Comparison of Visual Function after Multifocal and Accommodative IOL Implantation

Purpose： To compare early visual function between patients undergoing phacoemulsification combined with multifocal and accommodative intraocular lens implantation.
Methods： A total of 112 patients with age-related cataract undergoing phacoemulsification in our hospital were recruited for this study and randomly assigned into multifocal （56 eyes; ZAM00 group） and accommodative （56 eyes; FLEX group） intraocular lens groups. Visual acuity and contrast sensitivity were statistically compared between the two groups.
Results： No significant difference was found in uncorrected distant visual acuity between the ZMA00 and FLEX groups at 1 week, or 1, 3, and 6 months after operation （all P〉0.05）. At postoperative 6 months, no statistical significance was noted in distant and intermediate best-corrected visual acuity or in contrast sensitivity between the two groups （all P〉0.05）. Patients in the ZMA00 group were superior to their counterparts in the FLEX group regarding near best corrected visual acuity, reading speed, and spectacle independence （all P〈0.05）.
Conclusion： ZMA00 and FLEX IOL implantation can provide excellent distant and intermediate visual acuity for patients with age-related cataract. ZMA00 IOL is superior to FLEX in terms of near visual acuity.     

Clinical Features and Differential Diagnosis of Acute Idio-pathic Blind Spot Enlargement Syndrome

Purpose： To study the clinical manifestations and the diag- nostic and differential diagnostic characteristics of acute idio- pathic blind spot enlargement syndrome （AIBSES）. Methods： Six patients diagnosed with AIBSES underwent complete eye examinations including fundus photography, fundus fluorescein angiography（FFA）, indocyanine green an- giography （ICGA）, optical coherence tomography （OCT）, electroretinogram （ERG）, and visual field examinations. Results： All patients had enlarged blind spots of variable sizes and densities. Three eyes had mild swelling of the optic disc and one eye had peripapillary scarring that corresponded to the permanent field defect. Two patients who underwent FFA had fluorescein leakage of blood vessels around the optic disc and ICGA highlighted diffuse, small hypofluorescent spots scatter- ing throughout the posterior pole. OCT showed that the inner and outer segment （IS/OS） line were absent in five patients and the middle cone outer segment tip line was absent in the nasal macular area in one eye.     

Favorable Outcome in Open Globe Injuries with Low OTS Score

Purpose： Open globe eye injuries can have profound social and economic consequences. Here, we describe two cases of war and outdoor activity open globe eye injury where, despite a low OTS score, current microsurgical technology allowed for a favorable outcome. Case report 1 ： A 33-year-old Libyan soldier had been treated for an open-globe grenade blast trauma to his left eye, which showed light perception and OTS score 2. He had undergone a lensectomy and PPV with silicone oil tamponade. Surgical treatment included scleral buckling, cornea trephination, tem- porary Eckardt keratoprosthesis, PPV revision, intraocular lens （IOL） implantation, and corneal grafting. Six months later, his VA was improved to 20/70. Case report 2： A 35-year-old man presented with a corneal laceration in his left eye from a meat skewer, with marked hypotony and LP. After primary corneal wound closure, B- scan ultrasonography revealed massive vitreous hemorrhage （OTS score 2）. The patient underwent open cataract extraction with IOL implantation, 23 gauge PPV, laser photocoagulation of the retinochoroidal laceration, and a gas tamponade. After three weeks, the patient underwent a 2nd 23G PPV due to a fibrinous reaction. Six month later, the patients exhibited 20/ 25 VA.     

Progress of Application of Sedation Technique in Pediatric Ocular Examination

Pediatric ophthalmic test requires meticulous observation and precise measurement. However, children are unable to ac- tively cooperate with the test. If they were forced to receive the examinations, it is difficult to deliver accurate diagnosis and treatment, and cause negative influence upon physical and mental health. Consequently, sedation technique plays an ex- tremely vital role in pediatric eye examinations. This study was designed to summarize the application of chloral hydrate in pediatric eye examination and propose different methods of medicine administration for children of varying ages, aiming to improve the effect of sedation. In addition, the feasibility of use of dexmedetomidine, which had been proven to be effec- tive in pediatric sedation examination, into pediatric oph- thalmic sedation examination was evaluated, thereby offering more options for the development of pediatric ocular sedation test.     

Follow-up of a Case of Vitelliform Macular Dystrophy Over an 8-year Period

Purpose： To show the follow-up of a case of vitelliform mac- ular dystrophy with morphological and visual functional tests over an 8-year period. Methods： Retrospective review of medical records. The mor- phological examination included color photography, fluores- cein angiography, and ocular coherence tomography （OCT）. The visual functional tests included visual acuity, electro-ocu- logram （EOG） and multifocal electroretinography （mfERG）. The patient was observed for 8 years, from 2003 to 2011. Results： During the follow-up, the improvement of sensory retinal detachment and reduction of yellow-white deposit were observed with color photography and fluorescein angiography. OCT revealed a decrease in sensory retinal detachment and subretinal hyper-reflective deposits; both of these morphologi- cal changes were correspondent. Visual acuity was maintained throughout the follow-up. The Arden ratio of EOG was de- creased. The amplitudes of mfERG were decreased but slightly increased during the follow-up.     

Nursing Care of the Laryngeal Mask Airway in Pediatric Cataract Surgery

Purpose： To investigate the important experience of nursing care of the laryngeal mask airway （LMA） in children undergoing cataract surgery.
Methods： Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and received perioperative nursing care. The safety of perioperative nursing for these children was also evaluated.
Results： Through perioperative nursing care and psychological counseling for children with LMA, all patients were anesthetized without complications and underwent successful surgeries. No severe postoperative complications were observed.
Conclusion： Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.     

Relationship between Refractive Error and Ocular Biomet- Fics in Twin Children： the Guangzhou Twin Eye Study

Purpose： A cross-sectional study was conducted to explore the relationship between refractive error and ocular biometrics in children from the Guangzhou twin eye study. Methods： Twin participants aged 7-15 years were selected from Guangzhou Twin Eye Study. Ocular examinations included vi- sual acuity measurement, ocular motility evaluation, autore- fraction under cycloplegia, and anterior segment, media, and fundus examination. Axial length （AL）, anterior chamber depth （ACD）, and corneal curvature radius were measured us- ing partial coherence laser interferometry. A multivariate linear regression model was used for statistical analysis.Results： Twin children from Guangzhou city showed a de- creased spherical equivalent with age, whereas both AL and ACD were increased and corneal curvature radius remained unchanged. When adjusted by age and gender, the data from 77% of twins presenting with spherical equivalent changes in- dicated that these were caused by predictable variables （RZ= 0.77, P〈0.001）. Primary factors affecting children＇s refraction included axial length （β=-0.97, P〈0.001 ）, ACD （β3=0.33, P〈 0.001）, and curvature radius （β=2.10,P〈0.001）. Gifts had a higher tendency for myopic status than did boys （β=-0.26,P〈 0.001）. Age exerted no effect upon the changes in refraction （β=-0.01, P=0.25）.     

Prevention and Control of Perioperative Incision Infection in Patients Undergoing Day Cataract Surgery

Purpose： To explore the effects of the prevention and control of perioperative incision infection on the quality of day cataract surgery. Methods： The nursing care and efficacy of 5087 patients un- dergoing day cataract surgery between October 2012 and Oc- tober 2013 were retrospectively reviewed. The disinfection and isolation guidance was established for perioperative prevention and control of infection, topical administration of ocular a- gents, reexamination and healthcare instruction, and alterna- tive measures were taken. Results： All 5087 patients successfully underwent day surgery of phacoemulsification combined with intraocular lens im- plantation. All cases recovered without incision infection.     

Relationship between Corneal Thickness,Corneal Curvature,and Intraocular Pressure before and after Laser Treatment for Simple Myopia

Purpose： To determine the relationship of central corneal thickness （CCT）, curvature （CC）, and intraocular pressure （IOP） as determinative factors for corneal biomechanics and in refractive surgery.
Methods： The study investigated 48 eyes from subjects who visited the Excimer Laser Surgery Clinic at the Department of Ophthalmology. The refractive error, IOP, CCT, and CC were measured in all participants. After 3 months, all examinations were repeated.
Results： Linear regression demonstrated a significant positive relationship between pre- and postoperative CCT, CC, and IOP values. The IOP showed a significant correlation with CCT （P=0.033） for pre-PRK, but no significant relationship was seen post-PRK. The CCT also correlated significantly with CC both pre- and post-PRK （P〈0.05）.
Conclusion： The IOP was significantly correlated with CCT before PRK, but its behavior differed after surgery. Nearly the same correlation was seen between CCT and CC before and after the PRK; nevertheless, IOP measurements should be calculated or estimated more precisely after PRK based on CCT corrections.     

Herniation of the Retina in the Central Macula in an Adult after Iridocyclitis

Purpose： To report an unusual case of retinal hernia in the central macula in an adult after iridocyclitis. Case report： We report a case of a 46-year-old male who presented with blurred vision 2 weeks after complete resolu- tion of acute iridocyclitis. Anterior segment and vitreous body examinations were unremarkable. Yellowish spots in the mac- ular area were observed. Spectral domain optical coherence tomography （SD-OCT） imaging of the macula showed loss of the inner segment/outer segment （IS/OS） photoreceptor junc- tion, with irregularity of the retinal pigment epithelium （RPE）, and a V-shaped hernia of the retina into the choroid. The macular lesions emerged as mild window defects on fluo- rescein angiography and were visualized as hypofluorescent patches on all-phase indocyanine green angiography. At a one month follow-up, the best-corrected visual acuity improved to 20/20, which was followed by partial restoration of the IS/OS line, but a V-shaped hernia of the retina remained unchanged on SD-OCT.     

Clinical Observation of Transepithelial Corneal Collagen Cross-linking by Iontophoresis of Riboflavin in Treatment of Keratoconus

Purpose： To evaluate the efficacy and safety of transepithelial collagen cross-linking by iontophoretic delivery of riboflavin in treatment of progressive keratoconus. Methods： Eleven patients （15 eyes） with progressive kerato- conus were enrolled. After 0.1% riboflavin-distilled water so- lution was deliveried via transepithelial iontophpresis for 5 min with 1 mA current, and ultraviolet radiation （370 nm, 3 mW/ cm2） was performed at a 1.5 cm distance for 30 min. The fol- low up were 6 months in all eyes. The uncorrected visual acu- ity, corrected visual acuity,endothelial cell counting, corneal thickness, intraocular pressure, corneal curvature, corneal to- pography, OCT and corneal opacity before and 6-month after surgery were analyzed. Results： At 6 month postoperatively, mean uncorrected visual acuity and corrected visual acuity changed from 0.36 to 0.30 and from 0.42 to 0.57 without statistical significance. The mean value of each index of corneal curvature declined with- out statistical significance.Kmax value dereased from 60.91 to 59.91, and the astigmatism declined from 3.86 to 3.19. Cen- tral corneal thickness decreased from 460.93 μm to 455.40 μm, and thinnest corneal thickness declined from 450.87 μm to 440.60 μm with no statistical significance. Intraocular pres- sure was significantly elevated from 10.85 mmHg to 12.62 mmHg. Endothelial cell count did not change significantly. No corneal haze occurred. Mean depth of corneal demarcation line was 288.46 μm at 1 month postoperatively.     

视疲劳诊疗专家共识（2014年）

近年来,随着社会环境变化,视频终端普及和工作节奏加快,视觉使用已远超负荷,越来越多的人开始抱怨眼睛干涩、胀痛及视物模糊等视疲劳症状。流行病学研究结果显示,23％学龄儿童、64％～90％电脑使用者及71．3％干眼患者均有不同程度的视疲劳症状。然而,目前我国对于视疲劳的定义、临床症状、病因、发病机制及诊治等尚无统一标准,临床治疗水平参差不齐,使得治疗效果不明确。基于上述现状,本学组牵头,召集专家。根据专家多年实践经验和科学研究．充分讨论．结合国内外同期研究成果,共同制定出视疲劳诊疗专家共识,以期为视疲劳的临床诊疗提供指导性意见。     

Ophthalmic Evaluation of Children from the Tibet Plateau with Congenital Heart Disease

Purpose： To perform ophthalmic examinations to evaluate the ocular characteristics of children living in the Tibet plateau and diagnosed with congenital heart disease. Methods： Children with congenital heart disease underwent a conventional ocular examination including distant acuity test, slit-lamp examination, fundus examination, non-contact in- traocular pressure measurement, measurement of corneal thickness, and fundus photography. Results： Forty-two Tibetan children, aged between 4 and 18 years and diagnosed with congenital heart disease, were en- rolled in this study. The percentage of low visual acuity was 4.76%, mean intraocular pressure was （13.67±2.15） mmHg, average corneal thickness was （492.55±33.79） μm, 96.43% had an anterior chamber depth of 1/2 corneal thickness （CT）, and 35.7% had an obvious fundus vascular tortuosity.     

Clinical Analysis of Early and Mid-late Elevated Intraocular Pressure after Silicone Oil Injection

Purpose： To discuss the incidence and clinical features of early and mid-late elevated intraocular pressure after pars plana vitrectomy and silicone oil injection, and to evaluate the clinical management of eyes with secondary glaucoma.
Methods： This was an observational consecutive case series of 691 eyes in 679 patients who were treated with pars plana vitrectomy and silicone injection. The diagnostic criteria of early elevated intraocular pressure after silicone oil injection was ≥21 mmHg two weeks after surgery, while mid-late elevated intraocular pressure was ≥21 mmHg after two weeks. The incidence and clinical management of elevated intraocular pressure were analyzed.
Results： In total, 211 of 691 eyes （30.54%） developed elevated intraocular pressure two weeks after pars plana vitrecto my and silicone injection. Of the 211 eyes, 101 eyes （47.87%） had ocular inflammation, 64 eyes （30.33%） showed hyphema, 35 eyes （16.59%） had silicone oil in the anterior chamber, 6 eyes （2.84%）had excess silicone oil injected, and 5 eyes （2.37%） had rubeosis irides. Eighty three of 691 eyes （12.01%） developed elevated intraocular pressure after two weeks. Of these 83 eyes, 25 eyes （30.12%） had rubeosis irides, 16 eyes （19.27%） had issues related to topic steroid therapy, 13 eyes （15.66%） had a papillary block, silicone oil in the anterior chamber, 10 eyes （12.05%） had a silicone emulsion, 10 eyes （12.05%）had peripheral anterior synchiae, and 9 eyes （10.84%） had silicone oil in the anterior chamber. All eyes with elevated intraocular pressure were treated with antiglaucoma medications and surgeries.
Conclusion： The reasons for elevated intraocular pressure differed between early and mid-late after pars plana vitrectomy and silicone oil injection. The elevated intraocular pressure can be controlled effectively by immediate diagnosis and proper treatment with medicine and operation.     

Utilization of Gene Mapping and Candidate Gene Mutation Screening for Diagnosing Clinically Equivocal Conditions： A Norrie Disease Case Study

Prenatal diagnosis was requested for an undiagnosed eye disease showing X-linked inheritance in a family. No medical records existed for the affected family members. Mapping of the X chromosome and candidate gene mutation screening identified a c.C267A[p.F89L] mutation in NPD previously described as possibly causing Norrie disease. The detection of the c.C267A[p.F89L] variant in another unrelated family confirms the pathogenic nature of the mutation for the Norrie disease phenotype. Gene mapping, haplotype analysis, and candidate gene screening have been previously utilized in research applications but were applied here in a diagnostic setting due to the scarcity of available clinical information. The clinical diagnosis and mutation identification were critical for providing proper genetic counseling and prenatal diagnosis for this family.     

Relationship between Foxp3-3279 （rs376158） Polymorphism and Dust Mite Allergic Conjunctivitis

Purpose： To investigate the genotyping of Foxp3-3279 （A/ C,rs376158） genes in patients with dust mite-induced allergic conjunctivitis from Guangdong province and to explore the association between these genes and the susceptibility to dust mite allergic conjunctivitis. Methods： In total, 80 patients with dust mite allergic con- junctivitis and 103 healthy Han Chinese were enrolled in the study and received genotyping of Foxp3-3279 （A/C,rs376158） by PCR-SSP technique. Results： Genotype frequency of Foxp3-3279 AA, CA, and CC in patients with dust mite allergic conjunctivitis were 1.25%, 25.00% and 73.75%,respectively. Gene frequency of C and A in patients with dust mite allergic conjunctivitis were 86.25% and 13.75% with no significant difference from healthy coun- terparts （both/9〉0.05）.     

Influence. of Psychological Intervention before Emergent Ocular Trauma Surgery on Patients＇ Negative Emotions

Purpose： To investigate the effect of preoperative psychological intervention on alleviating negative emotions in patients undergoing emergent ocular trauma surgery.
Methods： A total of 100 patients undergoing emergent ocular trauma surgery were selected using convenience sampling and randomly divided into control （n=49） and experimental （n= 51） groups. Patients in the control group received conventional nursing and their counterparts in the observation group were treated with individualized psychological interventions including psychological support, relaxation training, and humanistic care based on conventional nursing care. Self-rating anxiety scale （SAS）, self-ruling depression scale （SDS）, and fear visual analog scale （FVAS） scores were statistically compared between the two groups.
Results： The scores of SAS, SDS, and FAVS were significantly lower in the experimental group than in the control group （all P〈0.001）.
Conclusion： Comprehensive psychological intervention effectively eliminates negative emotions in patients undergoing emergent ocular trauma surgery and accelerates their physical and mental recovery.     

Ultrasonographic Feature of Persistent Hyperplastic Primary Vitreous

Purpose： To observe the ultrasonographic features of, patients with,persistent hyperplastic primary vitreous （PHPV）.
Methods： Thirty-two subjects （34 eyes） diagnosed with PHPV were evaluated by ultrasonography.
Results： The ultrasonography demonstrated a retrolental mass extending from the optic disc to the posterior lens capsule, manifested as band, regular triangle, or inverted triangle shapes. The band-shaped echo was characterized as a linear band extended from the optic disc to the posterior lens capsule. The regular triangle-shaped echo was manifested as a membranous septum with a wide base extended from the optic disc to the posterior lens capsule, and the anterior part became narrower. The inverted triangle echo was characterized as a membranous septum with a narrow base extended from the optic disc to the posterior lens capsule, and the anterior part become wider.
Conclusion： Ultrasonography is noninvasive and safe, and can offer real-time display of intraocular structures. This is especially important in individuals who are uncooperative or unsuitable for fundus examination due to media opacity. Combined with clinical feature, ultrasonography provides vital evidence for the diagnosis of PHPV. Thought observing ultrasonographic feature, clinicians could evaluate the size, position and severity of lesions in PHPV patients, and which would be helpful to determine the surgical approach and clinical prognosis.     

An Association between Corneal Inflammation and Corneal Lymphangiogenesis after Keratoplasty

Purpose： To examine the relationship between corneal inflammation and corneal lymphangiogenesis after keratoplasty.
Methods： Rat corneal lymphangiogenesis was examined by lymphatic vessel endothelial receptor （LYVE-1） immunohistochemistry and whole mount immunofluorescence at 1, 3, 7, 10, and 14 days after corneal transplantation. Corneal inflammation was evaluated by inflammation index （IF） grading and NF-κB immunohistochemistry at the same time points. The association between lymphatic vessel counting （LVC） and the IF scores was then examined.
Results： LYVE-1 positive lymphatic vessels occurred in the corneal stroma on day 3, developed throughout days 7 and 10, and peaked in number at day 14 after keratoplasty. Corneal inflammation was strong on day 3, and then resolved gradually, but increased again from days 7 to 14 after the transplantation. LVC was strongly and positively correlated with IF after keratoplasty（r=0.41 ;P〈0.05）. However, changes in IF scores and LVC were not parallel.
Conclusion： A close, but not parallel, relationship was found between corneal lymphangiogenesis and corneal inflammation after corneal transplantation.     

Comparison of Postoperative Pain Following Laser-assisted Subepithelial Keratectomy and Transepithelial Photorefrac-tive Keratectomy:a Prospective,Random Paired Bilateral Eye Study

Purpose： To compare postoperative pain following laser-as- sisted subepithelial keratectomy （LASEK） and transepithelial photorefractive keratectomy （T-PRK, two-step surgery） and alleviate postoperative subjective pain. Methods： Thirty patients （60 eyes） with myopia or myopic astigmatism were consecutively recruited into this prospective, randomized paired study. Patients underwent LASEK in one eye, and T-PRK in the other. The degree of pain was rated on a scale of 0-10 on postoperative days 1,2 and 3. Uncorrected visual acuity （UCVA） and subepithelial corneal haze were as- sessed at postoperative 1 and 3 months. Results： The pain was relieved on the 4th postoperative day in all patients, healing of corneal epithelium was observed at 4-5 days after surgery and contact lenses were removed promptly.At postoperative 1 day, the mean subjective pain score in the LASEK group was 3.2±1.88 and 4.43±1.61 in T- PRK group （P=0.008）.No significant difference was found be- tween two groups on postoperative 2 and 3 days. At postoper- ative 3 months, the percentage of UCVA t〉0.8 in the LASEK group was 100% and 96.7% in the T-PRK group （P=0.24）, 93.3% of patients in the LASEK with UCVA ≥ 1.0 and 90% in the T-PRK group（P=0.64）. In the LASEK group, the value of corneal haze was 0.26±0.21 and 0.27±0.25 in the T-PRK group（P=0.877）.