Objective: We used ultra-high resolution spectral domain optical coherence tomography (UHR-OCT) to analyze the subclinical changes in retinal neurons, axon injury, and retinal thickness in neuromyelitis opticaspectrum disorders (NMOSD) patients. Methods: This case-control study included 21 cases of NMOSD patients and 20 matched healthy volunteers (control group). The NMOSD patients were divided into a subgroup without optic neuritis (NO-ON) (13 eyes) and a subgroup with optic neuritis (ON) group (13 eyes). The thickness of the total retina of each patient and control subject was evaluated by using UHR-OCT. Data of each layer were analyzed using one-way ANOVA. Results: Except at the central region, the total retinal thickness of the ON group in whole mapping images was significantly thinner than the control group and NO-ON group. There were significant differences in total thickness between the NO-ON group and the control group in some regions (nasal interior [NI], P=0.011; temporal interior[TI], P=0.003; superior exterior [SE], P=0.019; inferior exterior [IE], P=0.002). The thicknesses of the retinal nerve fiber layer (RNFL) and the combined ganglion cell layer and inner plexiform layer (GCL+IPL) in the ON group was significantly thinner in each quadrant compared with the control group (P < 0.001). The RNFL thickness of the NO-ON group was thinner in the nasal and temporal areas compared with the control group (NI, P=0.049; TI and temporal exterior [TE], P < 0.001). The GCL+IPL thickness in the NO-ON group was thinner than control group (SE, P < 0.001; IE, P=0.002). The thickness of inner nuclear layer (INL) in the ON group was thicker than in the control group (superior interior [SI], P=0.001; inferior interior [II],
P=0.003; TE, P=0.043); however the thickness of the INL in the NO-ON group was thinner than in the control group (SE, P=0.015; IE, P=0.012). The thickness of Henle fiber layer and outer nuclear layer (HFL+ONL) in the NO-ON group was thinner than for the control group (SI, P=0.009; SE, P=0.018; II, P=0.001; IE, P=0.001 ), but there were no significant differences between the ON group and the control group. Conclusions: There were significant changes in the different retinal layers of NMOSD patients compared to healthy controls. The thicknesses of RNFL and GCIPL in the NO-ON subgroup were decreased,suggesting that NMOSD patients with no optic neuritis potentially have structural damage in the retinal nerve.

Objective: To investigate the relationship between six lipoprotein ratios and retinal vascular diameter.Methods: This cross-sectional study was performed from January 2010 to December 2010 and included 4 882 Chinese government officials age ≥40 years in Guangzhou who had no history of major cardiovascular events such as stroke or myocardial infarction. Serum lipids were analyzed and retinal vascular caliber was assessed using standard fundus photographs and validated software. A multiple linear regression model was designed to analyze the relationship between the following conditions: low density lipoprotein cholesterol/high
density lipoprotein cholesterol (LDL/HDL), apolipoprotein B/high density lipoprotein cholesterol (ApoB/HDL), apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1), total cholesterol/high density lipoprotein cholesterol (TC/HDL), triglyceride/high density lipoprotein cholesterol (TG/HDL), low density lipoprotein cholesterol/apolipoprotein B (LDL/ApoB) ratios and retinal vascular diameter. Results: After adjustment for traditional cardiovascular risk factors, multiple linear regression analysis showed that LDL/HDL, ApoB/HDL, and ApoB/ApoA1 ratios all have a negative correlation with retinal arterial caliber ( β=-0.61, -1.91,-2.58, P=0.046, 0.020, 0.010 respectively). However, they have a positive correlation with retinal venous caliber ( β=2.01, 4.63, 5.99, respectively, P < 0.001). The relationships between TC/HDL, TG/HDL, and LDL/ApoB and retinal vascular caliber were not statistically significant. Conclusions: LDL/HDL, ApoB/HDL, and ApoB/ApoA1 ratios are significantly associated with a decrease in the retinal vascular caliber.The ratios of TC/HDL, TG/HDL, and LDL/ApoB are not associated with retinal vascular caliber.

Objective: To analyze the time-dependent characteristics and possible prognostic factors for postoperative visual field improvement in patients after undergoing endonasal transsphenoidal pituitary tumor resection surgery. Methods: This retrospective case series study included 110 patients (212 eyes) who with visual
field defect underwent endonasal transsphenoidal pituitary tumor resection at the Fifth People's Hospital of Shanghai Fudan University between January 2013 and February 2016. Preoperative scans of the pituitary Time-Dependent Characteristics and Prognostic Factors of Visual Field Improvement in Patients after Endonasal Transsphenoidal Pituitary Tumor Resection were made by computed tomography or magnetic imaging resonsance. Preoperative eye examinations
included visual acuity, refraction, slit-lamp examination, fundus examination, intraocular pressure measurement, and central static visual field perimetry with a Humphrey-750i perimeter. Visual fields were measured again 1 week after surgery. Thirty patients (45 eyes) with visual field improvement and complete 3, 6, and 12 months follow-up data were analyzed for visual field improvement tendency. The mean deviation (MD) was used to quantify the visual field defect. Univariate analysis and multivariate logistic regression analysis for the prognostic factors of postoperative visual field improvement were carried out with SPSS 24.0 statistical software. Results: In the 30 patients with complete follow-up data, there was significant improvement in the postoperative visual field at 1 week after surgery, but the rate of improvement gradually declined over time. One patient experienced a pituitary tumor recurrence 12 months after surgery.There were significant differences in preoperative best corrected visual acuities (F=17.025, P < 0.001),preoperative MD absolute values (F=37.580, P < 0.001), preoperative full superotemporal quadrant visual field defects (χ2=17.459, P < 0.001), optic chiasm compressions (χ2=11.296, P=0.004), and maximum tumor diameters (F=13.197, P < 0.001) among the normal, improved, and unimproved postoperative visual field groups. Multivariate logistic regression analysis indicated that preoperative best corrected visual acuity (BCVA) (β=2.241, P=0.011, OR=9.406), preoperative MD absolute value (β=0.195, P < 0.001, OR=1.215), preoperative full superotemporal quadrant visual field defect (β=1.614, P=0.002, OR=5.024), and the maximum tumor diameter (β=0.512, P=0.023, OR=1.668) were the relatively independent prognostic factors for postoperative visual field improvement. Conclusions: After endonasal transsphenoidal pituitary tumor resection surgery, the visual field improvement was greatest at 1 week. Preoperative BCVA, preoperative MD absolute value, preoperative full superotemporal quadrant visual field defect, and the maximum tumor diameter were the relatively independent prognostic factors for postoperative visual field improvement.

Objective: To measure the choroidal thickness of patients with primary angle closure (PAC) before and after Nd:YAG laser peripheral iridotomy (LPI) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT); and to compare the difference between the choroidal thickness of patients with PAC and normal subjects. Methods: This was a prospective cohort study. Thirty patients (48 eyes) who were diagnosed with PAC were selected as the PAC group in the ophthalmology clinic of Shaoxing People's Hospital from October 2015 to February 2017. Thirty patients (50 eyes) undergoing regular physical examination were selected as normal controls in our hospital during the same period. Intraocular pressure and central anterior chamber depth were measured in the normal control group and PAC group before LPI, and 1 week, 1 month, 3 months and 6 months after LPI. Choroidal thickness was measured with EDI-OCT at the subfovea, as well as at 0.5, 1.5 and 3.0 mm from the fovea superiorly,inferiorly, temporally, and nasally. Repeated measures ANOVA was used to compare data between the two groups at different time points, and to plot the choroidal thickness of the receiver operating characteristic curve to determine the best diagnostic limits. Pearson correlation analysis was used to assess the correlation among choroidal thickness, intraocular pressure and central anterior chamber depth. Independent t test was used to compare between the two groups. Results: The central anterior chamber depth of the PAC group was more shallow than that of the normal control group (t=-14.383, P < 0.001). The difference in central anterior chamber depth was statistically significant before LPI and 1 week, 1 month, 3 months and 6 months after LPI (F=10.313, P=0.001). And the central anterior chamber depth of the PAC group became deeper from preoperation to 3 months postoperation (P < 0.01). The choroidal thickness of the PAC group was greater than that of the normal control group at 13 points before LPI (all P < 0.01). The difference in choroidal thickness was statistically significant before and after LPI (F=240.512, P < 0.001). The choroidal thickness of the PAC group at 1 week, 1 month, 3 months and 6 months after LPI was significantly thinner than that at pre-operation (P < 0.001). The choroidal thickness of all subjects in the two groups was negatively correlated with the depth of the central anterior chamber at SF, T1, T2, T3, S2, S3, I1, I2 and I3 (r=-0.249, -0.239, -0.416, -0.330, -0.184, -0.176, -0.189, -0.184, -0.160, P < 0.001). There was no correlation between choroidal thickness, intraocular pressure or axial length. Conclusions: The choroid in patients with PAC is thicker than in the normal group. The choroid in PAC patients became thinner after LPI surgery. Choroidal thickening may be one of the pathogenic factors of PACG. In addition, choroidal thickness plays a role in the early diagnosis of PAC and the disease observation and assessment of the
therapeutic effect of LPI.

Objective: To study ablation error and its central corneal thickness variations in patients with myopia after small incision lenticule extraction (SMILE), and to investigate the influence of low, moderate and high myopia on central corneal ablation error. Methods: This was a retrospective case-control study. Sixty-one myopic patients (a total of 120 eyes) who had undergone SMILE surgery from January 2017 to August 2017 at the Eye Hospital of Wenzhou Medical University were chosen for the study. Data were organized by refractive status into low (24 eyes, -0.50 D≤low myopia≤-3.00 D), moderate (54 eyes, -3.00 D < moderate myopia ≤-6.00 D), and high (42 eyes, high myopia > -6.00 D) myopia groups. The central corneal thickness (CCT) of patients undergoing SMILE was measured by the Sirius anterior segment analysis system preoperatively and postoperatively at 1 month and 3 months. Among different myopia groups, the ablation error was calculated simultaneously during each visit and was defined as the difference (△CCT) between actual central corneal ablation thickness (A-CCT) and the predicted central corneal thickness (P-CCT). The difference ratio of △CCT (defined as △CCT/P-CCT) and the relationship (in diopters) between △CCT, CCT, and ablation diameter were analyzed. Data were analyzed with a paired-samples t-test, ANOVA, Kruskal-Wallis H test, and Pearson correlation analysis. Results: Among the three myopia groups, results for A-CCT were all less than the P-CCT, and the differences in △CCT between any two groups were found to be statistically significant (F=21.047, 35.100, all P < 0.001). No significant difference was found in the difference ratios of △CCT among the three groups. The △CCTs of the low, moderate, and high myopia groups were -8.9 ± 5.0 μm, -15.6 ± 6.2 μm, -21.4 ± 5.9 μm, respectively. The differences between A-CCT and P-CCT were significant (t=8.67, 18.50, 23.65,P < 0.001). Moreover, there were significant correlations both in the relationship of corneal ablation error with preoperative refractive status and ablation diameter after SMILE surgery (r=0.649, 0.384, all P < 0.001). However, SMILE surgical ablation error and preoperative corneal thickness had a negative correlation (r=-0.219, P=0.016). Conclusions: A-CCT in low, moderate and high myopia groups after SMILE surgery is less than the predicted thickness. △CCT increases as the degree of myopia increases. There are significant differences in △CCT between different myopia groups, nevertheless the difference ratio of △CCT basically remains consistent.

Objective: To determine the effect of different ablation depths on the curative effect after small incision lenticule extraction (SMILE). Methods: A total of 116 eyes (58 patients with anisometropia) that underwent SMILE were included in this retrospective study from April 2016 to July 2017 in Ningbo Yinzhou People's Hospital. The deeper ablated eye in each patient was assigned to Group A, while the contralateral eye was assigned to Group B. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), higher-order aberrations (HOA), and other parameters were recorded preoperatively and at 1 day, 1 week, 1 month, and 6 months postoperatively. The average preoperative corneal curvature, axial length, corrected intraocular pressure, and expected ablation depth were recorded, while the actual ablation depths were calculated. The data were analyzed by repeated measurement ANOVA, paired samples t-tests, Pearson correlation analysis, and linear regression analysis. Results: The mean safety index and the mean effective index were greater than 1.0 in both groups 6 months postoperatively. Mean postoperative SEs were both within the range of ±0.5 diopter (D). The increases of corneal total higher-order aberrations
(t=3.747, P=0.001), spherical aberration (t=3.308, P=0.002), and vertical coma (t=3.507, P=0.001) in Group A were all higher than in Group B at 1 month postoperatively. Two cases of diffuse lamellar keratitis occurred in Group A while three occurred in Group B. All were cured by glucocorticoid treatment. The
deviations between the expected and actual ablation depths in Group A were greater than that in Group B (t=4.250, P<0.001). The deviation between the expected and actual ablation depths was correlated with the expected ablation depth (r=0.397, P<0.001), axial length (r=0.350, P=0.002), and SE (r=-0.308, P=0.007).
Using multiple linear regression, the following relationship was determined: D=0.171×expected ablation depth -8.201, where D was the deviation between the expected and actual ablation depths. Conclusions:Within the range of indications, ablation depth did not affect the safety, stability, or effectiveness of SMILE
surgery. However, the deeper the expected ablation depth was, the more corneal total HOA, spherical aberration, and vertical coma were introduced after surgery, and the worse the predictability of ablation depth was. The predictability of ablation depth was weakly correlated with expected ablation depth axial
length, and preoperative SE.

Objective: To report clinical observations of secondary corneal amyloidosis (SCA) related to trichiasis diagnosed and treated at Qingdao Eye Hospital. Methods: In this retrospective series of case study, medical records of 7 patients with trichiasis-related SCA from January 2014 to December 2015 were reviewed. Patient age, gender, history of disease, clinical manifestation, diagnosis methods, treatments, and histopathological results were analyzed. The depth of amyloid deposition in the corneal stroma was examined with optical coherence tomography (OCT) or ultrasound biomicroscopy (UBM). Results: The patients were 5 males and 2 females, age 11-86 years. All patients had a history of trichiasis. The common characteristics of the corneal lesions were a unilateral and well-circumscribed mass, with an irregular and mulberry-like surface, protuberant from the corneal surface at the position irritated by trichiasis. OCT or UBM showed Descemet's membrane was uninvolved in all cases. Lamellar keratoplasties were performed for 3 patients, and 1 patient underwent lesion excision combined with amniotic membrane covering. For the other 3 patients, the entropion and trichiasis were corrected with surgeries, but the mass was not resected because visual acuity was not obviously affected. Amorphous eosinophilic materials, with positive Congo red stain and apple-green birefringence beneath the epithelium were revealed by histopathology.Conclusions: SCA related to trichiasis typically presents a unilateral, well-circumscribed, irregular, and mulberry-like mass protuberant from the corneal surface at the position irritated by trichiasis.

Objective: To compare the retinal nerve fiber layer thickness and the central foveal thickness in children with hypermetropic astigmatism amblyopia or simple hypermetropic amblyopia. Methods: Children and teenage (n=147) with monocular anisometropic amblyopia who were admitted to the Ophthalmological Vision Care Centre of Zaozhuang Municipal Hospital from January 2015 to December 2016 were enrolled in this case control study. The included eyes were divided into three groups according to their refractive states: Group B were unilateral simple hypermetropic amblyopic eyes (75 eyes); Group C were unilateral hypermetropic astigmatism amblyopic eyes (72 eyes) and Group A were the healthy contralateral eyes of Group B and Group C (147 eyes). The thicknesses of retinal nerve fiber layer and the central fovea were measured by optical coherence tomography. Statistical analysis of the data was performed by ANOVA. Results: The thicknesses of the retinal nerve fiber layer in Group A, Group B, and Group C were 105 ± 10 μm, 113 ± 10 μm, and 119 ± 14 μm respectively. The central foveal thickness of each group was 190 ± 25 μm,201 ± 23 μm, and 209 ± 24 μm respectively, with significant differences between groups (F=14.241, 16.179,all P < 0.001). The thicknesses of the retinal nerve fiber layer and central fovea were larger in both Groups B and C than in Group A (all P < 0.001 for each thickness). The thicknesses of the nerve fiber layer and the fovea in Group C were larger than in Group B (P < 0.001 for each thickness). Conclusions: The thicknesses
of the retinal nerve fiber layer and the macula central fovea of eyes with hypermetropic astigmatism amblyopia were significantly greater than in eyes with simple hypermetropic amblyopia.

Objective: To observe the efficacy and safety of implantable collamer lens (ICL) replacement by phakic posterior chamber intraocular ICL. Methods: The research was based on the retrospective analysis of seven high myopia patients (10 eyes) who underwent ICL V4c replacement after phakic posterior chamber intraocular collamer lens implantation with a V4c centra flow lens in Chongqing  Aier Ophthalmology Hospital from April 2015 to March 2016. The replacement was performed
because the vault size after the original lens implantation was less than 100 μm. All patients were followed for 6 months. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA),vault, corneal endothelial cell density (ECD), pupil diameter, intraocular pressure (IOP), and lens opacities were observed. Repeated measures analysis of Variance and paired t-test were used to analyzed the data pre- and post-operation. Results: The UCVA (LogMAR) before the original ICL implantation was 1.52±0.29. Before the ICL replacement, the UCVA was 0.02±0.08, and at six months after replacement, the UCVA was 0.00±0.08. The difference was significant (F=230.08, P<0.001).The UCVA and BCVA at 6 months after ICL replacement surgery improved compared to the values
before lens replacement (P<0.05), but compared with before ICL replacement the difference was not statistically significant. Compared to BCVA ICL implantation before, UCVA 6 months after ICL replacement surgery equal to or better than BCVA before ICL implantation for all 10 eyes. Prior to replacement of the original lens, the vaults were 74 ± 25 μm. At six months after replacement, the vaults were 410 ± 175 μm (t=5.93, P<0.001), which was close to normal. There were no significant differences in ECD, pupil diameter, or IOP before the original implantation, before ICL replacement, and at the postoperative 6-month time. No cases of lens opacities occurred, and no serious complications were detected during the follow-up. Conclusions: For cases where the vault after phakic posterior chamber intraocular collamer lens implantation is too low, ICL replacement surgery is effective, but the long-term safety needs further observation.

The technologies of virtual reality (VR) and augmented reality (AR), which are considered as a cross-discipline subject in the computer, photology and ophthalmology fields, has expanded rapidly in recent years. There has been an increase in clinical applications, especially for the optometric field. To further promote the development of related research, the application and research progress of virtual reality and augmented reality technology in medical education, surgical assistance, disease diagnosis and treatment are reviewed.