A continuous decrease in incision size has become a significant trend in the development of cataract phacoemulsification surgery. With the advancement of surgical instruments and equipment in recent years， microincision cataract surgery has gradually become the preferred choice for ophthalmic clinicians. The purpose for decreasing incision size is to improve safety during and after surgery， minimize the change in corneal shape， and to benefit patient outcomes. Since this is a newly developing surgical approach， there are still debates on issues regarding the selection of an optimal surgical procedure for microincision cataract surgery and the most suitable incision size. With the continuous improvement in surgical techniques， ultrasound phacoemulsification equipment and the design of intraocular lenses， especially the widely increasing application of femtosecond laser for the treatment of cataract， what will be the developing trends in microincision cataract surgery in the future? This series of questions merits an in-depth discussion.

Objective  To observe the visual quality of microincision phacoemulsification cataract surgery and evaluate the stability of microincision intraocular lens by evaluating the IOL tilt and decentration. Methods  A retrospective study was carried out on 20 patients. The patients received 1.8 mm microincision phacoemulsification cataract surgery with Akreos MI60 implantation. The uncorrected visual acuity （UCVA）， best corrected visual acuity （BCVA）， ocular aberration， staylights， the tilt and decentration of the IOLs were analyzed at 3 months， 6 months postoperation. Statistical analysis was carried out using the repeated-measured analysis of variance （ANOVA）. Results  The UCVA and BCVA were significantly improved at 3 months and 6 months after the operation （P<0.05）. There was significant difference of staylights at 3 months and 6 months postoperation comparing with preoperation results. No significant difference was found for the average tilt and decentration of IOL of 1 week， 3 months， and 6 months after the surgery（P>0.05）. No significant difference was found for the higher-order aberration of 1 week， 3 months， and 6 months postoperatively （P>0.05）. Conclusion  The 1.8 mm microincision phacoemulsification with Akreos MI60 implantation can provide good lens stability and stable visual acuity for the patients.

Objective  To compare the architecture and wound edema degree changes of clear-corneal 3.0 mm incisions and 2.2 mm incisions after cataract removal. Methods  It was a prospective randomized controlled study. Fifty-eight eyes of 35 age related cataract patients were included and the density of all the cataracts varied from grade Ⅱ to Ⅲ （Emery-Little′s classification）. Patients were randomized to have phacoemulsification through a small-incision （3.0 mm， n=30） or clear corneal microincision （2.2 mm， n=28） by random digital table. Anterior segment optical coherence tomography evaluation was performed at 2 hours， 1 week， 1 month and 3 months after surgery. Incisional corneal thickness and wound architecture， including epithelial gaping， endothelial gaping， local detachment of Descemet′s membrane and loss of coaptation， were assessed. Independent sample t test， nonparametric Wilcoxon rank-sum test and Chi-square test were used for data analysis. Results  There was no statistically significant difference in incisional corneal edema degree between 2 groups at all time points. At 2 hours after the surgery， the difference between 2 groups in the occurrence of epithelial gaping， endothelial gaping， local detachment of Descemet′s membrane and loss of coaptation was not statistically significant. At 1 week postoperatively， the incidence of epithelial gaping was higher in the 3.0 mm group than 2.2 mm group and the statistical difference was significant （23% vs 4%， χ²=5.192， P<0.05）. All different morphological incisions in both group recovered at 3 months postoperatively. Conclusion  Compared to the traditional small-incisions， the wound morphological characteristics of microincisions might recover faster in the cataracts varying from grade Ⅱ to Ⅲ.

Objective  To observe clear corneal incision aberrations and contrast sensitivity corneal wavefront after 1.8 mm micro-incision phacoemulsification with different locations. Methods  86 patients （86 eyes） with age-related cataract in our Hospital Kenmin of Wuhan University were selected， use in randomization method divided into two groups according to different locations： temporal 10∶00 bit incision or temporal 2∶00 bit incision group： 43 cases （43 eyes）； 12∶00 bit incision group： 43 cases （43 eyes）. Corneal wavefront aberrations and contrast sensitivity were recorded preoperative and postoperative at 1 month and 3 months. Independent  sample t tests， rank sum test， chi-square test were used. Results  The differences of visual acuity between the 2 groups was statistically significant after 1 month and 3 months postoperation （χ2=8.053， 10.532， P<0.05）. 1 month and 3 months postoperation Z42 in group A and group B were 0.03±0.04 μm and 0.09±0.06 μm， 0.03±0.03 μm and 0.08±0.04 μm， respectively. The difference was statistically significant （t=4.54， 4.93， P<0.05）. The difference was statistically significant in total higher order aberrations （t=2.16， 2.76， P<0.05）. There was no statistically significant differences in contrast sensitivity between the 2 groups 1 month and 3 months postoperation. Bright and bright glare under each spatial frequency conditions or dark and dark glare under different frequency conditions with statistically significant differences between the 2 groups （P<0.05）. Conclusion  1.8 mm clear corneal incision phacoemulsification incision with temporal corneal incision has less wavefront aberrations and  better visual quality than the 12∶00 incision， which is an ideal surgical incision site.

Objective  To study and compare the effects of a 2.2 mm or 2.75 mm coaxial clear corneal incision （CCI） phacoemulsification on changes in corneal astigmatism. Methods  A prospective， randomized and controlled clinical study was conducted on 167 eyes of 134 cataract patients who were randomly divided into 2 groups： a 2.2 mm group （70 eyes of 57 patients） and a 2.75 mm group （97 eyes of 77 patients）. A superior incision was made when preoperative corneal astigmatism was <0.50 D， while an incision was made at the highest refractive power meridian when corneal astigmatism was ≥0.50 D. Uncorrected visual acuity （UCVA）， best corrected visual acuity （BCVA）， corneal astigmatism （CAD）， and corneal astigmatism axis （CAA）， were measured in both groups before the surgery and 1 week， 1 month and 3 months after surgery. A comparison and analysis between and within groups were performed on the above indicators at each time. Data were analyzed using an analysis of variance of the repeated measurement data， an independent samples t test， a group design Wilcoxon rank sum test， and an independent sample R×C contingency table χ² test. Results  Postoperative CAD decreased significantly in both groups， 0.73±0.43 D （preoperatively） changed to 0.49±0.36 D（3 months postoperatively） （P＜0.01） in the 2.2 mm group； 0.87±0.57 D （preoperatively） decreased to 0.53±0.38 D （3 months postoperatively） （P＜0.01） in the 2.75 mm group. The CAD of the 2.2 mm group briefly increased 1 week postoperatively （P＜0.05）， then decreased to preoperative levels （P＞0.05）. There was no significant change in the CAD of the 2.75 mm group 1 week postoperatively （P＞0.05）， then there was a significant reduction 1 month postoperatively （P＜0.05）. There was no significant difference in the changes in CAD amplitude between the groups. The overall distribution of CAA within groups showed no significant difference before and after surgery， and no significant difference between groups. Conclusion  By making CCI at the highest refractive power meridian， both the 2.2 mm and 2.75 mm CCI could partially correct the

Objective  To compare the outcomes of 1.8 mm coaxial microincision phacoemulsification-trabeculectomy with ultra-thin IOL implants compared to 3.0 mm small incision phacoemulsification-trabeculectomy with foldable IOL implantion. Methods  In a prospective controlled study， 68 cases of glaucoma and cataract were selected at the Inner Mongolia Autonomous Region People′s Hospital between October 2011 and October 2013. All patients were randomly divided into two groups. In the small incision group， 34 patients underwent 3.0 mm coaxial microincision phacoemulsification-trabeculectomy with foldable IOL implantation； for the microincision group， 34 patients underwent 1.8 mm small incision phacoemulsification-trabeculectomy with ultra-thin IOL implantation. All cases were followed up at 1 week， 1 month and 3 months. Visual acuity， corneal endothelial cell density， surgically induced astigmatism， intraocular pressure， filtering bleb and complications were evaluated. A t-test， repeat measured ANOVA and Pearson′s chi-square test were used to determine statistical differences between the two samples. Results  At 1 week postoperatively， visual acuity tended to be better in the microincision group and the difference was significant （χ2=7.114， P<0.05）. At 1 month and 3 months postoperatively， the difference in corrected visual acuity between the 2 groups was statistically significant （χ2=8.053， 10.532， P＜0.05）. At 1 week postoperatively， there was a significant difference in corneal endothelial cell density between the 2 groups （t=10.254， P＜0.05）. This was also true at 1 and 3 months （t=7.291， 9.334， P＜0.05）. At 1 week， 1 month and 3 months postoperatively， there was a significant difference in surgically induced astigmatism between the 2 groups （t=9.112， 10.732， 16.014， P<0.05）. IOP decreased after surgery （F=55.934， 69.063， P＜0.01） but there was no significant difference between the 2 groups. There was also no significant difference in blebs between the 2 groups （χ2=0.031， P>0.05）. No iris injury， posterior capsule rupture or anterior chamber bleeding was foun

Objective  To study the safety and efficacy of treatment using a pupil dilator during phacoemulsification for a small pupil cataract with a 2.2 mm coaxial microincision. Methods  A total of 32 consecutive patients （40 eyes） with a small pupil cataract were enrolled in this retrospective study and underwent coaxial microincision cataract surgery using the Graether pupil dilator. Postoperative vision， corneal edema， anterior chamber reaction， pupil changes and complications were observed after surgery. Results  The mean pupil size was 5.5-6.5 mm during surgery and all surgeries were completed successfully. There were no cases of iris damage or posterior capsular rupture. Visual acuity was 1.0 or better in 15% of eyes （6 eyes） at 1 month after surgery， 22 eyes （55%） were 0.5-0.8， 11 eyes （28%） were 0.1-0.4， and only 1 eye （2%） was 0.05. Pupil shape was round or approximately round and all pupils had a light reflex during the follow-up period after surgery. Conclusion  The treatment for a small pupil cataract using a pupil dilator during phacoemulsification with coaxial microincision cannot only maintain a sufficient surgical field but also protect the iris， result in good postoperative vision with fewer complications， increases the safety and efficacy of phacoemulsification.

Objective  To compare and evaluate the postoperative outcomes of small incision lenticule extraction （SMILE） and laser in situ keratomileusis with femtosecond laser （FS-LASIK） for myopia． Methods  Thirty-six patients （72 eyes） with myopia were selected for small incision lenticule extraction （SMILE group） and another 35 patients （70 eyes） were selected for laser in situ keratomileusis with femtosecond laser （FS-LASIK group）． Uncorrected visual acuity （UCVA）， best corrected visual acuity （BCVA）， spherical equivalent （SE） and wavefront aberration were measured preoperatively and at 1 day and 7 days and 1 month， 3 months and 6 months postoperatively． Total higher order aberrations （HOAs）， horizontal and vertical comas， and spherical aberrations were recorded with the Zywave system． Data were analyzed using a chi square test and independent samples t test. Results  The UCVA in the FS-LASIK group was better than the UCVA for the SMILE group at postoperative 1 day. The 2 groups had similar UCVAs at 7 days and 1 month postoperatively. The UCVA in the SMILE group was better than UCVA for the FS-LASIK group at 3 months postoperatively. At different time points after the operations， there were no significant differences in UCVA≥preoperative BCVA between the 2 groups. Differencs in SE between the 2 groups were not statistically significant at 7 days and 6 months postoperatively. Total HOA root mean square （RMS） showed an increase in both groups postoperatively， and a decline at 3 months and 6 months postoperatively. The HOA of the SMILE group was lower than that of the FS-LASIK group， but the difference between the 2 groups was not statistically significant. The spherical aberrations of the 2 groups increased significantly at 1 day， 7 days， 1 month and 6 months postoperatively but declined by 6 months postoperatively. Vertical coma increased in the 2 groups after the operations but declined after 3 months postoperatively， falling close to preoperative levels at 6 months postoperatively. Horizontal coma in the two groups increased significantly after the oper

Objective  To evaluate the changes in higher order aberration （HOA） in myopic patients after small incision lenticular extraction （SMILE）； to compare the relationship between spherical equivalent refractive error （SE） and aberrations. Methods  This was a retrospective study. Forty patients （76 eyes） with myopia underwent small-incision lenticular extraction using the Visumax femtosecond laser. Postoperative changes in corneal HOA， uncorrected visual acuity （UCVA） and SE were analyzed during a 3 months follow-up period. The main outcome measures of HOA， UCVA and SE before and after the surgery were evaluated. Data were analyzed using ANOVA and pearson correlation. Results  Corneal HOAs for 3 mm and 5 mm corneal diameters increased slightly. For the 5 mm corneal diameter， significant increases in corneal HOA and spherical aberrations （SA） were measured 1 month after surgery （P<0.05）. Three months after surgery， SA also increased compared to measurements 1 month after surgery （P<0.05）， for the 3 mm corneal diameter， SA also increased compared to 1 month after surgery （P<0.05）. Significant correlations were found between preoperative SE and total HOA， coma aberrations， or trefoil aberrations. At spatial frequencies of 5， 10， 15， 20， 25， and 30 c/d， modulation transfer function （MTF） 1 day after surgery increased significantly compared to preoperative measurements （P<0.01）， and then decreased 1 week after surgery （P<0.05）. At 3， 6， 12， 18 c/d， contrast sensitivity （CS） slightly increased over time. There were no serious intraoperative or postoperative complications in this study. Conclusion  Significant improvement in UCVA and was observed after surgery， but there was also an increase in HOA， especially SA. More HOA were induced after surgery with a larger preoperative SE.

Objective  To study corneal nerve damage by observing the corneal subepithelial nerve plexus density and corneal sensitivity after LASIK and LASEK. Methods  In this prospective clinical study， 102 LASIK （204 eyes） and 34 LASEK （68 eyes） postoperative patients from the Central Hospital of Cangzhou City were enrolled. Nerve plexus density under corneal epithelium basal cells and corneal sensitivity were examined in both groups 1 day preoperatively and 1 week， 1 month， 3 months， 6 months， 1 year， and 2 years after the surgery. Repeat measured ANOVA was used to statistically analyze and compare the above two indicators. Results  The LASIK group： corneal subepithelial nerve plexus density was 1 582±175 μm preoperatively and 208±32 μm at 1 week， 254±32 μm at 1 month， 588±65 μm at 3 months， 648±65 μm at 6 months， and 938±119 μm at 1 year. All measurements had decreased significantly after surgery （F＝7.13， P<0.05）. However， the measurements had almost returned to preoperative levels 2 years after surgery （t＝0.147， P>0.05）. Corneal sensitivity was 58.82±0.53 mm preoperatively and 0.59±0.40 mm at 1 week， 15.59±2.67 mm at 1 month， 41.18±3.44 mm at 3 months and 52.88±2.58 mm at 6 months. All measurements had decreased significantly after the surgery （F＝78.13， P<0.05）. However， the measurements had almost returned to preoperative levels at 1 year after surgery （t＝1.144， P>0.05）. The LASEK group： corneal subepithelial nerve plexus density was 1 406±195 μm preoperatively and was 182±33 μm at 1 week， 538±83 μm at 1 month， 784±74 μm at 3 months， and 1 024±74 μm at 6 months. All measurements had decreased significantly after surgery （F＝34.51， P<0.05）. However， the measurements had almost returned to preoperative levels at 1 year after surgery （t＝1.906， P>0.05）. Corneal sensitivity was 58.82±0.53 mm preoperatively and 1.18±0.53 mm at 1 week， 38.82±3.11 mm at 1 month， and 55.29±1.00 mm at 3 months. All measurements had decreased significantly after the surgery （F＝361.98， P<0.05）. However， measurements had almost returned to preoperative levels 6 months after surgery

Objective  To evaluate the efficacy and safety of ranibizumab combined with photodynamic therapy versus ranibizumab monotherapy for the treatment of wet age-related macular degeneration （AMD）. Methods  In this meta analysis， searches were conducted in Pubmed， EMbase， Cochrane Library， CNKI， and Wanfang databases. Six randomized control trials （RCT） in the literature were selected for meta-analysis， a total of 626 eyes： a monotherapy group （323 eyes） and a combined treatment group （303 eyes）. The methodological quality was conducted according to evidence-based medicine （EBM）. The qualities of the RTCs were evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions， Version 5.0. The Cochrane Collaboration′s software RevMan 5.0 was used for meta-analysis. Results  The results of the meta-analysis showed the following： ①Best corrected visual acuity（BCVA）： the monotherapy group showed greater improvement in BCVA compared with the combined treatment group [WMD=-2.84， 95％CI（0.25-5.43）， P<0.05]. The incidence of people who gained ≥15 letters in the monotherapy group was higher than the combined treatment group [WMD=0.66， 95％CI（0.45-0.96）， P<0.05]. However， there was no significant difference between the two groups in the incidence of people who lost ≥15 letters [WMD=1.37， 95％CI（0.78-2.41）， P>0.05]. ②Central retinal thickness （CRT）： There was no significant difference between the two groups [WMD= -3.17， 95％CI（-25.64-31.97）， P>0.05]. ③Lesion size （LZ）： There was no significant difference between the two groups [WMD=0.24， 95％CI（-0.38-0.86）， P>0.05]. ④Injection times： There was no significant difference between the two groups [WMD=-1.00， 95％CI（-2.56～0.56）， P>0.05]. ⑤Complications： The combined treatment group had a higher probability of retinal hemorrhage than the monotherapy group [RR=2.65， 95％CI（1.04-6.71）， P<0.05]. Conclusion  Meta-analysis shows that ranibizumab monotherapy is effective in achieving a BCVA gain comparable to the combined treatment regimen of ranibizumab with verteporin PDT and in wet age-related macular degenerat

Objective  To evaluate the use of Lenstar LS900 in the implantation of an intraocular contact lens （Visian Implantable Collamer Lens， ICL）. Methods  The clinical data of patients with hypermyopia who underwent ICL implantation from January 2012 to June 2013 were retrospectively analyzed. Comparisons between preoperative and postoperative visual acuity （logMAR）， intraocular pressure， and corneal endothelial cell were measured. Postoperative ICL vault， angle-opening distance 500 μm from the scleral spur （AOD 500）， and the shape of the anterior surface of the iris were evaluated. The measurement data were analyzed with a paired t test， and the correlation between preoperative spherical equivalent and predicted error （PE） was done with Pearson correlation analysis. Results  Twenty-seven patients （54 eyes） were included. Postoperative uncorrected visual acuity （UCVA） （0.06±0.05） improved significantly compared with preoperative UCVA （1.22±0.33）（t=25.306， P＜0.01）， and there was no statistically significant difference with preoperative best corrected visual acuity （BCVA） （0.06±0.05） （t=-0.640， P>0.05）. Postoperative spherical equivalent （SE） error （-0.21±0.1 D） decreased significantly compared with preoperative SE error （-9.34±1.97 D） （t=34.304， P<0.01）. There was no significant difference between preoperative and postoperative intraocular pressure （13.82±1.83 mmHg and 14.93±2.12 mmHg， respectively） （t=1.851， P>0.05）. The endothelial cell loss rate at 3 months postoperatively was 2.69%±2.16%. ICL vault for 72% of the eyes was in the ideal range at 3 months postoperatively. No cataracts formed in any of the patients during the follow-up period. Conclusion  The use of Lenstar LS900 in ICL implantation is safe and effective. Postoperative refractive error is accurate， and the ICL vault is in an ideal range in most patients.

Objective  To study the differential diagnosis and management of the infusion misdirection syndrome during phacoemulsification. Methods  This was a retrospective case study. Thirteen patients （13 eyes） diagnosed with infusion misdirection syndrome who suddenly developed a shallow anterior chamber and high intraocular pressure during phacoemulsification were selected by differential diagnosis between January 2005 and June 2013. Patients were treated with a 20% mannital rapid intravenous drip to decrease intraocular pressure， pars plana vitreous cavity puncture aspiration and dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system. Results  Four eyes were treated with a 20% mannital rapid intravenous drip， 3 eyes underwent pars plana vitreous cavity puncture aspiration and 6 eyes underwent dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system during the operation. The anterior chamber re-formed and intraocular pressure decreased after the above management procedures. The remaining operative procedures could be finished successfully. No posterior capsular rupture or vitreous prolapse occurred in any cases. Visual acuity was 0.2 in 3 eyes， 0.3-0.4 in 6 eyes and 0.5-0.6 in 4 eyes on 1 day postoperatively and 0.3-0.4 in 2 eyes， 0.5-0.6 in 6 eyes， and 0.7-0.8 in 5 eyes at 1 week postoperatively. The cornea was clear， anterior chamber depth was normal， the pupil was round and centered， and the IOL was in position in every operated eye. Conclusion  Infusion misdirection syndrome during phacoemulsification can be diagnosed definitely by differential diagnosis. A 20% mannital rapid intravenous drip， pars plana vitreous cavity puncture aspiration and especially single channel dryness vitrectomy by a 23/25G vitreoretinal surgery system can resolve shallow anterior chamber and high intraocular pressure that occurred during the operation. The rest of the operation could be finished successfully.

Recent studies indicate that the development of myopia is closely related to the remodeling of scleral extracellular matrix metalloproteinases， as the most important enzymes of regulating the scleral extracellular matrix have gained more and more attention， in which MMP-2 is the most widely studied. As a target factor in the study of the pathogenesis and treatment of myopia， not only a large number of studies have shown that its activity increased significantly associated with the development of myopia， many researches on myopia treatment also achieved fruitful results by inhibiting MMP-2. Years of researches of MMP-2 in myopia study is reviewed in this paper.