江西近视手术人群角膜前表面非球性参数调查分析

Objective To assess the distribution features of Q-value of corneal anterior surface in Jiangxi myopia population for laser refractive surgery and to investigate the relationship between Q-value and other related parameters, such as spherical equivalent (SE), corneal curvature, cornea astigmatism, wavefront data and age. Methods The K&Q calculator of Orbsean- Ⅱ anterior segment system was used to obtain the Q-value of 6 mm optical zone in 411 cases (822 eyes) .There were 188 male subjects (376 eyes) and 223 female subjects (446 eyes). Accnrding to SE, subjects were divided into three groups including low myopia, moderate myopia and high myopia. According to different age, subjects were divided into three groups including group Ⅰ (age from 17 to 25), group Ⅱ (age from 26 to 34) and group Ⅲ (age from 35 to 44). Statistical analysis was used to comprehend the distribution characters of Q-value and its relations with SE, corneal curvature, cornea astigmatism, wavefront data and age. Results The Q-value of 822 eyes (411 cases) distributed as positive normal distribution, the average of Q- value was -0.148± 0.120 (range from -0.73 to 0.56) and -0.130± 0.128for male subjects and -0.163± 0.110 for female ones with statistically significant difference in Q-value in different genders (t=4.069, P <0.01). A significant difference was observed in Q-value among 17-25 years, 26-34 years and 35-44 years groups (F =4.567, P <0.05) as well as between 26-34 years group and 35-44 years group (P =0.004). However, there was no significant difference found between different myopic groups (F =1.434, P >0.05). The Q-value shown significantly negative relationship with C12, the Q-value show poor relationship with cornea curvature, cornea astigmatism, RMSh and C8. But the Q-value was not related with SE, RMSg, C7, cornea thickness, ocular pressure and age. Conclusions In Jiangxi myopia population for refractive surgery corneal curvature of majority population become flatter from center to periphery (Q<0), minority become steeper from center to periphery (Q>0). The Q-value of corneal anterior surface is independent from myopic SE. The Q-value show poor relationship with cornea curvature, cornea astigmatism, RMSh and C8, C12 is the most important related factor of Q-value. The Q-value is significantly greater in males than in females. A significant difference is observed in Q-value between 26-34 years and 35-44 years group.     

Characteristics of posterior corneal astigmatism and aberration in cataract patients with high myopia北大核心CSCD

Objective: This study was to investigate the characteristics of posterior corneal astigmatism (PCA) and aberration in cataract patients with high myopia. Methods: A retrospective study was designed. Two hundred and eighty-two eligible eyes of 190 cataract patients were enrolled in Eye and ENT Hospital of Fudan University from September to December, 2014.The eyes were classified into two groups according to axial length (AL): high myopia group with 139 eyes (AL≥26 mm) and control group with 143 eyes (AL was 20 to 25 mm). The mean keratometric mid-radius of curvature (Km), corneal central thickness (CCT), astigmatism and aberrations were measured by the rotating Scheimpflug System (Pentacam), and the AL were measured by the partial coherence interferometry (IOL Master). This study followed the Helsinki declaration, and was approved by the Ethic Committee of Eye and ENT Hospital, Fudan University. Informed consent was signed from each patient. Results: In high myopia group, the mean PCA was 0.3 D (range 0~0.9 D) and 92.8% eyes had PCA values <0.5 D. The steep corneal meridian was aligned vertically (60°~120°) in 87.1% eyes for the posterior corneal surface. There was no significant difference in PCA between the high myopia group and the control group (P=0.797). Significant positive linear correlations was found between PCA and anterior corneal astigmatism (ACA), PCA and anterior corneal root mean square (RMS), PCA and anterior lower-order RMS, PCA and posterior corneal RMS, PCA and posterior high-order RMS, PCA and posterior lower-order RMS (r=0.235, P=0.005; r=0.217, P=0.010; r=0.229, P=0.007; r=0.395, P=0.000; r=0.243, P=0.004; r=0.384, P=0.000). Compared with total corneal astigmatism (TCA), anterior corneal measurements overestimated with-the-rule astigmatism (WTR) by a mean of (0.27±0.18)D in 65.67% eyes, underestimated against-the-rule astigmatism (ATR) by (0.27±0.18)D in 88.10% eyes and underestimated oblique astigmatism (Obl) by (0.22±0.10)D in 63.33% eyes. Compared with total corneal aberrations, anterior corneal aberrations measurements overestimated by (0.275±0.176)μm in 87.05% eyes, and the anterior corneal astigmatism types had no effect on the result. Conclusions: In high myopia group, 92.8% eyes had PCA values <0.5 D and the main astigmatism type in posterior corneal surface was ATR. The posterior corneal astigmatism and aberration were needed to consider in choosing intraocular lens (IOL) before cataract surgery. Copyright © 2018 by the Chinese Medical Association.     

非球面切削LASEK和LASIK治疗不同厚度角膜的高度近视

Objective To compare the clinical curative effect of corneal wavefront-guided combining Q-value guided aspheric keratctomy excimer LASEK for high myopia of thin cornea (<500μm) and corneal wavefront-guided combining Q-value guided LASIK for high myopia of thick cornea (>500μm). Methods Of selected 25 high myopia of thin cornea (42 eyes), and 38 high myopia of thick cornea (65 eyes), compared the preoperative uncorrected visual acuity (UCVA), age, corneal thickness, atherectomy thickness,remnant thickness, spherical equivalent (SE), Coma-like RMS (root of mean square), spherical-like RMS,RMSg (root of mean square of general aberration) with postoperative UCVA of 2, 4 weeks, 1 month, 3, 6 months SE, Coma-like RMS, spherical-like RMS, RMSg, Level of Haze. Results There were no statistically significant differences between two groups 6 months aiter operation in UCVA, spherical equivalent (SE),Coma-like RIMS, spherical-like RMS and RMSg. Both groups showed high safety, efficacy, predictability and the same clinical curative effect. Conclusions Aspheric keratectomy excimer LASEK for high myopia of thin cornea and corneal wavefront-guided combining Q-value guided LASIK for high myopia of thick cornea have the same clinical curative effect.     

非球面切削LASEK和LASIK治疗不同厚度角膜的高度近视

Objective To compare the clinical curative effect of corneal wavefront-guided combining Q-value guided aspheric keratctomy excimer LASEK for high myopia of thin cornea (<500μm) and corneal wavefront-guided combining Q-value guided LASIK for high myopia of thick cornea (>500μm). Methods Of selected 25 high myopia of thin cornea (42 eyes), and 38 high myopia of thick cornea (65 eyes), compared the preoperative uncorrected visual acuity (UCVA), age, corneal thickness, atherectomy thickness,remnant thickness, spherical equivalent (SE), Coma-like RMS (root of mean square), spherical-like RMS,RMSg (root of mean square of general aberration) with postoperative UCVA of 2, 4 weeks, 1 month, 3, 6 months SE, Coma-like RMS, spherical-like RMS, RMSg, Level of Haze. Results There were no statistically significant differences between two groups 6 months aiter operation in UCVA, spherical equivalent (SE),Coma-like RIMS, spherical-like RMS and RMSg. Both groups showed high safety, efficacy, predictability and the same clinical curative effect. Conclusions Aspheric keratectomy excimer LASEK for high myopia of thin cornea and corneal wavefront-guided combining Q-value guided LASIK for high myopia of thick cornea have the same clinical curative effect.     

Clinical Efficacy of Toric Orthokeratology in Myopic Adolescent with Moderate to High Astigmatism

Purpose:.To observe the efficacy of toric design orthokeratology.(ortho-k).for correcting myopia and astigmatism in myopic adolescents with moderate to high astigmatism.Methods:.This was a self-controlled clinical study..Twentyfour subjects(42 eyes).aged 9 to 16 years with myopia of 2.50-6.00 D complicated with rule astigmatism of 1.50-3.50 D were fitted with Lucid Night Toric Ortho-k Lenses(LUCID,KOREA)..The changes in uncorrected visual acuity(UCVA),spherical degree, refraction, axial length(AL),.and corneal status were assessed at baseline, 1 night, 1 week, 1 month, 3months, 6 months, and 1 year after the commencement of ortho-k lens wear.Results: The success rate of the first lens fit was 92.8%. The UCVA after ortho-k wearing was improved significantly compared to the baseline during each visit(all P<0.01), and became stable 1 month after ortho-k. The manifest myopia was significantly reduced from(-3.41±1.27) D to(-0.41±0.37) D by toric ortho-k and the degree of astigmatism from(-1.81±0.53)D to(-0.41±0.39) D after 1 month of lens wear(P<0.01).The mean AL was(24.47 ±0.91) mm at baseline, which did not significantly differ from(24.49 ±0.87) mm and(24.48 ±0.94) mm after 6 months and l year,.respectively,.of lens wear(both P >0.05)..Grade 1 corneal staining was observed at 1week(23.8%),.1 month(21.4%), and 1 year(16.7%) following lens wear, and was improved by lens cleaning,.discontinuing lens wear, and moistening the cornea with eye drops.No severe adverse events were reported.Conclusion: The toric ortho-k lens was effective and safe for correction of low to moderate myopia in children with moderate to high astigmatism..The lens also effectively controlled axial length elongation during 1 year of observation..However,the long-term efficacy remains to be elucidated.     

Distribution and correlation of refractive parameters in children with different corneal curvatures in southeast China

AIM: To analyze the distribution of refractive status in school-age children with different corneal curvatures (CC) and the correlation between CC and refractive status. METHODS: A total of 2214 school-aged children of grade 4 in Hangzhou who were screened for school myopia were included. Uncorrected distance visual acuity (UCDVA), non-cycloplegic refraction, axial length (AL), horizontal and vertical corneal curvature (K1, K2) were measured and spherical equivalent (SE), corneal curvature radius (CCR) and axial length/corneal radius of curvature ratio (AL/CR) were calculated. UCDVA<5.0 and SE≤-0.50 D were classified as school-screening myopia. According to the different CCRs, the patients were divided into the lower corneal curvature (LCC) group (CCR≥7.92) and the higher corneal curvature (HCC) group (CCR<7.92). Each group was further divided into the normal AL subgroup and the long AL subgroup. The refractive parameters were compared to identify any differences between the two groups. RESULTS: Both SE and AL were greater in the LCC group (P=0.013, P<0.001). The prevalence of myopia was 38% in the LCC group and 44% in the HCC group (P<0.001). The proportion of children without screening myopia was higher in the LCC group (62%) than in the HCC group (56%). Among these children without screening myopia, the proportion of long AL in the LCC group (24%) was significantly higher than that in the HCC group (0.012%; P<0.001). The change of SE in the LCC group was less affected by the increase of AL than that in the HCC group. CONCLUSION: School-aged children in the LCC group have a lower incidence of screening myopia and longer AL. Low CC can mask SE reduction and AL growth to some extent, and the change of AL growth change more in children with low CC than high CC. Before the onset of myopia, its growth rate is even faster than that after the onset of myopia.     

Effect of the posterior corneal surface on total corneal astigmatism in patients with age-related cataract

AIM: To explore the effect of the posterior astigmatism on total corneal astigmatism and evaluate the error caused by substituting the corneal astigmatism of the simulated keratometriy (simulated K) for the total corneal astigmatism in age-related cataract patients. METHODS: A total of 211 eyes with age-related cataract from 164 patients (mean age: 66.8±9.0y, range: 45-83y) were examined using a multi-colored spot reflection topographer, and the total corneal astigmatism was measured. The power vector components J0 and J45 were analyzed. Correlations between the magnitude difference of the simulated K and total cornea astigmatism (magnitude differenceSimK-Tca), anterior J0, and absolute meridian difference (AMD) between the anterior and posterior astigmatisms were calculated. To compare the astigmatism of the simulated K and total cornea both in magnitude and axial orientation, we drew double-angle plots and calculated the vector difference between the two measures using vector analysis. A corrective regression formula was used to adjust the magnitude of the simulated K astigmatism to approach that of the total cornea. RESULTS: The magnitude differenceSimK-Tca was positively correlated with the anterior corneal J0 (Spearman’s rho= 0.539; P<0.001) and negatively correlated with the AMDR (Spearman’s rho=-0.875, P<0.001). When the anterior J0 value was larger than 1.3 D or smaller than -0.8 D, the errors caused by determining the total corneal astigmatism with the karatometric calculation tended to be greater than 0.25 D. An underestimation by 16% was observed for against the rule (ATR) astigmatism and an overestimation by 9% was observed for with the rule (WTR) astigmatism when ignoring the posterior measurements. CONCLUSION: Posterior corneal astigmatism should be valued for more precise corneal astigmatism management, especially for higher ATR astigmatism of the anterior corneal surface. We suggest a 9% reduction in the magnitude of the simulated K in eyes with WTR astigmatism, and a 16% addition of the magnitude of the simulated K in eyes with ATR astigmatism.     

Proportion and characteristic of emmetropia in schoolchildren aged 6-11y: the Shenzhen elementary school eye study

AIM: To investigate the proportion and characteristic of emmetropia in schoolchildren aged 6-11, especially estimate the normal value of ocular biometric parameters of emmetropia. METHODS: A population-based cross-sectional study was conducted on children aged 6-11y in Shenzhen. Totally, 2386 schoolchildren from two primary schools were involved. The axial length (AL) and the corneal radius of curvature (CRC) were measured by partial coherence laser interferometry. Noncycloplegic refraction and refractive astigmatism (RA) was measured using autorefraction. The axial length-to-corneal radius of curvature ratio (AL/CRC), corneal astigmatism (CA) and spherical equivalent refraction (SER) were calculated. RESULTS: The proportion of emmetropia in elementary school students was 41.30%. This percentage decreased gradually from 6 to 11 years of age and decreased rapidly after 9 years of age. The mean and 95%CI of each parameter were provided for boys and girls aged 6 to 11 years of age with emmetropia according to each age group. The change trend of parameters of boys and girls are similar. After 7 years of age, the AL of non-emmetropia started to increase faster than that of emmetropia. The change trend of AL/CRC was the same as that of AL. The other parameters tend to be stable after 7 years of age. CONCLUSION: The age of 7-9 is an important period for the changes of refractive state and ocular biometric parameters of primary school students, and it is a special focus period for children myopia prevention. The normal value and variation of ocular biometric parameters of emmetropia can provide the basis for the clinical judgment of whether or not children’s ocular biometric parameters obtained by single measurement and changes obtained by multiple measurements are abnormal.     

Comparison of age-related changes between corneal and ocular aberration in young and mid-age myopic patients

AIM: To study the dynamic character of aberration between the cornea and the ocular with aging, and to evaluate the symmetry of the aberrations between right and left eye in order to supply the data for clinic to do the refractive surgery reasonably. METHODS: This is a comparative case series study. 82 normal cases (164 eyes) including 37 females (74 eyes) and 45 males (90 eyes) were recruited through the routine examinations、Topolyzer and wavefront analysis. The average age was 25.9±5.0 years old (range 18 to 49 years old), and the mean spherical equivalent (SE) is -3.82±2.21D (range -1.00 to -6.00D). The changes of aberrations regarding age, the relationship between anterior corneal and total aberrations were analyzed,as well as the symmetry between right and left eyes by using Zernike terms. RESULTS: The Z 3 1, RMS3 of corneal aberrations, Z 3 1, Z 4 0 , RMS3 and RMS4 of ocular aberrations had a positive correlation with age. The zernike terms both in corneal and whole eye were significantly correlated between right and left eyes. CONCLUSION: The corneal horizontal coma, ocular horizontal coma and ocular spherical aberrations become to increase at the age of more than 40 years old. The dynamic change of aberration with aging, balance between corneal and ocular, and the symmetric character between left eye and right eye should be designed carefully in the treatment nomogram before the refractive surgery.     

Treatment of retinal detachment of the course of retinopathy of prematurity

Cryo- and laser therapy of stage 3 have reduced, but not eliminated the occurrence of retinal detachment in stages 4a, 4b and 5 of ROP. In this disease the treatment of these stages is still the greatest challenge to the ophthalmologist. Therefore, the aim of this paper is to present our up-to-date possibilities of treatment of different kinds of retinal detachments in ROP, including segmental scleral buckling, encircling scleral buckling, scleral resection, vitrectomy and its modifications in ROP. Guidelines of surgery of retinal detachment in active stage 4 and 5 of retinopathy of prematurity have been described.     

Analysis of some of the possible neonatal risk factors of development of retinopathy of prematurity

PURPOSE: The aim of the study was to evaluate some of the possible risk factors for retinopathy of prematurity (ROP) treated with laser photocoagulation or cryocoagulation. MATERIAL AND METHODS: The study comprised 71 preterm infants with ROP needing treatment and 118 prematures without ROP or with ROP requiring no treatment, as a control group. All infants were born with gestational age < or = 32 weeks and birth weight < or = 1500g. The perinatal variables, including some of clinical data, the length of mechanical ventilation as well as continous positive airway pressure (CPAP), duration of total parenteral nutrition and some of laboratory data were analyzed, to evaluate their correlation with the development of ROP. RESULTS: Gestational age before 28 weeks (OR = 5.11), episodes of convulsiones (OR = 2.15), mechanical ventilation for more than 20 days (OR = 5.86) and > 30 days (OR = 7.47), CPAP for more than 5 days (OR = 4.15) and > 10 days (OR = 2.84), total parenteral nutrition for more than 10 days (OR = 7.84) and > 20 days (OR = 9.02) and elevated peak of alanine aminotransferase (AIAT) levels (OR = 3.17) were significant risk factors for ROP requiring treatment. CONCLUSIONS: The opthalmic examination for retinopathy of prematurity requiring laser photocoagulation or cryocoagulation should be obligatory for prematures born < or = 32 weeks of gestational age, with birth weight < or = 1500 g.The frequency of the consecutive ophthalmic examinations depends on the severity of prematurity and on the presence and intensification of the risk factors for ROP.     

角膜曲率的分析

目的：探讨我国人角膜曲率半径的正常值及不同性别、不同年龄的角膜曲率半径差异。方法：对10998只眼的角膜曲率进行检测，并按男、女10岁一组进行统计分析。结果：（1）K1为7.65mm,K2为7.71mm，平均K值为7.67mm。较眼科学正常值K:7.77mm短0.1mm。（2）K的平均值男性较女性的长0.1155mm。且女性各年龄段角膜曲率半径均男性的有不同程度的减短。（3）男女均随年龄的增长，角膜曲率半径大致呈递减趋势，即：角膜曲率半径与年龄成反比关系。（４）男女K1,K2之比，均随年龄增长而增长，即K1逐渐增长而增长，即　K1值逐渐增长，K2逐渐减短。结论：本文测定的角膜曲率较眼科文献中的提供的正常值短0.1mm，并且存在着年龄、性别上的差异。     

艾滋病眼部并发症的资料分析

目的:通过调查分析,了解艾滋病眼部并发症的临床表现、治疗及预后。方法:收集赞比亚卡布韦总医院眼科2008-08/2009-08就诊患者。结果:艾滋病眼部并发症症状重,病程长,致盲率高。结论:充分认识、掌握艾滋病眼部并发症的临床表现,提高艾滋病的检出率,早发现、早治疗,提高艾滋病患者的生活质量。同时应强调预防是降低艾滋病发生率的关键。