The eye is a complex bio-optical organ. Both the biological function and optical function of the eye should be taken into consideration when eye doctors are making a diagnosis or providing treatment for any ocular diseases. Compared to any other clinical specialties， ophthalmology benefits the most from the newest technologies that significantly influence clinical applications. In this paper， we will systematically introduce the most common and advanced ophthalmic devices and ocular biomaterials， in order to encourage their clinical use in vision care.

Objective  To build a low repetition rate femtosecond fiber laser with its pulse width narrower than 200 fs and pulse energy bigger than 50 nJ and realize making blasting holes on pig cornea by optical expanding and focusing femtosecond laser. Methods  Experimental study. Introducing very long polarization maintaining fiber into the ring cavity， the mode-locking fiber laser under the similariton amplifier scheme was used to be the oscillator. The signal laser was amplified and compressed by propagating it through the construction of pre-chirp， amplifier and de-chirp to realize outputting high quality pulse train. The high power fiber laser was expanded by the lens group. The expanded laser beam was focused into the pig cornea by the plane objective with different numerical aperture （NA） to realize making high quality blasting holes. Results  This laser facility realized outputing a very stable 19.1 MHz， 109 fs， 1.4 W， 73.2 nJ mode-locking fiber laser. After five fold expansion， the laser beam was focused into the pig cornea by the NA=0.2 plane objective to get blasting holes whose aperture were 45~75 µm. Focusing the laser beam into the pig cornea by the NA=0.5 plane objective， the aperture of the blasting holes were about 30 µm. Conclusion  Introducing very long Polarization Maintaining fiber into the similariton amplifier ring cavity can improve stability effectively. The construction of pre-chirp， amplifier and de-chirp can use the nonlinear affects to depress the third order dispersion to realize high quality amplify and compression. After expanded by lens group， using higher NA plane objective to focus the expanded laser beam into the cornea can realize making higher quality blasting holes.

Objective  To acquire the corneal data automatically by designing and developing corneal data analysis software with the Orbscan II corneal topography system， providing automatic analysis function for corneal clinical diagnosis. Methods  Based on the existing corneal topography system， the corneal data analysis software hooked the process of the Orbscan using API Hook. During the measurement of the cornea， the program acquired the corneal data in real time， and through sharing memory file， took the data into the program process of the corneal data analysis software to realize collection， acquisition and analysis of the corneal data. Results  The acquired data were carried out partial differential analysis and regression to calculate and produce Q-value of the 360 semi-meridian. It used OpenGL graphics technology to vividly demonstrate aspheric properties and morphological images of individual corneal surface in VC++ 6.0 development environment. Conclusion  The corneal data of the Orbscan II corneal topography system could be obtained automatically by the analysis program， which achieved seamless connection of software development， provided the actual three-dimensional corneal morphology and Q-value distribution curve for patients， better extended the function of the corneal topography system， and provided the data foundation and automatic analysis function for the further study of cornea.

Objective  To assess the effect of the use of containers with a sterilizing filter in autologous serum eye drops for the treatment of dry eye. Methods  Sixty dry eye patients were recruited for this prospective cohort study. Autologous serum was kept in containers with a sterilizing filter for 30 patients and， for the other 30 patients， autologous serum was kept in conventional containers. Subjects completed the Schirmer Ⅰ test （SⅠT， main outcome）， ocular surface disease index （OSDI）， fluorescein tear breakup time （BUT）， and corneal fluorescein staining （CFS） at baseline， and 2 weeks and 4 weeks after treatment. During home therapy， it is recommended not to use the same conventional container for more than 3 days， and the same containers with a sterilizing filter for more than 14 days. Sixty rabbits were selected for contamination test. Containers with a sterilizing fliter （30 rabbits） or conventional containers （30 rabbits） opened to give drops to rabbits. Contamination of autologous serum was tested at 3， 7， 14 and 21 days after use. A repeated measured ANOVA and Friedman repeated measured ANOVA on ranks were used for statistical analysis. Results  In the group using conventional containers， contamination was found in zero bottle at day 3， 2 bottles at day 7， 4 bottles at day 14 and 12 bottles at day 21 while no contamination was found in containers with a sterilizing filter. No significant difference was found in SⅠT， OSDI score， BUT and CFS between the two groups during 4 weeks treatment. Conclusion  Containers with an adapted filter can reduce the contamination rates in autologous serum eye drops and extend the use of autologous serum eye drops without affecting therapeutic efficacy.

Objective  To develop a revised Chinese version of the Catquest-9SF questionnaire and assess its applicability， item discrimination， reliability and validity in a Chinese cataract population； to provide a comprehensive and easy instrument for measuring vision function-related quality of life in China； and to analyze the influence on quality of life for patients awaiting cataract surgery. Methods  This was a cross-sectional investigation. Translation， back translation and cross-cultural adaptation were used to create a revised version of the Catquest-9SF questionnaire for a Chinese cataract population. One examiner interviewed 150 cataract patients waiting for surgery at the Eye Hospital of Wenzhou Medical University. A second examiner independently interviewed 50 patients from the same group. The revised Chinese version of the 9SF was tested for its applicability， item discrimination， reliability and validity through internal consistency， inter-scorer reliability， content validity and format validity.  An analysis of related factors affecting the score was also conducted. Results  The revised Chinese version of the Catquest-9SF demonstrated excellent applicability and item discrimination. The questionnaire showed good internal consistency with Cronbach′s α value of 0.90 and inter-scorer reliability with the Bland-Altman 95% limit of agreement value of -2.1~2.0. Pearson's correlation coefficient （0.988） also confirmed excellent inter-scorer reliability. The scale-level content validity index （S-CVI） value was 0.98. One common factor was extracted by exploratory factor analysis and explained 55.89% of the variance. The cumulative variance contribution rate also reached 55.89%. The scores showed significant correlation with visual acuity （r=0.43， P<0.01） and age （r=-0.22， P<0.01）. There were statistical differences between genders （t=-2.30， P<0.05）， but there were no differences in education level， or first eye or second eye surgery. Conclusion  The revised Chinese version of the Catquest-9SF is a simple and effective instrument for evaluating visual function related to quality of life in South Chinese cataract patients. The questionnaire has good applicability， item discrimination， reliability and validity.

Objective  To investigate postoperative state of military personnel underwent laser assisted corneal refractive surgery and the ill effects on life and train， and to discuss visual standard of recruit after laser assisted corneal refractive surgery. Methods  Cross-sectional study. From May to December 2013， we investigated some service members underwent laser assisted corneal refractive surgery， including general information， history of refractive error， degree of myopia， time between operation and enlistment， rank of hospital carried surgery， type of surgery， postoperative recovery， present discomfort of eyes and ill effects on daily life， military training and military working. Results  There were 837 cases of military members underwent laser assisted corneal refractive surgery. The youngest one was only 16 years. Moderate degree of myopia was the commonest. The shortest time between operation and enlistment was no more than 1 week. Most surgery was carried in specialized ophthalmic hospital and department of ophthalmology of third-level hospital. Stroma ablation （93.1%， mainly LASIK） was the most popular type of surgery. Most of them gained good recovery and only a small part （10.4%） had some obvious complications. Some had serious impacts on daily life and military training （0.8%）. The condition of eyes of most soldiers underwent refractive surgery did not conform to present standard of recruit after refractive surgery. Conclusion  Most of recuits recovered well after laser assisted corneal refractive surgery， and a few of them had complaints. Visual acuity standard of recruit after laser assisted corneal refractive surgery had large differences from present situation and should be adjusted.

Objective  To evaluate the changes in the function of the macular region in patients with different degrees of myopia at different sites on the retina before laser in situ keratomileusis （LASIK） and 3 months after LASIK. Methods  Ninety-one patients（169 eyes）with myopia ranging in age from 18-32 years were enrolled from 2012 to 2013 for this prospective controlled study. Patients were divided into 3 groups： 58 eyes， low myopia； 57 eyes， moderate myopia and 54 eyes， high myopia. All patients underwent strict examinations before the surgery was performed. All patients underwent multifocal electroretinogram （mERG） examinations using RETI-SCANK （Roland， Germany） to determine the function of the macular region before and after LASIK. The latencies and the amplitude densities of the P1 and N1 waves were measured at each ring. All exams were performed by the same surgeon. The distinctions among the 3 groups and before and after LASIK were then analyzed using ANOVA and paired t test. Results  The study showed that the amplitude densities of the three groups before and after LASIK were the highest at ring one， which decreased rapidly but then increased at the most eccentric ring. The latencies were shortest at ring one， and delayed gradually at the more eccentric rings， and then increased at the farthest eccentricity. The tests showed that there were no statistically significant differences in amplitude densities or latencies between any group before or after LASIK. Conclusion  LASIK surgery has no influence on the function of the macular region in myopic eyes.

Objective  To identify  a potential disease-causing mutation in the FBN1 gene in a Chinese family with ectopia lentis （EL）. Methods  Case series study. Complete physical， ophthalmic and cardiovascular examinations of all family members were conducted. Peripheral blood samples were collected from the proband and his family members with informed consents. Genomic DNAs were isolated from peripheral blood leukocytes. All 65 exons and exon-intron boundaries of the FBN1 gene were amplified by polymerase chain reaction （PCR）. After purification， the PCR products were bidirectionally sequenced. Results  All 3 ectopia lentis individuals were found to carry a novel missense mutation of c.1999T>C （p.Cys 515Arg） in FBN1 that is predicted to be harmful by the SIFT and Polyphen-2， while normal members of the family did not have this mutation. Furthermore， subject Ⅱ-2 and Ⅲ-1 did not show detectable abnormalities in the cardiovascular system compared to Ⅰ-2， who had ascending aorta dilation. Conclusion  The EL family patients with the c.1999T>C （p.Cys 515Arg） mutation in the FBN1 gene showed  different cardiovascular presentation. However， whether the younger mutation carriers of the family will evolve towards Marfan′s syndrome with aging needs long-term observation.

Objective  To explore a simple and feasible new model of optic nerve injury in order to study the apposition factor on the regeneration of the optic nerve. Methods  Experimental study. The optic nerve was exposed in 25 adult SD rats under abdomenal anesthesia by separating the posterior pole of the left eyeball with a supraorbital margin incision. A microwave tube was used to make a resection of the optic nerve 0.5 mm behind the eyeball and 2.0 mm away from the optic disc. A PBS solution was infused into the area where the optic nerve′s hyalotome was suctioned off， the supraorbital margin incision was sutured step-by-step. Fifteen hours after the injury， electroretinograms （ERGs） and visual evoked potentials （VEPs） were measured in the retinas of the model and normal eyes. Results  Observation of the optic nerve′s longitudinally frozen section showed that there was consistent and precise damage. The ERGs and VEPs of the model eyes only had baseline activity without the peaks and troughs of the normal eyes. The image of the optic nerve′s frozen section confirmed that the optic nerve sheath had been preserved. The axon′s axoplasm had been suctioned off and the two broken ends of the axoplasm could be seen. Conclusion  The model eye′s optic nerve axon had been suctioned off and did not function on telefax. The model for injuring an animal′s optic nerve by suction was successful.

Objective  To investigate pathological changes in the molecules of human retinal pigment epithelium （hRPE） exposed to an extremely low frequency electromagnetic field （ELF-EMF）， and study its possible significance in the occurrence and development of myopia. Methods  In this experimental study， the experimental group was composed of hRPE exposed to 50 Hz electromagnetic fields； the untreated group was composed of hRPE without exposure. The changes in hRPE cell morphology were observed and cell proliferation in hRPE was measured by a CCK8 assay. The expressions of matrix metallo-proteinase-2 （MMP-2）， tissue inhibitor of metalloproteinase 2 （TIMP-2）， transforming growth factor-β2 （TGF-β2） and fibroblast growth factor 2 （FGF-2） mRNA in hRPE were detected by reverse transcription-polymerase chain reaction （RT-PCR）. The concentrations of TGF-β2 and FGF-2 in the culture medium of hRPE were assayed by enzyme-linked immunosorbent assay （ELISA）. The difference between the two group using independent t test. Results  hRPE cell morphology changed， and the proliferation of hRPE was inhibited （t=-7.069，-3.652， -6.974， P<0.05）. The mRNA expressions of MMP-2， TIMP-2 and TGF-β2 were up-regulated significantly （t=10.562， 6.277， 4.940， P<0.01）. However， the mRNA expression of FGF-2 was down-regulated significantly （t=-6.905， P<0.01）. The results of ELISA indicated that after exposure to ELF-EMF， the expression of TGF-β2 in hRPE supernatant medium was up-regulated significantly （t=-4.079， P<0.05）. However， the expression of FGF-2 in hRPE supernatant medium was down-regulated （t=4.441， P<0.05）. Conclusion  ELF-EMF changed the proliferation of hRPE， and also changed the expressions of MMP-2， TIMP-2， TGF-β2 and FGF-2 mRNA in hRPE， which might induce the occurrence of myopia through pathological changes in the molecules of hRPE.

Objective  To describe the clinical outcomes of femtosecond laser-assisted penetrating keratoplasty. Methods  This retrospective surgical case series consisted of 16 eyes from 16 patients who were treated with VisuMax femtosecond laser-assisted penetrating keratoplasty at Nanjing General Hospital of Nanjing Militory Command PLA. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts with a 90° side cut angle on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity （UCVA）， best corrected visual acuity （BCVA）， astigmatism， corneal thickness and endothelial density count. The mean follow-up was 9.6±5.6 months. Results  All eyes were successfully treated. The mean UCVA increased from LP-0.15 to HM-0.5， and the mean BCVA increased from LP-0.3 to HM-0.8. The mean astigmatism was 2.91±2.57 D， the mean central corneal thickness was 554.9±23.3 µm and the mean endothelial cell density was 2 433±322 cell/mm2. Conclusion  This study shows that VisuMax femtosecond laser-assisted penetrating keratoplasty provides a rapid visual improvement and reduces astigmatism due to precise graft-host alignment and visual acuity improves in varying degrees postoperatively.

Retinitis pigmentosa （RP） and age related macular degeneration （AMD） affect 7.5 million people worldwide and are the leading causes of inherited and age-related blindness. Although new therapeutic strategies， such as gene therapy and stem cell therapy， etc.， are emerging from intensive research， a retinal prosthesis offers a good treatment option for patients at the severe end-stage of RP or AMD. To improve the device performance and to provide patients with better functional vision， researchers are aiming for the next generation high-resolution retinal prostheses， which should solve current important questions and possess critical safety features. This article discusses some key design factors， such as selecting the implant locations， affixing the implant device， and designing the microelectrode array， etc. Several critical safety features， including charge density and charge balancing， power consumption and heat dissipation， voltage compliance monitoring and self-locking， backward data telemetry， etc.， are discussed for consideration in the design of the next-generation devices. This review presents some ideas and inspirations for the relevant designers， doctors and patients.

Cataract surgery solves both visual and refractive problems in patients with cataract combined high myopia. And phacoemulsification cataract surgery were safely operated in high myopia patients. Compared to common cataract surgery， it is also a challenge procedure with intraoperative and postoperative complication in high myopic eye with pathologic posterior staphyloma， deeper anterior chamber， vitreous liquefaction and opacities， and posterior vitreous detachment， peripheral retinoschisis and retinal atrophy. This review will describe the related researches in cataract combined with high myopia.

To study patients with high myopia combined with primary open-angle glaucoma （POAG）. Because of the morphological changes of the optic disc and retinal-choroidal structures in pathologic myopia， it is very difficult to identify combined glaucoma. For patients with high myopia combined with POAG， early diagnosis and therapy are essential and can significantly enhance visual acuity and quality of life. In this paper， we review the relationship between high myopia and POAG and the changes in visual function when high myopia is combined with POAG in order to provide effective indexes for clinical diagnosis.