Chinese Journal of Optometry Ophthalmology and Visual science

With the rapid development of mini-invasive endoscopic techniques,in recent years many ophthalmic endoscopic surgeries such as endoscopic transnasal optic canal decompression and endoscopic transethmeid orbital decompression have been developed and extensively used in clinics.Good results have been achieved and many new findings have been exploited for physiopathology and treatment of a variety of optic nerve diseases,orbital diseases and lacrimal disorders.However,along with its increasingly extensive application,many problems have arisen due to relatively poor surgical conditions and equipment at the medical institutes,performance of surgery without experience and training in ophthalmic endoscopic techniques,improper surgical indications and the lack of an objective system for evaluating surgical outcomes.Therefore,it is necessary and important to establish strict and regular training programs,to develop a guide for regular diagnosis and treatment,and to carry out basic and clinical research for the systematic and precise development of this advanced technique.

Objective To study the effects of endoscopic dacryocystorhinostomy on chronic dacryocystitis.Methods It was a retrospective study.Eighty-four cases (86 eyes) of chronic and recurrent dacryocystitis treated with endoscopic dacryocystorhinostomy with silicone stent intubation were studied retrospectively.Results After 3～12 months of follow-up,the following outcomes were noted:there were no clinical symptoms or signs in 70 eyes (81.40％),10 eyes (11.63％) had improved and the other 6 eyes (6.98％) were not satisfactory.A total of 80(93.02％) of 86 operations had good resuhs.Conclusion Endoscopic dacryocystorhinostomy with silicone stent intubation for the treatment of chronic dacryocystitishas without facial scars can be used as the preferred method for treatment of this disease.Inserting the stent correctly can prevent ostiole atretostomia and dilate the lacrimal passage,and will improve the success rate of endoscopic dacryocystorhinostomy.

Objective To evaluate the significance of helical CT virtual endoscopy in nasal endoscopic optic nerve decompression for locating the optic nerve canal.Methods It was a retrospective case series study.45 patients (38 males,7 females) undergo the nasal endoscopic optic nerve decompression in the affiliated eye hospital of Wenzhou Medical College between October 2009 and March 2011 were collected.The average age of patients was 32.8±15.1 (9-67 years).Sinus cavity of all patients were reconstructed by helical CT virtual endoscopy and the data were compared with the results of operations.Results Sinus cavity and the locating mark of optic nerve reconstructed by helical CT virtual endoscopy accorded with the the results of operations in all patients,except 4 patients with optic canal comminuted fractures.Sphenoid sinus crest bone were found in 8 ptients (19.51％) and the opticocarotid recess were found in 35 patients (85.37％) which were wally reconstructed by helical CT virtual endoscopy,and were confirmated in operations.Conclusion Sinus cavity and the locating mark of optic nerve can be wally reconstructed by helical CT virtual endoscopy,which can provide a visual,clarity image for operator.

Objective To discuss the differences in the response AC/A between progressive myopes,stable myopes and emmetropes,and to try to analyze the causes for the differences.Methods Fifty-one subjects (17 progressive myopes,17 stable myopes and 17 emmetropes) participated in the study.The accommodative response and heterophoria were measured under 9 different stimulus states.And the response AC/A and accommodative error index (AEI) were calculated.A one-way ANOVA was used to analyze the data.Results There was a significant difference in the response AC/A between progressive myopes,stable myopes and emmetropes (F=4.051,P＜0.05).Progressive myopes had a higher AC/A ratio than stable myopes and emmetropes.No significant differences were found in the AEI values for the three refractive groups (F=2.579,P＞0.05).At high stimulus levels (3.21-4.12 D),progressive myopes showed more esophoria than stable myopes and emmetropes,but significant-differences were found between the three refractive groups only at the 4.12 D level (F=3.828,P＜0.05).Conclusion Progressive myopia has a higher response AC/A and more esophoria than stable myopes and emmetropes,which suggests that high AC/A and large esophoria may be the risk factors for myopia progression.And the large esophoria may be the reason for the high AC/A ratio.

Objective To investigate the binocular vision achieved in children after successful surgical alignment for esotropia and to identify clinical factors that may be associated with the outcome.Methods Consecutive cases surgically aligned within ±8 PD of orthotropia were consecutively reviewed during a follow-up period from Nov 2008 to Sept 2011 in the Eye Center of Provincial Hospital affiliated with Shandong University.The Worth 4 dots flashlight test was used to evaluate the central and peripheral fusion of the children after successful surgical alignment for esotropia,and a titmus stereogram was used to evaluate stereoacuity.A Chi-square test was used to compare the status of postoperative peripheral binocular fusion for differeut types of esotropia.A logisitic regression analysis with odds ratios comparison was used to investigate the influence of the type of esotropia:the duration of the treatment for amblyopia,age at the time of the operation,the anisometropic equivalent of the two eyes and alignment at the last follow-up on the re-establishment of postoperative peripheral fusion.Results Of the 111 children with successful surgical alignment for esotropia,sixty-eight (61.3％) achieved peripheral fusion,six (5.4％) achieved central fusion,and fifty-six (50.5％)achieved different degrees of stereoacuity.The age at the time of the operation (b=-0.842,P＜0.001),the treatment duration of the amblyopia (b=-0.135,P＜0.05),and the alignment at the last follow-up (b=-1.305,P＜0.05) showed negative correlations with the postoperative peripheral fusion.There was no significant correlation between anisometropic equivalent of the two eyes and postoperative peripheral fusion (b=-19.670,P＞0.05).This was statistically significant (x2=15.977,P＜0.01) since differences in postoperative peripheral fusion were achieved for different types of esotropia.Patients with congenital esotropia were least likely to achieve peripheral fusion (OR=1.0),followed by non-accommodative esotropia (OR=3.008),partially accommodative esotropia (OR=4.475),and high AC/A ratio esotropia (OR=82.217).Conclusion The earlier the age at the time of surgery,the more likely that surgical alignment is successful.The shorter the duration of the treatment for amblyopia and the smaller the angle of orthotropia after surgery led to a greater probability for achieving peripheral fusion.The ease of achieving peripheral fusion after successful surgical alignment for esotropia depends on high AC/A ratio of esotropia,partially accommodative esotropia,non-accommodative esotropia,and congenital esotropia.

Objective To investigate the prevalence of complete posterior vitreous detachment in rhegmatogenous retinal detachment (RRD) patients and to evaluate the following diagnostic tests:fundus examination,B-scan ultrasound and optical coherence tomography (OCT).Methods Thirty patients (30 eyes) with RRD who underwent vitrectomy in Shanghai First People's Hospital were included in this prospective case-series study.Patients received comprehensive ocular examinations that included fundus examination,B-scan ultrasound and OCT.TA stain (triamcinolone acetonide) was used to assist during the vitrectomy surgery as well as being the gold standard for PVD diagnosis.Data were analyzed using a Kappa test.Results The rate of detection for the prevalence of complete PVD was as follows:10.0％ by TA stain,76.7％ by B-scan,36.7％ by fundus examination and 13.3％ by OCT.Different rates of PVD detection were found by the above examinations and,of these,the difference was most significant between B-scan and observation during surgery.Conclusion Observation during surgery with the help of TA is comparatively the most persuasive diagnostic method for PVD.Different examination methods can be selected for individual cases.

Objective To observe the incidence of visual axis opacification after pediatric intraocular lens surgery with two different vitrectomy instruments.Methods In a retrospective case series study,the records of children less than 8 years of age who underwent intraocular lens surgery for congenital and developmental cataract in Shandong Eye Institute were retrospectively reviewed.Posterior capsulotomy and anterior vitrectomy were performed with 18-gauge coaxial vitrectomy instruments between June 2003 and June 2006,while pars plana sutureless 25-gauge instruments were used between July 2006 and June 2008.A Chi-square test was used to compare the two methods for the occurrence of visual axis opacification.Results Ninteen children with bilateral cataract and 16 with unilateral cataract underwent posterior capsulotomy and anterior vitrectomy with 18-G coaxial vitrectomy instruments,while 19 children with bilateral cataracts and 12 with unilateral cataract underwent surgery with 25-G vitrectomy instruments.The occurrence of postoperative visual axis opacification was 15％(8/54) and 2％(1/50),respectively.There was a statistically significant difference between the two methods (x2=5.393,P＜0.05).With 18-G vitrectomy instruments,3 eyes had intraocular lenses implanted in the sulcus during surgery and 14 eyes developed iris synechia postoperatively.On the contrary,with 25-G instruments all eyes had well-centered intraocular lenses in the capsule bag and mild iris synechia formation was only observed in 2 eyes.Conclusion Compared to 18-G vitrectomy instruments,posterior capsulotomy and anterior vitrectomy with 25-G instruments decreased the incidence of postoperative visual axis opacification during initial intraocular lens surgery.In addition,modified pars plana sutureless 25-G vitrectomy systems appeared to be safer and more effective.

Objective Using intraocular cow hitch knots to fix the luxated intraocular lens (IOL) in the vitreous cavity without IOL extraction,and observe the effect of the surgery.Methods It was a retrospective case series study.A three-port vitrectomy were using to suture the IOL which were dislocated in the vitreous cavity.After the vitrectomy,intraocular cow hitch knots were used to fixate the IOL haptics in 12 patients with a luxated IOL in the vitreous cavity.Patients were followed up for 6～61 months,visual acuity and surgical complications associated with the procedure were evaluated after the surgery.Results The postoperative best-corrected visual acuity (BCVA) of 12 patients were 2/100 to 20/20.In all 12 cases,the IOL fixated stably and remained well positioned during the follow-up.Postoperative complications included corneal edema in all eyes,ocular hypotension in 5 eyes,temporary ocular hypertension in 2 eyes,and fibrin exudates in the anterior chamber in 1 eye.Retinal detachment was observed in 2 cases,which were reattached by scleral buckling.Conclusion Fixating the IOL in vitreous cavity directly after vitrectomy using intraocular cow hitch knots enables secure fixation of the luxated IOL in the vitreous without extracting it.This technique is the simplest and most effective method for management of IOL dislocation into vitreous cavity.

Objective To measure the changes in the peripapillary and perimacular retinal nerve fiber layei (RNFL) thickness.of patients with Leber's hereditary optic neuropathy (LHON) with spectral-domain optical coherence tomography (OCT).Methods In this retrospective case-control study,the peripapillary and perimacular RNFL thickness of clinical patients with LHON (33 people,66 eyes) and normal volunteers (67 people,67 eyes) was measured by Heidelberg OCT,and blood samples of clinical patients with LHON were collected from three primary mtDNA mutation points (G11778A,G3460A and T14484C).The patients were divided into two groups,the LHON group and those suspected of having LHON,based on their genetic diagnosis.The differences in the thickness of the peripapillary and perimacular RNFL were then compared.The comparisons included the temporal side,superior temporal quadrant,inferior temporal quadrant,nasal side,nasal superior quadrant,nasal inferior quadrant,and the average thickness of 360° RNFL.Results There were 18 LHON patients and 15 patients suspected of having LHON based on the mutation detection of the 33 clinical patients.Peripapillary RNFL had significant differences in the temporal quadrant,temporal superior quadrant,temporal inferior quadrant and nasal superior quadrant among the three groups (F=145.14,11.25,57.10,4.48,P＜0.05).Perimacular RNFL had significant differences in all quadrants (F=24.07,67.01,85.99,130.21,121.90,128.66,P＜0.05).The peripapillary RNFL of the LHON patients was thinner than that of the normal volunteers except for the nasal side and nasal inferior quadrant (P＜0.05).All quadrants of the perimacular RNFL of the LHON patients were thinner than that of the normal volunteers (P＜0.05).The peripapillary RNFL of the patients suspected of having LHON was thinner than that of the normal volunteers in the temporal quadrant,temporal superior quadrant,and temporal inferior quadrant (P＜0.05).All quadrants of the perimacular RNFL of patients suspected of having LHON were thinner than those of the normal volunteers (P＜0.05).Conclusion In later stages,the LHON patients presented with an optic atrophy,not only in the papillomacular bundle,but also in the superior and inferior temporal quadrants.The nerve fibers of the nasal quadrant are relatively unchanged.

Objective To investigate the relationship of magnitude and location between central corneal thickness (CCT) and the thinnest corneal thickness (TCT),and the effect of myopia on corneal thickness.Methods Data obtained with a Pentacam from 300 eyes of 150 patients who had undergone refractive surgery for myopia were randomly divided into 3 groups for a retrospective case control study.The relationship and difference in ocular parameters between the fellow eyes were analyzed by Pearson correlations and paired t tests,respectively.Analysis of variance (ANOVA) was used to compare the data among the multiple groups,and an independent samples t test was used to compare data from the ipsilateral eyes.Results The mean CCT was 555.83±31.83 μm and the mean TCT was 552.88±31.4 μm in the left eyes.The mean CCT was 554.10±31.47 μm and the mean TCT was 549.26±31.25 μm in the right eyes.The TCT location was inferotemporal to the corneal apex in 108/150(72.00％) of the left eyes and in 106/150(70.67％) of the right eyes.There were no significant differences in corneal thickness among the three myopic groups.Conclusion TCT was not consist with the CCT.The TCT location was mainly inferotemporal to the corneal apex in both eyes.Corneal thickness has no significant effect on myopia.

Objective To investigate the forward shift of the posterior corneal surface and related influential factors after laser in situ keratomileusis (LASIK).Methods It was a prospective case series study.Eighty-two patients with myopia (38 males and 44 females) who had undergone LASIK at Union Hospital between December 2006 and February 2007 were retrospectively reviewed.The average age was 24.2±5.5 years,ranging from 18 to 44 years.No case of keratoconus was found during 3 years of follow-up.Intraocular pressure,corneal thickness and topography measurements were obtained with a Goldmann tonometer,ultrasonic corneal pachymeter and Orbscan Ⅱ z before and after surgery.All surgery was performed by the same surgeon using a 217Z100 Bausch & Lomb.Results After LASIK,the best fit sphere radius of the posterior corneal surface was shortened by 113.32±66.87 μm,with an average forward shift of 71.97±28.70 μm.The difference in the posterior corneal surface power between pre-and post-operation was 0.93±0.54 D.The forward shift of the posterior corneal surface showed a positive correlation with preoperative intraocular pressure (r=0.461,P＜0.01),and a negative correlation with residual stromal bed thickness (r=-0.453,P＜0.00).There was a forward shift of varying degrees in the posterior comeal surface in most cases,including several severe cases.But no corneal ectasia was observed during the follow-up period of 36 months.Conclusion The forward shift of the posterior corneal surface could be an inevitable response because of corneal thinning after LASIK,and a change in the posterior corneal surface showed a positive correlation with preoperative intraocular pressure and a negative correlation with residual stromal bed thickness.

Objective To study the changes in contrast sensitivity and glare sensitivity after intensive glucose control during a six-month follow-up period.Methods In a prospective case series study,108 eyes of 54 patients who underwent intensive glucose control treatment were included in this study.The Takagi CGT-1000 was used to obtain contrast sensitivity and glare sensitivity for the eyes of all patients.Measurements were taken at pre-treatment,3 and 6 months after intensive glucose control.The repeat measurement ANOVA and the least-significant difference (LSD) pairwise were used for statistical comparison and data analysis.Results Contrast sensitivity:contrast sensitivities at 6.3°,2.5°,1.6° and 1.0° 3 months after intensive glucose control were higher than those before treatment (t=2.521,3.298,2.808,3.275,P＜0.05); contrast sensitivities at 2.5° and 1.0° 6 months after intensive glucose control were higher than those before treatment (t=2.096,2.059,P＜0.05).There was no significant difference in contrast sensitivity at each frequency between 3 months and 6 months.Glare sensitivity:Glare sensitivities at low,moderate and high frequencies 3 months and 6 months after intensive glucose control were higher than those before treatment.However,there was no statistically significant difference at each frequency between the pre-treatment and post-treatments (F ranged from 1.092 to 3.046,P＞0.05).Conclusion Intensive glucose control can improve visual function for the short term and may delay the progress of visual function damage in the early stage of diabetic retinopathy.

Objective To evaluate the efficacy and safety in the treatment of age-related cataract by comparing manual small incision sutureless cataract surgery (MSICS) with phacoemulsification (Phaco).Methods In a systematic review and meta-analysis,trials were identified by searching databases for randomized clinically controlled trials on the treatment of age-related cataract by manual small incision sutureless cataract surgery and phacoemulsification.The following databases were searched up to February 2012:Cochrane Library,Embase,PubMed,CBM,CNKI and VIP.The quality of the included trials was assessed and meta-analyses were performed with RevMan 5.1 software.Results A total of 13 randomized clinically controlled trials involving 2870 eyes were included.There were no statistically significant differences in the ratio of postoperative visual acuity ≥0.3 (Z=0.61,P＞0.05),endothelial cell loss (Z=0.78,P＞0.05),or postoperative complications (Z=0.74,P＞0.05).But there were statistically significant differences in postoperative astigmatism between the two groups 6 weeks after surgery (Z=10.16,P＜0.01).MSICS was far more economical and time saving than phacoemulsification.Conclusion Meta-analysis shows that MSICS has equal efficacy and safety compared to Phaco in the treatment of age-related cataract.Because MSICS is far more economical and time saving,it should be recommended for use in basic hospitals in China.

Objective To Compare the astigmatic results between circular vacuum aspiration rings and oval vacuum aspiration rings in Sub-Bowman's Keratomileusis (SBK).Methods It was a retrospective case controlled study.A total of 51 patients (102 eyes) who underwent SBK in the West China Hospital.Either circular vacuum aspiration rings or oval vacuum aspiration rings were chosen to make the corneal flaps.Circular vacuum aspiration rings were used in 49 eyes and oval vacuum aspiration rings were used in the other 53 eyes.Corneal curvature was measured with corneal topography and was used to calculate the astigmatic values.An independent samples t test was used.Results The astigmatic values 1 week after surgery for the oval vacuum aspiration ring group were -0.90±0.54 D and-0.84±0.71 D for the circular vacuum aspiration ring group.Astigmatic values change before 1 week after surgery in the oval vacuum aspiration ring group was 0.58±0.77 D and was 0.57±0.76 D in the circular vacuum aspiration ring group.There was no significant difference between the two groups.No complications were detected that would significantly affect visual acuity during or after surgery.Conclusion These results suggest that oval vacuum aspiration rings in SBK will not increase the induced astigmatism.