Refractive development archives can be used to understand the underlying development of myopia and further seek effective strategies for prevention and control of the current “myopia boom” in China. Because the crystalline lens plays an important role in the process of human eye emmetropization during childhood,we suggest that crystalline lens refractive parameters be added into the refractive archives. Furthermore, a long-term, comprehensive and standardized longitudinal cohort study is encouraged to clarify the growth patterns of the crystalline lens power is encouraged. This information has unique importance in exploring the association between the crystalline lens and the visual feedback mechanism.

Objective: To demonstrate the changes in posterior corneal curvature after femtosecond laser LASIK with different corneal hysteresis (CH) measurements in high myopia. Methods: This was a prospective study. One hundred and three patients (206 eyes) were collected from January 2014 to January 2015 at the First Affiliated Hospital of Harbin Medical University, and were divided into two groups according to CH: group A (CH<9.6) and group B (CH>9.6). The changes in posterior corneal curvature were obtained by an analysis at pre-operation and postoperative 1 month, 3 months, 6 months and 12 months. Data were analyzed with t-test and repeated measure ANOVA. Results: One hundred patients (200 eyes) finished the study at last. There were 54 patients in group A and 46 patients in group B. The posterior corneal curvatures of group A at postoperative 1 month, 3 months, 6 months and 12 months were 6.37±0.09 D, 6.44±0.09 D,6.43±0.09 D, and 6.43±0.09 D, respectively. The differences were statistically significant between pre-operation and the different postoperative times (F=104.11, P<0.001). There was a statistically significant difference between 1 month and 3 months (P<0.05), but no significant differences between 3 and 6 months or 6 and 12 months. The posterior corneal curvatures of group B at postoperative 1, 3, 6 and 12 months were 6.29±0.08 D, 6.36±0.09 D, 6.37±0.09 D, and 6.37±0.09 D, respectively. There were statistically significant differences between pre-operation and all of the different postoperative times (F=138.05,P<0.001). There was a statistically significant difference between 1 month and 3 months (P<0.05), but no significant difference between 3 months and 6 months or 6 and 12 months. There were statistically significant differences between group A and group B after surgery in the values of posterior corneal curvature at different time points (t=4.78, 4.39, 3.56, 3.17, P<0.05). Conclusions: Presurgical corneal hysteresis influences the effect of femtosecond laser LASIK on posterior corneal curvature. CH can be set as the index to clinically evaluate the safety of femtosecond laser LASIK.

Objective: To assess the repeatability of central corneal thickness (CCT) measurements in adolescents and children using the Corvis ST and to examine the agreement between Corvis ST and SS-1000 swept-source optical coherence tomography (SS-1000 OCT). Methods: In this case series study, 44 children who visited the Eye Hospital, Wenzhou Medical University, from January to April of 2015 were enrolled. The age range was between 8 to 14 years old. The subjects were myopic without any other disease. CCT measurements were obtained first with the Corvis ST and then with SS-1000 OCT. The data of the right eyes was analyzed. An intraclass correlation coefficient (ICC), Bland-Altman plots and repeated-measures analysis of variance (ANOVA) were used to assess the repeatability of the Corvis ST. Paired t-tests and Bland-Altman plots were used to compare the agreement between the two devices. Results: The mean ICC of the Corvis ST was 0.987. Bland-Altman plots showed agreement between any two of three measurements (95% limits of agreement was -15.6~16.2 μm, -15.7~13.4 μm, -16.0~13.1 μm, respectively). No statistical significance was found with repeated-measures ANOVA. The mean values of CCT acquired from Corvis ST and SS-1000 OCT were 553±29 μm and 540±28 μm. CCT measured by the Corvis ST was 13 μm thicker than that by SS-1000 OCT (t=-6.037, P<0.001). The 95% limits of agreement were -15.2~41.6 μm for these two devices. Conclusions: The Corvis ST shows excellent repeatability of CCT measurements in healthy children’s eyes. Though there is a good agreement between the two devices for CCT measurements,there are significant differences between them. The measurements acquired by Corvis ST should not be directly interchangeable with SS-1000 OCT measurements in clinical practice.

Objective: To study the effects of small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK) on corneal densitometry (CD) after refractive correction for myopia. Methods:This was a retrospective non-randomized cohort study. Ninety patients (172 eyes) underwent refractive surgery from July 2016 to November 2017, in which 45 patients (86 eyes) underwent SMILE and the other 45 patients (86 eyes) underwent FS-LASIK. The CD data was calculated automatically by the Pentacam system before surgery and 3 months after surgery. For CD analysis, the average CD in the three concentric radial zone centered on the apex of the cornea (0-2 mm, 2-6 mm, 6-10 mm diameters) were divided into three layers that were defined according to different corneal depths (the anterior 120 μm as the 1st layer,the posterior 60 μm as the 3rd layer, and the center part between them as the 2nd layer). The overall CD of the cornea was also measured. A covariance analysis was used to compare the CD between the two groups,and a Wilcoxon test was used to compare the CD within groups. A Spearman test was used to analyze the relationship between the change in CD and CCT, IOP, corneal curvature and SE. Results: In the SMILE group, CD after surgery was lower than before surgery and differences were significant (all P<0.05), except for the 2nd layer in the 0-2 mm range (Z=-1.956, P=0.051). In the FS-LASIK group, CD after surgery was lower than before surgery and differences were significant (all P<0.05). Except for the 0-2 mm 1st and 3rd layer (Z=-2.927, P=0.003; Z=-2.261, P=0.024), the diffrences were not significant for other radial zone and layers. When the changes in CD were compared between the two groups, there were no statistically significant differences for the 3rd layer in the 6-10 mm range (F=1.808, P=0.181), the 3rd layer (F=3.281, P=0.072), and the total layer (F=3.666, P=0.057). The rest had statistically significant differences (all P<0.05), and the CD of the SMILE group was lower than that in the FS-LASIK group. Conclusions: Both SMILE and FS-LASIK decrease corneal densitometry, and they have similar effects on total corneal densitometry.

Objective: To compare early changes in dry eye after femtosecond lenticule extraction (FLEx) and small incision lenticule extraction (SMILE). Methods: Twenty-eight subjects (56 eyes) underwent FLEx and 33 subjects (66 eyes) underwent SMILE in this prospective non-randomized study at the Refractive Center of Hainan Eye Hospital and Key Laboratory of Ophthalmology from February to October 2014. Ocular surface disease index (OSDI), Schirmer Ⅰ test (SⅠT), noninvasive tear breakup time (NIBUT), and tear meniscus height (TMH) were evaluated at 1 day, 1 week and 1 month after surgery but corneal fluorescein staining (FL) was measured only at 1 week and 1 month postoperatively in all patients. Concentrations of interleukin-1α (IL-1α) and tumor necrosis factor-α (TNF-α) in collected tears were assessed by multiplex antibody microarray at 1 day, 1 week and 1 month after surgery in both groups. Data were analyzed using repented measured ANOVA. Results: The NIBUT of the FLEx group was shorter than that of the SMILE group (P=0.029) and the FL scores of FLEx were worse than that of the SMILE group (P=0.037) at 1 week after surgery. OSDI scores of both groups were better than baseline levels (all P<0.001). There were no significant changes found in OSDI, SⅠT and TMH between the FLEx and SMILE groups. Higher tear concentrations of IL-1α were found in the FLEx group than that in the SMILE group (P=0.019). There was no significant difference in tear concentrations of TNF-α between the two groups. Conclusions: The early dry eye in the SMILE group was milder than in the FLEx group.

Objective: To analyze refractive status and visual acuity and its relationship to binocular visual function in children with anisometropic amblyopia. Methods: A total of 106 children (106 eyes) with anisometropic amblyopia were recruited from November 2015 to September 2016 in nine hospitals in Beijing. All children were divided into the following groups based on risk factors for anisometropia: hyperopia anisometropia(67 cases), myopia anisometropia (5 cases), astigmatism anisometropia (12 cases), hyperopia combined astigmatism anisometropia (20 cases) and myopia combined astigmatism anisometropia (2 cases). Visual acuity, uncorrected and best corrected visual acuity, refractive status, and distant/near stereoscopic vision were tested. Pearson's correlation was used to analyze the correlation between dioptric differences and UCVA/BCVA in high refractive errors eye and distant/near stereoscopic vision. The correlation between BCVA difference of the two eyes and distant/near stereoscopic vision were also calculated. One-way ANOVA compared BCVA in high myopic eye and distant/near stereoscopic vision between groups.Results: There was a correlation for the dioptric difference between UCVA and BCVA, distant stereoscopic vision, and random dot stereograms (RDS) stereoscopic vision in high refractive errors (all P<0.05).There was a significant correlation between the difference in BCVA and distant stereoscopic vision and RDS stereoscopic vision (all P<0.05). There was a statistically significant difference between the five groups for BCVA, distant stereoscopic vision and RDS stereoscopic vision (F=6.221, 5.271, 3.622, 3.647,3.464, P<0.05). Visual acuity for high refractive error eye in the myopia anisometropia group was best compared to the other four groups. The differences were statistically significant between each group (all P<0.05). Distant stereoscopic vision in the hyperopia anisometropia group was best compared to the other four groups. The differences were statistically significant between each group, except hyperopia combined astigmatism anisometropia and myopia combined astigmatism anisometropia groups (all P<0.05). RDS stereopsis in the myopia anisometropia group was best compared to the other four groups. The differences were statistically significant between each group (all P<0.05). Conclusions: Visual acuity and stereoscopic vision are correlated to the dioptric difference. Stereoscopic vision is significantly correlated with the difference in BCVA. Stereoscopic damage is different in patients based on the type of anisometropia.

Objective: To evaluate the changes of peripapillary and macular retinal vasculature parameter in nonarteritic anterior ischemic optic neuropathy (NAION) patients. Methods: In this case-control study,eighteen consecutive patients (18 eyes) who were clinically diagnosed with atrophic NAION (at least 3 months after onset of symptoms) between October 2017 and June 2018 were included. Twenty healthy outpatient patients (20 eyes) with normal eye examination were selected as the control group. The optic nerve head and macular was scanned by optic coherence tomography angiography (OCTA) for all subjects.The following parameters, including peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell complex (GCC), whole en face image vessel density (wiVD) of the radial peripapillary capillaries (RPC), peripapillary RPC vessel density (ppVD), superficial capillary plexus (SCP), deep capillary plexus (DCP), and parafoveal vessel density (pfVD) were measured. Multi-factor regression analyses were used to analyze the effects of blood flow parameters on the incidence of NAION, LogMAR BCVA, pRNFL and GCC. Pearson correlation between ppVD and pRNFL was analyzed. Results: Compared with the control group, pRNFL thickness, RPC wiVD and ppVD of the NAION group were significantly reduced (t=-6.567,-6.958, -6.668, P<0.001) and the SCP wiVD, DCP wiVD and GCC thickness were significantly reduced (t=-6.226, -2.760, -6.340, P<0.001). NAION development was related to ppVD (b=0.502, OR=1.653,P=0.045). The LogMAR BCVA of the NAION group was related to SCP wiVD (b=-0.726, P=0.003), the pRNFL thickness was related to ppVD (b=0.883, P=0.001), and significant correlations were also found between ppVD and pRNFL thickness in the superior and inferior sectors (r=0.946, P<0.001; r=0.680,P=0.031). Conclusions: OCTA provided detailed visualization of the peripapillary and macular retinal capillary rarefaction predominating near larger vessels, correlated with visual acuity loss and pRNFL thickness thin in affected eyes of NAION whose disease course was more than 3 months. The sparser the ppVD of the affected eye is, the more likely NAION is to develop, and the poorer visual acuity is correlated with thinner pRNFL and sparser of SCP wiVD.

Objective: To assess the factors associated with low visual acuity after orthokeratology lens removal and the efficacy of myopia control. Methods: This was a retrospective study. Children who were examined and followed up for at least 6 months at Tongren Eye Care Center during April 2015 and January 2017 were enrolled in the study. Participants were divided into two groups based on their uncorrected visual acuity (UCVA) after removing orthokeratology lenses. Age, visual acuity, refraction,intraocular pressure, corneal curvature, e value, corneal diameter, pupil diameter, and axial elongation were compared between groups. Univariate and multivariate regression analysis were conducted to assess the factors associated with visual acuity. Results: Fifty children (96 eyes) participated in the study, with 52 eyes in the group with UCVA≤0.8 and 44 eyes in the group with UCVA>0.8. Mean age was 10.6±2.4 years. At baseline, mean spherical refraction was -3.62±1.18 D; mean cylinder refraction was -0.33±0.43 D; mean axial length was 25.18±0.75 mm. Using univariate analysis, and worse visual acuity was associated with longer axial length (b=-0.09, β=-0.29, P=0.003), higher spherical refraction (b=0.07, β=0.36, P<0.001), and higher cylinder refraction (b=0.12, β=0.22, P=0.030) at baseline. Using multivariate linear analysis, worse visual acuity was only associated with higher spherical refraction (b=0.05, β=0.27, P=0.018) at baseline. Axial elongation was 0.07±0.15 mm in the group with VA≤0.8 and 0.11±0.15 mm in the group with VA>0.8, the difference was not significant. Conclusions: Longer axial length and higher spherical refraction are the main factors associated with visual acuity after orthokeratology lens removal. Despite worse visual acuity, myopia control is still effective.

Objective: To investigate the changes due to wearing long-term overnight orthokeratology lenses on the stability of tear film as measured by different diagnostic devices. Methods: This was a prospective clinical study. One hundred eighteen patients, who were treated with orthokeratology lenses at The Fourth Affiliated Hospital of the China Medical University from January 2016 to October 2017, were included in the study. The patients’ ages ranged from 8 to 18 years (11.8±2.5). Measurements of tear meniscus height (TMH), noninvasive first breakup time [NIBUT (f )] and noninvasive average breakup time [NIBUT (av)] in each subject were obtained with a Keratograph 5M. Measurements were taken before lens wear and 1, 3, and 6 months after lens wear. The lipid layer interference patterns of the lacrimal film were divided by the DR-1 Tearscope Plus. Data were analyzed by repeated measures analysis of variance and by Pearson correlation analysis. Results: 1. Tear meniscus height: The TMH results showed a consistent but not statistically significant difference before and after wearing orthokeratology lenses. 2. NIBUT(f) and NIBUT(av): NIBUT had decreased by the time of the l-month visit (P<0.001); after that, all of the above changes decreased slightly and then stabilized. 3. Grades of tear film quality. There was a decrease in the stability of tear film from before lens wear to 1 month after lens wear (P<0.001), but there were no significant grade differences at 3 months and 6 months compared to prior measurements. 4. There was a small correlation between the variation in the lacrimal film lipid layer interference patterns and the BUT measured by different diagnostic devices during the follow-up study (r=-0.145, P=0.011; r= 0.147,P=0.019). Conclusions: Wearing contact lenses does not induce tear deficiency. It can result in decreasing the stability of tear film during the early stages of lens wear, but stability is gradually restored after that. Oculus keratography and DR-1 Tearscope Plus can assist in the diagnosis of dry eye diseases at different levels.

Objective: To analyze the etiology and related factors of destructive ophthalmic surgeries, including enucleation of the eyeball, evisceration and orbital exenteration. Methods: The medical records of 676 patients (676 eyes) who underwent ophthalmic destructive procedures were reviewed retrospectively from July 2011 to September 2017 at the Eye Hospital, Wenzhou Medical University. There were 437 males and 239 females; aged from 7 months to 90 years old, and the causes of the operation and its distribution were analyzed. Results: In 676 cases, 230 cases were enucleation, accounting for 34.0%; 426 cases were evisceration, accounting for 63.0%; 20 cases were orbital exenteration, accounting for 3.0%. There were 31 children younger than 12 years old, among them, 18 cases of enucleation and 2 cases of orbital exenteration due to retinoblastoma. There were 430 cases of adults aged from 19 to 60 years old. Ocular trauma related diseases were the first cause, about 219 cases. There were 191 elderly patients over the age of 60. Keratitis and cornea related diseases (57 cases) and glaucoma (51 cases) were the main causes. And in older patients, removal of orbital contents was a common cause of eyelid malignancy. Conclusions: In different age groups, the main causes of unilateral blindness are different. Therefore, the emphases of the promotion of preventive health care knowledges and treatment priorities should be different among different age groups.

Objective: To analyze the ocular surface status in meibomian gland dysfunction patients after cataract surgery. Methods: This was a prospective study. We studied 83 eyes of 67 meibomian gland dysfunction patients who were treated in the Ophthalmology Department of Shanghai Pudong Hospital from January 2015 to January 2017 underwent phacoemulsification and intraocular lens implantation were studied and analyzed preoperatively and at 1 month, 2 months and 3 months postoperatively. Ocular symptom scores, lid margin abnormalities, corneal fluorescein staining (CFS), tear film breakup time (BUT),Schirmer Ⅰ test (SⅠT), and lower tear meniscus height, depth, and area using Fourier domain optical coherence omography were measured. Statistical methods are repeated measures of variance analysis. Results: The ocular symptom scores were worse at 1 month, 2 months and 3 months postoperatively (F=1193.031,P<0.001). BUT decreased postoperatively (F=21.042, P<0.001). However, lid margin abnormalities,CFS, lower tear meniscus (height, depth and area) and the SⅠT did not change significantly postoperatively.Conclusions: A worsening of ocular symptoms may occur without accompanying obvious structural changes in meibomian gland dysfunction patients after cataract surgery.