Chinese Journal of Optometry Ophthalmology and Visual science

Objective To evaluate the short-term outcomes after femtosecond laser-assisted laser in situ keratomileusis （FEMTO-LASIK） in highly astigmatic myopes. Methods Eyes with more than 2.0 diopters （D） of astigmatism were identified from patient records. The mean preoperative cylinder was -2.45±0.62 DC in myopic eyes. Patients were examined preoperatively and 3 months postoperatively. Laser in situ keratomileusis was performed with a WaveLight FS200 femtosecond laser and a WaveLight eye-Qexcimer laser. Preoperative and postoperative refractions were converted to vector values. Induced torsion of the cylinder axis and the correction achieved for sphere and cylinder were determined. Data were analyzed using a paired t test and linear regression. Results After 3 months， the mean sphere was +0.37±0.50 D in myopic eyes and the mean cylinder was -0.57±0.44 D. Spherical equivalent（SE） correction was +0.18±0.48 D from the target value. Astigmatism was undercorrected by -0.30±0.43 D（t=6.17， P<0.01）， and the mean induced torsion of the axis was 0.09±0.34 radians（t=2.22， P<0.05）. Attempted and achieved SE corrections were highly correlated （R2=0.96）. Conclusion Laser in situ keratomileusis in highly astigmatic eyes can precisely correct SE refraction but leads to astigmatic undercorrection. A slight counterclockwise torsion of the cylinder axis was induced.

Objective To observe the orientation of dynamically stabilized toric soft contact lenses （TCL） in Chinese subjects and discuss the effect of myopic refractive error， the amount of astigmatism and its axis. Methods This was a prospective clinical study. One hundred and ninety one subjects were fitted with dynamically stabilized TCLs. Subjects were classified into different groups based on the amount of sphere， cylinder and cylinder axis. The amount of rotation and stability of the lenses in the right eye was recorded and their relationship with myopic refractive error， astigmatic amount and axis were analyzed. Data were analyzed with ANOVA， Fisher′s exact test and Wilcoxon signed-rank test. Results There was no difference between corrected visual acuity of the dynamically stabilized TCLs and that of spectacles （Z=-1.061， P>0.05）. The lenses had good centralized positioning and mobility. Lenses on eyes with non-oblique and greater amounts of astigmatism became relatively stable within a shorter time. Lenses in the high myopia group had better stability compared with the moderate myopia group （χ2=5.371， P<0.05）. The amount of rotation was higher in the oblique astigmatism group than in with-the-rule and against-the-rule astigmatism groups （χ2=7.046， P<0.05； χ2=6.462， P<0.05）. The higher the astigmatism， the better the stability and the less amount of lens rotation. Conclusion Spherical refractive error， amount of astigmatism and axis affect the orientation of dynamically stabilized TCLs to some extent. People with high myopia and against-the-rule astigmatism were the ideal subjects for fitting dynamically stabilized TCLs.

Objective To study the expression of IL-1 beta on the ocular surface of dry eye patients and to study its correlation with symptoms and signs of dry eye； to investigate IL-1 beta′s effect on dry eye pathogenesis. Methods Clinical trials. In this case-control study， 30 dry eye patients （60 eyes） and 15 age- and gender-matched control subjects （30 eyes） without symptoms or signs of dry eye were selected from patients who had been treated in our hospital from September 2012 to February 2013. All subjects underwent full ophthalmologic examinations （including OSDI questionnaire， Schirmer′s test （SIT）， tear break-up time （BUT）， corneal fluorescence staining and conjunctival lissamine green staining）. Impression cytology was used to collect conjunctiva epithelial cells from dry eye patients and controls， then these samples were stained by IHC reaction to detect the expression of IL-1 beta by real-time PCR. Results The average OSDI questionnaire scores for the case group and controls were 24.1±2.2 and 14.3±1.3. SIT scores were 4.13±1.68 mm and 10.53±0.74 mm. BUT times were 4.17±1.10 s and 8.80±1.21 s. Corneal fluorescence staining results were 4.3±1.5 and 0.6±0.5. Conjunctival lissamine green staining results were 5.7±2.0 and 1.9±1.4. There were significant differences between dry eye patients and control subjects （t=22.23， -19.88， -18.20， 12.85， 9.62， P<0.05）. The average expression of IL-1 beta in the case group and controls was 0.65±0.37 and 0.22±0.06. There were significant differences between dry eye patients and control subjects （t=6.31， P<0.05）. The expression of IL-1 beta was positively correlated with scores on the OSDI questionnaire （r=0.81， P<0.05）， corneal fluorescence staining （r=0.58， P<0.05）， and conjunctival lissamine green staining （r=0.48， P<0.05）， and was negatively correlated with BUT （r=-0.45， P<0.05） and SIT （r=-0.43， P<0.05）. With IHC staining， brown particles could be seen in the conjunctiva cells in patients with dry eye， but not in the controls. Conclusion IL-1β as an inflammatory mediator is involved not only in dry eye disease， but is also associated with the severity of dry eye and damage on the ocular surface.

Objective To investigate the clinical characteristics of acute macular neuroretinopathy （AMNR） and the therapy to treat it. Methods This was a retrospective study. The clinical data of 16 patients （25 eyes） diagnosed with acute macular neuroretinopathy from December 2007 to March 2012 were analyzed. The patients （12 males and 4 females） ranged in age from 24 to 72 years with an average age of 51.1±12.7 years. Visual acuity ranged from light perception （LP） to 1.2. Color fundus photography， optical coherence tomography （OCT）， fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA） were performed on these patients. The etiology and the pathogenesis as well as the therapy and visual prognosis of AMNR were evaluated. Results Among the 16 patients， 9 patients were bilateral and 7 were unilateral. All 16 patients （25 eyes） showed grey-yellow lesions in the macular area. FFA revealed that the optic disc was stained in the late stages. Some patients showed the dilatation of micro-retinal veins with dye leakage in the late phases of FFA. ICGA revealed poor perfusion in the macula and the posterior area of the retina. The OCTs of all patients showed the inner segment/outer segment-choriocapillary （IS/OS-CC） band was partially absent with a thickened outer plexiform layer overlying these areas in different degrees. Some patients showed local neurosensory epithelium detachment in OCT images. The resilient packet ring （RPR） and treponema pallidum hemagglutination assay （TPHA） tests were positive in all 16 patients. HIV was simultaneously positive in one patient. Ten patients （14 eyes） agreed to anti-syphilis therapy. The follow-up ranged from 2 weeks to 2 years. The grey-yellow lesions disappeared in 9 patients （12 eyes） and visual acuity improved to 1.0 in 9 eyes. Only one patient （2 eyes） did not have an improvement in visual acuity due to a short follow-up of 2 weeks. Six other patients （11 eyes） were lost and failed to return for unknown reasons. Conclusion Syphilis infection is one of the many causes of AMNR. The main pathological abnormality is located at the outer retina and IS-OS junction. Immunologic examinations such as spirochaeta pallida and HIV are very important in the fundus clinic. Treatment with penicillin resulted in a rapid cure and always had a good prognosis.

Objective To evaluate the changes in macular structure in the early stages after undergoing scleral buckling surgery for rhegmatogenous retinal detachment （RRD）； to use melanin-related near-infrared fundus autofluorescence （NIA） combined with optical coherence tomography （OCT） for studing the changes. Methods This was a prospective case-series study. Melanin-related near-infrared fundus autofluorescence （NIA） and optical coherence tomography （OCT） examinations were performed on 21 patients with local primary RRD three months after undergoing a successful scleral buckling procedure for retinal reattachment. The RRDs in all 21 eyes involved the macula. To check the anomalies fo the images and the recovery of the vision after surgery. Changes invision after surgery were compared with a paired t test. The correlation of NIA and BCVA was analyzed with the relevance of two-way disorderly classification variable data. Results NIA revealed that 16 eyes had hypofluorescence surrounded by hyperfluorescence and 5 eyes had uneven hyperfluorescence. Submacular fluid was found in 20 eyes. The retinal nerve fiber layer in the central fovea became thinner in 6 eyes. In one eye， the retinal nerve fiber layer in the central fovea became thicker， and in another 14 eyes the thickness of the retinal nerve fiber layer was normal. The reflection from the photoreceptor inner and outer segment junction （IS/OS） was abnormal in all 21 eyes. Visual acuity measured with NIA revealed that the hypofluorescence which was surrounded by hyperfluorescence had improved at the 3-month follow-up compared to the 1-day follow-up examination （t=9.922， P<0.05）， while VA measured at the same time revealed that uneven hyperfluorescence had not improved at the 3-month follow-up （t=2.409， P>0.05）. The macular NIA results and the change in postoperative BCVA were highly correlated （r=0.502， P<0.05）. Conclusion Macular function and structure do not fully recover in the early stages after undergoing scleral buckling to treat RRD. More attention should be paid to this problem.

Objective To evaluate the clinical efficiency and safety of iris hooks and a capsular tension ring （CTR） for treatment of a subluxated lens in patients with cataract. Methods This study was comprised of 22 patients （22 eyes） with cataract and a subluxated lens． Among these patients： 13 had traumatic cataracts， 4 had Marfan syndrome， 3 had a suspensory ligament broken during phacoemulsification， and 2 had unclear reasons for a subluxated lens． A 3.2 mm clear corneal incision was made with a continuous curvilinear capsulorhexis （CCC）． Four disposable iris hooks were inserted through the incisions and placed in the capsulorhexis to support the capsule and a CTR was implanted. Phacoemulsification and posterior chamber intraocular lens （IOL） implantation were performed． Results The capsular tension ring and IOL were smoothly implanted in all patients. After the operation， all patients had improved visual acuity， and the intraocular lens was basically in the normal position without tilting or obvious decentration in all the eyes. The follow-up period lasted for 6-36 months． Best corrected visual acuity （BCVA） was 0.2-0.4 in 6 eyes， 0.5-0.8 in 11 eyes， and over 0.8 in 5 eyes. Four of the eyes were examined at a follow-up of one year or more after cataract surgery. No serious complication such as retinal detachment was seen in any patient. Conclusion The use of iris hooks and CRT in cataract patients with a subluxated lens extracted by phacoemulsification can improve stability and reduce complications. This procedure is an effective supplemental device in cataract surgery.

Objective To investigate the effect of phacoemulsification techniques on posterior subcapsular cataracts and to minimize the risk of posterior capsular rupture. Methods The medical records of 23 eyes of 13 patients with posterior subcapsular cataract who had phacoemulsification were reviewed retrospectively. The surgical techniques， parameters of the phacoemulsification machine， intraocular complications， management and surgical outcomes were examined. Results Among the 23 eyes with posterior subcapsular cataract that underwent phacoemulsification surgery， posterior capsule rupture occurred in 7： 4 from the removal of posterior subcapsular opacity， 2 from anterior chamber collapse， and 1 from polishing the capsule. Anterior vitrectomy was performed on 2 eyes. In 1 eye， the cortex was dislocated posteriorly and was removed later by central vitrectomy. Conclusion Posterior capsule rupture may occur during any stage of posterior subcapsular cataract surgery. Capsule rupture occurs most commonly during posterior opacity removal， and this type of cataract needs more gentle maneuvering to avoid the collapse of the chamber or overinflation. It is important to try to postpone the removal of the opacity until the final stage of cortical aspiration to avoid early rupture of the posterior capsule.

Human beta defensins are widely expressed in the mucosal epithelial cells of organs and tissues. Beta defensins not only exhibit broad-spectrum antimicrobial activity against bacteria， fungi and enveloped virus， but also regulate immune response and inflammation. This research area has become a hot topic in recent years. The eyeball， as an exposed organ， is susceptible to all kinds of pathogens， resulting in infections and visual impairment. Over the past decade， several studies have demonstrated that， like many tissues in the body， the eye and its associated structures secrete and express beta defensins， which play an important role in the defense mechanism of the eye. In this review， we focus on the biological activities of beta defensins， their expression and distribution in the eye， their roles and potential applications in eye diseases.