total incidence rates of complications in the 3 groups were close(P>0.05).

CONCLUSION: All of LASIK, WF-LASIK and SMILE can improve vision of patients with refractive errors. However, patients treated with WF-LASIK have the best visual quality after operation, and those treated with SMILE can obtained better tear film stability after operation.

Abstract:It is estimated that currently, about 46%-64% of patients with diabetes mellitus(DM)suffer from diabetic keratopathy(DK). With the increasing prevalence of DM, DK has gradually been concerned by ophthalmologists. Nevertheless, its pathogenesis is not yet clear. Oxidative stress is a pathological process that causes excessive production of reactive oxygen species(ROS)and reactive nitrogen species(RNS)in the body, which damages tissues and cells. It participates in the occurrence and development of many diseases, including the ocular complications of DM. This study aims to review the research progress of oxidative stress in the pathogenesis and the treatment of diabetic corneal lesions, thus providing references for clinical diagnosis and treatment of DK.

Abstract:The microRNAs(miRNAs)is a non-coding small RNA molecule with the function of regulating gene expression, which can be released by cells and tissues in various biological fluids, including serum or plasma. A large number of studies have confirmed that the expression of different miRNAs in diabetic retinopathy(DR)can be specifically increased or decreased. Recently, more and more evidence shows that some miRNAs in serum and plasma are specifically expressed in DR and participate in the occurrence and development of DR, and can become biomarkers for the diagnosis of DR and monitoring of DR progress. In addition, the regulation of these miRNAs levels may delay the progression of DR for early intervention in patients with DR. miRNAs is expected to become a new therapeutic target for DR. This paper mainly reviews the progress of miRNAs in the diagnosis and monitoring of DR and possible new therapeutic targets in recent years.

Abstract:Myopia is a global public problem that causes visual impairment. Its occurrence and development are often accompanied by changes in the various structures of the eye, especially pathological myopia, which involves degenerative changes in the sclera, choroid, and retina. In recent years, with the increasing prevalence of myopia, the exploration of pathological mechanism and the prevention and treatment of myopia have become an important issue that cannot be ignored in the world. The occurrence and development of myopia involves the participation of many factors and can cause serious visual damage. As an important vascular tissue in the eye, the thickness change of choroid has been proved to play a vital role in the occurrence and development of myopia. In order to comprehensively and effectively prevent and control the occurrence and development of myopia, especially high myopia, the change of myopic choroidal thickness and its related mechanisms should be one of the main directions of the pathological mechanism of myopia. This article reviews the research of changes of myopia choroidal thickness by domestic and foreign scholars in recent years, to discuss the relationship between choroidal thickness, choroidal vasculature, choroidal molecular changes and myopia, myopia-related complications, and myopia-related visual impairment. Provide new ideas on prevention and intervention of myopia.

Abstract:High myopia complicated with fundus lesions is one of irreversible blinding eye diseases. Posterior seleral staphyloma(PSS)is one of the most basic pathologies in a series of complications of high myopia. This article reviews the pathogenesis, examination methods, classification and treatment of PSS in high myopia by sorting out domestic and foreign literature, providing a better understanding of the prevention and control of PSS.

Abstract:The circadian rhythm is a set of autonomous endogenous oscillators resulting nearly 24h cycles. The biological clock, including central and peripheral biological clock, is a clock system that regulates the circadian rhythm of the body. The biological clock gene and its encoded protein constituent the transcription-translation oscillation loop, which could regulate the circadian rhythm of biochemical, physiological, and behavioral processes through neural and humoral pathways. The mammalian eyeball contains a complete biological clock system, thus controlling the circadian rhythm of important physiological functions and various parameters of the eyeball. Abnormal circadian clock genes caused by various reasons will affect the circadian rhythm and may lead to the occurrence and development of the ocular diseases. Therefore, the pathogenesis and clinical manifestations of ocular diseases are characterized by diurnal variation. The change of circadian clock gene expression is not only involved in the pathophysiological process of ocular diseases, but also may be an important target for the prevention and treatment of diseases. This article introduces the circadian rhythm characteristics of corneal disease, glaucoma and myopia and the related biological clock regulation mechanism. Further research on the circadian clock provides a new strategy for the prevention and treatment of ocular diseases.

Abstract:Aquaporins(AQPs)is a family of transmembrane channins with low activation energy, high selectivity and rapid transport of water molecules, widely expressed in eye tissues. It was found that AQPs has physiological functions in eye tissue including maintaining the internal lens circulation homeostasis, participating in atrial aqueous circulation, mediating retinal signaling and promoting damage repair. Mutations or abnormal function of AQPs can lead to the occurrence of various ophthalmic diseases. If the expression and function of AQPs can be changed by using certain drugs or technical means, it is expected to become a new target for the treatment of ophthalmic diseases in the future.

Abstract:Endothelial-to-mesenchymal transition(EndoMT)is a change in the transformation or differentiation of endothelial cells into mesenchymal cells under physiological or pathological conditions, accompanied by changes in phenotype and function, and is an important part of fiber repair. It is widely involved in the pathophysiological process of embryonic development, tumor invasion and a variety of fibrotic diseases. Research on the role of EndoMT in ocular diseases has also made some progress. This article will review the basic biological characteristics, mechanism and research results of EndoMT in ophthalmological diseases, intending to theoretically reveal its possibility as a treatment target and a key point of regenerative medicine technology in related diseases, provide a reference for clinical practice and scientific research.

Abstract:Accurate target diopter is necessary for refractive cataract surgery to achieve satisfactory postoperative results. Although the measurement accuracy of ocular biological parameters, the prediction accuracy of the intraocular lens calculation formula, and the advancement of surgical technology and equipment are constantly improving, it still can be affected by pre-, intra-, and post-operative factors. Some patients still need optical products or even surgical correction for the occurrence of posterior refractive errors. This article briefly reviews the possible reasons and correction methods of refractive errors after cataract surgery.

Abstract:High intraocular pressure is the most concerned complication of the implantation surgery of V4c implantable contact lens(ICL). According to the appearance time of intraocular pressure elevation, it can be divided into three periods: the early period(1wk after surgery), the middle period(1-4wk after surgery)and the late period(1-3mo after surgery). During the early period, the intraocular pressure increase is mainly caused by the residue of the intraoperative viscoelastic. In the middle period, the application of the hormone drugs results the elevation of the intraocular pressure. Furthermore, during the late period, persistent increasing of the intraocular pressure may cause the secondary glaucoma. Identifying the mechanism of different periods of intraocular pressure rise correctly and thus formulating a reasonable treatment plan, is of great significance for the prevention of glaucoma and other long-term vision threatening complications. Therefore, this article reviews the appearance time and mechanism of the intraocular pressure rise after surgery.

Abstract:Diabetic retinopathy(DR)is a common clinical condition caused by hyperglycemia, leading to retinal microvascular damage and neurodegeneration. With the development of advanced technologies, handheld electrophysiology(RETeval), optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)have been extensively studied and applied in early diagnosis of DR. These technologies are non-invasive and quantifiable, assisting in DR diagnosis in a fast and convenient manner. In this review, the principles and applications of RETeval, OCT and OCTA will be discussed in detail.

Abstract:AIM: To measure the levels of IL-8 and IL-12p70 in the aqueous humor of patients with primary acute angle-closure glaucoma(AACG)and age-related cataract(ARC), and to investigate the clinical significance.

METHODS:Totally 29 eyes of 29 AACG patients, and 17 eyes of 17 ARC patients were enrolled in the study from October 2019 to December 2020. The levels of IL-8 and IL-12p70 were measured in the aqueous humor using Cytometric Beads Array. The clinical information was recorded in the same time for the correlation.

RESULTS:The level of IL-8 in AACG group was statistically elevated compared with the control group(Z= -5.384, P<0.05). However the IL-12p70 level did not differ in AACG group compared with ARC group(Z= -1.587, P=0.112). The IL-8 level was positively correlated with the duration of acute attack(r_s=0.387, P=0.038). The concentrations of IL-8 and IL-12p70 in the filtration surgery group were significantly increased than that of the non-filtration surgery group(P<0.05).

CONCLUSION: The level of the inflammatory factor IL-8 in the aqueous humor of patients with AACG was significantly elevated. With the progression of the disease, the concentration of the immune-related factor IL-12p70 increased differentially. Both inflammation and immunity may play an important role in the pathogenesis of AACG.

Abstract:AIM: To analyze the errors of objective visual quality after the implantation of segmented refractive multifocal intraocular lenses in patients with age-related cataract.

METHODS: In this retrospective study including 180 eyes of 116 patients with senile cataract, implantation of either Aspira-aA IOL or LS-313 MF30 IOL was performed in Hainan Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat-sen University. According to the implanted IOL, the patients were divided into the SIOL(Aspira-aA)group(61 patients, 96 eyes)and the MIOL(LS-313 MF30)group(55 patients, 84 eyes). Three months postoperatively, uncorrected distance visual acuity(UCDVA), best corrected distance visual acuity(BCDVA), uncorrected intermediate visual acuity(UCIVA)and uncorrected near visual acuity(UCNVA)were assessed. Total higher-order aberrations(HOAt), internal higher-order aberrations(HOAi), corneal higher-order aberrations(HOAc), spherical aberration(SA), coma aberration(CA), trefoil aberration(TA), Strehl ratio(SR), average height of modulation transfer function(MTF AvgHeight)and dysfunctional lens index(DLI)were measured by iTrace visual quality analyzer(scanning diameter 3mm)three months postoperatively.

RESULTS: Three months postoperatively, there was no statistically significant difference between the two groups in UCDVA and BCDVA(t=-0.789, -0.815; all P>0.05). UCIVA and UCNVA in the MIOL group were better than those in the SIOL group, with statistically significant difference(t=1.971, 3.215; all P<0.05). No statistically significant differences were observed in HOAc and spherical aberration between the two groups(t=1.126, -0.995; all P>0.05). HOAt, HOAi, coma aberration and trefoil aberration were larger in the MIOL group than those in the SIOL group(t=-2.518, -2.926, -2.859, -3.128; all P<0.05). Strehl ratio, MTF AvgHeight and DLI in the MIOL group were lower than those in the SIOL group, with statistically significant difference(t=2.8537, 2.014, 3.292; all P<0.05). The results of retinal letter, MTF AvgHeight and SR showed that HOAt and HOAi increased significantly in the MIOL group. The retinal spot diagram showed that coma aberration and trefoil aberration increased significantly with the addition of +3D spherical diopter.

CONCLUSION: Segmented refractive multifocal intraocular lens can provide excellent uncorrected distance, intermediate and near visual acuity. There may be errors in aberration measurement by iTrace visual quality analyzer after segmented refractive multifocal intraocular lenses implantation. The design of intraocular lens may lead to the postoperative increase in aberration and a decrease in objective visual quality.

Abstract:AIM: To investigate the subjective visual quality, reading fluency and patient satisfaction after a unilateral or bilateral implantation of the Tecnis Symfony extended depth of focus intraocular lens(IOL)with cataract.

METHODS: The retrospective analysis on the 48 patients(71 eyes)with cataract phacomulsification surgery in our hospital, which were randomly divided into two groups. The bilateral group with 23 patients(46 eyes)bilateral implanted the Symfony extended depth of focus IOL, the unilateral group with 25 patients(25 eyes)implanted the Symfony IOL in one eye and an aspherical monofocal IOL in the other eye. The uncorrected distance visual acuity(UDVA), uncorrected intermediate distance visual acuity(UIVA), uncorrected near distance visual acuity(UNVA), and best corrected distance visual acuity(BCVA)were measured 3, 6mo after surgery. The contrast sensitivity, reading fluency, reading speed, patient satisfaction and the occurrence of complications were also observed.

RESULTS: In the unilateral group, there were no significant differences in the UDVA and BCVA between an eye with the Symfony IOL and an eye with monofocal IOL 3mo after surgery(P>0.05). After 6mo of surgery, UDVA were significantly better than pre-operation in two groups, average visual acuity of LogMAR was under 0.1. There were no significant differences in UDVA, BCVA, UIVA and UNVA between two groups(P>0.05). The patients'far, intermediate, and near distances satisfaction were higher after 3mo of surgery. There were no statistically significant differences in spatial frequency contrast sensitivity between the two groups under photopic/mesopic conditions and mesopic with glare 6mo after surgery. The scores of satisfactions for reading fluency were better in the bilateral group than in the unilateral group(P>0.05). After 6mo, the reading speed of binocular group was slightly higher than the unilateral group(P<0.05), but there was no significant difference between two groups(P >0.05).

CONCLUSION:The Symfony extended depth of focus IOL provides good far, intermediate, and near visual acuity in the bilateral group and the unilateral group, while maintaining the same level of visual quality. In both groups over 90% patients were spectacle independent. Symfony IOL has widely adaptability and highly predictability, patients can obtain better satisfactions for reading fluency and reading speed. It is more suitable for intermediate vision.

Abstract:AIM: To study the incidence and risk factors of posterior capsular opacification(PCO)after cataract surgery in diabetic patients.

METHODS: Clinical data of 182 cases(203 eyes)who underwent cataract phacoemulsification combined with intracellular lens implantation in our hospital from April 2016 to August were collected. The patients were divided into diabetic group(DM group, 98 eyes)and non-diabetic group(non-DM group, 105 eyes)according to whether they had diabetes before operation. DM group were divided into groups according to whether PCO occurred 30mo after cataract surgery, 26 eyes in the PCO group, and 72 eyes in non-PCO group. The incidence and grading of PCO in the DM group and the non-DM group were compared. The effects of preoperative diabetic course, HbA1c level and the presence of diabetic retinopathy on PCO in DM group were tested.

RESULTS: The incidence of PCO was 10.2%, 14.3%, 22.4%, 26.5% at 12, 18, 24 and 30mo in the DM group and 2.8%, 4.8%, 10.5%, and 14.3% in the non-DM group. Two groups of patients with the degree of PCO are gradually increasing, and the degree of each point in time the PCO patients with DM group were heavier than patients without DM group(all P<0.05). There were differences in the preoperative course of diabetes and the presence of DR between PCO and non-PCO groups(P<0.05), but there was no difference in the preoperative level of HbA1c(P>0.05).

CONCLUSION: The incidence of PCO in diabetic patients after cataract surgery was higher than that in non-diabetic patients, and the degree of opacity was more severe. Preoperative course of diabetes and the presence of DR were risk factors for PCO.

Abstract:AIM:To investigate the efficacy and safety of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane(ILM)flap and PPV combined with ILM tamping in the treatment of large basal diameter idiopathic macular hole(IMH), and to analyze the correlation between postoperative visual acuity and preoperative parameters.

METHODS:This study is a retrospective clinical study. Totally 56 patients(57 eyes)with macular hole bottom diameter greater than 1 000μm, who treated in Joint Shantou International Eye Center from January 2018 to December 2020, were enrolled in this study. Thirty eyes were involved in PPV combined with inverted ILM flap(Group 1)and 27 eyes were involved in PPV combined with ILM tamping(Group 2). The best corrected visual acuity(BCVA), the closure of the macular hole, thickness of foveal neurosensory layer and complications were compared between the two groups at 1wk and 1mo after the surgery. Person correlation analysis was used to explore the correlation between preoperative parameters and BCVA at 1mo after operation.

RESULTS: There was no significant difference in gender, age, eye type, course of disease, preoperative BCVA, postoperative macular hole healing classification, preoperative hole bottom diameter and eye axis between the two groups(P>0.05). The closure rate of macular hole in Group 1 was 97%, of which type 1 closure was 80%. The closure rate of macular hole in Group 2 was 100%, of which type 1 closure was 78%, and there was no significant difference in the closure rate(P=0.99). The postoperative follow-up BCVA of patients in both groups was better than that before operation(all P<0.01). The BCVA of Group 1 was better than Group 2 at 1mo after operation, and the difference was statistically significant(t= -2.20, P=0.03). There was no significant difference in the thickness of foveal neurosensory layer between two groups at 1mo after operation(t=0.407, P=0.69). The BCVA at 1mo after operation was positively correlated with the hole diameter and preoperative BCVA(r=0.435, P=0.004; r=0.440, P=0.001). There was no complication in both groups during and after operation.

CONCLUSION:PPV combined with inverted ILM flap and PPV combined with ILM tamping can improve the closure rate of the hole. The long-term visual acuity of PPV combined with inverted ILM flap is better than that of PPV combined with ILM tamping. There is a significant positive correlation between postoperative BCVA and the bottom diameter of the hole and preoperative BCVA. Preoperative bottom diameter can be used as one of the basis for clinical prognosis.

Abstract:AIM: To explore the efficacy and safety of sutureless autologous conjunctival transplantation under topical anesthesia in the treatment of pterygium.

METHODS: Retrospective study. A total of 126 patients(126 eyes)with primary pterygium treated in the ophthalmology department of our hospital during 2018-01/2019-09 were selected as subjects. According to the mode of operation, the patients were divided into observation group(64 eyes, 64 cases in seamless autologous conjunctival transplantation group)and control group(62 eyes, 62 cases in suture group). The operation time, postoperative wound healing time, ocular irritation symptoms, tear film rupture time and postoperative recurrence were compared between the two groups.

RESULTS: The operation time of the patients in the observation group was significantly shorter than that in the control group(t=6.19, P<0.01); The conjunctival healing time in the observation group was significantly shorter than that in the control group(t=12.82, P<0.01). The incidence of irritation symptoms in the control group was significantly lower than that in the control group(χ²=6.46, P=0.01). Except that there was no difference in the comparison of tear film rupture between the two groups before operation(t= -0.033, P>0.05), the comparison at different time points and the comparison between the two groups after operation were statistically significant(all P<0.05).There was no recurrence at 6 and 12mo in the observation group, but 1 eye and 2 eyes in the control group at 6 and 12mo, respectively. There was no significant difference in postoperative recurrence rate between the two groups(P >0.05).

CONCLUSION: Pterygium excision combined with seamless autologous conjunctival transplantation has a definite effect on pterygium, reduces the incidence of postoperative irritation symptoms, shortens the operation time and helps to promote postoperative conjunctival healing.

Abstract:AIM: To investigate the effect of perioperative synoptophore scintillation training on postoperative restoration of binocular visual function in patients with constant exotropia.

METHODS: We retrospectively reviewed 68(136 eyes)patients with constant exotropia, who successfully underwent surgical ophthalmological treatment from January 2017 to March 2021. Patients were divided into group A(n=35 cases, 70 eyes)and group B(n=33 cases, 66 eyes)according to whether or not they received perioperative synoptophore scintillation training. Group A included 19 males(38 eyes)and 16 females(32 eyes)(mean age: 29.34±12.72 years). Group B included 13 males(26 eyes)and 20 females(40 eyes)(mean age: 30.12±8.75 years). One month postoperatively, the patients were examined with a synoptophore, and the restoration of simultaneous vision, fusion function, and stereoscopic function were compared between the two groups.

RESULTS: There were no significant differences in age, sex, and preoperative far and near deviations between the two groups(P>0.05). Postoperatively, the restoration rates of simultaneous vision, fusion function, and stereoacuity were 54%, 54%, and 43% in group A, respectively. And 27%, 27%, and 15% in group B, respectively. Statistically, there were respectively significant differences between the two groups(χ²=5.117, 5.117, 6.280; all P<0.05).

CONCLUSION: Perioperative synoptophore scintillation training can effectively improve the binocular vision function of adult patients and older children(>12 years)with constant exotropia without binocular vision function and enhance the therapeutic effect of surgery.

Abstract:AIM: To observe the changes of retina superficial capillary plexus densities and aqueous humor factors in patients with diabetic macular edema(DME)before and after conbercept injection, and to explore the effect of conbercept on macular microcirculation in DME patients.

METHODS: A prospective case-control study was conducted. Totally 11 eyes of 10 patients diagnosed as DME in the Ophthalmology Department of the First Affiliated Hospital of Hainan Medical University from December 2019 to December 2020 were collected as DME group, 15 cataract patients without systemic basic diseases and fundus oculi diseases were collected as cataract group, and 20 age-and sex-matched healthy people with normal vision were collected as control group. All patients in DME group were treated by intravitreal injection of conbercept once a month for a total of 6 times. The retinal perfusion densities of the superficial capillary plexus(PSCP), retinal vessel densities of the superficial capillary plexus(VSCP), foveal avascular zone(FAZ), central macular thickness(CMT)and best corrected visual acuity(BCVA)were compared between the control group and DME patients before operation. The aqueous humor factors in cataract group and DME group were measured by multiplex flow immunoassay. The differences of aqueous humor factors in cataract group and DME group were compared. The changes of VSCP, PSCP, FAZ, CMT, BCVA and factors of aqueous humor in DME group after 6 conbercept injections were compared.

RESULTS: There were significant differences in PSCP, VSCP, FAZ area, BCVA and CMT between DME group and control group before operation(P<0.01); there were significant differences in angiopoietin-like protein 4(ANGPTL4), vascular endothelial growth factor(VEGF), interleukin-6(IL-6), interleukin-8(IL-8)in aqueous humor of DME group and cataract group before operation(P<0.001); PCSP and BCVA were increased and CMT were decreased in DME group after continuous conbercept injection for 6mo(all P<0.05); the concentrations of ANGPTL4, VEGF and IL-6 in aqueous humor of DME group decreased significantly(all P<0.05); patients injected with 1mo conbercept in the DME group had the most obvious improvement of BCVA and PSCP as well as the most obvious decline of CMT; while the ANGPTL4, VEGF and IL-6 in aqueous humor concentration had the most obvious decrease when they were injected with 1mo conbercept; VEGF in aqueous humor was positively correlated with the absolute value of CMT.

CONCLUSION: Conbercept injection in DME patients can improve retinal ischemia, reduce the concentration of VEGF and related factors in aqueous humor, effectively increase BCVA and relieve macular edema.

Abstract:AIM: To evaluate the clinical efficiency of phacoemulsification combined with intrascleral fixation of intraocular lens(IOL)by using Yamane's technique in the treatment of acute secondary angle-closure(ASAC)caused by lens subluxation.

METHODS: Clinical data of 15 patients(15 eyes)with ASAC caused by lens subluxation who underwent phacoemulsification combined with intrascleral fixation of IOL by using Yamane's technique from June 2019 to December 2020 were reviewed retrospectively. The patients were followed for 3mo. The preoperative and postoperative intraocular pressure(IOP), best corrected visual acuity(BCVA), positions of the IOL and complications were observed.

RESULTS: All the operations were successfully completed. The postoperative IOPs were lower than preoperative IOPs. There were overall differences between preoperative and postoperative IOPs(F=165.57, P<0.001). Through further pairwise comparison, the IOPs at 1d, 1wk, 1, and 3mo after operation were significantly different from IOPs before operation(all P<0.001). The IOPs remained normal range at 1wk, 1, and 3mo after operation. The BCVA at 3mo after operation was significantly better than the preoperative BCVA(t=10.717, P<0.001). All IOLs were in the expected position without an obvious tilt or displacement. No serious complications occurred after the operation.

CONCLUSION: The surgical strategy of phacoemulsification combined with intrascleral fixation of IOL by using Yamane's technique in the treatment of ASAC caused by lens subluxation was safe and effective by lowing IOP, rescuing visual, maintaining stability of IOL and reducing complications.

Abstract:AIM: To observe the preliminary therapeutic effect of low-temperature plasma ablation combined with drugs in the treatment of infectious corneal ulcer.

METHODS: Retrospective case study. A total of 30 eyes were selected from 30 patients with infectious corneal ulcer who were admitted to the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University from December 2018 to March 2020. All patients had positive etiological examination and ulcer or infiltration depth ≤1/2 of corneal thickness. Local low-temperature plasma ablation combined with eye drops was applied to the cases whose corneal ulcer did not improve significantly or corneal infiltration continued to worsen after 3-7d of conventional anti-infection treatment. Postoperative follow-up was 3-6mo to observe the clinical effect.

RESULTS: After low-temperature plasma ablation combined with eye drops treatment, the infection in 12 eyes of 12 patients with bacterial corneal ulcer was controlled in 11 eyes of 11 patients and ulcer healed gradually. Keratoplasty was performed in 1 eye due to aggravated infiltration. Among 18 eyes of 18 cases with fungal corneal ulcer receiving low-temperature plasma ablation and combined local antifungal treatment, 13 eyes of 13 cases gradually healed; 2 eyes of 2 patients showed lichen-like changes after the first ablation, but the lesion area was significantly smaller than before and gradually improved after re-ablation treatment; there was no effect in 3 eyes of 3 cases and keratoplasty was finally performed. All the patients were followed up for 3-6mo, 26 eyes of 26 patients were cured and the infection had no recurrence with remaining corneal pannus or leukoplakia. Confocal microscopy did not detect mycelium in cured patients with fungal infection.

CONCLUSION: In this preliminary observation, low-temperature plasma ablation combined with drug therapy can effectively control infection, promote healing and improve visual acuity for infective corneal ulcer with infiltration less than 1/2 corneal thickness, and no obvious complications were observed.

Abstract:AIM: To compare the consistency of angle Kappa and angle Alpha in age-related cataract eyes with three different instruments.

METHODS: Prospective study. Totally 60 eyes of 30 patients with age-related cataract from December 1 to December 30, 2020 were collected. After adapting to 10min in the darkroom before operation, the angle Kappa and angle Alpha were measured with iTrace, Lenstar 900 and IOL Master 700 biometric instruments, respectively. The difference and consistency of the three instruments were analyzed.

RESULTS: The results of angle Kappa measurement of iTrace, Lenstar 900 and IOL Master 700 were 0.25±0.13, 0.19±0.11, 0.21±0.11mm(F=1.903, P=0.155). The results of angle Alpha measurement of the three instruments were 0.31±0.11, 0.36±0.16, 0.36±0.14mm(F=2.999, P=0.052). The proportion of angle Kappa of the three instruments greater than 0.5mm is 3%, 2% and 2%, and the proportion of angle Alpha greater than 0.5mm is 5%, 15% and 22%. The distribution of angle Kappa and angle Alpha is mainly in the temporal side of both eyes. Compared with the angle Kappa distribution of both eyes, the temporal distribution ratio of angle Alpha is higher, and the distribution of angle Alpha measured by iTrace is closer than that of Lenstar 900 and IOL Master 700 along the horizontal line. There was a positive correlation between angle Alpha and angle Kappa measured by each instrument(r=0.2941, 0.4082, 0.5137; P=0.0226, P=0.0012, P<0.0001). The consistency of angle Kappa measurement results of three kinds of instruments was good, while that of angle Alpha measurement results was poor.

CONCLUSION: When making the decision of multifocal intraocular lens implantation before cataract surgery, the consistency of angle Alpha measured by Lenstar 900, IOL Master 700 and iTrace is poor, so it is necessary to compare and refer to the results of various instruments in clinical application. When the data of angle Alpha could not be obtained before cataract surgery, the angle Kappa measured with the three instruments could provide useful information for multifocal IOL implantation decision.

Abstract:AIM: To compare the safety and effectiveness of pars plane filtering(PPF)and trabeculectomy(TRA)on neovascular glaucoma(NVG).

METHODS: This retrospective comparison was done in 12 patients(one eye with NVG in each)who were treated with PPF surgery and 15 patients who were treated during the same period with TRA, one eye was treated in each patient. Intraocular pressure(IOP), complete surgical success rate, peripheral anterior chamber depth(PACD), postoperative anterior chamber morphology, visual acuity and complications were observed and compared between the two groups.

RESULTS: The IOP was significantly reduced at each time point after the surgery 1, 3d, 1wk, 1, 3mo after operation(P<0.05), and there was no significant between-group difference at any time point(P >0.05). The rate of complete success observed 3mo after operation was superior in PPF group(92% vs 53%, P<0.05). PACD was found to be deeper at 1wk after the operation in PPF group as compared with the values before the operation and was deeper than that in TRA group(P<0.05); while this comparison in TRA group showed no significant change(P>0.05). After the operation, the anterior chamber angle was open and the anterior chamber was deepened in PPF group. No significant changes in visual acuity before and after the operation within each group and between groups were observed 3mo after the surgery(P>0.05). The incidence of postoperative hemorrhage in anterior chamber was lower in PPF group(8% vs 47%, P<0.05).

CONCLUSION: Both PPF and TRA surgery can successfully control IOP of NVG. However, PPF surgery appeared to be superior as having a higher complete success rate. In addition, PPF surgery makes the anterior chamber deeper and wider, and result in fewer severe postoperative complications.

Abstract:AIM: To investigate the efficacy of anti-inflammatory treatment and anti-vascular endothelial growth factor(VEGF)treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME).

METHODS: The clinical data of RVO-ME patients who were treated in the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University from 2019-06/2020-12 were retrospectively collected. A total of 108 cases(108 eyes)of RVO-ME patients were collected, including 52 cases(52 eyes)with cystoid macular edema(CME), 38 cases(38 eyes)with macular edema with serous retinal detachment(SRD), and 18 cases(18 eyes)with diffuse retinal thickening(DRT). Patients with various types of ME were further classified into anti-VEGF group and anti-inflammatory group. The observation metrics such as best corrected visual acuity(BCVA)and foveal thickness(CMT)before and 3mo after surgery were collected and compared in each group.

RESULTS: There was no difference in baseline data between the anti-VEGF group and the anti-inflammatory group in all types of ME patients(all P>0.05). Patients with CME in the anti-VEGF group in BCVA, CMT, and the sum of CME diameter after operation were different from that before operation(Z= -4.463, -4.541, -4.541, all P<0.001); the postoperative BCVA, CMT, and the sum of CME diameter in the anti-inflammatory group were significantly different from those before operation(Z= -3.743, -4.345, -4.372, all P<0.001); and there was no difference between the anti-VEGF group and the anti-inflammatory group in the postoperative CMT and the sum of CME diameter(Z= -1.017, -0.968, all P>0.05), but there was a difference in BCVA after operation in two groups(Z= -1.978, P<0.05). SRD patients in the anti-VEGF group had differences in postoperative BCVA, CMT, and SRD heights compared with preoperative ones(Z= -4.111, -4.198, -4.198, all P<0.01); the BCVA, CMT, and SRD height in the anti-inflammatory group after operation were different from those before operation(Z= -3.410, -3.408, -3.408, all P<0.05); and there was no difference in BCVA and CMT between the two groups after operation(Z= -0.857, -1.030, all P>0.05), but the postoperative SRD height in the anti-inflammatory group was significantly lower than that in the anti-VEGF group(Z= -2.117, P<0.05). DRT patients in the anti-VEGF group were significantly different in BCVA and CMT after operation compared with preoperative ones(Z= -2.207, -2.521, all P<0.05), and in the anti-inflammatory group after injection, BCVA and CMT were significantly different from preoperative ones(Z= -2.207, -2.521, all P<0.05). There were differences in BCVA and CMT after injection in the anti-inflammatory group compared with those before operation(Z= -2.207, -2.803, all P<0.05). There was no difference in postoperative BCVA and CMT between the two groups(Z= -0.359, -0.845, all P>0.05).

CONCLUSION: Anti-inflammatory and anti-VEGF treatments are effective for all kinds of ME in improving vision and reducing CMT. Anti-VEGF treatment is superior to anti-inflammatory treatment in improving BCVA of CME patients and is inferior to anti-inflammatory in decreasing SRD thickness of SRD patients.

Abstract:AIM: To observe the difference of curative effect between internal limiting membrane(ILM)inversion and insertion and ILM peeling and to analyze the influence of different surgical methods on the morphology of hiatus healing.

METHODS: A retrospective analysis of the clinical data of 22 patients with macular hole, who received vitrectomy in the First People's Hospital of Zunyi City from June 2017 to June 2020. According to the surgical methods, they were divided into 8 cases and 8 eyes in the ILM peeling group and 14 cases and 14 eyes in the ILM inversion covering group. The two groups of patients underwent best corrected visual acuity(BCVA)test, non-contact intraocular pressure and optical coherence tomography(OCT)examination before and 1wk, 1, and 3mo after operation were analysed.

RESULTS: The macular hole closure rate in the ILM peeling group was 75%, and the hole closure rate in the ILM inversion and insertion group was 93%. There was no statistically significant difference in the hole closure rate between the two groups(P=0.527). The trends of BCVA over time in the two groups were similar, but there were differences in time(F_time=18.426, P_time<0.001)and no difference between groups and interactions(F_{between groups}=1.319, P_{between groups}=0.289; F_{between groups×time}=1.658, P_{between groups×time}=0.211). The BCVA of the two groups was statistically significant 1wk after operation compared with that before operation(t= -2.200, -3.092; all P<0.05); The BCVA of the ILM inversion and insertion group was improved 3mo after operation compared with that before operation, and the difference in the group was statistically significant(t=2.503, P=0.019). There was no difference in overall foveal thickness between the two groups after surgery(F_time=1.054, P_time=0.346; F_{between groups}=0.110, P_{between groups}=0.750; F_{between groups×time}=2.391, P_{between groups×time}=0.152).

CONCLUSION: Both ILM inversion and insertion and ILM peeling can effectively increase the rate of macular hole closure. The macular structure healing after the ILM inversion and insertion is better, and the postoperative visual function improvement is more satisfactory.

Abstract:AIM: To observe the effect of intravitreal injection of ranibizumab in the treatment of retinal vein occlusion macular edema(RVO-ME), and to apply Logistic regression analysis to screen the factors that affect the vision recovery of patients.

METHODS: A total of 106 patients(106 eyes)with retinal vein occlusion and macular edema who were treated in the ophthalmology clinic of our hospital from January 2018 to June 2019 were selected for the study. The clinical data of the patients were retrospectively analyzed and all were given 0.05mL ranibizumab. The monoclonal antibody was injected into the vitreous cavity of the affected eye, and the patients were followed up to observe the treatment effect. The patients were divided into good group and poor group according to the degree of vision recovery after 3mo of treatment, and the two-class Logistic regression analysis was used to screen the factors that affect the vision recovery of patients.

RESULTS: The Logarithm of the minimum angle of resolution(LogMAR)of the affected eye at 1d, 1wk, 1, and 3mo after treatment was significantly lower than before treatment, and the macular foveal retinal thickness(CRT)was significantly lower than before treatment. The difference was statistically significant(all P<0.05), and there was no significant difference in the average intraocular pressure of the affected eye before and after treatment(P>0.05). During and after the treatment, the patient did not develop complications such as endophthalmitis, increased intraocular pressure, lens opacity, and retinal detachment. Logistic regression analysis showed that there was no capillary perfusion in the foveal area of the macula and the center of the macula before treatment. Incomplete outer membrane and incomplete inner plexiform layer structure in the concave area are risk factors that affect the efficacy of ranibizumab injection.

CONCLUSION: Intravitreal injection of ranibizumab in the treatment of retinal vein occlusion combined with macular edema is effective and safe in the short term. It can effectively reduce macular edema of the affected eye, improve vision, and normal intraocular pressure after treatment, and it is easy to operate and effective. It has the advantages of repeating, little damage to tissues, no obvious adverse reactions, less pain for patients, economical and practical. In addition, the lack of capillary perfusion in the foveal area of the macula before treatment, the incomplete outer membrane of the foveal area, and the incomplete structure of the inner plexiform layer are risk factors that affect the efficacy of ranibizumab in the treatment of retinal vein occlusion and macular edema.

Abstract:AIM:To analyze the prevalence and influence factors of macular choroidopathy secondary to high myopia, so as to better understand the development of macular choroidopathy in patients with high myopia.

METHODS: The current study carried out a retrospective analysis on highly myopic patients aged 40 and above(2016-01/2019-07). A total of 232 patients(461 eyes)with high myopia were included. The fundus images and OCT results of all patients were evaluated to divide the cases into two main categories, non-choroidopathy 99 patients(255 eyes)and choroidopathy 133 patients(206 eyes), with choroidopathy including choroidal atrophy and choroidal neovascularization. The statistical analysis on the prevalence of different disorders and the multivariate regression between the influence factors were performed.

RESULTS: The prevalence of macular choroidopathy was 36.0%(166 eyes), of which, the prevalence of choroidal atrophy was 19.5%(90 eyes), and the prevalence of choroidal neovascularization was 16.5%(76 eyes). Multivariate Logistic regression analysis showed that axial length was the influence factor of choroidal atrophy(P<0.01), age and axial length were the influence factors of choroidal neovascularization(all P<0.01), gender, age and axial length were the influence factors of choroidopathy(all P<0.01).

CONCLUSION: Choroidal atrophy and choroidal neovascularization were prone to occur in patients with high myopia, and the prevalence was higher in women. In addition, the prevalence increased with the increase of age and diopter.

Abstract:AIM:To investigate the clinical effect of modified free conjunctival flap transplantation with limbal stem cells in the treatment of pterygium and its impact on tear film function.

METHODS: A total of 60 pterygium patients admitted to our hospital from March 2017 to March 2021 were randomly divided into the control group and the observation group, with 30 cases in each group. The control group was treated with amniotic membrane transplantation, and the observation group was treated with modified free conjunctival flap transplantation with limbal stem cells. The treatment period of both groups was 21d. And then the clinical efficacy, operation duration, corneal wound repair time, xerophthalmia score, tear film rupture time value and basic tear secretion test value before and 1, 3mo after treatment, and the occurrence of adverse reactions were compared between the two groups.

RESULTS: The total effective rate of clinical treatment in the observation group was higher than that of the control group(χ²=5.963, P=0.015), the operation duration in the observation group was longer than that for the control group(t=-2.643, P<0.05), and the repair time of corneal wound was shorter than that of the control group(t=2.182, P<0.05). At 1 and 3mo after surgery, dry eye score in two groups decreased compared with that before surgery(all P<0.05), and there was a difference between observation group and control group(t=2.082, 3.956; all P<0.05). The time of tear film rupture at 1 and 3mo after surgery was increased compared with that before surgery(all P<0.05), and there was a difference between the observation group and the control group(t=4.245, 2.070; all P<0.05).The experimental value of basal tear secretion at 1 and 3mo after surgery increased compared with that before surgery(all P<0.05), and there was a difference between the observation group and the control group(t=2.076, 2.223; all P<0.05).There was no significant difference in the incidence of complications between the two groups(P=0.572).

CONCLUSION: The improved free conjunctival flap transplantation with limbal stem cells can effectively improve the clinical symptoms and tear film function of patients with pterygium, which is beneficial to the recovery of postoperative corneal wound, and can reduce the incidence of adverse reactions.

Abstract:AIM: To characterize a large cohort of patients presenting to the Department of Ophthalmology in Hunan Children's Hospital for ocular trauma, thus to offer supports for treatment and prevention of ocular trauma in children.

METHODS:The retrospective study was conducted between January 2016 and December 2020, and the medical recorded of 2 298 children(2 332 eyes)diagnosed with ocular trauma in the Ophthalmology Department and Ophthalmic Emergency of Hunan Children's Hospital were reviewed. The record data included gender, age, wounded eye, time of day, injury month, cause of injury, zone of injury, types of ocular injury, complications, method of treatment and prognosis of visual acuity.

RESULTS: The results showed that 44.26% of ocular trauma occurred in the age of 3-6 years old in children, and 1 718 cases(1 745 eyes)in male children versus 580 cases(587 eyes)in female children, with a male to female ratio of 2.96:1.00. The high incidence months were February and November for pediatric ocular injury. Collisions and falls were the main causes, accounting for 40.95%, following with blunt object injury and sharp object injury, accounting for 40.82%. Eyelid and other accessory organs were the main injury sites(65.40%). After injury, 58.62% of the children were treated with debridement, primary closure or topical administration of eye drops, 38.38% were treated with debridement and suturing, and 3.00% were treated with complex intraocular surgery. Most children patients were difficult to cooperate with the vision examination. Among the children who completed the vision examination, 60.60% showed visual impaired due to eye trauma. And after treatment, their vision improved to varying degrees. The severe impairment of visual acuity was mainly caused by corneal contusion, traumatic cataract, vitreous hemorrhage, bulbar foreign body and rupture of eyeball.

CONCLUSION: Pediatric ocular injuries are usually accidental, with an increasing incidence in recent years. The majority of children with ocular trauma are male and preschool children, with generally mild injuries and relatively good visual prognosis. Prevention and education on children's ocular traumas should be emphasized, and timely treatments after injury can effectively reduce the visual damage.

Abstract:AIM: To describe the clinical characteristics of 6 premature infants diagnosed as familial exudative vitreoretinopathy(FEVR).

METHODS: From August 2018 to January 2019, the researchers collected six premature cases of FEVR from Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine. All 6 infants born prematurely had examinations of fundus photography and fluorescein angiograms under anesthesia. Medical history and angiographic features were analyzed retrospectively.

RESULTS: Six infants born prematurely were initially misdiagnosed as retinopathy of prematurity ROP. All underwent injection anti-vascular endothelial growth factor(anti-VEGF)drug into vitreous body cavity subsequently, two of whom were treated with injection anti-VEGF drug into vitreous body cavity twice. Six infants born prematurely had follow-up examinations of fundus photography and fluorescein angiograms with the machine of Retcam digital imaging system under anesthesia, they were eventually diagnosed as FEVR. Then 2 cases were treated with laser photocoagulation, 1 case was treated with injection anti-VEGF drug into vitreous body cavity combined laser photocoagulation, 1 case was treated with injection anti-VEGF drug into vitreous body cavity, 2 cases maintain the follow-up visit.

CONCLUSION: Clinically, premature infants FEVR, tend to be misdiagnosed as ROP initially. If the demarcation line separating the avascular from the vascular retinal regions presents persistent or the condition turns to be worse, more examinations will be required to confirm the diagnosis such as fluorescein angiograms under anesthesia. FEVR is a lifelong disease, its symptoms, if present, typically take a progressive course during childhood and adolescence. Early diagnosis of FEVR is crucial due to its progressive nature and the genetic/familial underpinnings of the condition. The correct identification of those FEVR patients can help them receive timely treatment and genetic counseling for those of child-bearing age.