As both a cause and consequence,ocular surface inflammation plays a key role in the development of dry eye,leading to a series of physiopathological alterations.Anti-inflammatory therapy in addition to tear supplements are some of the important treatments for moderate to severe dry eye.Recent advances in research on cyclosporine and non-steroidal anti-inflammatory drugs have provided a solid foundation for anti-inflammatory management in dry eye.Due to the complexity of dry eye disease,the evaluation of the significance of ocular surface inflammation in the development of dry eye should be based on individual characteristics as a guideline for anti-inflammatory therapy.

Objective To investigate the therapeutic effect of Vitamin A on the riN30very ofdry eye that was induced by benzalkonium chloride(BAC)topical medication in the mouse．Methods In this rand()mired controlled experimental studv．50 BALB／c mice were treated with the topicaladministration of 0．25％BAC tO establish the dry eye condition．Based on the consistency of tear filmbreak—up time(BUT)，corneal fluorescein staining scores and inflammation index，the eyes werere—selected and 30 mice were randomly divided into three groups on day 21 after the BAC treatment．with 10 mice(20 eyes)in each group．Group C was set up as a blank control，while groups A and Bwere treated with 5000 IU／(g·m1)Vitamin A eye drops and microemulsion solvent drops．respectively．BUTs．corneal fluorescein staining ScoreS．innammation index and tear volumes were evalanted ineach group On days 0，l，3，5 and 7 after the therapeutic treatment．Global specimens werecollected Oil day 7．Sections were stained with hematoxylin and eosin fHE)OI"by periodic acid．Sehiff(PAS)assay，and labeled with cytokeratin 10(KIO)antibody．The expression of K10 in the cornea and conjuncfiva Wag quantified by Western Blot．The data were analyzed by one-way ANOVAs．Results On days 0，1，3 and 5，NO clinical differences were observed among the groups．Onday 7。the BUT values were(4．20,0．89)S，(3．32,1．01)S and(3．28±0．74)s in groups A，B andC．respectively．The BUT in group A was significantly longer than those in groups B and C(F=6．852，P=O．002)．The corneal fluoreseein staining scores were 3．74,1．31，5．47,1．81 and 5．83,1．54in groups A，B and C，respectively．The scores in group A were significantly lower than those ingroups B and C(F=8．853，P<0．01)．No significant differences were found in the corneal inflammatoryindex or tear volume among the groups．Corneal morphology showed a loosened corneal epitheliumfeature in groups B and C，but corneal integrity in group A．PAS assay revealed similar gobletcell numbers between group A and normal eyes，but fewer goblet cells in groups B and C．Cytokeratin 10 Was almost negatively expressed in Vitamin A treated groups，while it remainedpositive in the entire coiTleal epithehal layer with other treatnlents．The level of K10 in the corneawas down—regulated in Vitamin A treated groups．Conclusion Vitamin A treatment presentedmarked therapoutie effects Oil BAC-induced mouse dry eye，with a mol'e stable tear film，betterrecovery of epithelial integrity，an increased number of goblet ceUs，and the elimination ofsquamons metaplasia，when compared to the treatment of micmemulsion solvent eye drops only orwithout treatment．This experiment show the great potential of Vitamin A in the clinical treatmentof dry eye．

Objective To evaluate long-term changes of tear mm after phaeoemulsificafionsurgery．Methods A self controlled study was performed．Two hundred fifty—six cataract patients(256 eyes)underwent phacoemulsification in the Department of Ophthalmology，Shanghai first People’SHospital．Shanghai Jiaotoag University．wer{e randomly enrolled in this prospective study．The teal"film break up time(BUT)，Schirmer I test(Sit)，and Fluorenscein integral(FI)Were memsured l day preoperatively and patients were followed up for 3 months postoperatively．Statistical analysis includedan independent samples t test，paired t test，ehi-square test，Mann—Whitney test，multiple linearregression，Spearman correlation analysis and Pearson correlation analysis．Results Ninety-six patientsparticipated in the 3-month postoperative follow-up period．All the information on the 96 patients andthe original 256 patients was eonsistent．except for their ages．The 3-month postoperative 8cores of BUT，Sit and FI did not differ from preoperative scores．According to regression analysis，thepostoperative BUT scores correlated positively with preoperative BUT scores(r=0．38，P<O．01)，andcorrelated negatively with age r=-0．22．P=O．02)．The postoperative Schirmer I test scores correlatedpositively with preoperative Schirmer I test$4t!ores fr=0．41，P<O．01)．The postoperative FI test scoresnot only correlated positively with preoperative F1 test scores(r=O．35，P=O．01)，hut also correlatednegatively with preoperative BUT scores(r= -0．32，P<0.01)and preoperative SIT scores(r= -0．22，P<O．01)．Conclusion At 3 month after phaeoemulsification，the results of objective tear film examinationsshow a return to preoperative levels．

Objective To evaluate the efficacy of using¨absorbable punctal plug in thetreatment of preoperative dry eye after laser in situ keratomileusis(LASlK)．Methods This Wag aprospective，randomized．double—blind study．Forty—one consecutive patients with mild to moderate dyeeye were included．Absorbable punctal plugs were randomly implanted in one eye of each patient．Fluorescent staining(FL)，break-up time BUT)，Schirmer I test(SIT)and ocular surface disease index(OSDI)grading were performed before and 1 week and 1，3，and 6 months after LASIK．Results No complications were observed except plug extrusion in one case．FL staining WaS significantly lowerin the treated eyes compared to control eyes at 1 week(z---2．124，P=O．034)，I month(Z=-2．009，P=0．045)and 3 months(z=-2．120，P=O．034)after LASIK．SIT was significantly higher in the controleyes at 1 week after LASIK(Z=-2．005．P=0．045)．Conclusion An absorbable punctal plug is ltllleffective method for treating dry eye patients after LASIK．

Objective To study the effects of the tumor metastasis suppressor gene KAI1 on the adhesion,migration and invasion of human retinoblastoma HXO-Rb44 cell.Methods In this experimental study,the HXO-Rb44 cell was transfected with KAI1 eukaryotic expression plasmid,i.e.pCMV-KAI1,to overexpress KAI1.It was labeled HXO-Rb44-KAI1.The control cells transfected with plasmid vector pcDNA3.1 (+) and no transduction were labeled HXO-Rb44-KAI1/zero and HXO-Rb44,respectively.Forty-eight hours after transfection,the cells were dispersed and the homogeneous adhesion of the cells in the 3 groups was observed by microscopy.Forty-eight hours after transfection,migration and invasion tests were conducted in Transwell chambers with or without Matrigel.The migration and invasion abilities of the cells in the 3 groups were evaluated by counting the cells in the lower wells in 5 high-power fields (HPF) with ×100 magnification.The comparison was made using one-way ANOVA by SAS 8.0 statistical software.Results The expression of KAl1 in HXO-Rb44-KAI1 cells was stronger than HXO-Rb44-KAI1/zero and HXO-Rb44 cells 48 hours after plasmid transfection.The homogeneous cell adhesion ability of HXO-Rb44-KAI1 cells was also stronger than the control cells.The Transwell migration test showed the cell number/HPF in the lower wells was 20.4±4.0,46.0+4.5and 52.1+3.6 in HXO-Rb44-KAI1,HXO-Rb44-KAIl/zero and HXO-Rb44 cells group respectively (F=256.71,P＜0.01).An invasion test showed the cell number/HPF in lower wells was 16.7±3.3,42.5±3.7 and 47.3±5.2 in HXO-Rb44-KAI1,HXO-Rb44-KAI1/zero and HXO-Rb44 cell group,respectively (F=235.12,P＜0.01).Conclusion KAI1 may enhance the homogeneous cell adhesion ability of the HXO-Rb44 cell,and inhibit its migration and invasion ability.

Objective To evaluate the correlation between functional and anatomical assessments with multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in patients with acute central serous chorioretinopathy (CSC).Methods Cross-Sectional study.Forty eyes of 40 patients with acute CSC underwent Cirrus HD-OCT (Carl Zeiss) and VERIS ScienceTM 4.9 (EDI) visual evoked response imaging system examinations.Correlation analyses were performed between the central area of the OCT corresponding to the summed responses from the first and second rings measured by mfERG,the second and third areas of the OCT corresponding to the third and fourth of the six concentric rings measured by nffERG,OCT parameters of the macular volume,total central foveal thickness (CFT),central subretinal fluid (SRF) thickness,SRF diameters,and central retinal thickness corresponding to the six concentric rings of the mfERG N1 and P1 response amplitudes and latencies.Results An increased macular thickness in the three areas of the OCT correlated to prolonged implicit times in the corresponding rings of the mfERG.OCT parameters of the macular volume,total CFT,SRF thickness,and SRF diameters were significantly correlated to the six concentric rings of the mfERG N1 and P1 response amplitudes and latencies.Conclusion The macular thickness in the three areas and the amount of the central subretinal fluid of the OCT are significantly correlated with the mfERG parameters.The amount of SRF in eyes with CSC,especially SRF diameters,can be measured to assess macular function.OCT and mfERG can synthetically evaluate functional and anatomical assessments in CSC.

Objective To observe the long-term changes in Q-value and higher-order aberrations after Q-value optimized ablation in high myopia.Methods Seventy eyes of 35 high myopic patients treated with Q-value optimized ablation were retrospectively studied,including 34 eyes of 17 patients treated with laser in situ keratomileusis (LASIK) and 36 eyes of 18 patients treated with laser epithelial keratomileusis (LASEK).Preoperative and long-term postoperative Q-value and higher-order aberrations were compared using a paired t test and an independent samples t test and the differences and influential factors were analyzed using Pearson correlation and linear regression.Results All patients had visual acuity over 0.8.Both Q-value optimized LASIK and LASEK had greater safety than one and validity close to one.Compared to preoperative Q-value,postoperative Q-value in both the LASIK and LASEK groups had changed from negative to positive.The differences in higher-order aberrations between preoperative and postoperative data were statistically significant in both groups (t=-3.90,-6.75,P＜0.01).Root mean square (RMS) value of third order (t=-3.50,-5.22),RMS value of fourth order (t=-6.79,-10.14),RMS value of spherical aberration (t=-8.57,-13.79) and RMS value of vertical coma (t=5.73,-5.50) in both groups showed statistically significant increases during the 3 years after surgery (P＜0.01).The changes in RMS value of vertical coma and RMS value of spherical aberration were not statistically different between the two groups.The horizontal coma had no significant change postoperatively.Postoperative higher-order aberrations (R2=0.372,F=16.96,P＜0.01) and spherical aberration (R2=0.2.24,F=10.93,P＜0.01 ) were correlated to preoperative spherical equivalent and optic zone.Postoperative vertical coma was correlated to preoperative spherical equivalent and target Q-value (R2=0.224,F=10.93,P＜0.01).Conclusion In high myopia,Q-value optimized ablation had good safety,efficacy and good predictability.Over 3 years,higher-order aberrations and spherical aberration increased while vertical coma decreased with no difference between two surgeries.Increase of the vertical coma may be relevant to the direction of flap hinge.Higher-order aberrations after surgery were mainly correlated to preoperative spherical equivalent and optic zone size.

Objective To determine the prevalence and development of astigmatism in 17-19 years of age young people and find out the relationship between the change in axis category and the amount of astigmatism with different amounts of myopia degree.Methods This was a cross-sectional study.Nine hundred and five 17-19 years of age young people were selected for the study using a random digital method to determine the refractive errors and axes of astigmatism.A chi-square test was used to analyze the data.Results Astigmatism degree in the -0.26-1.50 D with-the-role range accounts for the largest percentage.For males,with-the rule astigmatism was found in 71.7％ who had high myopia,about 71.1％ who had moderate myopia,and 69.2％ who had low myopia.With-the-rule astigmatism was found in female group who had high myopia section about 74.6％,approximately 84.0％ who had moderate myopia and low-degree myopia section approximately 92.0％.The most common amount of astigmatism was -0.25-1.00 D for all axes of myopia in both males and females in all myopic degrees.A higher proportion of males in the high myopia group had with-the-rule astigmatism (x2=4.619,P=0.032).A higher proportion of women had with-the-rule astigmatism in low-degree myopia group higher than that in the comparative male group (x2=8.705,P=0.003).A higher proportion of males in the low myopia group had ≤-2.00 diopters of astigmatism proportion than in the other two male groups (x2=6.635,4.256,P＜0.05) and as the myopic degree is higher,the proportion of males with ≤-2.00 diopters decreased.The proportion of females in the high myopia group with ≤-2.00 diopters of astigmatism was lower than that in the moderate myopia group (x2=11.780,P=0.001).Conclusion Among youths 17-19 years of age,with-the-rule astigmatism accounted for the largest percentage.Males with low myopia had a higher proportion of ≤-2.00 diopters of astigmatism compared to males in the other two groups and,as myopic degree increased,the proportion of males with ≤-2.00 diopters decreased.But females show the contrary trend.

Objective To investigate the effect of corneal crosslinking guided by riboflavin ultravilet rays on flap adhesion and healing in laser in situ keratomileusis (LASIK) in the rabbit.Methods LASIK flaps were created in 22 rabbit corneas in this experimental study.The right eyes were the experimental eyes while the left eyes were the control eyes.The edema and inflammation reaction of the corneas were observed with slit lamp at different time points (1 day,3 days,7 days after surgery).Histopathological changes,including inflammatory cell infiltration and keratocyte distribution in the corneas,were examined at different time points (1 week,1 month,3 months after surgery).One month after surgery,the adhesion of the corneal flap and corneal stroma was detected by a tensile resistance experiment and the diameters of collagen fibers in each group were compared by electron microscope section of 5 rabbit corneas.The data were analyzed by an independent samples t test and a paired t test.Results Yellow-green riboflavin could be found in the anterior chamber after 20 min,which suggested that riboflavin could penetrate the corneal stroma.There was no difference in corneal edema between the experimental and control groups.And the corneal edema had almost disappeared 3 days after LASIK.When compared to the control group,pathology showed that there was no further infiltration of inflammatory cells in the experimental eyes.There was a "no cell zone" in both eyes,and there was no difference between them.At different tension lengths,the adhesion of the corneal flap and the corneal stroma in the experimental eyes was stronger than in the control eyes after 1 month (P＜0.01).In electron microscope sections,mean collagen fiber diameter of the experimental eyes was bigger than in the control eyes (t=7.94,P＜0.01).Conclusion Animal experiments involving photodynamic corneal crosslinking gruided by riboflavin-ultravilet rays can promote the adhesion and healing of flaps after laser in situ keratomileusis.

Objective To evaluate the effect of intraoperative mitomycin C on the stability of refraction after laser-assisted subepithelial keratomileusis (LASEK) in treating high myopia.Methods In this prospective control study,66 eyes of 33 patients were divided into two groups.One eye of each patient was treated with 0.02％ mitomycin C (MMC) during LASEK for myopia (MMC group) while the other eye was not treated (control group).Corneal refraction,intraocular pressure using noncontact tonometry and haze were measured at 3,6,9,12 and 15 weeks after LASEK,and the two groups were compared using paired t test.Results The difference in refraction between the 3rd week and the 6th week in the MMC group was statistically significant (t=2.254,2.175,P＜0.05),while the differences between the other adjacent time points were not statistically significant.Refraction in the MMC treatment group became stable at 9 weeks after surgery.In the control group,the refractive differences between the 3rd and 6th weeks and the 6th and 9th weeks were statistically significant (t=3.315,2.440,2.356,P＜0.05),while the differences between the other times were not significant.Refraction in the control group became stable 12 weeks after surgery.The average course and frequency of using 0.1％ fluorometholone eye drops after surgery in the MMC group were 9 weeks and 2.6 times per day while course and frequency were 12.9 weeks and 2.9 times per day for the control group.Conclusion Intraoperative MMC can shorten the refractive fluctuation time after LASEK for treating high myopia.The effect may reduce the frequency and dosage of corticosteroid eye drops after surgery and avoid the occurrence of steroid-induced ocular hypertension and glaucoma.

Objective To investigate the frequency and anatomical characteristics of appositional angle closure after laser peripheral iridotomy in the fellow eyes of acute primary angle closure.Methods Prospective study.Fifty-four fellow eyes of acute primary angle closure without peripheral anterior synechia after laser peripheral iridotomy were studied.Mean age of (67.1±7.2)years (range 54-83 years).Uhrasounic biomicroscopy (UBM) were performed in darkness.Qualitative analysis of appositional angle closure and quantitative measurements of the angles from UBM images were taken.It was compared between the eyes of positive and negative appositional angle closure groups in intraocular pressure,gonioscopy and UBM parameters,including angle opening distance500 (AOD500),angle recess area750 (ARA750),trabecular-iris angle (T-I angle),trabecular-ciliary process distance (TCPD),peripheral iris thickness (IT1),iris-zonule distance (IZD),the position of iris insertion and central anterior chamber depth (ACD).All analyses were performed using a two-tailed Student's t test and two independent samples rank sum tests of SPSS 12.0 statistical software.Results Twenty patients (37％) were found to have appositional angle closure in at least one quadrant from UBM images in darkness after laser peripheral iridotomy,The indexes showing angle open degree (AOD500,ARA750,T-I angle) and the index showing ciliary body position (TCPD) in appositional angle closure positive group were less than those in negative group (t=11.741,11.089,12.175 and 4.349 respectively,P＜0.01).The index showing iris configuration and position IT1 in appositional angle closure positive group was more than that in negative group (t=-3.300,P=0.002).There were no significant differences in 1ZD,position of iris insertion and center anterior chamber depth between the two groups (t=-1.880,P=0.066; Z=-1.423,P=0.155; and t=0.072,P=0,942 respectively).Conclusion The fellow eyes of acute primary angle closure still appear appositional angle closure in darkness proportionally after laser peripheral iridotomy.The narrower angle,the more anterior position of the ciliary body,and the thicker peripheral iris,are the anatomical characteristics associated with appositional angle closure after laser peripheral iridotomy.It suggests the possibility of chronic angle closure development in the eyes having these anatomical characteristics in acute primary angle closure after laser peripheral iridotomy.

Objective To investigate the clinical features,treatment,therapeutic effect and complications of canalicular laceration indirectly caused by temporal blepharal contusion.Methods This study retrospectively analyzed 93 patients (93 eyes) with lacrimal canalicular laceration admitted to the Eye Hospital of Wenzhou Medical College from January 2004 to January 2010.Nosogenesis,features,methods for finding the nasal broken end of lacrimal canaliculus,treatment,therapeutic effect and postoperative complications of canalicular laceration indirectly caused by temporal blepharal contusion were summarized and analyzed,and described in percentages.Results Lacrimal canalicular laceration in all 93 eyes was caused by temporal blepharal contusion,such as a traffic accident,boxing or tumbling.The laceration in the eyelid of the inner canthus was very long,and the structure of the wound was not clean-cut.The nasal end of the broken lacrimal canalicoli was located in deeper tissue,close to the common canaliculus.All the paranasal broken ends were found directly or from the common lacrimal duct except for two patients whose treatments were terminated because of disorganized abrupt ends.Primary anastomosis of the lacrimal canal was performed on 89 patients,and secondary anastomosis of the canaliculus-to-lacrimal sac was performed on 2 patients.A support tube was implanted in each of 91 patients with canalicular laceration,then extubated 3 to 6 months after the operation.Follow-up observation of the 85 eyes showed completo patency in 77 patients (91％),stenosis of the canaliculus in 6 patients (7％) and obstruent canaliculus was still present in 2 patients.A few cases presented with abscission of the support tube,ectropion of the lacrimal point,or dehiscence of the canaliculi.Conclusion As a special type of caualicular injury,indirect canalicular laceration is caused by temporal blepharal contusion due to the horizontal tractive force action on the eyelid.Understanding the clinical features of the nasal end broken close to the common canaliculus helps in locating the abrupt ends.And anastomosis with a support tube is an effective treatment method.

Objective To explore the feasibility and advantages of iris retractors combined with a full-field non-contact lens used during vitreous surgeries of patients with small pupils.Methods Twenty-four patients were included in this prospective cohort study during February to June 2010 in Lihuili Hospital of Ningbo.The experimental group consisted of 12 patients (12 eyes),all of who had small pupils but needed vitrectomy.All vitreous surgeries in the experimental group were carried out with the help of iris retractors as well as full-field non-contact lenses.For those with cloudy lenses,which affect the operation,phacoemulsifications were also performed.The control group consisted of 12 patients (12 eyes) with normal pupils who needed vitreous surgeries during the same period of time.Closed pars plana vitrectomies with contact lenses were used on them.All patients were followed up for 6-12 months,and then the differences in visual acuity,the corneal epithelium,and retinal reattachment between the two groups were analyzed.Statistical analysis included the Mann-Whitney rank sum test,independent samples t test and Fish's exact test.Results There was no significant difference between the experimental and control groups for postoperative visual acuity; 1 eye in the experimental group and 2 eyes in the control group had recurrent retinal detachment,but there was no significant difference in retinal reattachment between the two groups.Corneal endothelial loss in the experimental and control groups was (15.7±6.9)％ and (16.1±6.4)％,respectively,with no significant differences between the two groups.No complications such as iridothexis or iris atrophy occurred.Conclusion The iris retractor is a useful implement in the course of phacoemulsification and vitrectomy with a small pupil,and it fully exposed the surgical field.A full-field non-contact lens is appropriate for use with an iris retractor rather than a corneal contact lens.Futhermore,it provides a clear and complete view during surgery.An iris retractor combines with a non-contact full-field lens is simple and safe for use in vitreous surgeries of patients with small pupils.

Diabetic retinopathy (DR) is one of the most important and common complications of diabetes.The incidence rate and blindness rate increase year by year.Diabetes duration and blood glucose levels are considered as the major risk factors of DR,the underlying mechanisms are not yet understood.In addition,there is increasing evidence supporting that genetic factors may play an important role in the development of DR.DR is a polygenetic disease,recent studies have screened dozens of genetic polymorphisms that may be associated with DR,including vascular endothelial growth factor gene polymorphisms and nitric oxide synthase gene polymorphisms that draw world-wide concern.Studying their mechanism in the development of DR is of great importance for prediction,early diagnosis and treatment.Therefore,recent advances in the studies of genetic polymorphisms associated with diabetic retinopathy are reviewed.