Corneal transplantation has developed rapidly in surgery ideas and instruments in the past 10 years. Penetrating keratoplasty， which has been the dominant procedure for more than half a century， and successfully caters to most causes of corneal blindness， has been gradually replaced by component corneal transplantation. Lamellar transplantation surgery， which selectively replaces only diseased layers of the cornea， has been a fundamental change in recent years. Endothelial keratoplasty， which selectively replaces the corneal endothelium in patients with endothelial disease， has resulted in more rapid and predictable visual outcomes. What′s more， femtosecond laser， which can replace the traditional corneal trephine， is also likely to play a part in corneal transplantation in the future. In short， the development of corneal transplantation ideas and technology can reduce complications， save donor cornea， and get faster visual recovery and better visual effects.

Objective  To report the clinical results of femtosecond laser assisted penetrating keratoplasty （FS-PKP）. Methods  It was a retrospective case series study. Six eyes of 6 patients who treated with FS-PKP were enrolled in this study. The vision of them were from hand moving to 0.05， and opacities were all from epithelium to endothelium. During the operation， the grafts were prepared to different shapes according to the character of the affections： 2 cases with Zig-Zag shape， 1 case with Zig-Square， 1 case with mushroom， and another 2 cases with hat shape. Results  During the follow-up period， the visions of all patients were better than preoperative ones. Three of them were better or equal to 0.5， and one was even to 1.0. The astigmatisms were from 2.25 D to 5.00 D at one year after operation. During the operation of one case with Zig-Zag shape， the meta-central cut were happened. Another patient with hat shape experienced high intraocular pressure early after operation. Conclusion  The FS-PKP appears  to be a good alternative surgical method for patients of corneal diseases because of the great manipuility and excellent postoperative results.

Objective  To describe the initial outcomes and safety of deep anterior lamellar keratoplasty （DALK） assisted by a femtosecond laser for stromal corneal pathology. Methods  In a case series， 14 eyes of 13 patients with various stromal corneal diseases （1 eye post-traumatic corneal scar， 8 eyes post-keratitis corneal scars and 5 eyes stromal corneal dystrophies） underwent DALK procedures by using a femtosecond laser. The parameters measured include uncorrected visual acuity （UCVA）， best-corrected visual acuity （BCVA）， endothelial cell density （ECD） and complications. Results  All eyes were successfully treated without intraoperative complications. Mean follow-up was 7.3±3.8 months（range， 2-14 months）. Uncorrected visual acuity improved in 11 eyes compared to preoperative UCVA. The mean difference between preoperative and postoperative UCVAs was a gain of 1.7 lines （range， unchanged-6 lines）. Best-corrected visual acuity improved in all eyes compared to preoperative levels. The mean difference between preoperative and postoperative BCVAs was a gain of 2.4 lines （range， 1-8 lines）. Adjuvant surgical procedures were performed on 3 eyes （treated with phototherapeutic keratectomy）， the mean reduction in endothelial cell density was 1% at the last follow-up. No graft rejection， infection， or epithelial ingrowth was found in this series of patients. Conclusion  Femtosecond laser-assisted deep anterior lamellar keratoplasty can improve UCVA and BCVA in patients with various stromal corneal pathologies. Our early results indicate that the femtosecond laser produced an effective and smooth dissection through opaque corneas even at deeper settings.

Objective  To evaluate changes in endothelial cell density， visual acuity and refractive outcomes after deep anterior lamellar keratoplasty （DALK） using glycerin-cryopreserved corneal tissue. Methods  This was a retrospective case-control study. The clinical data were collected from 44 patients （49 eyes） who had been diagnosed with keratoconus who had undergone DALK with glycerin-cryopreserved corneal tissue at Shandong Eye Institute and Hospital. Among them， 17 patients （17 eyes） were followed up at 1 month， 1 year， 2 years， 3 years， and 4 years.  Endothelial cell loss， visual acuity， and refractive status of these 17 eyes were recorded. Data were analyzed using a paired t test. Results  The mean follow-up period was 39.0±12.6 months and no graft rejection occurred. The mean endothelial cell density （ECD） was 2597±578 cells/mm2 before surgery， and was 1790±409 cells/mm2， 1703±443 cells/mm2， 1632±389 cells/mm2， 1638±357 cells/mm2， 1675±283 cells/mm2 and 1611±421 cells/mm2 at 1 month， 1 year， 2 years， 3 years， and 4 years postoperatively. Cell density was reduced by 34.2% at 4 years postoperatively compared with the density before surgery. The mean uncorrected visual acuity （UCVA） was 1.40±0.60 logMAR， and best-corrected visual acuity （BCVA） was 0.98±0.54 logMAR. Mean BCVAs at 1 month， 1 year， 2 years， 3 years and 4 years postoperatively were 0.44±0.12 logMAR， 0.36±0.20 logMAR， 0.32±0.23 logMAR， 0.29±0.20 logMAR and 0.27±0.16 logMAR. Conclusion  Glycerin-cryopreserved corneal tissue can be safe and effective for deep anterior lamellar keratoplasty to treat keratoconus and provides higher survival rates of the corneal endothelium.

Objective  To evaluate the risk factors， clinical features， and treatment of recurrent herpes simplex keratitis after penetrating keratoplasty （PKP）. Methods  This was a retrospective， interventional case series study. Three hundred twenty-nine patients （329 eyes） with herpes simplex keratitis who underwent penetrating keratoplasty at the Qingdao Eye Hospital between January 2000 and July 2012 were evaluated. All patients had failed to respond to topical and systemic antivirus drug treatment before penetrating keratoplasty was performed. The medical records of each patient were reviewed retrospectively. The clinical features， including recurrence time， position， and type， were summarized. Appropriate topical and systemic antivirus treatment was determined for all patients based on the clinical features. If there was treatment failure， conjunctival flap covering， amniotic membrane transplantation， or penetrating keratoplasty was performed. Results  Thirty-three patients （10%） experienced recurrence after penetrating keratoplasty. The recurrent type was mainly epithelial （54%） and 63% of the recurrences were at the border between donor and recipient tissues. Recurrence risk factors included immune rejection， secondary glaucoma， cataract surgery， upper respiratory tract infection， and lesions involving the limbus. Ten cases of the epithelial condition took a turn for the better simply with drug treatment； the remaining stromal and endothelial conditions （including changes from epithelial conditions） needed surgery： 5 cases of conjunctival flap， 12 cases of amniotic membrance transplantation， and 6 cases with PKP. With an average of 24.6±5.4 months for follow-up after treatment， 46% of the eyes had clear grafts. Conclusion  Immune rejection， secondary glaucoma， cataract surgery， upper respiratory tract infection， and lesions involving the limbus are major risk factors for the recurrence of herpes simplex keratitis after penetrating keratoplasty. Based on the clinical features of recurrence， appropriate precautions and treatment options can help to control recurrent infection.

Objective  To evaluate a custom-built dual channel dual focus spectral domain optical coherence tomography （OCT） instrument for imaging the whole eye in vivo， to demonstrate the feasibility and repeatability of this OCT instrument to measure anterior chamber depth and axial length compared to the IOLMaster. Methods  In a cross-sectional self-control study， 21 volunteers （39 eyes） without a history of ocular disease were enrolled. The anterior chamber depth （ACD） and total axial length （AL） were measured by the custom-built dual channel dual focus OCT and IOLMaster on the first day， and then by the OCT on the second day. The measurements of the two instruments were compared and the measurements with the OCT were compared for the 2 days. A paired t test， Pearson correlation analysis and Bland-Altman analysis were used for data analysis. Results  The ocular surfaces from the cornea to the retina could be assessed with this newly built dual channel dual focus spectral domain OCT in real time. The mean and standard deviation of the real anterior chamber depth and total axial length measured by the OCT system were 3.09±0.20 mm and 25.34±0.64 mm， respectively. No significant differences were found in the measurements with OCT taken on different days（t=-1.648， 1.129； P>0.05）. The mean and standard deviation of the anterior chamber depth and total axial length measured by IOLMaster were 3.58±0.21 mm and 25.24±0.65 mm， respectively. The mean and standard deviation of the anterior chamber depth by OCT was 3.64±0.20 mm. There was a significant difference in measuring the anterior chamber depth and total axial length with the OCT and IOLMaster （t=12.942， 8.984， P<0.05）. There was a high correlation in anterior chamber depth （r=0.990， P<0.01） and total axial length （r=0.997， P<0.01） measurements by the 2 devices. The 95% LoA （limits of agreement） were +0.001 mm to +0.119 mm and -0.018 mm to +0.178 mm for measurements of ACD and AL by the OCT and IOLMaster. Conclusion  Real-time whole eye images were successfully assessed by the custom-made dual channel dual focus OCT. There is good feasibility and repeatability with this newly built system.

Objective  To assess and compare the morphology of laser in situ keratomileusis （LASIK） flaps created by the IntraLase femtosecond laser and the Ziemer LDV femtosecond laser and to assess the effects on corneal biomechanics. Methods  This was a prospective and parallel control test. Sixty eyes of thirty patients were treated with LASIK： fourteen patients underwent IntraLase femtosecond laser surgery， while sixteen patients underwent Ziemer LDV femtosecond laser surgery. The corneal flap was set at 110 μm. Flap thickness was assessed at 14 measuring points across each flap at 1 week， 1 month and 3 months postoperatively with a Visante optical coherence tomography（OCT）. The corneal resistance factor （CRF） and corneal hysteresis （CH） were examined before surgery and 1 month and 3 months after surgery with an ocular response analyzer. Data were analyzed using repeated measured ANOVA and independent t test. Results  The respective mean corneal flap thicknesses at the top 1 week， 1 month and 3 months postoperatively were 125±11 μm， 125±10 μm， 126±7 μm in the IntraLase group and were 106±6 μm， 109±7 μm， 109±5 μm in the Ziemer LDV group. The mean deviations between achieved and attempted flap thickness were 20.9±3.8 μm， 19.0±3.0 μm， 18.7±3.3 μm in the IntraLase group and were 2.1±3.7 μm， 2.5±3.2 μm， 1.7±2.4 μm in the Ziemer LDV group. The differences were statistically significant （P<0.01）. The standard deviation between achieved and attempted flap thickness was 7～15 μm in the IntraLase group and was 4～8 μm in the Ziemer LDV group. The CRF and CH significantly decreased after surgery in both groups but there were no statistical differences between them. Conclusion  The predictability， accuracy and reproducibility were better with the Ziemer LDV femtosecond laser than Intralase femtosecond laser. There were no statistical differences in the corneal biomechanical effects between the two instruments.

Objective  To evaluate and compare central corneal thickness （CCT） among Mongolian and Han populations with myopia； to analyze the differences in corneal thickness measurements when using different instruments. Methods  In a prospective study， measurement agreement was assessed in 520 eyes of 260 pre-LASIK and pre-SBK patients using Pentacam， Orbscan and ultrasound. There were 112 Mongolian patients （224 eyes）， in which 60 were males （120 eyes） and 52 were females （104 eyes）； and 148 Han patients （296 eyes）， in which 82 were males （164 eyes） and 66 were females （132 eyes）. Pentacam， Orbscan and ultrasound were used to measure the preoperative CCT， and the results were analyzed using ANOVA and a t test. Results  CCT measurements between Pentacam， Orbscan and ultrasound in Mongolian males， mongolian females， Han males， Han females were significantly different （F=7.052， 19.057， 21.330， 17.391， P＜0.01）. CCT measurements were compared between the different genders in the Mongolian and Han populations with the three above-mentioned instruments. There were no significant differences between any two measurements except that CCT is thinner in Mongolian males compared with Mongolian females by Obscan （t=0.013， P<0.05）. Conclusion  CCT measurements using Pentacam were smaller than measurements obtained with Orbscan and ultrasound. Orbscan measurements of central corneal thickness in Mongolian men and women result in significantly different values.

Objective  Analyze astigmatism in 3-6 years old preschool children using vector analysis and to investigate the effect of cycloplegia on astigmatism. Methods  In this cross-sectional study， refraction and eye health were examined in 14 116 3-6 years old children （7 310 boys， 6 806 girls） in Yangpu District， Shanghai， China， from January 2012 to October 2012. Pre- and post-cycloplegic refractive measurements were taken with an autorefractor （Canon RK-F1， Japan） and axial length was measured with an IOLMaster （Carl Zeiss， Germany）. Of 13 080 eligible children， all the data from the right eyes were analyzed. Measurements of spherocylinder were transposed into M， J0 and J45 components by Fourier transformation. Data were analyzed using a paired t test. Results  Astigmatism in preschool children 3-6 years old was mainly with-the-rule （WTR）， especially in the high astigmatism group （HAG， ≥1.0 D）， followed by oblique axis astigmatism， and then against-the-rule （ATR） astigmatism. After cycloplegia， the prevalence of high astigmatism （≥1.0 D） decreased from 19.96% to 18.41%； the prevalence of normal astigmatism （0.25-0.75 D） increased from 28.59% to 33.72%. Meanwhile， the proportion of WTR astigmatism increased， and ATR astigmatism and the oblique axis astigmatism ratio declined slightly after cycloplegia. Total astigmatism declined only in the high WTR astigmatism group （-1.612±0.763 D vs. -1.457±0.645， t=-6.396， P<0.01）， mainly for J0 components. The J45 components remained the same before and after cycloplegia. Conclusion  Cycloplegia has a slight effect on astigmatism， especially in the high WTR astigmatism group. The astigmatism results for non-cycloplegia may be more important for preschool children when assessing and prescribing for astigmatism.

 Objective  To observe the clinical effect of PC-PRL （phakic refractive lens）implants to correct high myopia. Methods  This was a retrospective case series study. Twenty-five patients （45 eyes） with high myopia were implanted with PC-PRLs from January 2011 to May 2012. The postoperative follow-up period was 6 to 17 months （average 10.9±1.6 months）. A paired-sample t test was used to analyze uncorrected visual acuity， intraocular pressure， endothelial cell density， anterior chamber depth， and the occurrence of complications was recorded. Results  Uncorrected visual acuity （UCVA） 4.5~5.2 was better than preoperative best corrected visual acuity （BCAV） for 35 eyes （78%）. The mean postoperative IOP was 13.7±4.2 mmHg， which was not a statistically significant difference from the mean preoperative IOP （13.9±4.1 mmHg）. The mean postoperative endothelial cell density was（2609±296）cells/mm2， which was not a statistically significant difference from the mean preoperative endothelial cell density（2818±327）cells/mm2. The stability of PC-PRLs was high， average high arch was （0.380±0.135）mm， and there were no artificial crystals close to crystal position. Conclusion  PC-PRL implantation to correct high myopia is effective and safe and is the ideal treatment for patients with high myopia.

Objective To investigate the prevalence of anterior uveitis and to assess the etiology， classification， clinical features， treatment outcomes and prognosis of uveitis. Methods Six hundred fifty patients （206 patients were bilateral） with anterior uveitis referred to the Eye Hospital of Wenzhou Medical University during the period of December 2006 to July 2012 were retrospectively analyzed. The etiology， clinical characteristics， treatment outcomes and prognosis based on the case history， clinical manifestation， systemic diseases， auxiliary examination and laboratory examination were assessed. Results The average age at disease onset （394 males and 256 females） was 39.0±15.0 years. There were 689 eyes with acute anterior uveitis and 167 eyes with chronic anterior uveitis. The most common type was idiopathic uveitis （243 cases， 37.4%）， and it was followed in descending order by HLA-B27 associated uveitis that was not accompanied by systemic arthritic disease （123 cases， 18.9%）， ankylosing spondylitis （105 cases， 16.2%）， Fuchs syndrome （74 cases， 11.4%） and virus infection （44 cases， 6.8%）. The rate of complications was 39.5%. The rate of mild visual impairment （0.05~） was 20.3% and the rate of blindness （less than 0.05） was 4.3%. Conclusion Anterior uveitis was a disease with variable etiologies that usually occurred in young and middle-aged adults. The development of uveitis can be either bilateral or unilateral and can lead to severe complications. Careful and systemic examinations to actively identify the etiology are necessary for these patients.

Objective To determine whether intraoperative mitomycin C （MMC） can enhance the efficacy of limbal conjunctival autograft transplantation（LCAT） for the treatment of primary and recurrent pterygium. Methods This was a prospective case-control study. One hundred and thirty-four eyes of 114 patients with primary and recurrent pterygium were randomly divided into 2 groups. In group A， 63 eyes with primary pterygium and 7 eyes with recurrent pterygium were treated with pterygium resection and LCAT combined with a local application of MMC. In group B， 57 eyes with primary pterygium and 7 eyes with recurrent pterygium underwent pterygium resection and limbal conjunctival autograft transplantation alone. Epithelial regeneration， rate of pterygium recurrence， visual prognosis and complications were evaluated and compared between the two groups. The mean follow-up was 23.3±8.6 months with a range from 12 to 65 months. Data were analyzed using an independent t test and chi-square test. Results No intraoperative complications were found in any eyes. Postoperative corneal epithelial regeneration took an average of 4.0±0.8 days and 3.4±0.6 days in groups A and B， respectively （t=-3.71， P>0.05）. The rate of pterygium recurrence was 3% in both groups （χ²=0.008， P>0.05）. Postoperative visual acuity improved or remained stable in 74% of group A and 65% of group B （χ²=1.301， P>0.05）. Postoperative complications included delayed corneal epithelial recovery， limbal conjunctival autograft lag， corneal dellen， and subepithelial inclusion cyst in group A （6%） and group B （5%） （χ²=0.071， P>0.05）. Conclusion Intraoperative use of MMC does not enhance the efficacy of LCAT for the treatment of pterygium and may lead to a delay in corneal epithelial recovery.

Real-World Study （RWS） is originated in the practical clinical trials， which belongs to the category of drug epidemiology. It is non-random， open， no placebo research， and based on the clinical actual situation and the emphasizing the external validity of the research results. The RWS has received a lot of attention and in some field of medicine， disease-specific observational cohort， registry and management database have been well-established. While the RWS in ophthalmology is just starting up. In this article， the background， concepts， methods of RWS and its application in ophthalmology were reviewed.

Myopia is a common eye disorder found on a global scale. It is affected by both genetic and environmental factors. High myopia is closely associated with genetics. It is necessary to know the role of genetics in the development of high myopia. Recent progress on understanding the genetic mechanisms in the development of myopia is summarized in this paper.

 Myopia is one of the most common human eye diseases but its pathogenesis is still unclear. In recent years， several researchers have indicated that there are a variety of cell growth factors relating to the occurrence and development of myopia. Basic fibroblast growth factor （bFGF） and transforming growth factor-β （TGF-β） are important signaling molecules that could regulate myopic sclera remodeling by controlling the synthesis and degradation of the scleral extracellular matrix. However， further study about the specific pathways and mechanisms remains to be done. This review summarizes the expression in myopic sclera and the possible contributions of bFGF and TGF-β in regulating scleral remodeling.