Due to the diversity of femtosecond laser corneal refractive surgery, it is of great importance to advocate choosing customized procedures according to each patient's ocular biological parameters. Currently,femtosecond laser corneal refractive surgery has become the mainstream procedure to correct refractive
errors. This article evaluates the clinical status of the corneal surface refractive surgery by excimer laser,aiming to provide a reference for reasonable clinical application.

Objective: To introduce the surgical technique of big-bubble combined with the wet-peeling technique for deep anterior lamellar keratoplasty. Methods: Form January 2016 to June 2017, 59 Herpes simplex keratitis (HSK) patients at Eye Hospital, Wenzhou Medical University underwent deep anterior lamellar keratoplasty. When performing big-bubble deep anterior lamellar keratoplasty for treatment of herpetic corneal scars, we switched to the wet-peeling technique to finish the surgery if we encountered a type-2 big bubble or small bubbles. Results: Deep anterior lamellar keratoplasty was successfully performed on all 59 eyes with no occurrence of a microperforation. The occurrence rate of type-2 big bubbles was 71%.Conclusions: Type-2 big bubbles occurred in a high proportion of HSK patients. Converting to the wet-peeling technique for type-2 big bubbles or small bubbles, maintained the pre-Descemet's membrane and was a safe procedure.

Objective: To explore the association between sedentary behavior, physical activity and retinal microvessels caliber in normal people. Methods: In this cross-sectional study, 6 560 participants, age ≥ 40 years (range40 – 87 years) were recruited from March 2008 to July 2017. The calibers of retinal microvessels were graded using retinal photography, and each participant's self-reported sedentary behavior and physical activity time were obtained through an extensive questionnaire. Physical activity was classified as high-intensity activity(running, swimming and basketball), moderate-intensity activity (Taichi, shuttlecock kicking and cycling)and low intensity activity (walking). Multivariate linear regression was used to explore the relationship between life activity habits and retinal microvessel caliber. Results: After exclusion of some recruited particpants for different reasons, 5 857 subjects were inclinded in the final analysis. After adjustment for age, gender,body mass index, blood pressure, fasting plasma glucose, triglycerides, total cholesterol, smoking status,and drinking status, the sedentary time was negatively associated with the caliber of the central retinal arterioles (β=-0.29, P =0.032). There was no significant association between physical activity and retinal vascular caliber. Conclusions: Sedentary time was significantly and independently associated with a decrease in the caliber of central retinal arterioles. The results suggest that sedentary behavior probably increases the risk of cardiovascular diseases among Chinese adults.

Objective: To investigate the influence of different intensities of blue light shielding on the visual function of healthy adults. Methods: This self-controlled study enrolled 20 healthy adults who were students volunteers of Tongji University from August 2016 to March 2017. The subjects completed a 75-min reading task illuminated by blue light (440 nm) at shielding intensities of 0%, 20%, 30%, 40%, and 60%.Twenty-four color partial scoreswere calculated to detect variations in color discrimination. After completing the reading task, visual fatigue, accommodation response, and lens accommodation were assessed and compared amongthe five intensities of blue light shielding. The results were analyzed by signed-ranked test. Results: The scores of many colorswere significantly lower at blue light intensities of 30%, 40%, and60% compared to 0% intensity shielding (P < 0.05). The differences in color scores between 0% and 20% intensity shielding were not statisticallysignificant. After completing the reading task, the visual fatigue scores were lower with 20%, 30%, 40%, and 60% intensity shielding compared to 0% intensity shielding(all P < 0.05). The difference between before and after reading task in accommodation amplitude and positive relative accommodation were significantly lower at 20%, 30%, 40%, and 60% intensity shielding compared to 0% shielding (P < 0.05). Difference between before and after reading task in native relative accommodation were significantly lower at 40% and 60% intensity shielding compared to 0% shielding(P < 0.05). The differences betweenthe before and after reading task values of the 20% and 30% shielding were not significantly different from the 0% shielding. Lastly,differences between before and after reading task in lens accommodation at 20%, 30%, 40%, and 60% intensity shielding were not significantly different from 0% shielding. Conclusions: With blue light (centered at 440 nm) shielding of 20% to 60% intensity20 band wavelength, the accommodation and visual fatigue of healthy adults improved.When the shielding
intensity was 30% to 60%, the color perception was worse.

Objective: To evaluate the ability of scanning electron microscopy (SEM) and image computer statistical analysis (ICSA) to quantitatively assess the effectiveness of protein removal from soft contact lenses by soft contact lens care solutions. Methods: Soft contact lenses were soaked in artificial tears for 65 hours to simulate protein adsorption. Two contact lens care solutions and phosphate buffered saline(PBS) were then used separately to rub, rinse, and soak the lenses for 6 hours. After fixation with glutaraldehyde, the lenses were dried. The morphology and quantity of protein on the surface of the lenses were inspected by SEM and ICSA. The cleansing rate was expressed as a mass fraction, i.e., a percentage of before and after treatment with the care solution. Single factor analysis of variance was used to analyze the protein clearance rate of lens treated with different treatments by Tukey multiple comparison method.Results: The contact lens care solution had a significant cleaning effect on the surface protein of the lenses.For PBS and the two kinds of contact lens care solutions from different manufacturers, the protein clearance rates of the lenses were 89.58%, 98.18% and 98.38% at 100× magnification and 89.76%, 98.42% and 98.27% at 1 500× magnification. Conclusion: SEM combined with ICSA can effectively evaluate the protein cleaning efficacy of contact lens care solutions. Contact lens care solutions have a significant cleaning effect on the surface protein of the lenses.

Objective: To evaluate the clinical efficacy of Z-adjust topography-guided customized laser in situ keratomileusis (LASIK) for eccentric cutting induced by LASIK keratorefractive surgery. Methods:In this retrospective case series study, 10 eyes of 8 patients with eccentric cutting induced by LASIK surgery from June 2008 to December 2014 at Chinese PLA the 401th Hospital were enrolled. The patients were treated with Z-adjust topography-guided LASIK. The uncorrected visual acuity (UCVA), refractive status, corneal Q-value (which describes the corneal aspherical quality), and corneal keratometry were analyzed and compared. Results: The pre-operation UCVA (LogMAR) of all patients was 0.3 to 0.6,and the post-operative UCVA (LogMAR) improved significantly was -0.1 to 0.1. The corneal Q-value increased significantly from 1.26±1.55 diopter (D) (range 0.26 to 2.25 D) pre-operative to 0.28±0.35 D(range -0.27 to 0.50 D) at 3 months post-operative. The corneal keratometry decreased significantly from 40.98±3.56 D (range 39.25 to 43.50 D) to 37.32±1.47 D (range 36.25 to 38.50 D). The scotopic pupil diameter increased significantly from 5.9±0.4 mm (range 5.5 to 6.1 mm) to 6.8±1.1 mm (range 6.0 to 7.4 mm). The Z-adjust range for the X axis was adjusted from +0.005 to +0.052 mm, and for the Y axis, it was adjusted from +0.007 to +0.045 mm. Conclusions: The eccentric cutting of all eyes were corrected by Z-adjust topography-guided customized LASIK surgery, and the visual quality was greatly improved.

Objective: To analyze the causes of blindness and residual vision at the Quanzhou Blind School and provide information to help prevent childhood blindness and low vision. Methods: This was a cross-sectional study of all the students (n=126) at the Quanzhou Blind School. All students received routine ophthalmology examinations. A detailed individual-level questionnaire was administered that addressed the causes of blindness and low vision. Results: Among the 126 students, 66 had low vision, and 60 were blind. The major causes of blindness were retinopathy of prematurity (ROP) (23.3%), corneal degeneration (13.3%),
optic nerve atrophy (13.3%), and congenital glaucoma (11.7%). The major causes of low vision were congenital cataract (27.3%), nystagmus (13.7%), optic nerve atrophy (10.6%), and corneal degeneration(9.1%). Conclusions: Congenital or hereditary diseases were the leading causes of vision loss at the Quanzhou Blind School. ROP was the principle cause of blindness. Most low vision cases were due to congenital cataract.

Objective: To evaluate vision quality by observing the changes of ocular higher order aberration after wearing toric orthokeratology lenses. Methods: In this retrospective case series, the higher order aberrations (HOA) of both eyes of 25 toric orthokeratology lenses users, who had no ocular diseases other than myopia,were quantified with the CSO-Modia Wave wavefront analyzer from February 2015 to August 2016. Zernike polynomials were used to describe the wavefront measurements. Root mean square values of the total HOAs, total coma, total spherical, total astigmatism, and residual aberrations were obtained in the same eyes before and at 1-, 3-, 6-, and 12-months after fitting the contact lenses. The general linear model for repeated measurements and Bonferroni tests were used to analyze the data. Results: After wearing the lenses, in
5 mm and 7 mm pupil diameter astigmatism aberration, coma, spherical aberration, residual aberration and total higher order aberration were increased compare to before wearing, the difference was statistically significant (5 mm: F =5.15, 11.11, 10.73, 6.95, 11.18, respectively, all P < 0.05; 7 mm: F =2.93, 4.71, 9.34,5.01, 5.70, respectively, all P < 0.05). The aberration values increased gradually after lens wear. The values peaked at three months, and then gradually decreased. Conclusions: Wavefront analysis showed that the total HOAs, total coma, total spherical aberration, total astigmatism, and residual aberrations were increased after toric orthokeratology lenses wear. Toric orthokeratology lenses reduced the quality of vision in the subjects of this study.

Objective: To evaluate and analyze the effectiveness and the complications of large, porous hydroxyapatite(HA) ocular implants in pediatric patients. Methods: In this retrospective study, 26 cases of pediatric patients 6 to 59 months old, who underwent porous HA orbital unilateral implants between January 2009 and June 2016 at Eye Hospital, Wenzhou Medical University were reviewed. Recorded outcomes included the age, the size of the HA implants, implant-related complications, and the cosmetic satisfaction.Results: The implant diameter sizes were 18 mm (2 patients), 20 mm (9 patients), 21 mm (4 patients),22 mm (9 patients), and 23 mm (2 patients). All patients who underwent the implant procedure were free of complications during the study period. The parents of these patients were satisfied with the final cosmetic appearance. Conclusions: Large sized orbital implants (18- to 23-mm diameter) in pediatric patients between 6 and 59 months of age appear to be safe and effective.

Objective: To observe the preliminary application of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery for dense vitreous hemorrhage. Methods: In this retrospective case study,24 subjects (14 males, 10 females, mean±standard deviation age 62.3±16.6 years) were recruited from June 2015 to September 2016 at Eye Hospital, Wenzhou Medical University. One eye of each patient received iOCT to evaluate macular architecture after removal of a dense hemorrhage. Results: The etiologies for the vitreous hemorrhages included proliferative diabetic retinopathy (15 eyes), horseshoe
retinal tear (1 eye), retinal vein occlusion with neovascularization (4 eyes), polypoid choroidal vasculopathy(2 eyes), retinal arterial macro aneurysm (1 eye), and neovascularization due to unknown cause (1 eye).iOCT revealed macular edema (8 eyes), epiretinal membrane (2 eyes), macular edema and epiretinal membrane (1 eye), macular atrophy (2 eyes), and lamellar macular hole (1 eye). The iOCT macular findings were not consistent with examination under the operating microscope in six eyes. The differences resulted in intraoperative changes in the surgical management in four of these eyes. None of the patients experienced endophthalmitis associated with iOCT. Conclusions: Morphological changes of the macular area that are difficult to detect under the operating microscope can be observed by iOCT after removal of a dense vitreous hemorrhage. iOCT may help surgeons improve the management of vitreoretinal surgery.

Strabismus and amblyopia are common eye diseases correlated with visual development in children.Strabismus, amblyopia and the associated treatments are closely related with the sociopsychological health of children. Current researches indicates that children with strabismus are likely to be alienated and discriminated against. In comparison with normal children, they are more likely to have sociopsychological problems. Even more mental disturbance might occur in serious cases. Timely strabismic treatments could exert a positive sociopsychological impact on children with strabismus. Although there is no unanimous opinion about the psychological effect of childhood amblyopia, most research indicates that treatments for amblyopia might exert a negative influence on sociopsychological health. Effective psychological intervention could promote compliance with amblyopic treatments, and minimize treatments' negative impact on childhood mental health. With more research, the sociopsychological children may face will gradually be illuminated, and the findings will provide a more sound theoretical basis for psychological intervention.

Due to the complex of eye physiology and multiple anatomical barriers, systemically delivered drugs often cannot maintain a sustained drug level in posterior retina and vitreous. Though eye drop is convenient for patients, therapeutics that reaches retina or vitreous is very limited after topical administration. Intravitreal injection is invasive and prone to complications such as lens damage, vitreous bleeding, retinal detachment, and infection. In contrast to these routes of delivery, transscleral drug delivery has advantages such as large surface area, easy access and administration, and better safety profile without breach of the globe integrity.The challenge for transscleral delivery is that the therapeutics delivered onto the episclera needs to have an adequate concentration. If the episcleral concentration is too high, large portion of the delivered drug will be absorbed into systemic circulation and may cause systemic side effects. On the other hand, low episcleral drug concentration cannot build an effective concentration gradient for drug crossing the sclera and reaching choroid and retina. Therefore, many therapeutic compounds are not suited for transscleral delivery. In order to satisfy the proper episcleral concentration, scientists have been modulating the drug dissolution by microspheres or fabricating episcleral devices. Compared with episcleral implant or devices, episcleral microspheres do not need surgical procedure. The microspheres can be administrated by a simple needle injection.