Treatment of open globe injury （OGI） is a complicated， systematic work， and multi-step surgeries are usually required. Primary surgery to close the wound is very important and greatly influences the outcome of the secondary surgeries involving the structure and visual function of the traumatized eye. For that reason， we emphasize the importance of primary surgical management of OGI that includes the classification of OGI， the procedures， skills and timing of primary surgeons， and the management of complications and special cases.

Objective  To evaluate the appropriate timing for vitrectomy in penetrating eye injuries involving the posterior segment. Methods  Cases series study. Cases were selected from the database of the Eye Injury Vitrectomy Study （EIVS）， which was a multicenter cohort study established in 1997. Patients were classified into three groups based on the time that had elapsed between injury and vitrectomy： 4-14 days， 15-28 days and ≥29 days. Two main vision outcomes of injured eyes were assessed： favorable outcome （better than 4/200） and unfavorable outcome （no light perception -4/200）. Data were analyzed using Kruskal-Wallis and Spearman. Results  There were 12， 11 and 9 cases in the 4-14 days， 15-28 days and ≥29 days groups， respectively. There were no statistically significant differences in age， BCVA after injury， scleral wound， ciliary body damage， retinal detachment， or choroid damage among the three groups. The probability of the incidence of proliferative vitreoretinopathy （PVR） increased following an increase in the interval between the injury and vitrectomy （r=0.622， P<0.01）. Favorable vision outcomes were 9 cases， 4 cases and 1 case in the three respective groups. The probability of a favorable vision outcome decreased following an increase in the interval between the injury and vitrectomy （r=-0.468， P<0.01）. The Fisher exact test showed that visual outcomes from penetrating eye injuries involving the posterior segment that were treated with vitrectomy 4-14 days after injury were better than vitrectomies performed ≥29 days （P<0.01）. Vision improvement rate was negative correlated with interval between the injury and vitrectomy （r=-0.532， P<0.01）. Conclusion  The probability of PVR increased with a greater lapse in time. Thorough vitrectomy should be performed on patients no later than 14 days after open-globe injury.

Objective  To evaluate the efficacy of vitrectomy combined with giant intraocular foreign body removal through the corneal limbus； to analyze the relevant factors. Methods  The clinical data of 5 patients （5 eyes） with giant intraocular foreign bodies who were treated from 2008 to 2013 were analyzed retrospectively. Four patients were males and 1 patient was a female. The preoperative visual acuity ranged from light perception to 0.1. Intraocular pressure ranged from 5 to 24 mmHg. All patients underwent vitrectomy combined with giant intraocular foreign body removal through the corneal limbus. All 5 eyes had retinal detachment preoperatively. One eye was filled with C3F8 and silicone oil was injected in 4 eyes during the surgery. The mean follow-up was 2.5 years with a range from 1 to 5 years. Results  The giant intraocular foreign bodies were extracted successfully in all 5 eyes. Postoperative visual acuity increased in the 5 eyes. Intraocular pressure was 10 to 21 mmHg. The retina was attached in all eyes postoperatively. Postoperative complications included temporary intraocular pressure elevation in 1 eye， fibrosis exudates in the anterior chamber of 2 eyes， and slight vitreous hemorrhage in 1 eye. Conclusion  Vitrectomy combined with giant intraocular foreign body removal through the corneal limbus is a safe and effective method. An appropriate surgical technique should be chosen according to the shape and size of the intraocular foreign body.

Objective  To identify the characteristics of intraocular foreign bodies （IOFB） to provide references for the diagnosis of occult IOFB. Methods  One hundred forty-three eyes with IOFB from December 2007 to December 2013 were analyzed retrospectively. Results  Of the patients， 46 eyes were diagnosed with magnetic IOFB， 62 eyes were diagnosed with non-magnetic IOFB， 5 eyes were diagnosed with botanic IOFB， 19 eyes were diagnosed with stable IOFB （glass， pottery， plastics）， and 11 eyes were diagnosed with earth-based IOFB （stone， coal， powder， pencil core）. The IOFBs induced non-reaction （11.2％）， hyphema （7.0％）， cataract （60.1％）， vitreous hemorrhage （33.6％）， retinal detachment （30.1％）， endophthalmitis （11.9％）， iridocyclitis （3.5％）， glaucoma （5.6％） and siderosis （5.6%）. Five of the eyes were diagnosed with occult IOFB. Conclusion  Variations in IOFBs induce a variety of clinical manifestations in the eyes. It is very important to have knowledge of the clinical characteristics of IOFB to diagnose occult IOFB.

Objective  To investigate the correlation between the advanced glycation end products of receptor （RAGE） -429T>C gene polymorphism and diabetic retinopathy （DR） in type 2 diabetes mellitus. Methods  The -429T>C polymorphism of the RAGE gene was determined by polymerase chain reaction and direct sequencing in 120 normal control subjects and 185 patients with type 2 diabetes mellitus， including 92 patients with diabetic retinopathy （DR） and 93 patients with non-diabetic retinopathy （NDR）. The frequencies of the RAGE genotype， allele and biochemical criterion among those groups were compared by using a χ² test and an independent samples t test. Results  The disease course in the DR group was significantly longer than that in the NDR group （t=2.25， P<0.05）.  Other biochemical criteria in both groups were not significantly different （P>0.05）. In DR， NDR and normal control groups， the CC genotype frequencies were 3.3%， 1.1% and 1.7%， respectively. The frequencies of C allele were 17.5%， 13.4% and 15.4%， respectively. The CC genotype frequencies in the DR group were higher than in the NDR and normal control groups. The differences were statistically significant （χ²=7.938， 6.119， P<0.05）. The frequency of C allele in the DR group was higher than in the NDR and normal control groups. The differences were statistically significant （χ²=7.317， 5.456， P<0.05）. The differences in the CC genotype and C allele frequencies between the NDR group and the normal control group were not statistically significant （χ²=0.295， 0.329， P>0.05）. Single factor logistic regression analysis showed that C allele was associated with DR （OR=2.085，95%CI： 1.216-3.574）. Conclusion  RAGE -429T>C gene polymorphism may be associated with the development of DR and the C allele may be the risk factor for people in the Wuxi area.

Objective  To assess the role of an oculus keratograph in the measurement of pupil size under scotopic illumination and pupil reflection at 3 photostimulation modes. Methods  One hundred twenty-five subjects （125 eyes） were enrolled in this cross-sectional study． Pupil parameters were measured by two ophthalmologists under 3 photosti-mulation modes （scotopic conditions， pupillogram and anisocoria）. An independent sample t test and ANOVA test were used to verify the differences in pupil parameters between genders and refractive error groups. The differences in pupil size after different stimulations were analyzed by a paired t test. The reproducibility of the measurements was analyzed by an intraclass correlation coefficient （ICC） and Bland-Altman plot. Results  The differences were not statistically significant for the largest pupils under the 3 conditions （F=1.03， P＞0.05）. Under scotopic conditions， the minimum， maximum and range of pupil size were 5.34±0.95 mm， 6.18±0.85 mm and 0.86±0.37 mm， respectively. Under pupillogram mode， the pupil diameter of minimum and maximum， and range of pupil size and pupil diameter 1 second after stimulation were 3.57±0.74 mm， 6.10±0.92 mm， 2.54±0.40 mm and 2.34±0.46 mm， respectively. For anisocoric conditions， the minimum， maximum and range of pupil size and pupil diameter for 1 and 5 seconds after stimulation were 2.69±0.45 mm， 5.94±0.84 mm， 3.27±0.55 mm， 2.72±0.58 mm and 2.94±0.47 mm， respectively. There was a statistically significant difference in pupil size for 1 and 5 seconds with anisocoria （t=0.38， P＜0.01）. The ICCs of intraobserver and interobserver were all higher than 0.800. Pupil size was not correlated with gender or refractive error. Conclusion  The oculus keratograph can be used to measure pupil size and pupil reflection under different photostimulations and illumination levels with a high degree of reproducibility．

Objective  To evaluate the efficacy of vision training on functional vision loss and to analyze binocular vision characteristics in patients. Methods  This retrospective study was performed at the ophthalmic center， Tianjin Eye Hospital from July 2012 to October 2013. Twenty patients with functional vision loss were enrolled， including 10 males and 10 females. The average age was 11.2±5.9 years. All patients had routine examinations that excluded eye disease， amblyopia risk factors， and systemic disease. Based on the binocular vision characteristics， all patients participated in personalized vision training. All data were statistically analyzed with a paired samples t test and Pearson correlations. Results  Right eye refraction of patients ranged from +2.25 to -8.75 D； left eye refraction ranged from +2.87 to -8.63 D. Thirteen patients had convergence insufficiency， 4 had accommodative excess， 2 had basic exophoria and 1 had divergence insufficiency. After 2 months of vision training， distance and near vision in all patients had improved to 1.0 （Z=-3.948， P＜0.01； Z=-3.193， P＜0.01）. Near positive relative vergence （PRV） break point improved as well （t=-5.173， P＜0.01）. Additionally， monocular accommodative facility （MAF， Z=3.928， P＜0.01）， binocular accommodative facility （BAF， Z=-3.835， P＜0.01）， positive relative accommodation （PRA， t=4.094， P＜0.01）， and negative relative accommodation （NRA， t=-4.254， P＜0.01） had significantly improved. In addition， both distance vision （r=-0.584， P＜0.01； r=-0.658， P＜0.01） and near vision （r=-0.451， P＜0.01； r=-0.540， P＜0.01） were correlated with far exophoria and near positive relative vergence. Conclusion  The occurrence of functional vision loss is apparently related to binocular vision dysfunction in these patients. Visual acuity can be improved with vision training.

Objective  To determine the cycloplegic effects of 1% cyclopentolate on myopic children， using residual accommodation as an objective measurement. Methods  A total of 40 children with a mean age of 12.5±2.0 years were included in this case series study. Mean spherical equivalent of the right eyes was -2.52±1.05 D. One percent cyclopentolate was administered 3 times at 5 min intervals. After the third installation， far and near accommodative responses were measured at 25 min， 50 min， 75 min， 100 min， and 125 min using an open-field autorefractor （Grand-Seiko， WAM-5500）. The difference in the accommodative response between these 6 m and 33 cm was considered to be residual accommodation. Repeated measurement was used to evaluate the differences at the different time points. Results  The respective distance accommodative responses at the 6 time points were 0.27±0.79 D， 0.20±0.73 D， 0.14±0.61 D， 0.08±0.52 D， 0.11±0.40 D and 0.09±0.56 D and the differences were significant （F=6.18， P<0.05）. The respective near accommodative responses were 1.15±0.98 D， 0.42±0.81 D， 0.34±0.80 D， 0.16±0.69 D， 0.31±0.61 D and 0.32±0.76 D and the differences were significant （F=5.25， P<0.05）. The respective residual accommodations were 0.88±0.73 D， 0.22±0.55 D， 0.20±0.56 D， 0.08±0.61 D， 0.19±0.48 D and 0.24±0.45 D， and the differences were significant （F=7.28， P<0.05）. Conclusion  1% cyclopentolate is effective in paralyzing the ciliary muscle of myopic children aged 8-15 years， and reaches the strongest effect at 75 min. It is relatively accurate to finish refractions between 25 min and 2 hours after the last installation of 1% cyclopentolate.

Objective  To assess the value of the hand-held autorefractor SureSight in screening refractive errors in children 3 to 6 years old. Methods  In a cross-sectional study， 321 children with lower visual acuity than normal participated in the SureSight and Topcon examinations， under cycloplegic and non-cycloplegic conditions respectively. Data were evaluated with Bland-Altman and ROC based on the prevalence study. Results  In the comparison， it was found that the differences in spherical diopter， cylinder diopters and spherical equivalent （SE） between non-cycloplegia with SureSight （S1） and cycloplegia with Topcorn （T2） were significant. The correlation between S1 and T2 ranged from moderate（spherical diopter： r=0.59， P<0.05； SE： r=0.54， P<0.05） to high （cylinder diopter： r=0.89， P<0.05）. The ROC curve found that myopia， hyperopia and astigmatism suspects with S1 were ≤+1.13 D， ≥+1.44 D and ≥ 0.88 D when compared to T2. The Yonden index also showed better sensitivity and specificity for astigmatism （0.679） than myopia （0.298） and hyperopia （0.270）. Conclusion  As a vision screening technique to detect refractive errors in preschool children， SureSight can help identify suspected astigmatism， but had limitations for myopia and hyperopia.

Objective  To evaluate the effect of relative reference point photographic analysis on measuring horizontal binocular single vision. Methods  Self-control study. A 10△ prism was added onto the temporal side of subjects′ fully corrected glasses， which produced limited vertical diplopia. Different binocular single visual fields were produced by changing the distance between the prism rim and optical center of the glasses. Three subjects with good binocular vision were selected. At distances of 1 m， 2 m and 3 m， different binocular vision fields were produced 11 times. Every subject need to complete the measurements. Moving visual targets and a photographic method were used to measure the horizontal single visual field. A Pearson correlation analysis and a two-way ANOVA was used to analyze data. Results  The two methods could measure the horizontal field of single vision well. Horizontal single binocular fields measured with a moving target method were 14.3°±6.3° and were 15.5°±7.3° when measured by photographic methods. The Pearson correlation factor was 0.943. Two-way ANOVA showed the two methods were not significantly different when a visual target was at a distance of 1 m， 2 m or 3 m （F=2.14， P>0.05）. Conclusion  Relative reference point photographic analysis can be used to evaluate the horizontal binocular single visual field. It is as accurate as the moving visual target method.

Objective  To observe the effect of paired corneal incisions in correcting astigmatism after phacoemulsification guided by a navigation system. Methods  In this cohort study，patients with >1.0 D preoperative corneal astigmatism were selected. Thirty-five patients （40 eyes） who were selected for 2.8 mm paired corneal incisions were the experimental group， and 27 patients （30 eyes） who were selected for 2.8 mm single corneal incision were the control group. The changes in astigmatism were compared 3 months after the operation. The induced surgical astigmatism was calculated by vector analysis. An independent samples t test and a paired samples t test were used for statistical analysis. Results  Corneal astigmatism before and 3 months after the operation in the control group was 1.84±0.40 D and 1.49±0.36 D， and was 1.89±0.74 D and 0.71±0.60 D in the experimental group. The differences were statistically significant （t=7.55， P<0.05； t=13.93， P<0.05）. The difference between the 2 groups 3 months after the operation was also statistically significant （t=-6.31， P＜0.05）. Surgically induced astigmatism in the control and experimental groups was 0.38±0.18 D and 1.55±0.84 D， respectively. The average corneal curvatures before and 3 months after the operation in the control group were 44.18±1.31 D and 44.14±1.31 D， and were 44.33±1.51 D and 44.29±1.52 D in the experimental group. The difference was not statistically significant （t=1.21， P>0.05； t=0.73， P>0.05）. Conclusion  Paired corneal incisions in phacoemulsification are a safe and effective method for correcting corneal astigmatism.

 Objective  To preliminarily evaluate the clinical efficacy of femtosecond laser-assisted phacoemulsification. Methods  In this prapective study， 167 patients （200 eyes） with cataract were randomly divided into two groups. There were 86 patients （100 eyes） in the femtosecond laser-assisted phacoemulsification group （femto group） and 81 patients （100 eyes） in the traditional phacoemulsification group traditional group. Phacoemulsification power and time were recorded for each procedure. Changes in surgically induced astigmatism （SIA）， visual acuity， and corneal endothelial cell count were measured and complications were noted. Tear break-up time， the height of the tear meniscus and the grade of dry eye were also assessed preoperative and postoperative 1 week， 2 weeks， 1 month， 2 months for the two groups. Data were analyzed using independent t test and repeated measured ANOVA. Results  Statistically significant differences were found in the effective phacoemulsification time （EPT） and the average phacoemulsification power （AVE） of the two groups （t=7.19 and 3.73， both P＜0.05）. On the second month after surgery， there was no statistically significant difference in the visual acuity of the two groups （t=0.84， P＞0.05） while the difference in the SIA was obvious （t=2.78， P＜0.05）. The corneal endothelial cell loss rate of the femtosecond group was lower than that of the traditional group when the nuclear lens was less than or equal to grade Ⅲ （t=2.31， P＜0.05）， while the loss rate was higher when the nuclear lens was above grade Ⅲ （t=3.92， P＜0.05）. In the femtosecond group， at 1 week postoperatively， there was a reduction in the mean tear break-up time and a large increase in the grade of dry eye（F=6.80， P＜0.05）. In the traditional group， at 1 week （P＜0.05） and 2 weeks （P＜0.05） postoperatively， there was a reduction in the mean tear break-up time and a large increase in the grade of dry eye （F=24.00， P＜0.05）. At 1 week， there was a significant increase in the mean height of the tear meniscus （F=6.48， P＜0.05）. Conclusion  Femtosecond laser-assisted phacoemulsification is safe and efficient. It can reduce the use of ultrasonic energy， reducing SIA. The influence on the corneal endothelial cells differed according to the nuclear lens grade. The reason for this needs further study.

Objective  To evaluate the effect of refraction and visual rehabilitation on students in schools for the blind in Zhejiang province. Methods  In this cross-sectional investigation， 219 students in 3 schools for the blind in Zhejiang province were included. The students underwent eye examinations， visual acuity tests， refractive correction and low vision rehabilitation. Results were analyzed with a paired t test. Results  The differences in visual acuity were significant after refraction （3.53±0.34 vs. 3.85±0.27， t=-14.997， P＜0.01）. The BCVA of 153 patients <3.7， and 66 patients ≥3.7. The differences in visual acuity were also significant after using a telescopic device （2.03±0.94 vs. 2.12±1.06， t=-5.537， P＜0.01） for blind patients and for low vision patients （3.90±0.23 vs. 4.55±0.24， t=-28.537， P＜0.01）. After using a telescope， distance visual acuity was ≥3.7 in 24% of blind children and was ≥4.5 for 80% of low vision children. Conclusion  Refraction and low vision aids can improve students′ visual acuity which is important to further their education.

Intravitreous injection of vascular endothelial growth factor （VEGF） inhibition is the main method of wet age-related macular degeneration （AMD） treatment. The biggest drawback of this regimen is the high cost， which make poor people lose the treatment opportunity， and repeated drug injection， which increases the incidence of a lot of complications. Therefore， how to decrease the number of drug administration is the most urgent problem to solve. Non-steroidal anti-inflammatory drugs （NSAID） have the anti-inflammation and anti-angiogenesis effects. Previous studies have shown that NSAID as an adjunctive therapy of anti-VEGF drugs for AMD can improve the treatment effect， reduce the times of intravitreous injection of VEGF drugs， and reduce the central macular thickness. Thus， the mechanism of NSAID for CNV treatment and related progress in animal experiments and clinical trials were reviewed in this paper， in order to raise concerns of more ophthalmologist about this auxiliary treatment and to promote further researches.

Detachment of the retinal pigment epithelium is a prominent feature of many chorioretinal disease processes， in the elderly the most prevalent of which is age-related macular degeneration （AMD）. Understanding the pathogenesis and subtypes of retinal pigment epithelium detachment is essential because each subtype has a specific pathogenesis， natural history， prognosis， and optimal treatment strategy.