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Chinese Journal of Optometry Ophthalmology and Visual science
2018 Vol.20 Issue.11
Published 2018-11-25
Orignal Article
Case Report
Editorial
Review
Editorial
641
The Importance of Engineering Technology Research and the Transformation Application of Adaptive-Optics Optical Coherence Tomography
Hao Chen, Jinhai Huang, Rongrong Gao, Chaohong Li
Adaptive-optics optical coherence tomography (AO-OCT) was first reported in 2003 and has achieved great technological progress. Compared with traditional OCT, AO-OCT increases the imaging capability of OCT in ways that make it well suited for three-dimensional (3D) cellular imaging in the retina. It has been reported that it can achieve diffraction-limited retinal imaging with high resolution, and is being used to provide a new diagnostic and research tool in the field of ophthalmology. This article introduces the main research in engineering technology and transformation application of AO-OCT, which will deepen our understanding of AO-OCT.
2018 Vol. 20 (11): 641-647 [
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446
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Orignal Article
648
A Comparison of Axial Length Measurements with Swept-Source Optical Coherence Tomography Biometry and Partial Coherence Interferometry AL-Scan
Yifeng Li, Wenli Yang, Dongjun Li, Ziyang Wang, Wei Chen, Qi Zhao, Rui Cui, Lin Shen, Junfang Xian
Objective:
To compare a swept-source coherence tomography (SS-OCT) biometer (OA2000) with partial coherence interferometry (PCI) AL-Scan in terms of the axial length measurement success rate in eyes with cataract.
Methods:
A total of 378 eyes of 210 patients from the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University were included in this case series study from November 29th to December 15th 2017. The axial lengths of these eyes were measured with the two biometers and the axial length measurement success rates with the instruments were assessed. A paired
t
test was used to compare the difference in axial length measurements between the two instruments and a Pearson correlation analysis was used to assess the correlation between the two biometers. The intra-group correlation coefficient (ICC) and the Bland-Altman method were used to assess the agreement in axial length measurements between the two biometers. The sampled eyes were divided into three groups: axial lengths less than 22 mm, 22-26 mm and over 26 mm. The Bland-Altman method was used to assess the agreement in axial length measurements between these three groups.
Results:
The success rates of OA2000 and AL-Scan were 98.4% and 90.2%, respectively, with a statistically significant difference between the two (
χ
2
=56.19,
P
<0.001). The axial lengths measured with the two biometers were 24.532±2.678 mm and 24.526±2.679 mm, with a difference of 0.006±0.058 mm. The difference was not statistically significant (
t
=1.847,
P
=0.066). The axial length measurements were closely correlated (
r
=1.000,
P
<0.001), and the ICC was 1.000. The 95% agreement range for Bland-Altman analysis was 0.23 mm (-0.12-0.11 mm). The 95% agreement range for the three groups mentioned above was 0.20 mm (-0.10-0.10 mm), 0.20 mm (-0.09-0.11 mm) and 0.33 mm (-0.16-0.17 mm), respectively.
Conclusions:
The SS-OCT based OA2000 out performs the PCI based AL-Scan in terms of axial length measurements in eyes with cataracts. The correlation and agreement in axial length measurements with the two biometers were excellent, especially in patients with 22-26 mm axial length.
2018 Vol. 20 (11): 648-652 [
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463
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653
Measurement of Lenticular Decentration with the Coaxial Subject-Fixation Alignment Method in SMILE and Its Impact on Visual Quality
Shulin Wang, Chenjiu Pang, Bo Zhang, Shengwei Ren, Yuwei Gu, Lijuan Dai
Objective:
To measure lenticular decentration with the coaxial subject-fixation alignment method after femtosecond laser small incision lenticule extraction (SMILE), and to investigate its impact on visual quality.
Methods:
A total of 37 patients (74 eyes) with myopia and myopic astigmatism who underwent the SMILE procedure using the coaxial subject-fixation alignment method were included in the prospective study from August to October 2017 in Henan Provincial People's Hospital. Visual acuity, refraction, corneal topography and objective visual quality were measured. The Cartesian coordinate was established with the pupil center as the origin of the coordinate. Lenticular decentration was measured and calculated according to the offset value of the corneal topography and the video capture of the SMILE procedure. Patients were divided into groups based on lenticular decentration: group A (<200 μm), group B (200-300 μm) and group C (>300 μm). The modulation transfer function cutoff (MTF cutoff) was used to evaluate objective visual quality. Pre-op and post-op indexes were compared with a paired
t
-test and ANOVA, and the correlation of factors affecting the correction of astigmatism was analyzed by Spearman correlation.
Results:
Lenticular decentration was 223±108 μm and all treated eyes (100%) were within 500 (9-464)μm: group A (<200 μm) consisted of 32 eyes (43%), group B (200-300 μm) consisted of 26 eyes (35%), and group C (>300 μm) consisted of 16 eyes (22%). The mean value of the MTF cutoff preoperatively was 39.6±5.2 circle/degree (c/d), of which group A was 39.7±5.8 c/d, group B was 39.0±5.2 c/d, and group C was 40.2±3.9 c/d. The mean value of the MTF cutoff was 38.6±5.8 c/d one month after surgery: group A was 37.8±5.9 c/d, group B was 38.8±6.6 c/d, group C was 40.6±3.8 c/d, and there was no statistically significant difference among groups and between preoperation and 1 month postoperation in group C. There was a significant relationship between the MTF cutoff before and one month after the surgery (
r
=0.53,
P
<0.001). The vector distance that the lenticular center deviated from the pupil center was 209±104 μm, which was found to be associated with lenticular decentration (
r
=0.49,
P
<0.001).
Conclusions:
Although the coaxial subject-fixation alignment method in SMILE can cause slight lenticular decentration, it has no significant impact on visual quality after surgery.
2018 Vol. 20 (11): 653-658 [
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478
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659
Comparison of Agreement and Success Rate of Axial Length Measurement between IOLMaster700 and IOLMaster500 in Cataract Patients
Rui Cui, Wenli Yang, Dongjun Li, Ziyang Wang, Wei Chen, Qi Zhao, Yifeng Li, Lin Shen
Objective:
To compare the agreement and success rate of axial length (AL) measurement between IOLMaster700, a novel swept source biometer, and IOLMaster500, a traditional partial coherence interferometry (PCI) optical biometer.
Methods:
In this case series study, 840 age related cataract patients (840 eyes) were enrolled in Beijing Tongren Hospital from August to September 2017. AL measurement was performed using IOLMaster700 and IOLMaster500 respectively. The differences of success rates between the two instruments were compared by
χ
2
test. The differences of AL were compared by paired
t
test. The correlations and agreement were analyzed by Pearson correlation analysis and Bland-Altman analysis.
Results:
The success rate of IOLMaster700 and IOLMaster500 were 93.4% and 86.0%, respectively. There was significant difference between the two methods (
χ
2
=63.00,
P
<0.001). The AL measured by IOLMaster700 and IOLMaster500 were 23.38±1.02 mm and 23.35±1.01 mm, respectively, with a difference of 0.03±0.04 mm (
t
=-19.06,
P
<0.001). There was high correlation between two instruments (
r
=1.00,
P
<0.001). The 95% agreement range of Bland-Altamn analysis was 0.13 (-0.04-0.09)mm. The absolute value of the upper and lower limit was 0.09 mm.
Conclusions:
Correlation and agreement between IOLMaster700 and IOLMaster500 are very high for AL measurements. Compared with IOLMaster500, IOLMaster700 has better AL measurement efficiency.
2018 Vol. 20 (11): 659-662 [
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663
Characteristics of Macular Intra-Retinal and Choroidal Layers in Type 2 Diabetic Patients Studied with Optical Coherence Tomography
Yufei Wu, Fan Tan, Yue Zheng, Yuheng Zhou, Chaoming Wu, Meixiao Shen, Qi Chen
Objective:
To investigate the characteristic changes in the fine structure of the retinal and choroidal layers of type 2 diabetic patients using optical coherence tomography (OCT), and to provide an effective means for the early diagnosis and progress monitoring of diabetic retinopathy (DR).
Methods:
This case series study included 67 patients with type 2 diabetes at the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University from December 2015 to April 2017. The diabetic patients were divided into a diabetic without retinopathy (NDR) group of 40 cases (40 eyes), and a non-proliferative diabetic retinopathy (NPDR) group with 27 cases (32 eyes). In addition, the study enrolled 39 normal subjects (39 eyes) as a control group who were age, gender and refractive-error matched. Using RTVue-OCT, the macular region was scanned in radial mode and the 3D images of the retina and choroid were obtained from all subjects in a 6-mm area of the retina, which was divided into eight intra-layers using custom software. The 6-mm round was divided into three rings, including central, inner, and outer rings and the rings were further divided into nine regions (C, S1, T1, I1, N1, S2, T2, I2 and N2). Thickness data in each region was compared among the three groups by ANOVA.
Results:
There were no significant differences in the total retinal thicknesses among the three groups. The thickness of the retinal nerve fiber layer (RNFL) decreased in the NDR group in the C, N1, T1 and T2 regions compared to the control group (
P
<0.05). The membrane of the inner nuclear layer (INL) in the NDR group was thicker in S2 and T2, and it was even thicker in the NPDR group in the N1, I1, S2, T2, I2 and N2 regions (
P
<0.05) compared to the controls. The layer of the myoid and ellipsoid zone (MEZ) was thinner in the NPDR group compared to the control group in almost all regions except for the center (
P
<0.05). In addition, the choroid was significantly thinner in the NDR and NPDR groups in all nine areas compared to the control group.
Conclusions:
OCT can effectively detect the early changes in the fine structures of the macular retinal and choroidal layers. In patients with diabetes, extensive lesions in the choroid layer occur when DR has not been clinically diagnosed. It is speculated that choroidal thickness might be an effective indicator to predict early retinopathy in diabetic patients.
2018 Vol. 20 (11): 663-668 [
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669
Effect of Total Glucosides of Paeony on the Expression of Natural Killer T Cells in Livers of Experimental Autoimmune Uveitis Rats
Changying Jing, Jike Song, Beibei Wang, QingMei Tian, Xiaofeng Xie, Tao Zhang, Hongsheng Bi
Objective:
To investigate the effects of total glucosides of paeony (TGP) on natural killer T (NKT) cell gene expression in liver of experimental autoimmune uveitis (EAU) rats.
Methods:
Experimental study. Forty-five Lewis rats were randomly divided into three groups: normal controls, EAU-stimulated rats (model group), and EAU-stimulated rats treated with TGP (TGP intervention group). Control animals received an emulsion of phosphate-buffered saline (PBS) and CFA, which was injected subcutaneously. The other two groups were injected an equal volume of chylomicron containing interphotoreceptor retinoid-binding protein polypeptide (IRBP). Inflammation was observed by daily slit-lamp microscopy of the anterior segments after immunization. The incidence of inflammation and the inflammation scores were recorded. At 12 days after immunization, we extracted the eyes for pathologic examination, and CD4
+
T cells were collected from the livers. The expression levels of NKT cells were detected by flow cytometry. Reverse transcription polymerase change reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) were used to measure the gene and protein expression levels of interleukin (IL)-4 and interferon (IFN)-γ. Data were analyzed by one-way ANOVA.
Results:
Twelve days after immunization, the inflammatory score and pathological grade of the TGP group were significantly lower than in the EAU group, but higher than in the normal group. Flow cytometry showed that compared with normal control group, the number of liver NKT cells in the EAU group and in the TGP intervention group were significantly increased. Further, the increased in the number of NKT expression in the TGP intervention group was higher than in the EAU group (
P
<0.05) during the inflammatory phase. RT-PCR showed that on day 12 the expression of IFN-γ mRNA in the liver of the TGP intervention group was significantly higher than in the control group (
P
<0.001), but lower than in the EAU group (
P
<0.001). At the same time, the expression of liver IL-4 mRNA in the TGP group was lower than that of the normal group (
P
<0.001), but significantly higher than the EAU group (
P
<0.001). ELISA showed that the liver IFN-γ levels in the TGP group were significantly lower in the EAU group after 12 days (
P
=0.01). The concentration of liver IL-4 protein was higher in the TGP group than in the EAU group (
P
<0.001).
Conclusions:
TGP can treat uveitis in EAU rats by regulating the expression of liver IL-4 and IFN-γ genes and increasing the number of NKT cells.
2018 Vol. 20 (11): 669-676 [
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440
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Association between Daily Tea Consumption and Retinal Vascular Caliber
Xueping Zhang, Yin Hu, Na Liu, Keming Wang, Mingguang He
Objective:
To assess the association between daily tea consumption and retinal vascular caliber in Chinese people.
Methods:
In this cross-sectional study, 4 430 subjects aged 40 years or older without a history of cardiovascular events were enrolled. Standard retinal photos and a validated computer-based program were used to measure retinal vascular caliber. A self-report questionnaire was administrated to obtain data regarding tea consumption and other socio-demographic information. Daily tea consumption was quantified into five dose categories (never, occasionally, <1 cup/day, 1-2 cups/day and >2 cups/day) and three common tea types (green, oolong and black/Pu'er tea, according to the degree of fermentation). Multivariate linear regression models were adopted to assess the cross-sectional association of tea consumption with retinal vascular caliber.
Results:
The age of the study participants was 58.8±9.9 years. Among them, 775 (17.49%) never consumed tea and, 645 (14.56%), 1 240 (27.99%) and 1 770 (39.95%) were accustomed to green, oolong and black/Pu'er tea, respectively. Retinal vascular calibers were not associated with doses of tea consumption after adjusting for lifestyle factors and other cardiovascular confounders, whether analyzed in all participants or in subpopulations accustomed to distinct tea types (all
P
>0.05).
Conclusions:
There is no significant association between daily tea consumption and retinal vascular caliber in a Chinese population.
2018 Vol. 20 (11): 677-682 [
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375
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683
Alterations in Subfoveal Choroidal Thickness after Pars Plana Vitrectomy in Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment
Chao Feng, Yiqiao Xing
Objective:
To observe the changes in subfoveal choroidal thickness after pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD).
Methods:
This was a retrospective case control study. Thirty-five RRDCD patients whose retinas had been reset successfully after a single operation in the Eye Center, Renmin Hospital of Wuhan University from January 2016 to October 2017 were included in the study. The best corrected visual acuity (BCVA), intraocular pressure (IOP) and subfoveal choroidal thickness (SCT) were measured by optical coherence tomography (OCT) and recorded at 1 day, 1 week, 1 month and 3 months after the operation. Thirty-six patients with rhegmatogenous retinal detachment (RRD) whose retinas had been successfully reset served as the experimental control group and 40 patients from a normal population served as normal control group.
Results:
One day and 1 week after surgery, the SCTs in groups RRDCD and RRD were thicker than that of normal control group (1 day:
t
=9.220,
P
<0.001;
t
=6.826,
P
<0.001. 1 week:
t
=4.341,
P
=0.011;
t
=2.849,
P
=0.034), but there were no significant differences between the two groups overall. Three months after the operation, there was no significant difference in the SCT between the RRD group and the normal group (
t
=1.597,
P
=0.646), while the SCT in group RRDCD was thinner than that of both the normal and RRD groups (
t
=-3.144,
P
=0.028;
t
=-6.207,
P
=0.010). Correlation analysis showed that there was a positive correlation between SCT and BCVA in group RRDCD at 3 months after the operation (
r
=0.399,
P
=0.017). There was no significant correlation between SCT and BCVA in group RRD at 3 months after the operation (
r
=0.109,
P
=0.529).
Conclusions:
SCT become to be thin, and is related to BCVA can be used as a clinical indicator for evaluating the therapeutic effect of RRDCD.
2018 Vol. 20 (11): 683-687 [
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353
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688
Non-Infectious Posterior Scleritis: Clinical Analysis in a Series of 30 Patients
Zhizhang Dong, Yifeng Gan, Haihua Zheng, Mei Li
Objective:
Summarize the clinical features in posterior scleritis, to provide the basis for correct diagnosis and rational treatment in clinic.
Methods:
Retrospective interventional case series study. This study included 30 patients (40 eyes), average ± standard deviation age 35.2 ± 14.3 years, who were diagnosed from January 2007 to October 2016 at the Second Affiliated Hospital of Wenzhou Medical University and Zhongshan Ophthalmic Center of Sun Yat-sen University with non-infectious posterior scleritis. The medical history of all cases was documented, and the clinical features were recorded. The examinations included best corrected visual acuity, slit lamp examination, intraocular pressure, B-scan ultrasonography, and other routine eye and auxiliary examinations.
Results:
Posterior scleritis was unilateral in 20 cases and bilateral in 10 cases at presentation. Thirty-three eyes (83%) were painful and accompanied by vision loss. The visual acuity of 10 eyes (25%) was below 0.1, 13 eyes (32%) were between 0.1 and 0.6, and 17 eyes (43%) were between 0.6 and 1.2. The mean intraocular pressure was 13.2 ± 4.4 mmHg. Eighteen eyes (45%) had anterior uveitis, and 22 eyes (55%) had anterior scleritis. In the posterior segment, 22 eyes (55%) had optic disc swelling, 21 eyes (53%) had retinal phlebectasia, and 13 eyes (33%) had macular exudation detachment. Seven eyes (18%) had exudative retinal detachment, 3 eyes (8%) had macular stellate exudation, 3 eyes (8%) had choroidal detachment, 3 eyes (8%) had central retinal vein occlusion, and 2 eyes (5%) had a retinal or choroidal striae. B-scan ultrasound found increased thickness of the eyeball, with an average of 2.21 ± 0.85 mm. The posterior chamber had an annular hypoechoic with a typical T-sign.
Conclusions:
Non-infectious posterior scleritis exhibited some features in common with concurrent of anterior uveitis, disc swelling, retinal phlebectasia, macular exudation detachment, and retinal striae. B-scan ultrasound was the most useful diagnostic resource to confirm non-infectious posterior scleritis, with cases having the typical T-sign.
2018 Vol. 20 (11): 688-693 [
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390
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2345
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694
The Effect of Bandage Corneal Contact Lenses after Pterygium Surgery
Bing Xia
Objective:
To study the effect of bandage corneal contact lenses after pterygium surgery.
Methods:
This was a case-control study. Patients with an excised pterygium combined with autologous corneal limbal stem cell transplantation were selected at Tiantai People's Hospital of Zhejiang Province between February and June 2017. Patients were divided into two groups based on postoperative treatment: Experimental group was treated with autologous corneal limbal stem cell transplants combined with bandage corneal contact lenses, control group had routine treatment by covering the eyes after autologous limbal stem cell transplantation. There were 20 patients (20 eyes) in each group. After the operation, corneal irritation symptoms and healing time for the corneal epithelium were observed in the two groups. The data were compared using a
t
test, and a rank sum test.
Results:
The pain scores of the patients in the experimental group were significantly lower than the pain scores in the control group, and the difference between the two groups was statistically significant (2 hours postoperative:
Z
=-3.986,
P
<0.001; 1 day postoperative:
Z
=-3.153,
P
=0.002; 2 days postoperative:
Z
=-3.216,
P
=0.001; 3 days postoperative:
Z
=-2.377,
P
=0.017; 5 days postoperative:
Z
=-2.333,
P
=0.020). The recovery time for the corneal epithelium stained with fluorescein after surgery was clearly shortened in the experimental group, and the difference was statistically significant (
Z
=-3.714,
P
<0.001). No infection, recurrence, poor implant healing, subconjunctival cyst or other complications occurred after 2 to 6 months of follow-up.
Conclusions:
The application of bandage corneal contact lenses after pterygium surgery can relieve pain and irritation symptoms in patients, promote postoperative recovery, reduce the postoperative recurrence rate and improve postoperative quality of life.
2018 Vol. 20 (11): 694-697 [
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382
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Case Report
698
2018 Vol. 20 (11): 698-699 [
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473
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2270
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Review
700
Retrospection and Reflection on Eye Exercise School Policies and Their Evidence-Based Effects in the Context of Promoting Physical Activity
Youqiang Li
Beginning in 1963, the nature of the first set of eye exercises was not universally recognized during the nationwide popularization and promotion process. As a long-term implemented educational policy, the revised twice-daily eye exercises have undergone more than 50 years of development in our country. Current empirical research shows that there is no evidence that visual training, including eye exercises, can significantly curb the onset and progression of myopia; physical activity is a key factor in protecting the visual health of children and adolescents. For eye protection, the most important thing is to encourage them to go outdoors. In the context of promoting physical activity and its effect on the eye exercise policy, we should encourage empirical research, examine the effect of eye exercises on protecting children's vision, and explore the conversion of 10-minute eye exercises to moderate to vigorous physical activity time. It is important to promote physical activity as a comprehensive policy and not rely too much on eye exercises.
2018 Vol. 20 (11): 700-704 [
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182
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