In vivo confocal microscopy (IVCM) provides non-invasive, in vivo assessment of the corneal epithelium,keratocytes, inflammatory cells, nerves, conjunctival epithelium, follicles, and meibomian glands, along with objective quantitative analysis. Based on the changes at the cellular level, these assessments make
an effective basis for the determining the etiology, early and subtype diagnosis, treatment direction, and prognosis evaluation of dry eye. These advances constitute the beginning of a new era for the management of dry eye disease.

Objective: To analyze the factors that affect the dynamic cyclotorsion component (DCC) during femtosecond laser in situ keratomileusis (FS-LASIK). Methods: In this retrospective study, we analyzed 500 patients (1 000 eyes) who underwent bilateral FS-LASIK for correction of myopic astigmatism from June 2015 to July 2016 at Eye Hospital, Wenzhou Medical University. Ablation was performed using the SCHWIND AMARIS (750S) excimer laser system, and the magnitude of dynamic cyclotorsion was recorded during the operation. Differences of DCC between left and right eyes were compared with paired t-tests. The factors that affect DCC were analyzed using multivariate linear regression. The main factors were age, eye (right or left), gender, spherical equivalent (SE), pre-ablation spherical and astigmatism,ablation zone, ablation time, central ablation depth, and temperature and humidity in the laser cavity. The cut-off points were measured using receiver operating characteristic curves. Results: The mean DCC amplitude was 1.61°±0.90°, with 1.50°±0.85° in right eyes and 1.71°±0.94° in left eyes (t=-4.85, P<0.001).
The mean dynamic cyclortorsion degree (absolute value) was 1.44°±0.93°, with 1.32°±0.91° in right eyes and 1.56±0.95° in left eyes (t=-4.87, P<0.001). Ablation time (β=0.022, P<0.001), age (β=-0.026,P<0.001), eye (right or left, β=-0.213, P<0.001), and humidity in the laser cavity (β=-0.018, P=0.008) were statistically significant factors for the DCC amplitude. Eye (right or left, β=-0.238, P<0.001), age (β=-0.019, P=0.001), and humidity in the laser cavity (β=-0.016, P=0.025) were significant factors for the absolute degree of DCC. Conclusions: Ablation time, age, eye (right or left), and humidity in the laser cavity can affect the DCC during binocular FS-LASIK.

Objective: To explore the validity and effectiveness of multifocal electroretinogram (mfERG) technology in the diagnosis of primary open-angle glaucoma (POAG). Methods: In this case-series study, 60 POAG patients (86 eyes) who were diagnosed in the First People's Hospital from October 2014 to March 2016 were enrolled in the glaucoma group. There were 20 cases (27 eyes) of early POAG, 20 cases (29 eyes) of middle POAG, and 20 cases (30 eyes) of late POAG. Another 60 healthy subjects (120 eyes) were enrolled in the normal control group. All subjects in both groups received an mfERG examination for diagnostic testing. The density values and latency period of the P1 wave in every second-order reaction ring and quadrant were observed and compared. All data were analyzed using one-way analysis of variance and the χ2-test. Results: There was no change in the P1 wave density values in rings 1-5 between early glaucoma group and control group. However, the density values of the P1 wave in the inferior temporal and superior temporal quadrants in the early glaucoma group declined compared with those in control group (P<0.05). In the middle stage glaucoma group, the P1 wave response density value in rings 2-5 and the four quadrants declined compared with those in the control group (P<0.05). In the late glaucoma group, the density values of the P1 wave in rings 1-5 were also lower than those in the normal group (P<0.05). The latency periods of the P1 wave in rings 1-5 and in the four quadrants of every stage of glaucoma were prolonged compared with those in the control group (P<0.05). However, latency periods in the late glaucoma group were even more extended (P<0.05). Conclusions: The latency period and density changes of the P1 wave in rings 1-5 in mfERGs reflect retinal damage in glaucoma. These changes have clinical value in the diagnosis of early glaucoma.

Objective: To compare the silicone oil removal time and rate of three different methods. Methods: This clinical study included one eye from each of 52 consecutively enrolled patients who underwent silicone oil removal at the Eye Hospital, Wenzhou Medical University from October 2016 to July 2017. The patients were categorized into three groups for intraocular silicon oil removal: manual (Group A=19), vitrectomy (Group B, n=17), and modified vitrectomy (Group C, n=16). For Group A, a 10 ml syringe was connected to the 23-gauge cannula through a short section of blood transfusion tube. The oil was removed by pulling the plunger to the end where it was held to create sufficient negative pressure. For Group B, the small side of a blood transfusion tube was connected to the cannula on one side of the eye while the other side was connected to a vitrectomy apparatus. For Group C, the expanded side of a blood transfusion tube was connected to the cannula on one side of the eye while the other side was connected to a vitrectomy apparatus. The negative pressure of Group B and Group C was provided by the vitrectomy apparatus.Silicone oil removal time and rate (volume divided by the time taken for removal) were recorded. All statistical analyses were performed using analysis of variance and Fisher exact test. Results: The mean times of silicone oil removal in Groups A, B, and C were 4.2 ± 1.4 min, 6.1 ± 1.5 min, and 5.1 ± 1.2 min
respectively (F=8.9, P < 0.001). Furthermore, the mean time for Group A was shorter than for Groups B and C in pairwise comparisons (P < 0.05 ). The silicone oil removal rate in Groups A, B, and C were 1.42 ± 0.31 ml/min, 0.94 ± 0.21 ml/min, and 1.14 ± 0.20 ml/min respectively (F=18.0, P < 0.001). Moreover,the removal rate for Group A was higher than for Groups B and C, and Group C was higher than Group B in pairwise comparisons (P < 0.05). The incidence of low intraocular pressure (≤6 mmHg) at day 1 after surgery in Groups A, B, and C were 1/19, 0/17, and 1/16 respectively (P=0.76). Recovery of all intraocular pressures was achieved by 1 week after surgery. No other severe intraoperative or postoperative complications were noted for three approaches. Conclusions: All three methods for removal of intraocular silicon oil were safe and efficient. The removal time of the manual approach was the shortest and the rate was the highest of the three approaches.

Objective: To evaluate the safety, effectiveness, predictability, stability, and centrality of the automatic location tracking system contoura for the correction of ametropia with mild irregular astigmatism.Methods: In this prospective study, 23 consecutive patients (40 eyes) with ametropia and mild irregular astigmatism were studied from March to June 2016 at Hangzhou MSK Eye Hospital. Corrective surgery was performed using contoura, an automatic location tracking system. Uncorrected visual acuity, best corrected visual acuity, manifest refraction, and three-dimensional corneal topography were quantitatively assessed preoperatively and at 1 day, 2 weeks, and 3 months postoperatively. The results were analyzed with Pearson correlation analysis and one-way analysis of variance. Results: At 1 day, 2 weeks, and 3 months postoperatively, uncorrected visual acuity was -0.04±0.08, -0.06±0.08, -0.06±0.08 respectively.For all eyes, the best corrected visual acuity was equal to or higher than the preoperative values, and 32.5% of the eyes improved by 1 line while 2.5% improved by 2 lines at 3 months postoperatively. The actual corrected spherical equivalent was positively correlated with the predicted correction (r =0.999,P < 0.001). For residual spherical equivalent, all eyes were within ±0.50 D and 37.5% were within ±0.25 D.Uncorrected visual acuity and spherical equivalent were not statistically significant at each time point. The eccentric distances was statistically significant between 1 day and 3 months postoperatively (P=0.02).There were no significant differences among the remaining time points. All operations were successful, and no serious complications were seen during the 3-month postoperative period. Conclusions: The automatic positioning and tracking system contoura is safe, effective, predictive, stable, and centered for correction of ametropia with mild irregular astigmatism.

Objective: To investigate the correlation of myopia severity with axial length (AL), central corneal thickness (CCT), intraocular pressure (IOP), corneal curvature (CC), and choroid thickness (CT) in children and adolescents. Methods: In this case series study, we selected myopic children and adolescents who were diagnosed in Shanxi Eye Hospital from March to December 2016. All of the children and adolescents were subjected to cycloplegic refraction, and CCT, IOP, AL, CC, and CT measurements. They were divided into three myopia groups, mild, moderate, and high, based on the spherical equivalent (SE). We then analyzed the correlation of the degree of myopia with CCT, IOP, AL, CC, and CT. Differences between groups were analyzed by one-way analysis of variance. Relationships between the relevant factors were analyzed by Pearson correlation analysis. Results: Eighty myopic children and adolescents (158 eyes), 7.9±2.4 years old, were included in this study. The SEs were -2.28±0.85 diopters (D), -4.43±0.82 D, and -8.51±1.50 D in the mild, moderate, and high myopia groups respectively. The ALs were 24.0±0.7 mm, 25.0±0.6 mm, and 26.6±1.5 mm in the respective myopia groups (F=55.03, P<0.001). The CTs were 280±82 μm, 207±63 μm,and 184±72 μm in the respective myopia groups (F=12.64, P<0.001). There were no significant differences for CCT, IOP, or CC among the different groups. CT was significantly correlated to myopia (r =-0.590,P<0.001), AL (r =-0.567, P<0.001), and CCT (r =-0.300, P=0.007). Conclusions: There is a positive correlation between the progression of myopia and the increase in AL. There is a negative correlation between
myopia and the foveal CT. Finally, the relationship between myopia and CCT, IOP, and CC is not clear.

Objective: To compare the clinical outcome of digital and manual marking for toric intraocular lens (IOL) implantation. Methods: This prospective randomized control study included one eye each of 80 patients underwent cataract surgery with coexisting corneal astigmatism of more than 1.0 diopter (D).The eyes were randomly assigned to two groups. The observation group, 40 eyes, underwent Verion system assisted phacoemulsification and toric IOL implantation. The control group, 40 eyes, underwent toric IOL implantation with manual slit-lamp assisted preoperative marking. We recorded the uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), and corneal astigmatism before and after surgery, as well as the anticipated and observed residual astigmatism. The follow-up time was 3 months. Means and standard deviations were calculated. Data were performed by t-test, chi-square tests.Results: The mean postoperative UCDVA for the observation group was 0.11 ± 0.11 log minimum angle of resolution (logMAR), and for the control group it was 0.13 ± 0.13 logMAR (t=-0.96, P=0.34). The mean deviation from the targeted induced astigmatism (TIA) for the observation group was 0.12 ± 0.11 D and for the control group it was 0.21 ± 0.12 D (t=-3.71, P=0.001). The mean postoperative toric IOL misalignment measured by the slit lamp was 2.2° ± 1.6° for the observation group and 4.6° ± 3.0° for the control group
(t=-3.69, P=0.001). Conclusions: The intraoperative digital guidance of the Verion system provided better toric IOL alignment than did the manual slit-lamp assisted alignment. The Verion system resulted in less postoperative TIA and less postoperative toric IOL misalignment than did the manual-marking technique.

Objective: To evaluate the clinical results of cortex removal with biaxial irrigation and aspiration (IA) compared with coaxial IA in phacoemulsification. Methods: This prospective study enrolled cataract patients who underwent phacoemulsification and intraocular lens implantation at the Second People's Hospital of Hefei Affiliated to Anhui Medical University. The patients were divided into two groups (each with 30 patients, 30 eyes) based on the cortex removal mode: biaxial IA and coaxial IA. For the biaxial IA group, we made three corneal incisions: one main incision at 12??00 (phaco tip) and two side port incisions at 3??00 and 9??00 (irrigation and aspiration). For the coaxial IA group, we made one main incision and one side port incision at mutually perpendicular lines. In both groups, normal hydrodissection was set and the nucleus was aspirated with ultrasound phacoemulsification energy. The residual cortex was removed, and posterior capsule polishing was performed using either biaxial IA or coaxial IA. The time (in seconds) required for the removal of the cortex measured from instrument insertion in the eye until aspiration tip removal. Residual cortex, posterior capsule ruptures, visual acuity, and corneal astigmatism were recorded.Data were analyzed by the Mann-Whitney test, chi-square test, and Fisher's exact test. Results: The cortex removal time was 118 ± 10 seconds for the biaxial IA group and 150 ± 16 seconds for the coaxial IA group (Z=-6.174, P<0.001). Compared to coaxial IA, biaxial IA resulted in more stability of the anterior chamber and more effective cortex removal, the success rate of one-off suction in coaxial IA group and biaxial IA group were 57% and 100% respectively. There were no significant differences in visual acuity or corneal astigmatism between the two groups (P>0.05). One posterior capsular tear occurred in the coaxial IA group. Conclusions: Biaxial IA significantly reduced cortex removal time compared to coaxial IA. Biaxial IA appears to be safer and more efficient than coaxial IA in cortex removal.

Objective: To analyze the clinical features of diabetic macular edema (DME) after photocoagulation in proliferative diabetic retinopathy (PDR), and to provide the foundation for further research on the treatment of DME. Methods: This retrospective cross-sectional, observational study included 30 patients (43 eyes) who conformed to the inclusion criteria of Mianyang Wanjiang Hospital from January 2015 to December 2016. The features of DME that occurred after photocoagulation for PDR were assessed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Eyes were divided to subgroups according to with some clinical features or not. The causes of poor visual function of DME were assessed by comparing differences of best corrected visual acuity (BCVA) between subgroups in each characteristic group by independent samples t-tests or one-way analysis of variance. Results: The mean BCVA was 3.98±0.58. Of the 43 eyes with DME, 30 (70%) were classified as moderate or severe DME. Twenty-two eyes (51%) had a cystoid cavity gap of more than 350 μm, 27 (63%) had DME in the central fovea, and 35 (81%) had destruction of the ellipsoid zone and outer limiting membrane. Seven eyes (16%) had a little serous retinal detachment under the macula, nine eyes (21%) had epiretinal membranes, and six eyes (14%) had diabetic optic neuropathy. Five of these characteristics, i.e., ellipsoid zone destruction (t=3.62, P= 0.001),DME in central fovea (t=-1.23, P=0.029), large cystoid cavity gap (t=5.49, P<0.001), severity of DME (F=17.54, P<0.001), and diabetic optic neuropathy (t=-5.56, P<0.001), significanlty affect the BCVA. Conclusions: DME occurred extensively after photocoagulation treatment for PDR. For eyes with DME,
loss of BCVA was associated with the severity of the DME, ellipsoid zone destruction, DME in the central fovea, large cystoid cavity gap, and diabetic optic neuropathy.

Objective: To explore the information management methods for eye and vision care of children and to create and apply the information system for improvement of children's eye and vision care in the Huzhou municipal area. Methods: Using “the technical specification for eye and vision care for children” as a standard reference, an eye and vision care module was added to the health information system for children.A database was created, and relevant information was collected, curated, and monitored in real time by the children's health care provider at the city, county and township level. Results: After the creation of the information system for children's eye and vision care, and on the basis of the initial trial at 9 suitable sites at the city, county, and town levels, the system was then expanded to 112 work stations across the whole municipal area. Four thousand entries were entered into the system. The new management system had significantly improved the quality of health care, and increased the screening rate for children's eye diseases. This information system also benefited the establishment of the children's eye care archives and the collection and analysis of statistical information of children's eye disease. Conclusions: The creation of the information system improved the management for children's eye and vision care. It can also provided scientific evidence for policy evaluation and revision at the decision-making level. Further development of the children's eye and vision care management system will inevitably lead to better analysis of childhood eye diseases and improved medical care.

The pachychoroid spectrum disease includes central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovascularization and polypoidal choroidal vasculopathy. A spectrum of diseases with a pachychoroid-driven process have features of an increase in choroidal thickness and dilated
choroidal vessels in common. The investigation of mechanism and image features may help us to diagnose this kind of disease and give us the right directions to study in future steps.