Abstract:AIM: To explore an efficient, practical and objective quantitative method to evaluate the retinal neovascularization in mouse model of oxygen induced retinopathy (OIR). METHODS: Thirty C57BL/6J mice were explored in OIR model procedure. Eyes were removed for different staining methods including: (1) HE staining; (2) immunohistochemistry with Griffonia Simplicifolia Lectin(GSL);(3) Immunofluore- scence with FITC labeled CD31 antibody; (4) Two-step immunofluorescence with purified-CD31 antibody; (5) FITC-Dextran perfusion combined with two-step purified- CD31immunofluorescence. Images of the retinal vasculature were analyzed by imaging software. RESULTS: GSL immunohistochemistry could clearly demonstrate the deep and superficial capillary beds. FITC labeled CD31 Immunofluorescence was blurring with high fluorescence background which was hard to distinguish retinal neovascularization in some area. Excellent detail of neovas- cularization and preexistent retinal vessels was provided in two-step Purified-CD31 immunofluorescence group. CONCLUSION: GSL immunohistochemistry can clearly demonstrate neovascularization tufts in deep and superficial capillary beds. Immunofluorescence of specific antigen CD31 on vascular endothelium can selectively label the neovascularization of mouse retina. When combined with computer analysis software, it is an effective and objective quantitative method to evaluate the retinal neovascularization in OIR mouse model.

Abstract:AIM: To explore the effect of SDF-1α on the development of experimental corneal neovascularization (CRNV). METHODS: CRNV was induced by alkali injury in mice. The expression of SDF-1α and CXCR4 in burned corneas was examined by Flow Cytometry. Neutralizing anti-mouse SDF-1α antibody was locally administrated after alkali injury and the formation of CRNV 2 weeks after injury was assessed by Immunohistochemistry. The expression of VEGF and C-Kit in burned corneas was detected by RT-PCR. RESULTS: The number of CRNV peaks at 2 weeks after alkali injury. Compared to control group, SDF-1α neutralizing antibody treatment significantly decreased the number of CRNV. RT-PCR confirmed that SDF-1α neutralizing antibody treatment resulted in decreased intracorneal VEGF and C-Kit expression. CONCLUSION: SDF-1α neutralizing antibody treated mice exhibited impaired experimental CRNV through down regulated VEGF and C-Kit expression.

Abstract:AIM: To investigate roles of surfactant protein D (SP-D) and relative cytokines in human corneal epithelial(HCE) cells exposed to aspergillus fumigatus (AF) antigens. METHODS: HCE cells cultured in vitro with AF antigens and sampled at 0, 0.5, 1 hour, 2, 4, 6 and 8 hours. The expression of SP-D mRNA was evaluated by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR).The expression of SP-D protein was shown by ELISA and immunocytochemistry SP methods. The expression of NF-κB and relative downstream cytokines such as TNF-α, IL-1β, IL-8 and IL-10 in supernatant fluid were measured by ELISA. RESULTS: SP-D mRNA and protein were detected in untreated HCE cells. The expression of SP-D and the relative downstream cytokines rose after being stimulated with AF antigens. SP-D mRNA began to rise at 0.5 hour and the most significantly peak was in 2 hours. The protein of SP-D in supernatant fluid had the same trend with mRNA. Immunocytochemistry of SP-D showed positive expression and gradually increased to 6 hours, and then the expression began to decline. NF-κB was activated after treated by AF antigens and the changes had correlation with SP-D. TNF-α, IL-1β, IL-8 and IL-10 began to rise after given AF antigens 1 hour and were 1.82, 1.43, 1.12 and 1.28 times higher than the untreated HCE cells separately. The expression of TNF-α and IL-1β reached the peak at 2 hours, separately 2.80 and 2.86 times than the untreated. The expression of IL-8 and IL-10 gradually increased with a time-dependent manner. CONCLUSION: HCE cells exists SP-D and it may play a significant role in pathogenesis of keratomycosis. AF may induce human corneal epithelial cells to express inflammatory cytokines via SP-D and NF-κB pathway. SP-D possibly mediates the recognition to AF mycelium.

Abstract:AIM: To demonstrate that human platelet-derived growth factor-B (PDGF-B) cDNA could be expressed in primary cultured cat corneal endothelia cells by using gene transfer techniques; to explore a useful tool for the further studies of the molecular mechanisms of corneal endothelium failure and provide a potential effective genetic therapy for the blind patients. METHODS: Human PDGF-B cDNA was isolated from human placent by RT-PCR and inserted into pcDNA4 vector to construct recombinant eukaryotic expression plasmid pcDNA4-PDGF-B. The full length was confirmed by the DNA sequencing analysis. By tearing endothelium technique we obtained pure single layer of cat corneal endothelial cells. The pcDNA4-PDGF-B eukaryotic expression vector was transferred into cat corneal endothelial cells by EffecteneTM lipofectine. The transfection efficiency of EffecteneTM lipofectine in pcDNA4-B was detected with pcDNA4-GFP. 5 days later, RT-PCR was used to check the PDGF-B expression. Cell viability was tested by modified tertrozalium salt (MTT) method. Cell morphology was observed under inverted phase contrast microscope. RESULTS: The human PDGF-B cDNA was isolated successfully from healthy parturien placent tissue and the sequence was confirmed by computer automatic sequence and PCR analysis. Pure single layer cat corneal endothelial cells were successfully cultured by tearing endothelium technique. EffecteneTM lipofectine transfection technique could be effectively used to transfer pcDNA4-PDGF-B into cat corneal endothelial cells in vitro, the transfection efficiency was 30%. RT-PCR result showed that human PDGF-B gene was highly expressed in transfected cat corneal endothelial cells. The expressed PDGF-BB protein promoted the viability of cat corneal endothelial cells. CONCLUSION: Human platelet-derived growth factor-B (PDGF-B) cDNA could be highly expressed in cultured cat corneal endothelial cells by gene transfection techniques. Expressed PDGF-BB protein significantly promoted the viability of cat corneal endothelial cells, thus provided a potential effective method for corneal endothelium blindness genetic therapy.

Abstract:AIM：To investigate auto-cortex of crystalline lens induced iris neovascularization (INV). METHODS: Thirty-six eyes of 36 guinea-pigs were included and divided into three groups randomly in this cohort study. Group A: the right lens nucleus was extracted and the remaining cortical lens material was aspirated thoroughly. Group B: the lens was removed and 30μL precipitated lens cortex was injected into the anterior chamber again. Group C: aspirated the lens cortex of the left eyes and inject them into the right anterior chambers about 10μL. Clinical changes were followed by slit-lamp examination and photograph. The eye balls were enucleated at the day of 2, 4, 7, 11, 13, 17 after operation. HE was used to detect the pathological changes. RESULTS：Group A：INV had not been observed until the end of empirical study. The stromal layer contained thick wall vessels, without expansion. Group B: All eyes developed INV. Postoperative (po) 7 days; the eyes developed intense and extensive INV. The vessels of iris expanded remarkably and neovascularization was observed erupting from it’s lateral wall and stretching towards the anterior surface. Po11 days, INV regressed gradually after lens cortex had been absorbed. Group C: Po four（4） days, new blood vessels liking red line were presented on the anterior surface of the iris and they were not obvious. CONCLUSION: Anterior chamber inside lens coriaceous can induce iris new blood vessels.

Abstract:AIM: To investigate mitochondrial factors associated with Leber hereditary optic neuropathy (LHON) through complete sequencing and analysis of the mitochondrial genome of Chinese patients with this disease. METHODS: Two unrelated southern Chinese families with LHON and 10 matched healthy controls were recruited, and their entire mitochondrial DNA (mtDNA) was amplified and sequenced with the universal M13 primer. Then DNA sequence analysis and variation identification were perfomed by DNAssist and Chromas 2 software and compared with authoritative databases such as Mitomap. RESULTS: Mutational analysis of mtDNA in these two Chinese pedigrees revealed one common LHON-associated mutation, G11778A (Arg→His), in the MT-ND4 gene. In addition, there were two secondary mutations in Pedigree 1: C3497T (Ala→Val), and C3571T (Leu→Phe) in the MT-ND1 gene, which have not been reported; and two secondary mutations occurred in Pedigree 2: A10398G (Thr→Ala) in the MT-ND3 gene, and T14502C (Ile→Val) in the MT-ND6 gene. Three polymorphisms, A73G, G94A and A263G in the mtDNA control region, were also found. CONCLUSION: Our study confirmed that the known MT-ND4*G11778A mutation is the most significant cause of LHON. The C3497T and C3571T mutations in Pedigree 1 were also both at hot-spots of MT-ND1; they may affect the respiratory chain in coordination with the primary mutation G11778A. In Pedigree 2, the two secondary mutations A10398G of MT-ND3 and T14502C of MT-ND6 may influence mitochondrial respiratory complex I, leading to the mitochondrial respiratory chain dysfunction which results in optic atrophy together with G11778A. Therefore, not only the common primary LHON mutation is responsible for the visual atrophy, but other secondary mtDNA mutations should also be considered when giving genetic counseling.

Abstract:AIM: To compare the therapeutic effects of polysaccharide extract from Spirulina platensis (PSP) and extract from amnion membrane (AME) on alkali burn-induced corneal neovascularization (CorNV). METHODS: PSP and AME were extracted from dry powder of Spirulina platensis and human aminion membrane respectively. Murine CorNV was induced by applying 1N sodiumhydroxide (NaOH) solution directly on the mice corneas. PSP and AME extracts were administered topically on the corneas 4 times daily for 7 days. The therapy effects of PSP and AME extracts were evaluated daily using slit-lamp. At the end of the therapy, corneas were harvested for H&E staining, masson trichrome staining, immunohistochemical study, and semi-quantification reverse transcriptive PCR (RT-PCR) was utilized for measurement of inflammation-related molecules. RESULTS: Topical application of PSP extract had significant therapeutic effects on CorNV that could be shown in various assays of the corneas. Compared with AME extract, PSP extract treatment was more effective in suppressing CorNV in terms of vessel length and levels of cluster of differentiation 31 (CD31) proteins or the angiogenesis related genes like vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP2) and matrix metalloproteinase-9 (MMP9). PSP also inhibited inflammation more markedly by more effectively inhibiting mononuclear and polymorphonuclear cells infiltration into the corneal stroma and reducing levels of stromal cell-derived factor-1 (SDF1), tumor necrosis factor-alpha (TNFα) and macrophage inflammatory protein-3 (MIP3a). In additon, corneas of PSP group had a more regular and compact architecture of collagen with thinner corneal thickness than in the AME group. CONCLUSION: Polysaccharide extract from Spirulina platensis inhibited alkali burn-induced inflammation and CorNV more effectively than AME extract at the studied doses, thus may be used for the therapy of corneal diseases involving neovascularization and inflammation.

Abstract:AIM: To detect the expression of transforming growth factor beta-induced gene (TGFBI) protein in human corneal tissue and overexpress it in the human corneal epithelial cells in order to discuss the function of TGFBI in the pathogenesis of corneal dystrophy. METHODS: Immunohistochemistry(IHC) was used to detect the expression of TGFBI in the human cornea tissue. TGFBI cDNA was obtained by reverse transcription-PCR from human corneal total RNA extracted from cornea transplant donor and cloned into pCMV-N-HA vector. The recombinant pCMV-N-HA-TGFBI plasmid transfected human corneal epithelial cells. Forty-eight hours later, mRNA and proteins were harvested from cells for real-time PCR analysis and western blot assay respectively. RESULTS: IHC indicated TGFBI mainly exist below the human corneal epithelium layer. Transfection of recombinant pCMV-N-HA-TGFBI into human corneal epithelial cells resulted in effective expression of TGFBI, as shown by increased mRNA level detected by real-time PCR as well as increased protein level detected by Western blot. Meanwhile the result of real-time PCR and Western blot shown the expression of MMP1，MMP3 (matrix metalloproteinases MMP) increased while the expressin of TIMP1 (tissue inhibitors of matrix metalloproteinases TIMP) decreased. CONCLUSION: TGFBI mainly exists below the corneal epithelial layer, recombinant eukaryotic expression vector harboring human TGFBI cDNA was obtained and efficiently overexpressed in human corneal epithelial cells. Meanwhile the TGFBI overexpression in human corneal epithelial cells result in MMP1, MMP3 increasing and TIMP1 decreasing. The result might be helpful for studying the function and role of TGFBI in pathogenesis of corneal dystrophy.

Abstract:AIM: To study the optical property and biocompatibility of a tissue engineering cornea. METHODS: The cross-linker of N-(3-Dimethylaminoropyl)-N’ethylcarbodiimide hydrochloride (EDC)/ N-Hydroxysuccinimide (NHS) was mixed with Type I collagen at 10% (weight/volume). The final solution was molded to the shape of a corneal contact lens. The collagen concentrations of 10%, 12.5%, 15%, 17.5% and 20% artificial corneas were tested by UV/vis-spectroscopy for their transparency compared with normal rat cornea. 10-0 sutures were knotted on the edges of substitute to measure the corneal buttons’s mechanical properties. Normal rat corneal tissue primary culture on the collagen scaffold was observed in 4 weeks. Histopathologic examinations were performed after 4 weeks of in vitro culturing. RESULTS: The collagen scaffold appearance was similar to that of soft contact lens. With the increase of collagen concentration, the transparency of artificial corneal buttons was diminished, but the toughness of the scaffold was enhanced. The scaffold transparency in the 10% concentration collagen group resembled normal rat cornea. To knot and embed the scaffold under the microscope, 20% concentration collagen group was more effective during implantation than lower concentrations of collagen group. In the first 3 weeks, corneal cell proliferation was highly active. The shapes of cells that grew on the substitute had no significant difference when compared with the cells before they were moved to the scaffold. However, on the fortieth day, most cells detached from the scaffold and died. Histopathologic examination of the primary culture scaffold revealed well grown corneal cells tightly attached to the scaffold in the former culturing. CONCLUSION: Collagen scaffold can be molded to the shape of soft contact corneal lens with NHS/EDC. The biological stability and biocompatibility of collagen from animal species may be used as material in preparing to engineer artificial corneal scaffold.

Abstract:AIM: Many studies have demonstrated N-methyl-D-aspartate receptor-1-subunit (NMDAR1) is associated with amblyopia. The effectiveness of levodopa in improving the visual function of the children with amblyopia has also been proved. But the mechanism is undefined. Our study was to explore the possible mechanism. METHODS: Sixty 14-day-old healthy SD rats were randomly divided into 4 groups, including normal group, monocular deprivation group, levodopa group and normal saline group, 15 rats each. We sutured all the rats’ unilateral eyelids except normal group to establish the monocular deprivation animal model and raise them in normal sunlight till 45-day-old. NMDAR1 was detected in the visual cortex with immunohistochemistry methods, Western Blot and Real time PCR. LD and NS groups were gavaged with levodopa(40mg/kg) and normal saline for 28 days respectively. NMDAR1 was also detected with the methods above. RESULTS: NMDAR1 in the visual cortex of MD group was less than that of normal group. NMDAR1 in the visual cortex of LD group was more than that of NS group. CONCLUSION: NMDAR1 is associated with the plasticity of visual development. Levodopa may influence the expression of NMDAR1 and improve visual function, and its target may lie in the visual cortex.

Abstract:AIM: To explore the pathogenesis, influencing factors, ways of medical intervention and evaluation indicators of cataract by observing changes in serum biochemical indices in mice with targeted disruption of βB2-crystallin. METHODS: Nine 6-week-old male mice with targeted knockout of βB2-crystallin were used as the study group, and nine age- and sex-matched normal wild-type mice as the control group. The genetype of the modeled mice was identified by PCR technique. Tropicamide and phenylephrine eye drops were used as the cycloplegic agents to observe changes in lens opacity with a slit-lamp. The lens was then removed and blood was collected for biochemical evaluation in the serum. RESULTS: Two genotypes were successfully identified by PCR technique. Slit-lamp observation showed that the lens cortex was opaque and GSH level in the lens cortex was remarkably decreased in mice with βB2-crystallin deficiency compared with the control group (P<0.01). Serum Na+, Cl-, Ca2+, Mg2+ and Fe2+ levels, ALT and AST activities, and TP, ALP, Cr, TC, GLU content were decreased significantly compared with the control group (P<0.05). There was no difference in LDH, P, Cu2+, K+ levels between the two groups (P>0.05). CONCLUSION: Compared with the wild-type mice, serum biochemical indices underwent significant changes in mice with targeted disruption of βB2-crystallin gene, especially with abnormal distribution of Na+&Ca2+, which induced the formation of cataract.

Abstract:AIM: To evaluate the influence of different intraocular lens(IOL) designs made of PMMA on posterior capsular opacification(PCO) and compare with foldable designs. METHODS: Phacoemulsification and IOL implantation was done in one eye of 24 New Zealand White rabbits, with IOL of two different designs (Square edged or round edge) and two different materials(PMMA or HEMA). After three months, the animals were sacrificed and enucleated. Evaluation of PCO included posterior view, migration of anterior capsular epithelial cells to the posterior capsule following epithelial-mesenchymal transition were assessed by staining the histological sections of posterior capsule by hematoxylin-eosin(HE) and Periodic acid- Schiff (PAS). The IOLs were extracted and stained with HE to evaluate the presence of adherent cells on the lens surface. RESULTS: PCO was highest with round edged rigid lens. There was no significant difference in the PCO between the square edged PMMA and square edged foldable lens. CONCLUSION: It is the design of the IOL not the material that offers protection on PCO formation.

Abstract:AIM: To investigate the effects of estrogen replacement therapy (ERT) on apoptosis and vascular endothelial growth factor (VEGF) expression in ocular surface in an experimental rat model. METHODS: Forty female, Wistar rats were randomized in 4 groups in the study. Subcutaneous ERT (17β-estradiol, 10μg/kg/day) was administered to the first group without ovariectomy and to the second group with ovariectomy for three months. Third group had only ovariectomy and fourth group had sham operation. All rats were sacrificed in estrous cycles determined by vaginal smear test and their right eyes were enucleated at the end of the third month. Enucleated eyes were analyzed by immunohistochemical method for expressions of caspase-3, bcl-2, VEGF and TUNEL assay. RESULTS: Caspase-3 expression of conjunctival epithelium was significantly higher in group 3 than group 1 (P=0.005), and group 2 (P=0.007). TUNEL score of conjunctival epithelium was significantly higher in group 3 than group1 (P=0.006). TUNEL score of corneal epithelium was significantly higher in group 3 than group 2 (P=0.012), and group 4 (P=0.002). There was no significant difference between groups in that bcl-2 and VEGF expressions. CONCLUSION: We determined increased apoptosis in ocular surface epithelial cells in ovariectomized rats. ERT and endogen estrogen decreased the apoptosis, and did not result in difference in VEGF expression between the groups. Estrogen may be beneficial for the treatment of apoptosis-mediated ocular surface disorders such as dry eye. Further studies are needed on this subject for a better understanding of the role of estrogen and to provide a new insight for treatment and prevention of apoptosis-mediated ocular surface disorders.

Abstract:AIM: To assess and compare the flap morphology using anterior segment optical coherence tomography (AS-OCT) in laser in situ keratomileusis(LASIK) with Femto LDV femtosecond lasers versus Hansatome mechanical Microkeratome. METHODS: AS-OCT (Visante) was used to compare 1 month postoperatively the morphology of the flaps created with Femto LDV femtosecond lasers or Hansatome Microkeratome. The intended ?ap thickness was 110μm and 160μm respectively. The thickness of twenty-five points across each flap, which were 0mm, 1.5mm, 2.5mm, and 3.5mm to the corneal vertex on the horizontal, vertical, 45° and 135° meridian respectively, was evaluated. RESULTS: One month postoperative, the central flap thickness in the Femto LDV group was 107.43±4.70μm, while 125.90±17.50μm in the Hansatome group. The difference between the actual and the expected ?ap thickness was 5.61±3.84μm and 31.52±12.27μm, respectively. The Hansatome group had presented a statistically signi?cant result (P﹤0.001). Flap morphology showed a more regular planar shape in the Femto LDV group and a meniscus shape in the Hansatome group. CONCLUSION: AS-OCT is a direct and fast procedure to assess the flap morphology. The morphology by AS-OCT showed that the flaps created with Femto LDV femtosecond laser were more accurate and regular than the flaps created with Hansatome microkeratome.

Abstract:AIM: To study the tear film stability after lamellar keratoplasty. METHODS: Five female and eight male patients with lamellar keratoconus, aged from 18 to 32, were involved. After lamellar keratoplasty, SchirmerⅠtest(SⅠt), tear break-up time(BUT) test, fluorescein staining test were used to judge the effect of the surgery at different time point. RESULTS: The SⅠt were greatly increased in 7 days post operation (11.86±2.28 -25.14±1.97, 19.86±1.61) (P<0.05), there is no significant difference between 2nd month, 3rd month post-operative and pre-operation (11.86±2.28 - 14.57±1.48, 8.14±0.86) (P>0.05). The mean break-up time decreased in 7 days post operation (5.00±1.31 - 2.71±0.18, 2.57±0.20, 2.71±0.36, 2.43±0.20)(P<0.05). The mean scores of fluorescence increased post-operatively (0.14±0.14 - 8.00±0.00, 8.00±0.00, 8.00±0.00, 7.57±0.20) (P <0.01). CONCLUSION: Lamellar keratoplaty influence the tear film stability, artificial tears and improving corneal epithelium cured medicine should be used after surgery.

Abstract:AIM: To evaluate the visual outcomes and patient satisfaction of two multifocal intraocular lens implantation patterns, with the decision between the two patterns being guided by the patients’ choice of visual zones that best suited their lifestyle, or lifestyle zones. METHODS: This is a prospective non-randomized comparative study. The lifestyle zones of 32 consecutive age-related cataract patients (64 eyes) were investigated individually to guide the surgical decision between two multifocal intraocular lens implantation patterns. The first group (MIX) received a combined implantation of a ReZoom NXG1 lens in the dominant eye and a Tecnis ZM900 lens in the other eye. The second group (MATCH) received bilateral ReZoom NXG1 lenses. One year postoperatively, the patients were assessed for binocular uncorrected visual acuity, reading visual acuity, reading speed and depth of focus under different luminance and were surveyed for visual disturbances, satisfaction and complete spectacle independence. RESULTS: According to the determination of lifestyle zones, 18 and 14 patients were included in the MIX and MATCH groups, respectively. One year postoperatively, each of the patients exhibited positive visual outcomes and lifestyle satisfaction, although there were still some differences between the two groups. Generally, patients in the MATCH group had better distance visual acuity than those in the MIX group. In contrast, patients in the MIX group had better near visual acuity, better reading acuity and better reading speed than those in the MATCH group. Between the two groups, there was no clear difference in intermediate visual acuity, and the depths of focus between the two groups were approximately equal. The results of the mean NEI-RQL-42 questionnaire score, overall satisfaction, and complete spectacle independence did not differ between the two groups. CONCLUSION: Different multifocal intraocular lenses implantation patterns can have differing advantages and disadvantages; however, the best results with respect to visual outcome and patient satisfaction can be achieved by taking individual lifestyle zones into account.

Abstract:AIM: To prepare a new-type soft intraocular lens (IOL) that silicone intraocular lenses (IOLs) were modified by surface modification technique to assess IOLs biocompatibility. METHODS: With the technique of ion beam combined with low temperature and low pressure plasma, the surface characteristics of the IOLs including physical and optical properties were determined by the instruments of IOLs resolution, UV/VIS scanning spectrophotometer, contact angle measurement system, electron spectroscopy for chemical analysis (ESCA) and scanning electron microscope (SEM). RESULTS: The color of titanium (Ti) modified IOLs was light yellow and that of titanium nitride (TiN) modified IOLs was light brown. The absorptive degree of ultraviolet rays and the hydrophilicity of the surfaces of modified IOLs were increased, and appeared suitable chemical compositions. The resolution of unmodified and modified IOLs reached normal standard. The surfaces of unmodified and Ti-modified IOLs appeared uniform. The surfaces of TiN-modified IOLs presented fine porcelain structure. CONCLUSION: The optical properties of all IOLs and the surface morphology of the modified IOLs were not affected by modification processes. The surface properties of the modified IOLs were improved.

Abstract:AIM: To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis. METHODS：A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae.Local and systemic antifungal therapy more than one week for all patients, corneal ulcer enlarge or no shrink.Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm.Anterior segment optical coherence tomography（AS-OCT）examine the depth of corneal ulcer between 1/3-1/2,infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis. Complete removal lesions until transparent of stroma, make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva. Continued antifungal therapy. The vision, fungal recurrence, conjunctival flap rollback or desquamate were analysed. RESULTS：Ten patients had success done this surgery, the corneal ulcer was not enlarge and healing afteroperation.7 cases were bridging conjunctival flap and 3cases were single conjunctival flap. Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery, while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap, no conjunctival flap desquamate. CONCLUSION：It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.

Abstract:AIM: To evaluate the clinical factors related to chronic rhegmatogenous retinal detachment (RRD). METHODS: A retrospective case-control study. A total of 103 consecutive patients (103 eyes) with primary RRD were studied to evaluate the clinical factors related to chronic RRD. RESULTS: Chi-square test was used to sift out the following associated factors with chronic RRD: younger patients (P=0.0028), better preoperative best corrected visual acuity (BCVA, P=0.0316), atrophic retinal break (P<0.0001), inferior retinal break (P<0.0001), smaller break (P=0.0005); then the independent risk factors related to chronic RRD was determined by stepwise logistic regression analysis as following: atrophic retinal break (odds ratio (OR)=7.997, P=0.007), inferior retinal break (OR=14.127, P<0.0001) and better preoperative BCVA (OR=1.636 P<0.0722) . CONCLUSION: Atrophic retinal break, inferior retinal break and better preoperative BCVA are the independent risk factors related to chronic RRD.

Abstract:AIM: To evaluate changes in the anterior chamber depth (ACD), crystalline lens thickness (LT) and its refractive power after laser in situ keratomileusis (LASIK). METHODS: In all cases, the preoperative and postoperative central ACD which were measured with Pentacam, Orbscan, IOL-Master and A-scan ultrasonography, central corneal true net power which was measured with the Pentacam, Orbscan and IOL-Master, axial length (AL) which was measured with IOL-Master and LT which was measured with the A-scan ultrasonography were compared using the paired sample t test. Ocular refractive errors and lens refractive power at corneal plane were calculated and their correlations were also evaluated before and after LASIK. RESULTS: At 1 week after LASIK, LT and crystalline lens refractive power at corneal plane (Dlens) which were associated with the IOL-Master and Pentacam increased significantly (P≤0.005), ACD decreased significantly (P≤0.001), but no significant increase was observed in the Dlens which was associated with the Orbscan (P=0.261). Significant correlations between the changes in the ocular refractive errors and Dlens which were associated with the Pentacam were observed at 1 week and 6 months after LASIK (P=0.028; P=0.001). CONCLUSION: LT increased significantly after LASIK, and this might partially lead to ACD decrease, Dlens increase and a small quantity of myopic regression.

Abstract:AIM: To investigate the accuracy of intraocular pressure (IOP) as measured by a Reichert Ocular Response Analyzer (ORA), as well as the relationship between central corneal thickness (CCT) and IOP as measured by ORA, Goldmann applanation tonometry (GAT), and dynamic contour tonometry (DCT). METHODS: A total of 158 healthy individuals (296 eyes) were chosen randomly for measurement of IOP. After CCT was measured using A-ultrasound (A-US), IOP was measured by ORA, GAT, and DCT devices in a randomized order. The IOP values acquired using each of the three tonometries were compared, and the relationship between CCT and IOP values were analyzed separately. Two IOP values, Goldmann-correlated IOP value (IOPg) and corneal-compensated intraocular pressure (IOPcc), were got using ORA. Three groups were defined according to CCT: 1) thin cornea (CCT<520μm); 2) normal-thickness cornea (CCT: 520–580μm); and 3) thick cornea (CCT>580μm) groups. RESULTS: In normal subjects, IOP measurements were 14.95±2.99mmHg with ORA (IOPg), 15.21±2.77mmHg with ORA (IOPcc), 15.22±2.77mmHg with GAT, and 15.49±2.56mmHg with DCT. Mean differences were 0.01±2.29mmHg between IOPcc and GAT (P>0.05) and 0.28±2.20mmHg between IOPcc and DCT (P>0.05). There was a greater correlation between IOPcc and DCT (r=0.946, P=0.000) than that between IOPcc and GAT (r=0.845, P=0.000). DCT had a significant correlation with GAT (r=0.854, P=0.000). GAT was moderately correlated with CCT (r=0.296, P<0.001), while IOPcc showed a weak but significant correlation with CCT (r=?0.155, P=0.007). There was a strong negative correlation between CCT and the difference between IOPcc and GAT(r=-0.803，P=0.000), with every 10μm increase in CCT resulting in an increase in this difference of 0.35mmHg. The thick cornea group (CCT>580μm) showed the least significant correlation between IOPcc and GAT (r=0.859, P=0.000); while the thin cornea group (CCT＜520μm) had the most significant correlation between IOPcc and GAT (r=0.926, P=0.000). The correlated differences between IOPcc and DCT were not significant in any of the three groups (P>0.05). CONCLUSION: Measurement of IOP by ORA has high repeatability and is largely consistent with GAT measurements. Moreover, the ORA measurements are affected only to a small extent by CCT, and are likely to be much closer to the real IOP value than GAT.

Abstract:AIM: To evaluate the long-term results and complications of ahmed glaucoma valve (AGV) implantation in refractory glaucoma. METHODS: A retrospective review of 13 patients (13 eyes) with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 18 months was performed. All patients underwent a complete ophthalmologic examination and intraocular pressure (IOP) measurement before surgery and at 1 month, 3 months, 6 months, 1 year after surgery and yearly afterwards. Complications and the number of antiglaucoma medications needed were recorded. RESULTS: Mean age was 27.3±16.0 years. All eyes (100%) had at least one prior incisional surgery. Mean follow-up was 61.3±30.8 months. IOP was reduced from a mean of 35.0 ±7.0mmHg to 18.2±7.9mmHg at 12 months and to 17.0±4.1mmHg at 96 months (P<0.05) with a lower number of medications from baseline, 76.9% patients required additional procedures to achieve the success criteria set by previously published series. The most common complications were encapculated cyst formation in eight eyes (61.5 %) and tube exposure in four eyes (30.8%). CONCLUSION: Encapsulated cyst formation was the most common complication which hindered succesful IOP control after AGV implant insertion for refractory glaucoma. Despite cyst excision with anti-fibrotic agents, successful IOP reduction was not achieved in 76.9% of the patients without antiglaucoma medication.

Abstract:AIM: To evaluate ocular alignment and surgical results of strabismus surgery in neurologically impaired children. METHODS: Files of 33 neurologically impaired squint children were evaluated. Twelve patients had cerebral palsy(CP), 4 had CP with mental retardation, therest had mental-motor retardation of unknown cause. Cycloplegic refractions, type and angle of strabismus, surgeries performed were recorded. RESULTS: Mean follow-up was 34.0±16.5 months. Twenty-three patients had esodeviation, the remaining had exodeviation. In 19 patients, angle of deviations measured at different visits were highly variable. Twelve patients with stable angle of deviations or with unstable but high angle deviations had horizontal muscle surgery. Mean horizontal deviation decreased from 43.75±10,69 D to 12.83±8.38 D with surgery. CONCLUSION: In neurologically impaired strabismic children, surgery is effective in patients with stable deviations or unstable but high angle deviations. Decision for surgery should be made after a long follow up period.

Abstract: