The concept of translational medicine was presented by American scholars in 1993on the background that for the previous 30 years basic biomedical research had been separated from clinical practice. Therefore, it is urgent to effectively translate biomedical research into clinically applicable theories, technologies, methods, and drugs. A translational highway needs to be built from "bench to bedside". In the field of ocular fundus disease research, many unresolved puzzles need further investigation. Translational medical research is needed to change this situation. Although there are a lot of difficulties in the translational medical research process, there is no other choice but to confront and resolve these problems.

Objective To observe the efficacy and safety of an intravitreal injection of Ranibizumab combined with photodynamic therapy (PDT) for exudative age-related macular degeneration (AMD). Methods Retrospective case series study. To analyze the clinical data of 32 patients (41eyes) with exudative AMD who received an intravitreal injection of Ranibizumab combined with PDT for the initial treatment. All patients were assessed by ETDRS visual acuity chart, color fundus photography, fluorescein angiography (FFA) or indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Patients underwent PDT (600 mW/cm2, 50 J/cm2, 83 s), then Ranibizumab 0.5 mg (0.05 ml) was injected intravitreally 48-72 hours later. Treatments were repeated as follows: a single intravitreal injection of Ranibizumab 0.5 mg (0.05 ml), intravitreal injection of Ranibizumab combined with PDT, or just PDT if the monthly follow-up indicated. Performance on the ETDRS chart and retinal thickness before and after the treatment were analyzed with paired t test, leakage of choroidal neovascularization (CNV) complications were counted, and described by percentages. Results The follow-up period lasted 12-39 months. At the 12th month of the follow-up period, performance on the ETDRS chart had improved by 9.1 letters (t=-4.14, P＜0.01).Intravitreal injections of Ranibizumab were repeated (2.0±1.1)times/eye on average, and PDT was repeated (0.2±0.8)times/eye on average. At the end of the follow-up period, performance on the ETDRS chart had improved by 8.9 letters (t=-3.74, P＜0.01 ). Intravitreal injections of Ranibizumab were repeated (2.7±1.2)times/eye on average, and PDT was repeated (0.3±0.7)times/eye on average.CNV showed complete closure in 9 eyes (22%), partial closure in 27 eyes (66%), no change or expansion in 3 eyes (7%), and new CNV in 2 eyes (5%). The mean foveal thickness in the OCT images decreased 119.11 μm compared to that before treatment (t=4.419, P＜0.01). There was no increase in adverse reactions compared to a single intravitreal injection of Ranibizumab or PDT.Conclusion Intravitreal injection of Ranibizumab combined with photodynamic therapy for exudative AMD is well tolerated, with improvements in visual acuity, FFA or ICGA and OCT performance,and has good efficacy and safety.

Objective To investigate the differentiation features of bone marrow mesenchymal stem cells (BMSCs) cultivated with human retinal pigment epithelial cells (HRPECs), brain-derived neurotrophic factor (BDNF), epidermal growth factor (EGF), and basic fibroblast growth factor (bFGF) in vitro. Methods Experimental study. Three experimental groups were established based on the following criteria: HRPECs+EGF, BFGF, BDNF+BMSCs group (group Ⅰ), EGF, BFGF, BDNF+BMSCs group (group Ⅱ) and human BMSCs only (group Ⅲ). For group Ⅰ, HRPECs at passage 3were inoculated at the upper layer of a Transwell 6-well double layer culture plate, and human BMSCs at passage 3 were seeded at the lower layer of the culture plate; a DMEM-LG medium containing 20 ng/ml bFGF, 20 ng/ml EGF, 20 ng/ml BDNF and 10% fetal bovin serum (FBS) was added to each well (for immunocytochemical analysis, a 18 mm×18 mm cover slip was placed under the lower layer to allow cells to grow on it). For group Ⅱ, human BMSCs at passage 3 were seeded at the 6-well culture plate, and a DMEM-LG medium containing 20 ng/ml bFGF, 20 ng/ml EGF, 20 ng/ml BDNF and 10% FBS was added to each well. For group III, human BMSCs at passage 3 were seeded at the 6-well culture plate, and a DMEM-LG medium containing 10% FBS was added to each well. Cell morphology was monitored under an inverted microscope. After 2 weeks, cells were collected for immunocytochemistry and RT-PCR analysis. A Holm-Sidak test was used to analyze data. Results After induction, the cells in group Ⅰ presented a similar appearance to retinal pigment epithelial cells and intracellular pigment particles were visible. However, similar changes did not occur in group Ⅱ and group Ⅲ. Immunocytochemical analysis of RPE65 and keratin-18 showed the optical density value differences between group Ⅰ and group Ⅱ, and between group Ⅰ and group Ⅲwere statistically significant (RPE65: t=37.416, 36.236, P＜0.05; keratin-18: t=38.611,37.532, P＜0.05),while the difference between group Ⅱ and group Ⅲ was not statistically significant (RPE65: t=1.180,P＞0.05; keratin-18: t=1.079, P＞0.05). The expression of RPE65 and keratin-18 was examined by RT-PCR using cell extracted from the 6-well plate, and mRNA expression was calculated after a computer software analysis and a comparison to the internal control β-actin. The inter-group difference showed that the differences between group Ⅰ and group Ⅱ, and between group Ⅰand group Ⅲ were statistically significant (RPE65/β-actin: t=176.110, 174.820, P＜0.05; keratin-18/β-actin:t=243.230, 241.560, P＜0.05), but the difference between group Ⅱ and group Ⅲ was not statistically significant (RPE65/β-actin: t=1.283, P＞0.05; keratin-18/β-actin: t=1.670, P＞0.05). Conclusion BMSCs can be induced into retinal pigment epithelium-like cells when cocultured with HRPECs and BDNF, EGF, bFGF.

Objective To explore the influence of oxidative stress induced by hydrogen peroxide (H2O2) on age-related maculopathy susceptibility 2 (ARMS2) in the transcription and protein levels of human retinal pigment epithelial (ARPE-19) cells, and to investigate the effects of oxidative stress on the ARMS2 gene in retinal pigment epithelial cells. Methods Experimental study. Hydrogen peroxide in concentrations of 0, 100, 300, 500, 700 μmol/L was used for ARPE-19 cells for specified time periods, and then methyl thiazolyhetrazolium (MTF) was used to detect the effects at 2 and 4 hours. Changes of ARMS2 in transcription and protein levels were detected by Realtime-PCR and immunofluorescence. The comparisons which between groups were analyzed by One-way ANOVA. The least significant difference was used to compare the means. The correlation between H2O2 concentration and cell activity were measured with estimates of curve. Results With concentrations of 0-700 μmol/L of hydrogen peroxide for 4 hours, the optical density were 0.531±0.037, 0.370+0.017, 0.371±0.016, 0.33±0.006, and 0.297±0.012, respectively, the activity of ARPE-19 decreased with increasing concentrations (F=6.782, P＜0.01). The result of estimates of curve revealed that activity of ARPE-19 was negative correlated with the concentrations of hydrogen peroxide (r=-0.99, P=0.036). With concentrations of 100-700 μmol/L of hydrogen peroxide for 4 hours, Reahime-PCR results were 1.154±0.007, 1.324±0.022, 1.350±0.011, and 1.280±0.031, respectively, showed that hydrogen peroxide caused ARMS2 gene mRNA expression to increase (F=33.409, P=0.000). When the concentration of hydrogen peroxide increased to 300-500 μmol/L, ARMS2 gene mRNA expression reached a higher level, and then decreased with the increase of hydrogen peroxide. Immunofluorescence results were 7320±493, 14 300±848, 22 400±1596, 23 400±2405, and 19 200±561, respectively, showed that hydrogen peroxide caused ARMS2 protein expression to increase (F=22.843, P＜0.01). When the concentration of hydrogen peroxide increased to 300-500 μmol/L, ARMS2 protein expression reached a higher level, and then decreased with an increase in hydrogen peroxide. The change tendency for transcription and protein levels were the same. Conclusion ARMS2 in ARPE-19 cells can increase in transcription and protein levels with an increase in a low concentration of hydrogen peroxide.The expression of ARMS2 decreases when the concentration of hydrogen peroxide higher than the tolerance concentration of ARPE-19.

Objective To study the abilities of cell renewal and neuronal differentiation of retinal stem cells (RSCs) by comparing the characteristics with neural stem cells (NSCs) in aspects of cell proliferation and differentiation. Methods Experimental study. Cells of the ciliary body zone of postnatal 10 d rat and the brain of neonate rat were isolated respectively by enzymatic digestion, then were cultivated with serum-free DMEM/FI2 medium, 20 μg/L basic fibrulast growth factor (bFGF), 20 μg/L epithelial growth factor (EGF) and 1×B27 Supplement, the characteristics of proliferation of two kinds of cells were observed and compared. These two kinds of cells were identified by detection of nestin and 5-bromodeoxyuridine (BrdU) by immunocytochemistry staining, differentiation of RSCs and NSCs was induced by DMEM/F12 medium with 50 ml/L fetal bovine serum and 1 ×N2Supplement. The differentiated characteristics of two kinds of cells were observed, the marker nestin was detected after cell differentiation, the neuron marker neurone specific enolase (NSE) and glial marker glial fibrillary acidic protein (GFAP) of two kinds of cells were also detected by immunocytochemistry staining. A x2 test was used to test data. Results In the primary cultivation of both RSCs and NSCs, cell spheres with high refraction were observed 48 hour after isolation and cultivation. The passage of the cells was about in the 7th day of cultivation, and the cells of the next passage could also form the spherical shape. The expression of marker nestin and BrdU could be detected both in RSCs and NSCs by immunocytochemistry staining. The proliferation ability of RSCs was lower than NSCs. Both RSCs and NSCs became adherent to the bottom of the culture dish in the induced condition with serum, and some of the cells differentiated into cells with neuronal cell shapes. In the 7th day after differentiation, the ratio of nestin-positive cells was 9.5%±3.5% in RSCs,and which was 9.1%±0.7% in NSCs. The ratio of NSE-positive cells (11.2%+2.8%), and the ratio of GFAP-positive cells (18.9%+2.1%) in the differentiated RSCs were significantly lower than those in the differentiated NSCs (34.1%±6.3% and 41.9%±3.3%) respectively, the differences were significant (x2=103.23, 74.36, P＜0.05 for both). Conclusion The characteristics of the shape, proliferation and differentiation of RSCs from ciliary body zone are similar comparing with NSCs, but the abilities of proliferation and neuronal differentiation of RSCs are lower than NSCs.

Objective To compare the outcomes of 23-gauge (23-G) and 20-G vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation for proliferative diabetic retinopathy (PDR) with coexisting cataract. Methods Retrospective case-controlled study. Ninety-one patients (91 eyes) with PDR and coexisting cataract underwent 23-G (group A, 41 eyes) or 20-G (group B, 50 eyes) vitrectomy combined with phacoemulsification and IOL implantation were studied.One day, 1 week, 2 weeks, 1 month, and 3 months after surgery, the main outcome visual acuity (VA) and postoperative complications were measured. Statistical analysis was performed using an independent samples t test, a paired t test and a chi-square test. Results After the mean follow-up period of 17 months, VA improved significantly from 1.569±0.342 to 0.821±0.421 (t=8.99, P＜0.01)and from 1.658±0.312 to 0.834±0.399 (t=11.47, P＜0.01) in group A and group B, respectively. Postoperatively, 33 eyes (80%) were quiet with no chemosis in group A; in contrast, all eyes (100%) in group B showed marked congestion, chemosis, foreign body sensations and overall discomfort.Postoperative transient hypotony occurred in 3 eyes(7%)and 1 eye(2%),and inflammation in the fibrin anterior chamber was seen in 4 eyes(10%)and 14 eyes(28%)in group A and group B,respectively.The difference for the latter was significant(x2=4.75,P＜0.05).Conclusion For the management of PDR with coexisting cataract,23-G vitrectomy combined with phacoemulsification and IOL implantation is safe and effective with a faster recovery and greater comfort than in the combined 20-G vitrectomy.

Objective To analyze the changes in visual acuity, regression of retinal neovascularization and flash electroretinogram amplitude after retinal laser photocoagulation for diabetic retinopathy (DR). Methods Prospective case-controlled study. The visual acuity, fundus fluorescein angiography, and f-ERG of 48 eyes with proliferative diabetic retinopathy (PDR) and 72 eyes with preproliferative diabetic retinopathy (PPDR) were analyzed and compared 1 week before retinal laser photocoagulation and 1 month after. Number of changes in visual acuity and retinal neovascularization and non-perfusion regression were counted. Amplitude of rod response b wave, mixed response b wave, oscillatory potentials, cone response b wave, and 30 Hz before and after retinal laser surgery were compared with a paired t test. Results For the visual acuity of PPDR patients, 48 eyes remained unchanged and 24 eyes decreased. For the same group, non-perfusion dissipated in 54 eyes, non-perfusion persisted in 16 eyes, and perfusion did not subside in 2 eyes. For the visual acuity of PDR patients, 12 eyes improved, 26 eyes remained unchanged, and 10 eyes decreased. For the same group, neovascular dissipated in 24 eyes, some neovascular persisted in 16 eyes, and did not changed in 8 eyes. Before retinal laser photocoagulation and post laser, the amplitude of rod response b wave of the eyes was (186.7±34.1)μV and (106.7±24.8)μV; the amplitude of photocoagulation mixed response b wave was (381.2±60.4)μV and (273.2±47.8)μV, the amplitude of oscillatory potentials was (66.6±12.4)μV and (86.6±18.7)μV, the amplitude of cone response b wave was (97.4±3.5)μV and (67.2±9.4)μV, the amplitude of 30 Hz was (24.1±8.4)μV and (20.1±6.4)μV, the difference was significant (t=5.672, 5.343, 3.427, 3.578, 2.979, P＜0.01 for all). Conclusion After retinal laser photocoagulation, the visual acuity of DR patients improved or remain unchanged, non-perfusion or neovascular dissipate in some patients, amplitude of most f-ERG wave derease except oscillatory potentials. So retinal laser photoeoagulation is an effective treatment for DR patients.

Objective To determine the intraocular levels of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) in patients with neovascular glaucoma (NVG) and to evaluate the relationship between probable clinical diathesis and associated levels. Methods Experimental study. Fifty-four NVG eyes of 54 patients and 10 fresh healthy donor eyes for corneal transplantation as controls were selected. The levels of VEGF and PDGF in aqueous humor and vitreous liquid aspirates from them were measured. Of the 54 eyes, 17 had central retinal vein occlusion (CRVO), 22 had diabetic retinopathy (DR), 4 had retinal vasculitis (Eales disease),4 had retinal detachments (RD) and 7 had unidentified NVG (NA). Among them, the number of NVG cases with iris neovascularization grades Ⅰ , Ⅱ, Ⅲ and Ⅳ were 17, 12, 13 and 12, respectively,and 36 eyes were treated with prophylactic retinal photocoagulation and/or cryotherapy. The levels of VEGF and PDGF were measured using an enzyme-linked immunosorbent assay (ELISA) method. The differences in VEGF and PDGF levels between the NVG and control groups were analyzed with a Mann-Whitney U test. The differences in the various primary causes, in the iris neovascularization grades and between the prophylactic-treated and untreated groups were analyzed with ANOVA, LSD-t and independent samples t test, respectively. The correlation analysis between VEGF and PDGF levels in each group were checked with a Pearson test. Results The free VEGF and PDGF concentrations in aqueous humor from NVG patients were (926.3±223.5)ng/L and (226.2±81.5)ng/L and the concentrations in vitreous liquid were (1096.1±235.9)ng/L and (375.3±141.5)ng/L, which were higher than concentrations in normal control eyes (aqueous humor: ZVEGF=-4.993, ZPDGF=-4.891, vitreous liquid: ZVEGF=-4.991, ZPDGF=-4.992, all P=0.000). The free VEGF concentrations in aqueous humor and vitreous liquid from NVG secondary to CRVO were higher than those in the NA group (aqueous humor: t=1.746, P=0.033; vitreous liquid: t=1.917, P=0.027). There were no differences in VEGF between CRVO, DR, Eales, and RD eyes. The PDGF concentrations in aqueous humor and vitreous liquid from NVG with diabetic retinopathy (DR) were higher than the concentrations in NVG secondary to Eales disease (aqueous humor: t=1.697, P=0.043; vitreous liquid: t=1.762, P=0.038).There were no statistical differences between VEGF in aqueous humor and vitreous liquid among the various iris neovascularization grades. The vitreal PDGF level in iris neovascularization grade Ⅳ was higher than that in grade Ⅲ (t=1.740, P=0.049). The VEGF and PDGF concentrations in aqueous humor and vitreous liquid in NVG with previous retinal photocoagulation and/or cryotherapy were lower than those in non-intervention NVG (aqueous humor: ZVEGF=2.945, PVEGF=0.003; tPDGF=3.199,PPDGF=0.002; vitreous liquid:ZVEGF=3.165, PVEGF=0.002; tPDGF=2.984, PPDGF=0.004). Correlation analysis showed that there was a positive correlation between the VEGF and PDGF levels in aqueous humor (r=0.305, P=0.025) and vitreous liquid (r=0.303, P=0.026). In NVG secondary to CRVO, the VEGF level in vitreous liquid was positively correlated with PDGF (r=0.503, P=0.040), while the VEGF level in aqueous humor from NVG with DR was positively correlated with PDGF (r=0.462, P=0.030).Conclusion VEGF and PDGF levels are related to primary causes of NVG and iris neovascularization grading, and their release may be inhibited after retinal photocoagulation and/or cryotherapy in NVG eyes.

Objective The purpose of this study was to analyze the results of factors related to lens stability, and the correlations among them. Methods It was a noninterventional,observational study. Thirty-two subjects were enrolled in this study. Both eyes wore Lo-Torque frequent replacement toric soft contact lenses. Stability evaluations were done after 20 minutes of wear, including visual acuity with the contact lens, lens positioning, activity, rotation direction,rotation degree, rotation stability, and nasal and temporal rotation recovery speed. One eye of each subject was randomly selected. The correlations between the parameters were evaluated with SPSS 13.0statistical analysis software. Results The percent of temporal rotation was 59%, with a mean degree of (10.56±7.77)°. There was a negative correlation between nasal rotation recovery speed and overall assessment (r=-0.49, P=0.005). For the looser lens, rotation recovery was faster from the nasal side.The degree of rotation was significantly correlated with rotation direction (r=0.48, P=0.006); the amount of rotation to the temporal side was less than to the nasal side. There was a positive correlation between rotation degree and orientation stability (r=0.45, P=0.010), the less the degree of rotation, the better the stability. Conclusion Frequent replacement toric soft lenses rotate easily to the temporal side in the clinic. Attention should be paid to loose fittings and temporal rotation. There are many factors that affect lens stability, including overall assessment and degree of rotation. This study suggests that more attention should be paid to the overall assessment of the degree of rotation when dispensing toric soft contact lenses in the clinic.

Objective To investigate the effectiveness and feasibility of inducing myopia in mice with flickering light (FL) stimulation. Methods Experimental study. Forty-five C57BL/6 (B6)mice at age 28 days were randomly divided into 3 groups: control group, FL group and form deprivation (FD) group. Mice in the control group were raised under an illumination of 250 lx from 8 :00 am to 8:00 pm, and 0 lx from 8:00 pm to 8:00 am. For the FL group, the mice were raised under an illumination of a 50% duty cycle at 2 Hz for 6 weeks. During each flicker cycle, luminance varied between the maximum and minimum light levels of 250 lx and 1 lx from 8:00 am to 8:00 pm and 0 lx from 8:00 pm to 8 :00 am. Mter 6 weeks of FL, mice were raised under the same conditions as the control group for 2 weeks. Form deprivation was accomplished by covering the right eye of the mouse with a semitransparent hemispherical thin plastic shell for an eye diffuser.Mice in FD were raised under the same conditions as the control group. The refractive state and axial length (AL) of the right eye were measured with murine-specific eccentric infrared photorefraction and A-scan ultrasonography, respectively. The data were collected at pre-treatment and at the end of 2, 4, 6 and 8 weeks post-treatment. During the experiment, the eyes and action of all the mice were also observed. A one-way ANOVA was used to compare refraction and AL between groups. A paired t test was used to compare refraction and AL before and after flicker in FL group. An independent samples t test was used to compare refraction and AL between FL group and control group. Correlation between AL and time, refraction was analyzed with a Regression analysis. Results After 6 weeks of FL stimulation, refraction became more myopic compared to the control group [(-2.49+1.32)D versus (6.26±1.18)D, P＜0.01)], and their AL increased faster [(3.12±0.04)mm versus (3.08±0.02)mm], P＜0.01]. A positive correlation between refractive error and AL was found after treatment (r2=0.677, P＜0.01). The myopic shift decreased towards hyperopia after the removal of FL stimulation. After 6 weeks of FD, FD eyes were more myopic than FL eyes [(-6.42±2.21)D versus (-2.49±1.32)D, P＜0.05]. The AL of the FD eyes was longer than those of the FL eyes [(3.27±0.04)mm versus (3.12±0.04)mm, P＜0.05). However, some mice lost their eye diffusers, and in some mice lens opacities were found. Conclusion Myopia can be induced by FL stimulation in the B6 mouse. A myopic shift induced by FL is less than that by FD, but there are fewer side effects from FL, and FL is safer and easier to manipulate.

Objective To assess the accuracy of axial length (AL), corneal curvature (K1, K2 and Km) and anterior chamber depth (ACD) measurements with the Biograph/Lenstar LS 900 biometer and the IOL Master. Methods In this prospective clinical study, 68 eyes of 34 myopes, whose spherical equivalent were -0.50-10.00 D, with an average of (-4.11±2.31)D. AL, K1, K2, Km and ACD of these myopes were measured with the Biograph/Lenstar and IOL Master biometer. Data were analyzed using a paired samples t test, linear regression and Bland-Altman plots. Results The mean AL and ACD measured by the Biograph/Lenstar and IOL Master were (25.39±1.09)mm, (25.37±1.08)mm, and (3.80±0.26)mm, (3.78±0.26)mm, respectively. There were significant differences between the results of these two methods in AL (t=8.855, P＜0.01), K1, K2 and Km (t=-2.511, P=0.014;t=-2.413, P=0.019; t=-2.893, P=0.005), but not for ACD (t=1.073, P=0.287). A Pearson correlation revealed a high correlation for AL, corneal curvature and ACD measurements between the two devices tested (r＞0.9 for all, P＜0.01 for all). The Bland-Ahman showed that the two devices had non-comparable results for corneal curvature but comparable results for AL and ACD. Conclusion The AL and ACD values obtained with the Biograph/Lenstar are correlated very well to those of the IOL Master. It is important to note in clinical practice, that corneal curvature values acquired by these devices are not directly interchangeable.

Objective To investigate the factors that lead to early postoperative suture loosening after optical lamellar keratoplasty (LKP) for keratoconus. Methods Retrospective case series study. Keratoconous patients who received LKP in Shandong Eye Hospital between January 2006 and May 2010 were reviewed. The case histories of 52 patients (56 eyes) who underwent surgery before November 2009 were reviewed retrospectively. Patients were divided into two groups: a suture-loosening group (37 eyes) and a non-suture-loosening group (19 eyes). Corneal topography, pachymetry, keratometry, axial length, corneal diameter and corneal preservative methods used were analyzed. Nine patients who underwent surgery during November 2009 to May 2010 were examined by slit lamp, anterior segment optical coherence tomography, and laser confocal microscopy, with the purpose of studying the local features of early postoperative sutures. Results Of the 56 eyes reviewed retrospectively, early postoperative suture loosening occurred in 37 eyes (66%), with graft fissure occurring in 27 of those eyes (73%), and 96% of these fissures occurred in the first three months after surgery. Suture loosening mainly occurred in the inferior cornea (62%), 47% of the graft fissures occurred in the same quadrant as the apex and the thinnest point of the lesion. When the suture-loosening group and the non-suture-loosening group were compared, there were no significant differences in the distribution in the apex (x2=1.62, P＞0.05) and the thinnest point (x2=3.49, P＞0.05), or corneal thickness in the central (u=0.11, P＞0.05) and thinnest points (u=0.21, P＞0.05).And there were no significant differences in maximum curvature (u=0.66, P＞0.05), axial length (u=1.06, P＞0.05), corneal diameter (u=1.68, P＞0.05), or corneal preservative methods used (x2=3.06,P＞0.05). Anterior segment optical coherence tomography showed that the ratio of the suture spanning depth in the corneal tissue and the thickness of the cornea was significantly different between the two groups (0.4258±0.0420 versus 0.4869±0.0609, u=2.32, P＜0.05). Slit lamp and confocal microscopy showed that many of the eyes in the suture-loosening group suffered from new vessel formation and the sutures were primarily loosening on the limbus side of the cornea. Necrotic tissue, cicatricle and inflammatory cells were also found in the suture-loosening area. Conclusion Suture loosening and graft fissures often occur during the early period after LKP for keratoconus, and the loosening tends to be located in the inferior cornea. Insufficient spanning depth of the suture in corneal tissue,inflammatory reaction, new vessel formation, and keratopathy may be causes of suture loosening.

Objective To evaluate the perception of psychosocial difficulties due to strabismus and the effects of corrective surgery on adolescent and adult strabismus patients. Methods Investigative survey. The psychosocial problems of 56 patients (23 males, 33 females) were evaluated with an interview schedule before surgery. Patients were consulted 2-3 months after surgery to assess the psychological effects of the surgery. General information and detailed deviation data were also recorded. Data were analyzed with independent samples t tests, ANOVA and Pearson correlations.Results All 56 cases (17 cases of esotropia, 39 cases of exotropia) had .some psychosocial difficulties due to strabismus. Thirty-six patients (64%) had problems making friends and 61% of the patients had difficulty in maintaining good relationships with opposite-sex friends. Lack of self-confidence and problems with eye contact were reported in 82% and 93% of the patients, respectively. Seventy-four percent of the patients avoided public activities due to strabismus and 64% of patients planned to have corrective surgery to reconstructive binocular function. No significant difference was found in psychosocial functions due to sex, age, and types of strabismus and employment. There was no relationship between psychosocial function and age at time of surgery or deviation. Psychosocial functions, especially self-confidence, self-esteem and relationships with friends, improved after surgery. Most of the patients wished to be better informed about strabismus and be more comfortable about treatment during therapy. Conclusion Adolescent and adult strabismus patients have some difficulties with self-confidence, self-esteem and ability to interact in social situations. The psychosocial functioning of these patients improve after corrective surgery.

Objective To investigate changes in the width of the iridocorneal angle in the four quadrants (nasal, temporal, superior, inferior), central anterior chamber depth, lens thickness and intraocular pressure (IOP) in patients with chronic renal failure after hemodialysis. Methods Retrospective case series study. Thirty-five patients (70 eyes) with chronic renal failure were measured with tonometry (IOP), A/B scan (lens thickness) and ultrasound biomicroscopy (central anterior chamber depth, the trabecular iris angle and four directions of the angle opening distance) before and after hemodialysis. The patients were divided into 2 groups based on gonioscopy results: a narrow angle group (14 eyes) and an open angle group (56 eyes). IOP was measured in the 2 groups before and after hemodialysis. The patients' blood urea nitrogen (bun), creatinine (scr), albumin (alb),plasma osmotic pressure and dehydration were also checked before and after hemodialysis. All changes in the parameters were analyzed with a paired t test. Results IOP increased significantly in 35 patients (70 eyes) after hemodialysis (t=-3.389, P＜0.05). Central anterior chamber depth (t=8.043,P＜0.01), iridocorneal angle width (t=4.637, 8.893, 3.575, 3.436, P＜0.01 for all), and angle opening distance (t=3.122, 5.372, 3.838, 2.915, P＜0.01 for all) in 35 patients decreased, with the lens becoming significantly thicker (t=-9.132, P＜0.01) after hemodialysis. The IOP in narrow angle eyes (14 eyes) increased significantly (t=-0.045, P＜0.01) after hemodialysis while the IOP in open angle eyes (56 eyes) showed no significant change (t=-9.515, P＞0.05). Bun, scr and plasma osmotic pressure decreased in 35 patients (t=16.075, 13.676, 113.063, P＜0.01 for all) and alb increased (t=-7.756, P＜0.01) after hemodialysis. Conclusion Due to the movement of liquid in eyes cause by the osmotic pressure gradient after hemodialysis, the eyes of patients with chronic renal failure are characterized by a shallower central anterior chamber depth, a narrower iridocorneal angle width and a thicker lens. In addition, the IOP of narrow angle eyes increase significantly. As a result, it is recommended that the anterior chamber structure of patients with chronic renal failure should be checked and patients should receive appropriate treatment before hemodialysis.

Objective To evaluate the feasibility and the factors of prediction error of astigmatism after intraocular lens (IOL) implantation by modified SRK-T, and to study the value of modified SRK-T using for toric intraocular lens power calculation. Methods Retrospective case seriesstudy. This study included 68 patients (106 eyes) underwent phacoemulsification during Oct 2007 to June 2008 in Eye hospital of Wenzhou Medical College. The result of the spherical equivalent calculated by SRK-T and modified SRK-T was compared, and the astigmatism error predicted by modified SRK-T and subjective refraction was compared with vector analysis. Influencing factor of modified SRK-T was analyzed with a multivariate linear regression analysis. Results Spherical equivalent calculated by modified SRK-T and SRK-T was equal. The factors of prediction error in J0 was astigmatism of cornea (KS),J0=-0.108-0.102×KS (P=0.034); and in J45 was axial length (L) and average refraction of cornea (K),J45=1.797-0.019×L-0.031×K (P=0.009). Conclusion Modified SRK-T is a good option for toric intraocular lens power calculation. The influencing factors of prediction include Ks, L and K.

Objective To study the cause and control of outbreaks of rapidly growing mycobacterium keratitis (RGMK). Methods This was a retrospective case series study. Eleven eyes of 11 patients with RGMK following corneal foreign body trauma were participants in a study at the local hospital. Case histories were taken at the local hospital and patient's workplaces were investigated, and environmental cultures were taken to identify potential contaminants in the new outpatient offices, examination rooms and the patient's workplaces. The control measures stressed the importance of aseptic technique, foreign body removal with disposable needles as opposed to a foreign-body spud soaked in 2% glutaral. The patients received local and systemic antibiotic therapy,lesion cleaning followed by cauterization with tincture of iodine (5%) and even keratoplasty. Results The outbreaks of RGMK were traced to nonsterile foreign bodies or foreign-body spuds treated with frustrane glutaral. Infections in 9 cases were successfully treated with a regimen that included a combination of antimicrobial agents and local lesion cleaning followed by cauterization with 5%tincture of iodine. Two cases that had a poor response to 6 months of antibiotic therapy were successfully treated by keratoplasty. Conclusion RGMK can occur in an epidemic fashion following corneal foreign body trauma. RGMK has a long response period to medical management and the recalcitrant infections can be resolved by keratoplasty. Enhanced workplace protection, attaching importance to aseptic techniques, improved sterilization, multiple antibiotic therapy and close follow-up after removal will help to prevent outbreaks of RGMK.

Objective To explore the incidence of postoperative diplopia of strabismus.Methods Retrospective case series study. Medical records of 5900 patients between Jan 1999 and Dec 2009 underwent strabismus surgery were studied. Incidence of postoperative diplopia of strabismus,surgical age and strabismus type were analyzed, and surgical principle and design ideas were optical reflection normotopia when adult exotropia surgeries were done, and retain a small amount of amount of surgery for a muscle to avoid eye movement limited, and diplopia occurred. Binocular vision training was taken with synoptophore post surgery. Only 555 cases (9.41%) were complaints of diplopia post surgery in 5900 cases of strabismus surgeries, in which patients with transient diplopia were 552 cases (9.36%), diplopia completely disappeared after 3 days, 1 week or 1 month,and persistent dipiopia were 3 cases (0.05%), the symptoms persisted for 0.5-2.5 years. The incidence of postoperative diplopia of concomitant exotropia reached 12.58% (433/3443), make a contribution to the total rate for 78.02%. There was little relationship between age and incidence of diplopia. Conclusion Intractable diplopia after strabismus surgery is very rare, when patients who have temporary diplopia receive the synoptophore training and psychological intervention.

Retinal degenerative diseases, including retinitis pigmentosa, proliferative diabetic retinopathy, proliferative vitreoretinopathy, age-related macular degeneration, etc., which culminate in photoreceptor loss, are the leading causes of irreversible blindness. The development of stem cell transplanation gives hope for patients who are suffering from these diseases. Recently, a population of very small embryonic-like stem cells (VSELSCs) which express CXCR4, is identified in adult tissue,especially in bone marrow. VSELSCs express several markers of embryonic and primordial germ cells,and research has shown that these cells may differentiate into cells from all three germ layers. With their capacity to give rise to specialized cells, VSELSCs are identified as promising candidates for degenerative diseases. This review focuses on current research on VSELSCs, and discusses potential applications in treating retinal degenerative diseases.