Recent advancement in ophthalmic fundus imaging has already revolutionized the diagnosis and therapy of retinal disease. Currently available systems include color fundus image, red-free fundus images, fundus autofluorescence image (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (S-OCT). Comprehensive knowledge of the technical and clinical aspects of these current methods, with emphasis on the evaluation of appropriate diagnostic imaging information, would be of extreme importance in differentiating a variety of choroidal abnormalities and retinal diseases, and determining therapeutic strategies, as well as following the progression of the disease.

Objective To investigate the imaging features of the retinal pigment epithelium (RPE)-Bruch's membrane (BM)-choriocapillaris complex in central serous chorioretinopathy (CSC) with spectral-domain optical coherence tomography (Spectralis OCT). Methods This was a noninterventional, observational study. One hundred and eleven eyes of 109 consecutive patients (male 89, female 20) diagnosed with CSC were included. All the patients underwent a full ophthalmologic examination, including the visual acuity, slit-lamp microscope, pre-set lens, fundus photography, Spectralis OCT and fundus fluorescein angiography (FFA). Indocyanine green angiography (ICGA) was performed on some patients. The RPE-BM-choriocapillaris complex, which manifested as a high-reflecting band in Spectralis OCT, was carefully checked. Based on the visibility of BM, it was classified into two types: a visible type or invisible type. The visible type was then classified into an obvious type or occult type. If visible, BM appears thinner and more reflective than the RPE-BM-choriocapillaris complex. Meantime, the pigment epithelial detachment (PED) was classified into different types corresponding to the BM categories. The number of different categories were counted, measured and recorded as percentages. Results The visualization of BM manifested in all 11 eyes (100%), but differed to the extent for which it was visible. Of the 111 eyes, the BM was obvious in 99 eyes (89.8%). In the other 12 eyes (10.2%) it was difficult to discriminate, but there were still distinguishable differences from normal RPE-BM-choriocapillaris complexes. The visualization of BM was more obvious and wider in the 27 chronic CSC eyes than in the 84 acute CSC eyes when accompanied by the atrophy of choriocapillaris and RPE. BM was discriminated or visualized at all of the tracking leakage points demonstrated on FFA images. Conclusion BM is sandwiched between the RPE and choriocapillaris, and it cannot be distinguished in the normal high-reflecting band of the complex in a Spectralis OCT image. Visualization of BM in the RPE-BM-choriocapillaris complex demonstrates a detachment not only between BM and the RPE, but also perhaps between BM and the choriocapillaris. This discovery may offer new morphological and pathological evidence for central serous chorioretinopathy.

Objective To observe the features of the foveal photoreceptor layer in eyes with central serous chorioretinopathy (CSC) using spectral-domain optical coherence tomography (Spectralis OCT); to analyze the relationship between best corrected visual acuity (BCVA), the morphology of the outer segments (OS) and the thickness of the outer nuclear layer. Methods This was a prospective case control study. The morphology of the outer segments was observed and central thickness of outer nuclear layer (CTONL) at the central fovea was measured in 24 consecutive CSC eyes of 23 patients and 18 normal control eyes of 18 normal people on Spectralis OCT images. The eyes of CSC patients were divided into two groups based on the morphology of the outer segment: the preserved outer segement group and the atrophy group. The correlation between BCVA and CTONL in these groups was evaluated separately. An independent samples t test was used to compare CTONL and the average BCVA of the goups. A Pearson correlation test was used for the correlation between CTONL and BCVA in the CSC patient group. A Spearman rank correlation test was used for the correlation between symptom duration and CTONL in the CSC patient group. Results The outer segment band of the serous detached fovea was preserved well in 17 eyes (71%), and atrophic in 7 eyes (29%). The average CTONL was (73.6±19.6) μm in the CSC group, which was significantly less than that [(114.8±15.6)μm] in the normal group (t=7.274, P<0.01). The average CTONL was (53.0±14.1)μm in the atrophic subgroup, which was significantly thinner than that [(82.1±14.6)μm] in the preserved group (t =4.482, P<0.01). The BCVA was 4.86±0.14 in the atrophic group, which was significantly less than that (4.50±0.26) in the preserved group (t=4.294, P<0.01). BCVA was positively correlated with CTONL (r=0.918, P<0.01). The course of the disease was negatively correlated with CTONL and BCVA (r=-0.994,-0.989, P<0.01 for both). Conclusion BCVA is correlated with CTONL and the health of the outer segment, the BCVA of the preserved group is better than that of the atrophic group; the thinner the CTONL is, the worse the BCVA.

Objective To investigate the characteristics of the fundus image in central serous chorioretinopathy (CSC) patients who undergo or not undergo treatment. Methods This was a retrospective case control study. The fundus images of 36 patients who were diagnosed with CSC from Jan. 2009 to Dec. 2010 were analyzed. Eighteen of 36 cases (group A) with less than 3 months since onset were treated with photodynamic therapy (PDT) with a half-dose (3 mg/m2) of verteporfin and 18 of 36 patients (group B) with more than a 3-month period since onset were not treated. All eyes were imaged by spectral domain optical coherence tomography (Spectralis OCT) and fundus autofluorescence (FAF) at each follow-up visit. Eighteen cases in group A were imaged by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) each time and 9 of 18 patients with a severe decrease in visual acuity in group B were imaged by FFA and ICGA. The differences between Group A and B were observed. Results Group A patients presented with an abnormal increase in FAF before treatment and normal FAF after treatment. In the meantime, Spectralis OCT imaging showed serous neuroepithelial detachment with subretinal fluid (SRF), FFA showed ink-dot diffusion or a smokestack phenomenon, and ICGA revealed dilated and tortuous choroidal vessels with diffuse hyperpermeability. After 1 month, Spectralis OCT imaging showed a resolution of SRF in 16 of 18 patients who had undergone PDT treatment (group A). Fundus images of the other 2 patients showed that their conditions did not revert to normal until 3 months after treatment. Three months after treatment, Spectralis OCT clearly showed that there was a resolution of SRF in all patients, and FFA and ICGA showed an absence of fluorescence leakage and a recovery of dilated choroidal vessels. However, 16 of 18 patients in group B showed an abnormal FAF. There were mainly four phenotypic patterns in the FAF shapes such as pachy, variegated, round and short-lagenated. Two of 16 patients showed a descending tract with a downward-leading swathe of decreased autofluorescence originating from the posterior pole and extending below the inferior arcade. We called this the RPE track. There were 9 patients in group B who were imaged with FFA and ICGA due to persistent blurred vision and several recurrences, and the ICGA images showed late-stage obviously damaged areas. The size of the damaged areas in the partial patients was greater than 5 disc diameter. Conclusion Abnormal FAF could be seen in CSC without treatment due to SRF damaging the retinal pigment epithelium (RPE) cells and further leading to permanent RPE cellular dysfunction and poor visual acuity. Therefore, treatment intervention in the early stages is safe and necessary for partial CSC patients to avoid long-term damage and visual function loss.

Objective To combine two-wavelength fundus autofluorescence (FAF) with multifocal electroretinography (mf-ERG) in retinitis pigmentosa (RP) and discuss the microstructural abnormalities as seen with spectral-domain optical conherence tomography (Spectralis OCT). Methods This was a noninterventional, observational study, based on the observation and analysis of a series of cases. Fifteen eyes of 8 patients with RP were evaluated with Spectralis OCT, blue light fundus autofluorescence (BL-FAF, excitation 488 nm, emission ＞500 nm) and near-infrared fundus autofluorescence (NIR-FAF, excitation 787 nm, emission ＞800 nm). BL-FAF and NIR-FAF imaging were performed with a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2). Five of 8 patients received fundus fluorescein angiography (FFA) while 3 also had indocyanine green angiography (ICGA) simultaneously. Seven had fundus photography and mf-ERG was performed on 4 cases. The FAF distribution in RP was observed and the correlated changes of microstructural abnormalities were analyzed with Spectralis OCT and the response (Amp.P1) in mf-ERG. Results BL-FAF and NIR-FAF showed a hypoautofluorescent pattern in the atrophied area of the RPE and photoreceptor and bone spicule pigmentation, where mf-ERG showed that the peak in the fovea had disappeared and responses had markedly decreased throughout the macula. Spectralis OCT demonstrated that normal FAF demarcated the border within an area of preserved PR and RPE, while outer limiting membrane (OLM) showed disturbances. In several cases, the hyperautofluorescent pattern of NIR-FAF was less obvious than that of BL-FAF in these areas. In FFA images showing early stages, a window defect was seen at the posterior pole, suggesting RPE malfunction and in ICGA images of early stages, choroidal capillary atrophy was observed. Conclusion The two-wavelength FAF, Spectralis OCT and mf-ERG are useful noninvasive diagnostic tools to identify retinitis pigmentosa. The change in these measures indicate a common pathway for photoreceptor and RPE degeneration involving lipofuscin and non-lipofuscin fluorophores such as melanin (oxidation) with different pathophysiologic processes by BL-FAF and NIR-FAF.

Objective To describe the clinical features and characteristics of fundus fluorescein angiography (FFA) of juxtapapillary capillary hemangioma. Methods Retrospective case series study. Clinical data including fundus color photography from 10 eyes of 9 cases and FFA of 8 cases (9 eyes) were analyzed. The average age of the 9 cases was (26.8±9.7)years, and 4 eyes of 4 cases presented with peripheral retinal capillary hemangiomas. Six cases with 7 affected eyes were diagnosed with Von Hippel-Lindau disease. Results The type of tumor growth was endophytic in 8 eyes of 8 cases, and exophytic in both eyes of one case. The location of the growth relative to the disc was temporal, inferotemporal, or superotemporal in 5 eyes, and central on the disc in 3 eyes. In 9 eyes of 8 cases underwent FFA, FFA graph revealed "wash out" in the late phase in 5 eyes. Conclusion Juxtapapillary capillary hemangiomas often locate on the temporal or center of the disc. Associated lesions include retinal exudation and edema around the tumor. The type of tumor growth was more commonly endophytic. FFA is a vital ancillary test in distinguishing juxtapapillary hemangiomas from other diseases.

Objective To analyze the characteristics of diurnal intraocular pressure (IOP) curves in normal tension glaucoma (NTG) patients and primary open angle glaucoma (POAG) patients by measuring IOP over 24 hours. Methods This was a prospective case control study. Subjects diagnosed as POAG and NTG were enrolled from April 2006 to April 2009 in the Shanghai Beizhan Hospital and Eye & ENT Hospital of Fudan University. A total of 131 NTG patients and 102 POAG patients were included in this study. All the subjects accepted 24-hour IOP measurements by a non-contact tonometer every two hours starting at 8:00 am in a sitting position. The IOP between 0:00 to 6:00 am were also measured in a sitting position immediately after the subject was awakened. The main observation indices included an IOP fluctuating curve, average IOP, peak time and IOP, valley time and IOP and the IOP fluctuating value. Differences in these indices between the two groups were analyzed by a independent samples t test and chi-square test. Results The average IOP in the NTG group were (14.2±2.1)mmHg for the two eyes, and in the POAG group were (19.9±3.5)mmHg. The peak IOP in the NTG group were (17.0±2.4)mmHg for the two eyes, and in the POAG group were (24.7±4.3)mmHg. The valley IOP in the NTG group were (11.8±2.2)mmHg for the two eyes, and in the POAG group were (16.5±3.1)mmHg. IOP fluctuations in the NTG group were (5.2±1.8)mmHg for the two eyes, and in the POAG group were (8.2±3.1)mmHg. All differences between the two groups were statistically significant (t=-14.52,-16.44,-13.16,-8.90, P＜0.01 for all). Notably, 63.3% of the peak IOP in the NTG and 73.5% of the peak IOP in the POAG occurred outside working hours, especially during the period from 0:00 to 6:00 am with 51.5% peak IOP in the NTG group and 64.7% in the POAG group. Differences between the two groups were statistically significant (x2=8.150, P=0.017). Conclusion The fluctuation curves of IOP in NTG and POAG patients are similar over 24 hours. These properties are not only guidelines for establishing individual treatment, but also for evaluating the therapeutic effects and treatment adjustments during follow-up.

Objective To investigate the neuroprotective effect of fasudil for retinal ganglion cells and its mechanism research in rat acute elevated intraocular pressure (IOP). Methods Experimental study. Twenty-four SD rats were divided into 4 groups at random: N group (normal), M group(model), MP group (model+PBS: began PBS i.p. 25mg/kg qd a week before the operation) and F group (model+Fasudil: began Fasudil i.p. 25 mg/kg qd a week before the operation). Excavating their eyeballs and collectting blood from their hearts 7th day after operation, which was established by increasing IOP to 110 mmHg (lasting 60 minutes) through intra-anterior chamber infusion of saline solution, TUNEL was employed to observe apoptosis of retinal ganglion cells (RGCs) through apoptosis index (AI), immuno-histological assay to carry out on paraffin sections of retina and to research the distribution and expression with average optical density (OD) of Rho-associated kinase-2 (ROCK-2) and endothelin-1 (ET-1), Western blotting to view the expression of phosphorylated-myosin phosphatase target subunit-1 (p-MYPT-1), radio-immunity assay to survey the content of ET-1 in blood plasma, and blood rheometer to measure the blood viscosities, blood cell aggregation index (BCAI) and hematocrit (HCT). The results were analyzed using one-way ANOVA and LSD-t test. Results In TUNEL: there was remarkable difference in RGCs AI among the 4 groups (F=402.041, P=0.000). AI in F group [(33.3±2.0)%] was obviously decreased compared with M [(64.3±2.2)%] or MP [(62.5±2.2)%] group (P＜ 0.05). In immuno-histological assay: in N group ROCK-2 or ET-1 was only distributed in ganglion cells layer (GCL) and not found in other layers. The distribution of ROCK-2 in M, MP or F group was in GCL, inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL) and outer nuclear layer (ONL), and ET-1 was in anterior 4 layers, but not ONL. Meanwhile, the OD of ROCK-2 and ET-1 in retina of M or MP group were obviously increased compared with in N group (the OD of ROCK-2 in N, M, MP groups were 0.21 ±0.03, 0.52±0.06, 0.54±0.03, respectively, and the OD of ET-1 were 0.22±0.05, 0.51±0.03, 0.51±0.04, respectively.) (P＜0.01). And OD of ROCK-2 and ET-1 in F group were prominently decreased compared with M or MP group (the OD of ROCK-2 and ET-1 in F group were 0.37 ± 0.04 and 0.35 ±0.06, respectively) (P＜0.05), but still noteworthily increased compared with N group (P＜0.05). There was remarkable difference in expression of ROCK-2 and ET-1 in retina of 4 groups (F=82.862, 56.491, P=0.000 for both). In Western blotting assay, there was remarkable difference in expression of p-MYPT-1 in retina of 4 groups (F=606.236, P=0.000). Meanwhile, they in M or MP group (0.522±0.013, 0.520±0.013) were obviously increased compared with that in N group (0.263±0.014) (P<0.01). And it in F group (0.302±0.015) was prominently decreased compared with M or MP group (P＜0.05), but still noteworthily increased compared with N group (P＜0.05). In radio-immunity assay: there was remarkable difference in content of ET-1 in blood plasma of 4 groups (F=8.750, P=0.000). Meanwhile, they in M or MP group [(96±10)pg/ml, (96±10)pg/ml] were obviously increased compared with in N group [(72±10)pg/ml] (P＜0.05). And it in F group [(78±10)pg/ml] was prominently decreased compared with M or MP group (P＜0.05), but still noteworthily increased compared with N group (P＜0.05). There was remarkable difference in three kinds of blood viscosity (1 l/s, 115 l/s, 300 l/s), BCAI and HCT of the 4 groups (F=7.086, 4.279, 14.780, 37.351, 143.264, P＜0.05). Meanwhile, they in M or MP groups were obviously increased compared with that in N group (P＜0.05). And they in F group were prominently decreased compared with M or MP group (P＜ 0.05), but still noteworthily increased compared with N group (P＜0.05). Conclusion Fasudil could protect RGCs in rat acute elevated IOP and its mechanism may be related to inhibiting ROCK-2, decreasing p-MYPT-1, reducing actin-myosin cross link, restraining smooth muscle contraction, diminishing ET-1, depressing blood viscosity.

Objective It has been shown that visual performance and aberration are related to pupil diameter. This study investigated the correlation between visual performance and higher-order aberration for corresponding pupil sizes under bright and dark backgrounds in patients with myopia and myopic astigmatism. Methods This was a prospective clinical study. One hundred and twenty-three right eyes of 123 subjects with a spherical equivalent refraction (SE) from-0.5 D to-10.00 D were enrolled in this study. An iTrace wavefront aberrometer was used to measure the aberration. MFVA-100 was used to measure contrast visual acuities. 100%, 25%, 10% and 5% contrast visual acuities under bright and dark backgrounds, and the pupil size for corresponding conditions were recorded with a Pupillometer. The root mean square (RMS) values of the wavefront aberrations under the corresponding pupil sizes were calculated. The relationship between higher-order aberrations and contrast visual acuity under bright and dark backgrounds were analyzed. A paired t test and multiple linear regression analysis was performed. Results Under a bright background, contrast visual acuities of 100%, 25%, 10%, 5% were 5.155, 4.989, 4.759, 4.665; Under a dark background, the corresponding contrast visual acuities were 5.068, 4.875, 4.665, 4.439, the differences between the two backgrouds were significant of the same contrast (t=20.095, 18.241, 12.422, 28.538, P＜ 0.01). Under the same background, visual acuities among different contrast were significant (F= 500.564, 842.708, P＜0.01). Under a bright background, the RMS of coma (both the horizontal and vertical coma) was significantly associated with four different contrast visual acuities (r2=0.072, 0.124, 0.104, 0.119, P＜0.01 for all). Under a dark background, RMS of the fourth-order Zernike coefficients was significantly associated with contrast visual acuity (r2=0.045, 0.123, 0.161, 0.067, P＜0.05 for all). Conclusion The link between visual performance and aberration depends on the variation in pupil size. Under a bright background, coma is the main factor affecting visual performance. Under a dark background, fourth-order Zernike coefficients contributes to the degradation of the contrast visual acuity because of the larger pupil size.

Objective To assess binocular visual function after combined implantation of toric and multifocal or monofocal intraocular lenses in unilateral astigmatism cataract patients. Methods This was a prospective case control study. A total of thirty unilateral astigmatism patients undergoing phacoemulsification were recruited. AcrySof Toric IOL were implanted in the astigmatic eye of patients, with ReSTOR (15 eyes) or AcrySof IQ (15 eyes) in the contralateral eye. Six months postoperatively, patients were assessed for visual acuity (5.0 m, 60.0 cm, 40.0 cm), contrast sensitivity, amplitude of accommodation, and stereoacuity. Patients were surveyed for visual disturbances and lifestyle visual quality. Data were analyzed with a paired t test, an independent samples t test, or chi-square test. Results At 6 months postoperatively, for Toric-ReSTOR patients, uncorrected binocular logMAR visual acuity at 5.0 m, 60.0 cm, 40.0 cm was 0.05±0.05, 0.24±0.10, and 0.14±0.06, respectively. For Toric-AcrySof IQ patients, uncorrected binocular logMAR visual acuity was 0.06±0.07, 0.26±0.08, and 0.37 ±0.10, respectively. These values between the two group did not achieve significant differences except for near visual acuity (t=5.476, P=0.000). The contrast sensitivity for ReSTOR eyes was lower at 18 cpd under photopic and photopic glare circumstance than for the AcrySof IQ eyes (0.30 ± 0.37 versus 0.94 ±0.58, t=3.476, P=0.001; 0.34 ± 0.44 versus 0.88 ±0.52, t =2.975, P= 0.006). And was lower at 12 cpd under scotopic and scotopic glare circumstance than for the AcrySof  IQ eyes (0.05±0.22 versus 0.50±0.61, t=3.057, P=0.005; 0.05±0.22 versus 0.59±0.75, t=3.154, P=0.004). The amplitude curve of accommodation in Toric-ReSTOR patients had two wave peak (0 and-2.5 D), but only one (0 D) in Toric-AcrySof IQ patients. The stereopsis of Toric-ReSTOR eyes decreased slightly (53% versus 73%, x2=1.262, P=0.263). Patient satisfaction for mean near vision was significantly different: 80% for Toric-ReSTOR patients versus 26% for Toric-AcrySof IQ patients (x2=8.571, P=0.003). There were no visual symptoms in either group. Conclusion Although a combination of toric and mutifocal intraocular lens implantation compromises stereoacuity, it can still provide patients with high levels of spectacle freedom and good overall binocular visual acuity.

Objective To investigate the correlation between anterior corneal surface shape (including corneal curvature, corneal height, and asphericity) and corneal higher-order aberrations. Methods In this cross-sectional study, 57 eyes of 57 myopic subjects were included. The mean spherical refractive error was (-3.88±1.12)D (range-1.50--6.00 D) and cylinder was (-0.59±0.58)D (range 0--3.50 D). Anterior corneal surface shape was measured with a Pentacam (Oculus, Wetzlar, Germany) and index of surface variance (ISV), index of height asymmetry (IHA), aspheric index (Q-value) and anterior comeal aberrations were analyzed. A Pearson correlation analysis was used to assess the correlations between ISV, IHA, Q-value and anterior corneal higher-order aberrations. Results ISV had a significantly positive correlation with corneal vertical coma (Z3-1) and horizontal coma (Z3+1) (r=0.389, P=0.003; r=0.594, P＜0.001). A negative correlation was found between ISV and corneal spherical aberrations (Z40) (r=-0.400, P=0.002). ISV was positively correlated with comeal 3rd-order aberrations (S3) (r=0.683, P<0.001) but showed a negative correlation with corneal 4*-order aberrations (S4) (r=-0.373, P=0.004). IHA was positively correlated with comeal Z3-1 and S3 (r=0.446, P＜0.001; r=0.445, P<0.001). The Q-value showed a significant positive correlation with comeal Z40 and S4 (r=0.849, P＜0.001; r=0.761, P＜0.001). A negative correlation was found between the Q-value and 5th-order aberrations (r=-0.280, P=0.035). Conclusion Comeal 3rd-order aberrations increase with comeal surface curvature variance. Comeal vertical coma increases with the asymmetry of comeal upper and lower height. Comeal spherical aberrations increase as the anterior comeal surface shows more oblateness.

Objective To compare higher-order aberrations of the corneal anterior surface of Chinese normal eyes at different ages. Methods This was a prospective clinical study. Two hundred and one eyes of 201 subjects without organic eye diseases [age range from 11 to 50 years old; average (29.9 ± 11.5 )years old] were examined. The range of spherical equivalent error was from +0.50 D to-3.00 D, and the astigmatism of all eyes was less than 1.00 D. Patients were divided into four age groups: 11 to 20 years old (group 1), 21 to 30 years old (group 2), 31 to 40 years old (group 3) and 41 to 50 years old (group 4). Corneal higher-order aberrations were measured with an ALLEGRO Topolyzer. Coma, spherical aberration, trefoil, fourth-order astigmatism and four-lobe defect were compared among the four groups over 4 mm, 6 mm and 8 mm areas using one-way ANOVA. Results Significant differences were found among groups in trefoil over all areas (F=3.526, 2.800, 2.888, P＜0.05 for all). Trefoil in group 4 [(0.10±0.05), (0.17±0.08), (0.30±0.13)μm] were higher than group 2 [(0.08±0.04), (0.13±0.06), (0.22±0.11 )μm], differences were significant (P＜ 0.05 for all). Fourth-order astigmatism was significantly different between group 4 [(0.03±0.02)μm] and the other groups (P＜0.05) over the 4 mm area, as well as between group 4 [(0.08±0.08)μm] and group 2 [(0.05±0.03)μm, P＜0.05] over the 6 mm area. Significant differences were found among groups in spherical aberration and coma over the 8 mm area (F=4.796, 3.165, P＜0.05 for both), coma in group 4 [(0.58±0.24)μm] and spherical aberration in group 2 [(0.63±0.16)μm] were higher than the other groups (P＜0.05 for all). No significant difference was found among the four groups for the four-lobe defect. Conclusion There is a small difference between different age groups in higher-order aberrations of the corneal anterior surface. Spherical aberration decreases and coma increases with aging.

Objective To compare the changes in refractive status after 25-gauge sutureless vitrectomy and 20-gauge standard vitrectomy. Methods One hundred and twenty-one eyes of 121 patients who presented with vitreoretinal disease were included in this prospective study. Patients were randomly divided into two groups, the A group, 61 eyes that underwent 20-gauge standard vitrectomy, and the B group, 60 eyes that underwent 25-gauge vitrectomy. Outcome measures included visual acuity, refractive power, and changes in corneal topography after surgery. Data were analyzed with chi-square test, independent samples t test, one-way ANOVA and Mann-Whitney test. Results The visual acuity of the B group was much better than that of the A group at one week and one month after surgery (x2=8.81, P=0.012; x2=65, P=0.036). The postoperative refractive error in the A group developed into hyperopia, then gradually returned to baseline at three months after surgery. The spherical and astigmatism powers for each timepoint were significantly different in the A group (F=530.12, P＜0.05, F=392.06, P＜0.05), but no significant difference was found in the B group. In the A group, changes of spherical power at 1 week, 4 weeks, 12 weeks after surgery were (+1.93±0.07)D, (+1.06±0.04)D, (+0.15±0.03)D, and changes of astigmatism power were (1.62±0.07)D, (1.05±0.05)D, (0.41±0.03)D. In the B group, changes of spherical power at 1 week, 4 weeks, 12 weeks after surgery were (-0.06±0.02)D, (-0.04±0.03)D, (-0.03±0.02)D, and changes of astigmatism power were (0.05±0.01)D, (0.03±0.01)D, (0.03±0.02)D. Change of spherical power between the A and B groups at 1 week, 4 weeks, 12 weeks after surgery was significant different (t=200.6, 159.3, 26.0, P＜0.01 for all), as well as astigmatism power (t= 173.4, 156.3, 82.3, P＜0.01 for all). At one week after surgery, corneal topography analysis showed that corneal SimK1-K2, surface asymmetry index (SAI), and surface regularity index (SRI) were significantly different compared to baseline (F=4.21, 3.44, 3.28, P＜0.05 for all). However, the changes in comeal topography before and after surgery in the B group were still statistically insignificant. The changes of SimK1-K2, SAI, SRI in A group were significantly more than that in B group (U=51.5, 45.5, 47.0, P＜0.05 for all). Conclusion Compare to a 20-gauge vitrectomy system, a 25-gauge transconjunctival sutureless vitrectomy system provides a more stable refractive status and better improvement in visual function postoperatively in vitreoretinal surgeries.

Objective To study the relationship between retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and visual function, disease course and system dysfunction in patients with multiple sclerosis (MS); to evaluate the significance of RNFL thickness as a biological marker for axonal loss in the course of MS disease. Methods This was a cross-sectional study. Seventeen MS patients (32 eyes) and 17 healthy people (17 eyes) were matched by age and sex. All participants received a neurological evaluation and a complete ophthalmological examination, including visual acuity, OCT measurement of RNFL thickness, pattern visual evoked potentials (PVEP) and electroretinography (ERG) examinations. Patients were divided into three groups: MS patients with a history of optic neuritis (MS-ON group), MS patients without a history of optic neuritis (MS-NON group) and the control group. The results of OCT measurement of RNFL thickness, and PVEP and ERG examinations of the three groups were compared by ANOVA. The relationship between RNFL thickness and the score on the expanded disability status scale (EDSS), and disease course, and electrophysiology results were analyzed by Spearman correlation analysis. Results The MS-ON eyes showed RNFL thinning in the average, superior, inferior, nasal, and temporal quadrants [(72.4±16.6), (80.5±26.3), (84.2±29.5), (65.8±14.0), (54.2±16.4)μm] compared to the control eyes [(105.6±10.8), (119.7±18.2), (123.5±17.9), (91.1 ±21.2), (88.2±13.0)μm] (P=0.000 each). The differences in RNFL thickness in the average, superior, inferior, and temporal quadrants between MS-ON eyes and MS-NON eyes [(98.3±12.0), (115.5±18.2), (117.7±21.5), (72.0±15.0), (68.1 ±16.1 )μm] were significant (P＜0.05 each), while the nasal quadrant did not show significant differences. Compared to control eyes, RNFL in the nasal and temporal quadrants in MS-NON eyes showed a significant reduction (P＜0.05 each), while the average, superior and inferior quadrants did not show significant thinning. RNFL thickness in MS-ON eyes was significantly correlated with the disease course of MS [(8.8±9.8)year] (r=-0.659, P=0.028) and EDSS scores (2.9±2.2) (r=-0.741, P=0.046). In this research, no significant relationships were found between RNFL thickness and disease course or EDSS scores in the MS-NON group. RNFL thickness in MS eyes showed a significant relationship to the latency and amplitude of P100 wave of both the 60' and 15' angles (r=-0.416, 0.332,-0.317, 0.265, P＜0.05 each), and the latency and amplitude of the a wave and latency of the b wave in the ERG maximum response (r=-0.471, 0.415,-0.360, P＜0.05 each), while no relationship was found between RNFL thickness and the amplitude of the b wave. Conclusion RNFL thickness measured by OCT can be used for clinical application as a structural biomarker of axonal loss in MS patients.

Objective To systematically evaluate the effects of under correction and full correction of myopia in slowing the progression of myopia in schoolchildren aged 6 to 16 years. Methods Meta-analysis. We searched MEDLINE (1966-2010.10), EMBASE (1950-2010.10), the Cochrane Library, Clinicaltrials.gov, CBM (1980-2010.10) and the Chinese Clinical Trial Registry, and related conference proceedings. The articles retrieved were independently screened by two reviewers. The quality of the selected trials was assessed using a Jadad scale. Review Manager 5.0 software was used to perform the meta-analysis of the extracted data. And the fail-safe N was calculated to assess the potential for publication bias. Results Five trials were included with a total of 428 subjects, of whom 215 subjects had a full correction of their myopia. The results of the meta-analysis showed that the weighted mean difference in the change of myopia progression between the under correction group and the full correction group was-0.26 D (95%CI:-0.60-0.09, P=0.14). After excluding the three trials with a Jadad score of less than 3, a fixed-effects sensibility analysis was conducted and the results showed that the weighted mean difference in the change of myopia progression between the two groups was-0.21 D (95%CI:-0.32--0.10, P=0.0002). The number of fail-safe N was 8. Conclusion Full correction of myopia may slightly slow the progression of myopia in school-aged children compared to under correction of myopia, which needs to be further verified by high-quality randomized controlled trials.

Objective To analyze the indications for keratoplasty at Eye Hospital of Wenzhou Medical College, Zhejiang province, from September 1999 to December 2009 and the trend of surgical procedures. Methods The investigation involved an analysis of the indications for these patients, and age, gender, place of residence, diagnosis, surgical procedure, etc., were recorded. All the information was input into an Excel format for descriptive analysis. Results were illustrated with graphs and format. Results During the approximate ten-year span, patient age distribution was bimodal, the average age was 44.4 years with peaks in the 6th decade. There were more male than female patients. There was a higher percentage of male patients with bacterial keratitis and trauma than for women. Nearly two-thirds of the patients were from the Wenzhou area. There were 651 cases (727 eyes) underwent corneal surgery in our study. This included 439 cases (495 eyes) of penetrating keratoplasty, 103 cases (123 eyes) of deep lamellar keratoplasty, 62 cases (62 eyes) of lamellar keratoplasty, 40 cases (40 eyes) of keratoplasty combined with cataract surgery and 7 cases (7 eyes) with other types of keratoplasty. The leading indications for keratoplasty were infectious keratitis (168, 23.1%), including bacterial keratitis (86, 11.8%) and fungal keratitis (82, 11.3%). This was followed by herpes simplex keratitis (165, 22.7%) and corneal scarring (95, 13.1%), including congenital corneal scarring and scarring from infection, trauma (64, 8.8%), including chemical burn, thermal burn and explosion injury, keratoconus (58, 8.0%), bullous keratopathy (pseudophakic or aphakic) (57, 7.8%), corneal dermoid (including Goldenharr syndrome) (43, 5.9%), corneal dystrophy and degeneration (41, 5.6%) and regrafting (24, 3.3%). The number of penetrating keratoplasty cases has gradually declined since 2005 and lamellar and deep lamellar keratoplasty cases have shown a gradually increasing trend. Conclusion In our study, infectious keratitis was the leading indicator for keratoplasty at Wenzhou area. Herpes simplex keratitis was the leading indicator for a single disease. This was similar to northern China, but different from European and American countries. For patients with normal endothelial function, deep lamellar keratoplasty will gradually replace penetrating keratoplasty as the leading surgery.