Objective: To evaluate the effect of ultraviolet A/riboflavin corneal crosslinking (CXL) on keratoconic  patients with a corneal thickness less than 400 μm. Methods: In this prospective study, patients with  keratoconus were divided into a thin cornea group with a corneal thickness (CT) less than 400 μm and a  thick cornea group with a CT more than 400 μm. The patients in the thin and thick cornea groups were  treated with a hypotonic or isotonic riboflavin solution before and during CXL. Corneal morphological  parameters were evaluated before and after CXL during a 3-year follow-up. The data were analyzed with a  repeated measures ANOVA, t test, Wilcoxon rank sum test or Mann-Whitney U test. Results: After surgery,  the maximum keratometry (Kmax) of the thin and thick cornea groups underwent a continuous decrease  (F= 24.364, P<0.001; F=10.427, P=0.001). In the thin group, the Kmax value was 60.51±6.11 diopters  (D) before surgery and significantly decreased to 57.43±6.82 D, 56.13±6.85 D and 54.97±6.66 D at 1, 2  and 3 years after surgery (t=3.670, P=0.002; t=4.637, P<0.001; t=5.816, P<0.001). In the thick group, the  Kmax value was 54.56±6.27 D before surgery and significantly decreased to 53.25±6.42 D, 52.32±6.47  D and 51.58±6.70 D at 1, 2 and 3 years after surgery (t=2.266, P=0.040; t=3.302, P=0.005; t=3.769,  P=0.002). The Kmax value of the thin cornea group before surgery was higher than that of the thick  cornea group (t=2.714, P=0.011). There were no significant differences in Kmax between the two groups  at 1 year, 2 years or 3 years. In the thin group, there were significant differences between the preoperative  and 3-year postoperative visual acuity (UCVA), best corrected visual acuity (BCVA) and thinnest corneal  thickness (TCT) (Z=-2.716, P=0.007; Z=-3.063, P=0.002; t=4.468, P<0.001). In the thick group, there  were significant differences between the preoperative and 3-year postoperative UCVA, BCVA and TCT  (t=3.572, P=0.003; Z=-2.956, P=0.003; Z=-3.410, P=0.001). In the two groups, there were no significant  differences between the preoperative and 3-year postoperative intraocular pressure (IOP) or endothelial cell  density (ECD). There were no significant differences in pre- or postoperative UCVA, BCVA, IOP, or ECD  between the two groups. There were significiant differences in pre- and postoperative TCT between the two  groups (Z=-4.816, P=0.001; Z=-4.024, P<0.001). Conclusion: CXL is an effective and safe way to halt  disease progression and improve visual acuity in keratoconic patients with a CT less than 400 μm.

Objective: To evaluate the characteristics of posterior corneal astigmatism (PA) in cataract patients with  high myopia. Methods: In this series of case study, 215 eyes of 215 patients from Shanxi Eye Hospital  were recruited from January to June 2018 and divided into a high myopia group (94 patients, 94 eyes) and  a control group (121 patients, 121 eyes). PA, total corneal astigmatism (TA) and simulated keratometric  astigmatism (KA) were measured by arotating Scheimplfulg camera (Pentacam HR). The error produced  by TA using KA was calculated with vector and arithmetical analysis. Data were analyzed by t test and  correlation analysis Results: In the high myopia group, the mean magnitude of the pa was -0.33±0.20 D,  and exceeded 0.5 D in 30.8%. The steepest meridian was vertically aligned in 79.6% of the cases. In the control group, the mean magnitude of the PA was -0.31±0.18 D. There was no significant difference in PA  between the high myopia group and the control group (t=0.589, P=0.557). In the high myopia group, the  vector error between KA and TA was (0.12±0.21) D@4°. There was a correlation between the magnitude  of PA and KA, PA and Km (KA), and PA and Km (PA) (r=0.340, P=0.001; r=0.285, P=0.006; r=0.333,  P=0.001). For KA>0.5 D patients, the difference in magnitude between ta and Ka significantly increased  with an increase in the magnitude of pa（r=0.235, P=0.004). Conclusion: There was no significant  difference in PA between the high myopia group and the control group. In the high myopia group,  neglecting PA may lead to an incorrect estimate of ta. Personalized PA should be considered in patients  with Toric intraocular lens implants.

Objective: To investigate the role of Th17, Th1 and regulatory T cell (Treg)-related pro-inflammatory  cytokines on postoperative inflammation in children with juvenile idiopathic arthritis (JIA). Methods: This was a retrospective case-control study. Serum from 32 children with JIA and 35 controls with congenital  cataract in Inner Mongolia Autonomous Region People's Hospital from July 2013 to March 2018 were  ennolled before surgery and 1, 7, 30 and 90 days after surgery, and aqueous humor (AqH) was collected  at the commencement of surgery. Protein levels of inter leukin-1 beta (IL-1β), IL-6, IL-10, IL-23, IL- 27, IL-17 and IFN-gamma in serum and AqH were determined by the multiplexed immunoassay method.  A laser flare-cell photometer was used to quantify intraocular inflammation. Repeated measurements  of variance was used for statistical analysis of data. A Spearman correlation coefficient test was used to  evaluate the correlation between the protein levels of IL-6, IL-23, IFN-gamma in serum and AqHand  intraocular inflammation in JIA patients. Results: Serum IL-1β (106±27 pg/ml), IL-6 (305±82 pg/ml),  IL-10 (202±114 pg/ml), IL-23 (612±190 pg/ml), IL-27 (110±43 pg/ml) and IFN-gamma (172±43 pg/ml)  levels were significantly higher in children with JIA when compared to control patients after the first day  postoperatively, decreased rapidly, and attenuated gradually. AqH levels of the cytokines were below  the detection level in children with JIA and controls. Notably, the following serum levels were strongly  correlated with aqueous flare values in children with JIA: Serum IL-6 levels (r=0.085, P=0.002), serum  IFN-gamma levels (r=0.741, P=0.021), serum IL-23 levels (r=0.622, P=0.028). Serum IL-6 levels (r=0.729,  P=0.006), and serum IFN-gamma levels (r=0.669, P=0.019) correlated with aqueous cells. Serum IL-23  levels were not correlated with AqH in children with JIA (r=0.646, P=0.051). Conclusion: The increase in  the number of Th17, Th1 and regulatory T cell related proinflammatory cytokines IL-6 and IFN-gamma can  reflect inflammation in JIA children's eyes after surgery. Serum IL-1beta, IL-10, IL-23 and IL-27 levels can  be used to evaluate postoperative intraocular inflammation.

Objective: To evaluate the clinical effect of diclofenac sodium combined with vitamin C to relieve  discomfort after transepithelial photorefractive keratometry (TPRK). Methods: In this randomized control  trial, seventy patients undergoing TPRK surgery were recruited from February to June 2018 and divided  into observation group and control group, with 35 patients in each group. The observation group was  treated with diclofenac sodium eyedrops combined with oral vitamin C, and the control group was treated  only with diclofenac sodium eye drops. Symptoms and signs were observed on day 1, day 3 and day 4  after surgery, and eye irritation symptoms were evaluated by a questionnaire, including pain, foreign body feelings, tearing, photophobia, and discomfort in blinking. The results were analyzed with an unpaired t test  and repeated measures ANOVA. Results: There were statistically significant differences between the two  groups (pain score: F=10.219, P=0.002; foreign body feelings score: F=8.637, P=0.005; tearing: F=5.108,  P=0.027. Repeated measures ANOVA). There were statistically significant differences for the above  scores between the two groups on day 0 and day 1 after surgery (all P<0.05), but no statistically significant  differences on day 2. The differences between the two groups were not statistically significant (photophobia  score: F=3.626, P=0.061; discomfort score in blinking: F=2.778, P=0.100). But there were statistically  significant differences between the two groups in the total discomfort score (F=7.785, P=0.001).  Conclusion: Diclofenac sodium combined with vitamin C can relieve pain after TPRK surgery and reduce  discomfort in patients.

Objective: To investigate and analyze the difference in angle Kappa measured by Pentacam and Keratron  Scout in refractive surgery patients. Methods: One hundred ninety-six eyes of 98 patients screened for  refractive surgery were enrolled in this case series study. Pupil diameters and angle Kappa expressed in  rectangular coordinates were measured by Pentacam and Keratron Scout. Data differences and correlation  between the two examinations were compared and analyzed by a paired t test and Pearson correlation  analysis. Results: Pupil diameters measured by Pentacam and Keratron Scout were 3.17±0.44 mm,  3.19±0.53 mm (right eye), and 3.25±0.65 mm, 3.33±0.48 mm (left eye), respectively. The differences between the two instruments were not significant. The horizontal and vertical offset measured by the two  instruments were not statistically different. There was a significant correlation in the offset of the angle  Kappa measured by the two instruments (P<0.05). The correlation coefficients of the right eye horizontal  offset, right eye vertical offset, left eye horizontal offset, left eye vertical offset were 0.966, 0.969, 0.956  and 0.913, respectively. Conclusion: There is no statistically significant difference between angle Kappa  measured by Pentacam and Keratron Scout when pupil diameters are consistent. Both instruments can be  used as a reference for the adjustment in angle Kappa in refractive surgery.

Objective: To evaluate the visual outcomes in children with primary congenital glaucoma (PCG) whose  intraocular pressure (IOP) was controlled after surgery and to analyze the risk factors for vision loss.  Methods: This was a retrospective case series that included 45 PCG patients (72 eyes) with an IOP≤21  mmHg following glaucoma surgery from June 2017 to February 2018 at Zhongshan Ophthalmic Center.  The following information was collected from medical records: Sex, laterality, age at presentation and at  initial glaucoma surgery, age at last visit, preoperative IOP, corneal diameter, axial length, type of initial  glaucoma surgery, number of surgeries, antiglaucoma medication before initial surgery and at the last visit,  best corrected visual acuity (BCVA), cup-disc ratio and retinal nerve fiber layer thicknessat the last visit, and ocular comorbidity. The BCVAs at the last follow-up were categorized into 3 groups: Good (≥0.4),  moderate (0.3-0.1) or poor (<0.1). Onivariate and multivariate analyses were performed to determine  the risk factors for visual imparirment (BCVA≤0.3). Results: At the last follow-up, the mean logMAR  BCVA was 0.61±0.60. A good BCVA was attained in 54%, moderate in 35% and poor in 11%. The mean  spherical equivalent of refraction was -4.07±4.94 D; myopia was the predominant refractive error (50%).  The most common ocular comorbidity was corneal opacity (36%). Age at presentation, medication before  initial surgery, age at initial glaucoma surgery, number of surgeries and corneal opacity were associated  with vision impairment (P<0.1). Multivariate logistic regression analysis showed that multiple surgeries  (≥2) (OR=6.252, 95%CI: 1.174-33.285, P=0.032) were associated with BCVA loss. Conclusion: Good  BCVA is attainable in about 50% of affected eyes. Multiple surgeries are the main risk factor of vision  impairment. Early diagnosis, prompt, effective treatment, and timely management of ocular comorbidities  and correction of refractive error safter surgery may reduce the rate of severe visual impairment.

Objective: To observe the clinical effects of intravitreal injection of conbercept combined with Ahemd  glaucoma valve implant and panretinal photocoagulation treatment for neovascular glaucoma (NVG).  Methods: In this retrospective case series study, 16 NVG patients (17 eyes), at the Number 986 Hospital  of the Air Force, were treated from June, 2017 to June, 2018 with intravitreal injection of conbercept  combined with Ahemd glaucoma valve implants and panretinal photocoagulation. The disappearance of  neovascularization, intraocular pressure (IOP) and best corrected visual acuity (BCVA) were compared  between preoperative and postoperative conditions. The data were analyzed by repeated measures  ANOVA. The IOP between preoperative and every follow-up was analyzed with independent sample t test. Results: After injection, neovascularization was greatly diminshed by 3 d, and completely vanished by 1  month. The preoperative IOP was 43.3±7.6 mmHg, and postoperative IOP was 14.8±4.8 mmHg, 13.7± 3.9 mmHg, 14.5±4.6 mmHg, 13.6±5.4 mmHg and 13.9±4.6 mmHg at 3 d, 7 d, 1 month, 3 months, and 6  months, respectively. There were no significant differences in IOP at different postoperative time points  (F=9.58, P=0.006). Compared with preoperative levels, there were significant differences at every followup (P<0.05). Compared with preoperative measurements, the BCVA of 5 eyes improved. Conclusions: Intravitreal injection of conbercept combined with Ahemd glaucoma valve implants and panretinal  photocoagulation is a safe and effective treatment for neovascular glaucoma.

Objective: To use Rasch analysis to analyze and refine the Chinese version of the Low Vision Quality of  Life Questionnaire (CLVQOL). Methods: The CLVQOL was completed by 189 low vision patients who  attended the Low Vision & Vision Rehabilitation Center of the Eye Hospital, Wenzhou Medical University  from January 2017 to December 2017. Mean age of the patients was 40.9±20.2 years, and the male/female  ratio was 1.6:1. Based on the score for each item, Rasch analysis was performed on CLVQOL using the  following steps: Dimensionality, response ordering, local dependence, infit and outfit analyses, differential  item functioning, and subject targeting by using the Winsteps software version 3.72.2. Results: The  CLVQOL contains four subscales. The eigen value of first contrast showed that the unexplained responses  in each dimension are all around 2; the single-dimension test is still acceptable. Response ordering in  each subscale showed options 2 and 4 were not clearly separated from their adjacent options. No notable local dependence was found for any subscale. According to the results of fit analysis, the mean square  infit value of Q24 was 1.55, the mean square outfit value of Q24 was 1.58, both out of the range of 0.60  to 1.40. Differential item functioning was noted for sex on Q24, with a contrast difference >5. Analysis of  targeting indicated relatively poor matches. The mean person in each dimension was higher than the mean  item except on subscale 3, and the test information of each dimension was relatively narrow. Conclusion:  The Rasch analysis of the CLVQOL shows that CLVQOL has a good degree of reliability and validity,  but the option response to each item must redesigned to fit Chinese low vision patients according to their  socioeconomic status.

Objective: To investigate the effect and complications of augmentation with a posterior fixation suture  in superior rectus transposition (SRT) for abducens nerve palsy. Methods: Two groups of patients with  abducens nerve palsy treated with either SRT combined with a posterior fixation suture (A-SRT group,  n=10) or SRT (SRT group, n=11) were analyzed retrospectively from March 2014 to January 2019 in  Xuzhou No.1 People's Hospital. Changes in esotropia, vertical deviation, cyclotropia, and improvements  in abduction and adduction limitation were compared between the two groups. The follow-up time was  10-12 months. The data were analyzed by a Wilcoxon rank sum test and Mann-Whitney test. Results: There were significant differences between the A-SRT and SRT groups in esotropia (Z=-2.940, P<0.001)  and abduction limitation (Z=-3.272, P=0.001). The variations in esotropia were 40.0° (36.0°-45.0°) in  the A-SRT group and 28.0° (25.0°-30.0°) in the SRT group and the variations in abduction limitation  were 2.0 (1.0-2.0) and 1.0 (1.0-1.0), respectively. There was no significant difference between the two  groups in adduction limitation (Z=-1.855, P=0.064) or vertical deviation (Z=-1.505, P=0.132). There  was a significant difference between the two groups in the variation of subjective in cyclotropia inspected  by adouble Maddox rod (Z=-2.228, P=0.026). There was an incyclotorsional shift of 3.0° (0.0°-4.25°)  in the A-SRT group and 0.0° (0.0°-2.0°) in the SRT group. But there were no complaints of rotational or  vertical discomfort in either group. Conclusion: In augmentation with a posterior fixation suture in SRT  for abducens nerve palsy, although there is a possibility of slight in cyclotropia or adduction limitation,  abduction limitation was optimally corrected and the correction of esotropic deviation in the primary  position was perfect without any obvious subjective complaints of vertical or torsional diplopia.

Objective: To design a visual handbook of texts containing reading material from daily life that can be  used for self-testing,to provide the effects of visual experience and presbyopic refraction, and to test if the  handbook contents can replicate the demands of daily life. Methods: There were two steps in designing  this manual of visual effects based on experience. First, a questionnaire was used to obtain frequently  used, readable materials from daily life. Two, the contents of the manual were based on the information  obtained in the questionnaires. The contents of the handbook were classified into 4 groups, and newspapers  books, electrical networks, instructions, and receipts. The materials of each group were arranged in  descending order according to the word size of the title, and then printed in color. Results: Two hundred  valid questionnaires were collected from adults (18 years and above), including 96 males and 104 females.  This visual handbook of texts covers 39 types of reading material from daily life, including newspapers,  magazines, telephone directories, short messages, receipts, introductions, etc. The handbook has a total  of 50 pages. Song, Regular, Black, and Official scriptare used for the fonts. The word size, wave length  and contrast range from 4 to 26 pt, 450 (blue) to 620 (red) nm, and 25% to 90% contrast, respectively. Conclusions: All the contents in this handbook came from reading material encountered in daily life,  and background images were added to each category so it was closer to real-life experiences. Hence, the  contents in this handbook can reflect the visual demands of daily life, and can be used to assess if the  subjects' visual acuity can satisfy these demands.

Objective: To analyze the data of femtosecond laser small incision corneal stroma lens extractions  (SMILE) performed in Aiyan Ophthalmology Hospital, summarize the intraopearative and postoperative  complications and treatment. Methods: From January 2018 to November 2018, SMILE surgery was  performed on 515 cases (1015 eyes) of myopia or astigmatism in Aiyan Ophthalmology Hospital in  this retrospective series of case studies. A retrospective analysis of the occurrence of intraoperative and  postoperative complications was performed. Results: The overall incidence of complications was 7.88%,  of which 2 eyes (0.19%) were negatively affected by negative pressure, scans showed 3 eyes (0.29%) had  black areas, 12 eyes (1.18%) had an incision tear, in 7 eyes (0.68%) the corneal stroma lens was difficult to  find, 5 eyes (0.49%) had a residual lens, 32 eyes (3.10%) had an epithelial defect from the incision, 5 eyes  (0.49%) had bleeding in the incision area, 10 eyes (0.98%) had diffuse lamellar keratitis, 1 eye (0.09%) had  an intersegmental epithelial implantation, and 3 eyes (0.29%) had the remains of foreign matter under the  corneal cap. Vision was restored after appropriate treatment for complications to achieve the best corrected  visual acuity. Conclusion: SMILE surgery as a new type of corneal refractive surgery for the treatment  of myopic astigmatism has few complications. Effective prevention and treatment of intraoperative and postoperative complications is essential for surgical safety.

Objective: To analyze the epidemiological features, laboratory examination methods and results and  prognosis of fungal keratitis, in order to provide evidence for the diagnosis and treatment. Methods: This  was a retrospective analysis review. The medical records of 412 cases (412 eyes) of fungal keratitis at  Jizhong Energy Xingtai Mine Industrial Group General Hospital from January 2012 to December 2017  were analyzed with Kruskal-wallis H and so on of for epidemiological characteristics, clinical signs,  etiology, diagnostic methods and results and prognosis, and the effect of treatment. Results: The peak  period of fungal keratitis occurred in September to December, which accounted for 61.2% (252/412) of the annual total number of patients. The patients were mainly farmers, which accounted for 59.5%  (245/412). One hundred eighty-five patients (44.9%) had an injury history related to plant injury, which  was the primary cause, followed by non-plant injury in 86 patients (20.9%). The ratio of male to female  was 1.82:1, the age was 14 to 81 years, the average age was 45.6±14.3 years, with 41-60 years accounting  for 53.9% (222/412). The positive rate of fungal cultures was 88.8% (366/412), which was higher than the  KOH wet-mount of 77.2% (318/412). The difference between the two detecting methods was statistically  significant (χ2 =31.14, P<0.001). The pathogenic bacteria were identified as follows: 167 cases (40.5%)  of fusarium, 75 cases (18.2%) of alternaria genus, 62 cases (15.0%) of aspergillus genera, and 28 cases  (6.9%) of penicillium. Typical clinical signs of fungal keratitis caused by mycelium moss were the most  common (366 cases, 88.8%), followed by pseudopodia (224 cases, 54.4%) and hypopyon (111 cases,  26.9%). The differences in the severity classifications and prognosis of fungal keratitis caused by fusarium  spp., alternaria spp., aspergillus spp. and penicilium spp. were statistically significant (Hc=40.676,  P<0.001; Hc=40.109, P<0.001), and the disease classifications in fusarium and aspergillus were heavier  than in alternaria and penicilliun. The prognosis was poor in alternaria and penicilliun. Conclusions: Fungal keratitis increases year by year, KOH wet-mount and fungal culture are effective diagnostic  methods and fungal culture results are more reliable. In the first few pathogenic fungi, fungal keratitis  caused by fusarium and aspergillus are serious, and the prognosis is not good, while cases of alternaria and  penicillium are relatively mild with a good prognosis.

The tear film covering the entire ocular surface is an important component of the ocular surface microenvironment. The disturbance of the homeostasis of the tear film can result in the dysfunction of other  ocular structures, which will exacerbate the development of ocular diseases. This article reviews recent  research progress on the effect of tear film on other components of the ocular surface, such as the ocular  epithelium, corneal stroma, corneal nerve and ocular microbiota to provide new ideas for the pathogenesis  and treatment of ocular surface diseases.