Chinese Journal of Optometry Ophthalmology and Visual science

With the rapid development of modern medicine, there are several approaches for correcting refractive errors in high myopia. However, refractive progression after correction still continues. On the other hand, the management of fundus pathology in high myopia often fails to reverse or control the progression of the disease. Despite application of some advanced treatments, fundus pathology has become the main cause of blindness in these patients. Refractive progression is the result of scleral expansion and axial elongation and fundus pathology is a reaction of the choroid and retina to posterior scleral expansion. Therefore, intervention should be aimed at scleral expansion. There is no doubt about the rationality of controlling scleral expansion with posterior scleral reinforcement (PSR). However, this approach was restricted by the status of medicine and technology in the past because surgical techniques and materials could not meet the essential requirements for the surgery to have a real effect. As a result, PSR failed to gain wide clinical recognition. In recent years, as surgical techniques and materials have improved, the efficacy of PSR to stabilize axial length progression and treat macular retinoschisis, macular hole and macular detachment were further confirmed. Full attention should be paid to controll the progression of high myopia and fully understand the clinical value of PSR. The clinical indications of PSR should be to control and treat fundus pathology in high myopia. With gradual improvement and standardization of the surgical procedures and materials, the clinical results of PSR will continue to improve, and PSR is expected to become a key option for preventing blindness in high myopia.

Objective To investigate the early safety and biological compatibility of a bovine pericardium patch for posterior scleral reinforcement (PSR). Methods This was a retrospective case series study. Three hundred seventy-seven consecutive cases (670 eyes) of patients with progressive axial myopia who received PSRs at Shanghai Peace Eye Hospital from January 2006 to October 2014 were divided into two groups based on the type of reinforcement: a bovine pericardium patch was used in 330 eyes (182 cases) and dura mater was used in 340 eyes (195 cases). The follow-up time was more than 6 months. All patients underwent routine eye examinations and retro-ocular examination was performed on some patients using high frequency B-scan. Data were analyzed with chi-square tests. Results The constituent ratios of improvement, unchanged BCVA or a decline in BCVA 6 months postoperatively were 31.8% and 35.0%, 63.3% and 60.3%, and 4.8% and 4.7%, respectively, for both groups. There were no significant differences between the two groups (χ²=0.765,P>0.05). The incidence of chemosis was 68.2% and 75.9%, respectively, for the two groups (χ²=4.935,P<0.05). There was no evidence of infection, retinal detachment, intraocular hemorrhage, strabismus or diplopia in any patients. Rejection was observed in both eyes of one patient in the bovine pericardium patch group, and one eye of one patient in the dura mater group(incidences were 0.61% and 0.29%, respectively, in Fisher′s exact test, P>0.05). Local calcification was observed in three of 28 eyes in the test group, but not in 19 eyes of the control group (Fisher′s exact test, P>0.05). Conclusion Bovine pericardium patch is safe and biologically compatible for PSR.

Objective To evaluate the effects of postocular vascular hemodynamics and choroidal thickness after posterior scleral reinforcement for pathological myopia. Methods From January 2012 to June 2013, 34 patients (55 eyes) were enrolled in this prospective study and underwent posterior scleral reinforcement surgery. Two years after the procedure, visual acuity, refraction and axial length were measured, as well as choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) and postocular vascular hemodynamics using Doppler imagining (CDI). A paired repeated measures ANOVA was used to analyze the differences. Results There was a statistically significant improvement in postoperative best-corrected visual acuity (BCVA) at 1, 3, 6, 12 and 24 months compared with preoperative eyes (F=3.960, P＜0.01). Postoperative spherical equivalent (SE), axial length and intraocular pressure remained stable, and no statistically significant differences were found (F=1.374, 1.382, 1.193, P＞0.05). After the 1, 3, 6, 12 and 24 months observations periods, there was a statistically significant enhancement of postoperative peak systolic velocity (PSV) and end diastolic velocity (EDV) as well as a statistically significant decrease in the resistance index (RI) of the short posterior ciliary artery (SPCA) and central retinal artery (CRA) (SPCA: F=2.376, P<0.05; F=4.476, P<0.01; F=4.238, P<0.01. CRA: F=2.316, P<0.05; F=3.335, P<0.01; F=9.770, P<0.01). Significant differences in subfoveal choroidal thickness (SFCT) were found before and after the operation (F=2.875, P<0.05). The preoperative subfoveal choroidal thickness (SFCT) was 122.4±31.9 µm, which increased to 134.4±32.9 µm at 1 month, 139.0±35.7 µm at 3 months, 136.5±33.8 µm at 6 months, 134.9±31.5 µm at 12 months, and 135.9±35.4 µm at 24 months. The differences were statistically significant (P<0.05). Conclusion Scleral reinforcement surgery can improve visual acuity, prevent refractive progression and axial length elongation, increase postocular vascular hemodynamics and choroidal thickness so as to stabilize the progression of pathological myopia.

Objective Analyze the shapes and features of high myopic eyes by 3D-MRI exanmination. To investigate 3D-MRI exanmination methods and imaging manifestations of high myopic eyes, and to evaluate its clinical values when comparing with other diagnostic imaging facilities. Methods 65 cases (124 eyes) of high myopic (the spherical diopter was equal or less than -6.00 diopter, and the eye axial length was equal or more than 26 mm) accepted the routine ophthalmologic examination and orbit MRI examination, among which, 40 cases (80 eyes) had ophthalmic B-type ultrasound exanmination. The MRI imaging were processed into 3D models. Patients were divided into groups by age (①<50 years, ②≥50 years), spherical diopter (①-6.00 D~-12.00 D, ②-12.25 D~ -18.00 D, ③-18.25 D~-24.00 D), and eye axial length (①26.00 mm~28.00 mm, ②28.01 mm~30.00 mm, ③30.01 mm~32.0 mm, ④>32.00 mm). The diagnostic accuracy of MRI examination and ophthalmic B-type ultrasound exanmination were analyzed by McNemar test, the correlation between eye shapes and case data were analyzed by chi square test. Results The diagnostic accuracy of the posterior staphyloma detected by ophthalmic B-type ultrasound exanmination was 70%, and was 100% by MRI examination, the positive rate of posterior staphyloma detected by MRI had significant difference (P<0.05) at the level of α=0.05 compared with those by ophthalmic B-type ultrasound. The shape of high myopia eyeball can be divided into four types: spherical, conical, bowl and column. The distribution of the four types of high myopic eye in the age grous and eye axial group had significant difference (P<0.05), and had no significant difference in the spherical diopter group. In some cases, irregular uplift and depression can be seen on the 3D-MRI model, but can not be accurately displayed in the ophthalmic B-type ultrasound exanmination. Conclusion 3D-MRI model can demonstrate high myopia eyeball shapes and the location and characteristics of posterior staphyloma. It has a higher diagnostic accuracy compared with ophthalmic B-type ultrasound and can be taken as a new method of high myopia eye examination.

Objective To investigate how to develop a rabbit model for corneal ectasia in vitro with collagenase type II. Methods In this experimental study, 20 postmortem New Zealand white rabbit corneas were randomly divided into 4 groups: group I (the control group with 15% dextran), group II (5 mg/ml collagenase type II with 15% dextran), group III (10 mg/ml collagenase type II with 15% dextran) and group IV (15 mg/ml collagenase type II with 15% dextran). After epithelial debridement, corneas were mounted and pressed onto artificial anterior chambers and different kinds of solutions were applied to the corneas for 60 minutes. The average corneal curvature and central corneal thickness were measured before and after collagenase exposure at different intraocular pressure (IOP) levels (15 mmHg, 30 mmHg, 45 mmHg). Corneal specimens were processed for light microscopy with HE staining. Changes in average corneal curvature and central corneal thickness were analyzed statistically by one-way ANOVA in SPSS 17.0. Results After collagenase exposure, significant changes in △Km (F=8.46, 9.24, 8.58, P＜0.01) were seen among groups at 15 mmHg, 30 mmHg and 45 mmHg. A significant increase in △Km was seen in group IV across all IOP levels (P＜0.01) compared to group I, while no significant changes were seen in groups II and III (P＞0.05). No significant changes in △CCT were seen among groups across all IOP levels (F=0.22, 0.66, 1.60, P＞0.05). Light microscopy showed a loss of the normal lamellar structure and changes in collagen organization after collagenase exposure. Conclusion 15 mg/ml collagenase type II can induce a significant increase in average corneal curvature, which might be considered for a method of building the rabbit model for corneal ectasia in vitro.

Objective To investigate the corneal shape and wavefront abberation outcomes of simultaneous correction for presbyopia in hyperopic eyes using the SUPRACOR technique. Methods This was a self-controlled study. Forty-eight hyperopic eyes (24 patients) with presbyopia underwent corneal treatment using the SUPRACOR technique, delivering a biaspheric multifocal ablation profile, PresbyLASIK. All patients were measured preoperatively and 12 months postoperatively for uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), refractive error, the overall wavefront aberrations (RMWFS), higher order aberrations (RMHOA) and third-order coma and fourth-order spherical aberrations to investigate the impact of this type of ablation model for treating corneal shape and eye aberrations. The data were analyzed with a matching t test and Wilcoxon signed rank test. Results The mean UDVA at 12 months postoperatively improved from 0.2(1.0～-0.0)logMAR to 0.1(0.5～-0.1)logMAR (Z=-2.54, P<0.01). The mean UNVA improved from 0.5(1.2～0.3)logMAR to 0.2(0.7～-0.1)logMAR at 12 months postoperatively (Z=-7.23, P<0.01). The postoperative central corneal mean power of 6.0 mm (K value) and the Q value were 44.60±1.61 D and -0.59±0.18, respectively, both with significant difference compare to preoperative measurement (t=-14.23, -13.28, P<0.01). For central corneal curvature, there was an increase in the vertically oblong aspherical shape. Overall, (pupil diameter 5, 6 mm) RMWFS was lower than the preoperative value (t=4.63, 4.61, P<0.01) and RMHOAS increased compared to the preoperative value (t=-5.98, -5.51, P<0.01). The vertical trefoil (Z3-3) decreased with a negative change in direction and the vertical coma (Z3-1) increased with a positive change. The spherical aberration (Z40) value had a negative reduction. Conclusion SUPRACOR presbyopia treatment in hyperopic eyes can increase central corneal curvature, a hyperprolate aspherical shape with a positive increase in third vertical coma and a negative increase in fourth-order spherical aberration, increasing the depth of focus.

Objective To study contrast sensitivity (CS) in hypertensive disorders caused by a complication of pregnancy and the changes in the fundus during the follow-up period. Methods A prospective cohort study was applied to the research, ninety-eight patients with hypertensive disorders as a complication of pregnancy(the patient group) agreed to undergo eye examinations that included visual acuity, fundus examinations, and CS evaluations. Patients were followed up for 6 months and visual acuity and CS changes were monitored. Fifty pregnant women were selected as a control group during the same period. The corrected visual acuity for the two groups and the CS at each spatial frequency were compared with two independent sample t-tests. The CS of each spatial frequency in the three trimesters with retinopathy and during the follow-up was compared with a Kruskal-Wallis rank sum test. After multiple group analysis, a comparison between pairs of groups was analyzed with a Satterthwaite approximation test. Results The corrected visual acuities of patients with hypertensive disorders as a complication of pregnancy were lower than those for the normal control group at the first visit and after the six-month follow-up period (t=13.67, 2.27, P<0.05). Retinal disease worsened during retinopathy in the three trimesters and the CS values for each spatial frequency decreased (χ²=93.35, 88.28, 89.73, 102.48, 102.26, P<0.01). During the six-month follow-up period, CS spatial frequencies gradually approached normal and the 6 c/d frequency was close to that of the normal control group (P>0.05), but the other spatial frequencies were reduced (t=2.74, -5.42, -8.67, -4.60, P<0.01). The recovery of a CS for 1.5 c/d spatial frequency was the fastest, and recovery for 12 c/d was the slowest. There were no significant differences in spatial frequency CS between the two kinds of delivery methods used at birth (P>0.05). Conclusion Fundus changes in patients with hypertensive disorders as a complication of pregnancy and the decrease in CS are both more serious than for normal patients. CS with the low spatial frequency had the fastest recovery and a high spatial frequency was the slowest to recover. The two kinds of delivery methods for birth have no effect on the recovery of CS. CS is a better indicator than visual acuity to reflect the function of the retina in patients with hypertensive disorders as a complication of pregnancy.

Objective To compare and to analyze the distribution characteristics of binocular peripheral refraction in myopic patients without anisometropia. Methods This was a self-controlled study. One hundred fifty-three myopic adults who consented to undergo laser in situ keratomileusis (LASIK) were enrolled in the study. The Grand Seiko WAM5500 infrared auto-refractor was used to measure cycloplegic autorefraction at 0° in the central fovea of the retina, and at eccentricities of 15°, 30° and 45° in the temporal and nasal visual fields. Data of the peripheral refraction in patients without anisometropia were recorded. Data were analyzed with a paired t test. Results There were no significant differences in binocular refraction in areas located at 0°, and at eccentricities of 15°, 30° and 45° from the fovea in the temporal and nasal areas of the right and left eyes of myopic patients without anisometropia (P>0.05). Refraction in areas located at eccentricities of 15°, 30° and 45° from the fovea in the temporal and nasal areas were compared in one eye and there were significant differences between sphere and spherical equivalent (SE) in areas located at an eccentricity of 15° from the fovea in temporal and nasal areas (right eyes: t=5.31, 4.51, P<0.05; left eyes: t=3.39, 2.54, P<0.05). Astigmatism at an eccentricity of 45° in the temporal area was greater than at a 45° eccentricity in the nasal area (t=4.95, 3.74, P<0.05). However, there were no significant differences in other corresponding areas (P>0.05). There were no significant differences between peripheral refraction at 15° on the nasal retina and at the 0° location (P>0.05), but there were significant differences between other parts of the retina and at the 0° location (t=2.32~8.70, P<0.05). In the periphery, sphere and SE were hyperopic defocused with a significant increase in astigmatism. Conclusion The distribution of peripheral refraction in corresponding areas is bilaterally symmetric in myopic patients without anisometropia. The temporal retina of the paracentral area has a hyperopic defocus. In peripheral areas, the degree of hyperopic defocus increases, and astigmatism on the temporal retina is greater than that on the nasal retina.

Objective To investigate refractive error and amblyopia in a large group of patients with congenital ptosis presented to a specialist at the ophthalmology center. Methods This was a hospital-based retrospective analysis conducted at Beijing Tongren Eye Center from May 2010 to December 2012. We evaluated the frequency of ametropia and amblyopia in 242 eyes of 187 patients between 3 and 12 years of age with congenital ptosis. The patients were classified according to the degree of ptosis: mild, moderate or severe ptosis. Statistical analysis was performed using a chi-square and t-test. Results In 242 ptotic eyes, the frequency of myopia, hyperopia and astigmatism was 16.9%, 62.8% and 31.1%, respectively. The overall incidence of amblyopia in ptotic eyes was 29.8%. The incidence of amblyopia was higher in severe ptotic eyes than in mild or moderate ptotic eyes (57.8% vs. 41.2%, χ2=4.046, P<0.05). Conclusion The incidence of ametropia and amblyopia was high in congenital ptosis. Furthermore, amblyopia was more frequent in severe ptotic eyes.

Posterior sclera reinforcement (PSR) has been developed for more than 60 years. Unfortunately, its clinical efficacy hasn′t gained wide recognition even recently. The literatures about treating high myopia with PSR were searched in Pubmed, CNKI and VIP from 1965/01/01 to 2015/11/30 with the key words ″scleroplasty″, ″scleral reinforcement″ and ″high myopia″, among which the language categories, the number of the literatures in different time periods, the operation style, reinforcement materials and efficacy of PSR were analyzed. PSR was mainly carried out in Russia, Eastern Europe and China. The numbers of articles published on PSR gradually increased from the 1970 s, to reach the top in the mid of 1980 s, and gradually decreased after that time in Non-Chinese literatures. The first Chinese paper reported about PSR was published in the mid of 1980 s, the numbers of publication increased gradually. There is steady incrase in publication of PSR over last 15 years. The efficacy of PSR is still under controversial since too many operation styles and materials were chosen and lack of universal standards, most of which can′t meet the mechanical requirements of reinforcement. The number of Chinese literatures began to rebound in the new century. With the development of the new surgical techniques by our group and innovation of new reinforcement materials, PSR could be expected to gain the popularity in the new century for the treatment of retinopathy in highly myopic patients again.

Hematopoietic stem cell transplantation (SCT) is a reliable treatment for malignant hematological diseases. After receiving an allogeneic SCT, graft-versus-host disease is a major cause of death and disability. Depending on the time of its origin and clinical manifestations, GVHD can be divided into acute and chronic types. Acute GVHD is defined as a syndrome involving the skin, gastrointestinal tract, and liver. Chronic GVHD is defined as a syndrome and involves organs that typically include the skin, mouth, liver, gastrointestinal tract, lungs, and eyes. After receiving allogenic hematopoietic stem cell transplants, about 40%-60% of the patients will suffer from acute or chronic graft-versus-host disease, a disease that can lead to several serious ocular diseases and greatly affects the quality of life of patients. However, guidelines for treatment have not been issued so far. This paper provides an overview of the latest research progress on ocular HVGD and emphasizes the urgency for its prevention.

Progressive addition lenses, a multifocal intraocular lens or an accommodating intraocular lens (IOL) implantation are commonly used for presbyopia correction. The drawbacks of these methods include lower quality of life after wearing glasses and risks of intraocular surgery induced by IOL implantation. Additionally, though laser in situ keratomileusis (LASIK) has been widely used in refractive correction, the lack of a precise method for presbyopia treatment limits its application. Recently, a corneal inlay (KAMRA) implantation combined with LASIK surgery has been applied to correct presbyopia with the advantages of effectivity, safety, relocatability and reversible implantation. Thus, the clinical efficiency and safety of corneal inlay are reviewed in this paper to offer some insight as well as to help clinicians choose suitable surgeries that may be helpful in improving the safety of surgery and the quality of the patient′s life.