Objective: To evaluate and compare the methodological quality of the glaucoma clinical practice  guidelines (CPGs) and to provide references and recommendations for glaucoma guidelines. Methods: The  Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess the seven  guidelines, including the AAO's Preferred Practice Pattern (PPP) in Primary Angle Closure (AAO-PAC),  the AAO's PPP in Primary Open-Angle Glaucoma (AAO-POAG), the AAO's PPP in Primary Open-Angle  Glaucoma Suspect (AAO-POAGS), the EGS's Terminology and Guidelines for Glaucoma (EGS), ICO  Guidelines for Glaucoma Eye Care (ICO), and Asia Pacific Glaucoma Guidelines (APGG) and Consensus  of Glaucoma: China (CG). Domain scores were compared and intraclass correlation coefficients (ICCs)  and 95% confidence intervals (CI) were calculated. Results: The ICCs of the seven guidelines were above 0.9. In general, all the appraised guidelines scored favorably in domain 1 (Scope and Purpose) and domain  4 (Clarity of Presentation), whereas the other domains scored less favorably. The average scores of six  domains involved in the included guidelines were 84%±19% (domain 1, Scope and Purpose), 37%±18%  (domain 2, Stakeholder Involvement), 25%±25% (domain 3, Rigor of Development), 90%±16% (domain 4,  Clarity of Presentation), 34%±10% (domain 5, Application), 40%±34% (domain 6, Editorial). The six  domains' respective scores for AAO-POAGS were 99%, 42%, 61%, 97%, 41%, 77%, and for Consensus  of Glaucoma: China were 47%, 4%, 8%, 57%, 17%, 0%. Conclusions: AAO-POAGS were strongly  recommended among the seven guidelines. There was much room for Chinese glaucoma guidelines to  improve in formulating more rigorous guidelines.

Objective: To investigate the functioning of the anterior chamber angle after combined surgery in the  treatment of the chronic phase of acute angle-closure glaucoma with cataract. Methods: A retrospective  analysis was performed on 37 patients (37 eyes) in the chronic phase of acute angle-closure glaucoma  with cataract who were treated in the glaucoma center of Henan Provincial People's Hospital from  November 2017 to March 2018: All patients were treated with drugs after an acute attack for 3-14 days;  preoperative intraocular pressure (IOP) was higher than 21 mmHg; gonioscopic examination: angle closure  >2 quadrant; ultrasound biomicroscopy (UBM): Anterior chamber shallow, peripheral iris root and trabecular  meshwork attachment range >2 quadrant; lens nuclear turbidity ≥Ⅲ. All patients underwent conventional  double-incision surgery combined with trabeculectomy, phacoemulsification cataract extraction, intraocular  lens implantation, and angle separation. No anti-metabolite drugs were used during the surgery. The  scleral flap was tightly closed with an adjustable suture. The best corrected visual acuity (BCVA), IOP,  central anterior chamber depth, angle opening range and filtration bleb formation were observed before  and after surgery. The Wilcoxon test, analysis of variance, paired t test and Pearson correlation were used  to analyze the observation index. Results: At 7 days after surgery: The mean IOP was 18.8±1.7 mmHg,  which was significantly lower than IOP before surgery (t=16.562, P<0.001); filtration blebs were observed  in 15 patients. At 1 month after surgery: The mean IOP was 15.5±1.8 mmHg, which was significantly  lower than IOP before surgery (t=20.529, P<0.001); only 5 patients had functional filtering blebs. A half  year after surgery: The average IOP was 14.9±2.4 mmHg, the IOP of 23 patients was <16 mmHg, and  14 patients were between 16-20 mmHg, which was statistically significant compared with preoperative  IOP (t=24.458, P<0.001); UBM: All patients had a reopening range of >2 quadrants after surgery, and  there was no correlation between postoperative IOP and preoperative anterior angle (r=0.016, P=0.926);  the depth of the central anterior chamber was deeper than before surgery (t=-25.195, P<0.001); the  postoperative BCVA of 33 patients was improved compared with BCVA before surgery, the BCVA of  4 patients did not improve, the difference in BCVA before and after surgery was statistically significant  (Z=-5.017, P<0.001); 5 patients had functional filtering blebs formation in the upper conjunctiva,  32 patients had no obvious filtering blebs after surgery, ultrasound biomicroscopy also confirmed that no  effective filtering blebs formed under the conjunctiva. Conclusions: For patients in the chronic phase of  acute angle-closure glaucoma with cataract, combined trabeculectomy plus cataract surgery plus angle  separation can effectively reduce intraocular pressure. The decrease in intraocular pressure is likely to  depend on the recovery of the function of the trabecular meshwork, rather than to rely on the establishment  of an external filtration channel.

Objective: To evaluate the accuracy of the quantitative measurement of iris curvature by Rhinoceros and to  assess the changes iniris curvature in primary angle closure suspect after laser periphery iridectomy (LPI).  Methods: This was a prospective study. Sixteen patients (16 eyes) with primary angle closure suspect  (PACS) who planned to undergo LPI treatment in Taizhou Municipal Hospital were selected. The anterior  segment images of different axes were captured by Allegro Oculyzer. The curvature radius of the anterior iris surface was quantitatively measured by Rhinoceros 5.0. The repeatability of image capturing and image  measurement was assessed. The iris curvature of the patients with PACS was compared before and after  LPI. Sixteen normal persons (16 eyes) matched for age, sex, and pupil size were selected as the control  group. The iris curvature was compared between the PACS and control groups. The correlation between  iris curvature and central anterior chamber depth, anterior chamber volume and peripheral anterior chamber  depth at 6 mm in the PACS group were analyzed. The correlation between changes in iris curvature  and central anterior chamber depth, anterior chamber volume, and 6 mm peripheral anterior chamber  depth before and after LPI treatment were also analyzed. A paired t test, independent t test and Pearson  correlation coefficient were used for statistical analysis. Results: The coefficient of variation of anterior  segment image capturing was 3.02%. The coefficient of variation of anterior segment image measurement  was 2.54%. The radius of the iris curvature in the PACS group was 7.81±1.63 mm, which increased to  9.20±2.22 mm after LPI (t=-9.45, P<0.001). The radius of the iris curvature in the control group was  9.99±4.00 mm. The difference between the PACS group and control group was statistically significant  (t=-5.69, P<0.001). After correction for the central anterior chamber depth, there was a correlation between  the iris curvature radius in the direction of 0° (r=0.879, P<0.001), 90° (r=0.684, P=0.005), 180° (r=0.619,  P=0.014), 270° (r=0.740, P=0.002) and the peripheral anterior chamber depth at 6 mm in the corresponding  directions. After the treatment with LPI, except for the direction of 270° (r=0.453, P=0.078), there was a  correlation between the changes in iris curvature in the direction of 0° (r=0.693, P=0.003), 90° (r=0.560,  P=0.024), 180° (r=0.580, P=0.019) and the changes in peripheral anterior chamber depth at 6 mm in the  corresponding directions. Conclusions: This quantitative measurement of iris curvature has good accuracy  and repeatability. It can be used for the early diagnosis and quantitative evaluation of the therapeutic effect  of PACS.

Objective: To evaluate the clinical significance of self-monitoring 24-hour intraocular pressure (IOP) in  primary open angle glaucoma (POAG) patients with medical treatment. Methods: This was a case series  study. Forty-two POAG patients who had acceptable clinic IOP reading controlled by medicine were  selected in shenyang Aier Eye Hospital from August 2017 to January 2019, and divided into group A (IOP:  12.86±1.40 mmHg) and group B (IOP: 17.82±1.40 mmHg) based on the baseline IOP. All participants  were trained to use the iCare HOME rebound tonometer to measure 24-hour IOP at home by themselves  after certification. 24-hour IOP values was obtained every 2 hour starting from 7:30. The IOP was measured immediately in sitting position after waking up during 23:30 to 5:30. The observation indices included mean  IOP, peak IOP and IOP fluctuation amplitude in different periods. The timing of peak IOP and the proportion  of patients changing treatment were counted. One-way ANOVA, Kruskal-Wallis H test, t-tests and χ2  test were  used to analyze the data. Results: There was no significant difference among the mean IOP measured in the  period of clinic, office hours and 24-hour (F=1.314, P=0.271). The peak IOP during 24-hour was higher than  that during office hours and that during the clinic period (H=-40.979, -51.363, all P<0.001). 83.6% of the  patients' peak IOP occurred outside the office hours (86.5% in group A and 80.6% in group B), especially in  the night, with a proportion as high as 67.1% (64.9% in group A and 69.4% in group B). The 24-hour IOP  fluctuation of all patients, as well as the patients in group A and group B, were higher than that during office  hours (t=11.166, 8.110, 7.929, all P<0.001). 63.0% patients' 24-hour IOP fluctuation was greater than or equal  to 8 mmHg (51.4% in group A, 75.0% in group B). 49.3% patients' clinical management was changed based on  the result of self-monitoring 24-hour IOP, and the changing proportion in group B (63.9%) was higher than that  in group A (35.1%) (χ2 =6.035, P=0.014). Conclusions: Self-measurement of 24-hour IOP in POAG patients  with medical treatment would identify IOP peaks and fluctuations missed in routine clinical practice, which can  be used as an important evidence for clinician to evaluate therapeutic effects and adjust clinical management.

Objective: To evaluate the 24-hour efficacy of tafluprost on the reduction of intraocular pressure (IOP)  in patients with primary open angle glaucoma (POAG) and ocular hypertension (OHT). Methods: In this  case-series study, a total of 43 eyes of 22 newly diagnosed patients with POAG and OHT from Shengyang  Aier Eye Hospital were enrolled. All patients were trained to use an Icare HOME tonometer to measure  IOP by themselves. For the certificated patients, aphysician used GAT to measure their IOP three times, and  then the patients used Icare HOME to measure 24-hour IOP by themselves. Patients was given tafluprost  once a day at 2100. Icare HOME was used by the patients themselves to measure 24-hour IOP again one month later. A one-way ANOVA and Bland-Altman analysis were used to compare the consistency  of the GAT used by a physician and the Icare HOME used by patients to measure IOP. A paired t test was  used to compare IOP at each time point, the mean, the peak, the valley and the fluctuation of 24-hour IOP  before and after treatment with tafluprost. Results: The mean IOPs measured with GAT by a physician and  Icare HOME by patients were 18.2±3.7 mmHg (1 mmHg=0.133 kPa) and 17.4±4.2 mmHg, respectively,  with no statistically significant difference (F=0.837, P=0.363). Bland-Altman analysis showed that there  was a good consistency between GAT measured by a physician and Icare HOME measured by patients.  IOP decreased at all time points of assessment after 1 month (all P<0.05). The range of IOP reduction at  different time points was 1.8 to 5.5 mmHg (all P<0.05). The mean, the peak, the valley, and the fluctuation  of IOP at baseline were 19.4±5.0, 25.0±5.8, 14.1±4.5 and 10.9±3.8 mmHg, respectively, and were reduced  to 15.6±4.2, 20.4±4.5, 11.3±3.6 and 9.2±2.9 mmHg after treatment (t=9.450, 9.636, 5.939, 3.137, all  P<0.05). Conclusions: Tafluprost provides effective 24-hour IOP reduction in newly diagnosed patients  with POAG and OHT.

Objective: To investigate the effects of inter-arm systolic blood pressure differences (IASBPD) on visual  field progression in primary glaucoma patients with controlled intraocular pressure. Methods: In this  prospective clinical study, 69 primary glaucoma patients (69 eyes) who had visited Changsha Aier Eye  Hospital from August 2013 to November 2018 and who had at least 5 reliable visual reportson file were  selected. According to the guided progression analysis (GPA) of the Humphrey Field Analyzer, subjects  were divided into two groups, the visual field progression group and the non-progression group. All of the  patients underwent multiple sets of sequential blood pressure measurements on both arms. A student t test,  Fisher's exact test and logistic regression analysis were used for data analysis. Results: Thirty-four patients  (34 eyes) were included in the analysis, among which 15 patients (15 eyes) were in the progression group and the other 19 patients (19 eyes) were in non-progression group. The IASBPD of the two groups was  10.6±9.0 mmHg (1 mmHg=0.133 kPa) and 5.3±2.8 mmHg, respectively, and IASBPD in the progression  group was 5.26 mmHg (95% credibility interval: 0.14-10.37 mmHg) higher than that in the non-progression  group (t=-2.177, P=0.045). There were no significant differences in pulse pressure, mean arterial pressure,  or diastolic ocular perfusion pressure between the two groups (t=0.946, -1.118, -1.967, all P>0.05).  Logistic regression analysis showed that an IASBPD of ≥10 mmHg was a risk factor for visual field  progression (OR=20.310, P=0.022). Participants were also stratified into two groups with an IASBPD of  <10 mmHg (n=26) and ≥10 mmHg (n=8). The rates of visual field progression for the two groups were  30.8% and 87.5%, and rates of retinal nerve fiber layer thickness progression were 42.3% and 87.5%,  respectively (P=0.011, 0.030). Conclusions: Increased IASBPD may be one of the risk factors for visual  field progression in primary glaucoma patients with controlled intraocular pressure.

Objective: To study the effects of light/dark adaptation times on flash electroretinograms in normal adult  cynomolgus monkeys. Methods: In this experimental study, three adult cynomolgus monkeys were  selected and stimulated with standard electroretinogram (ERG) parameters after dark adaptation for 20 min,  40 min and 60 min. The scotopic-ERG was recorded using aroutine procedure. After dark adaptation for  40 min, the photopic-ERG was recorded for 1 min, 5 min and 10 min. One-way ANOVA was used to compare  the amplitude and latency. Results: There was no significant difference in the latencies of a and b waves  and OPs in the scotopic-ERG (F=0.052, P=0.949). When the dark-adaption time was less than 40 min, the  amplitudes of the a and b waves and OPs increased significantly as the adaptation time increased (F=50.800,  P<0.001). When the dark-adaptation time was more than 40 min, the amplitude reached the maximum and  no longer increased with time (F=0.016, P=0.899). For the photopic-ERG, the implicit times of the a and b waves were also unaffected by the length of the light-adaptation time (F=0.980, P=0.381). The amplitudes  of the a and b waves reached their maximum after 5 minutes of light adaptation (F=4.789, P=0.036) and  tended to be stable over time (F=0.135, P=0.717). Conclusions: In a certain period of time, the results of  flash ERG of cynomolgus monkeys are greatly affected by bright/dark time. So, the dark-adaptation time  for scotopic-ERG recording in cynomolgus monkeys should be at least 40 minutes, and the photopic-ERG  are best recorded after 5 minutes of light adaption.

Objective: To observe the characteristics of early macular microvascular changes in patients with systemic  lupus erythematosus using optical coherence tomography angiography (OCTA). Methods: This was a  retrospective series of case study. Thirty-one patients (62 eyes) who were diagnosed with SLE by the  Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University from May to  November 2018, were divided into a lupus retinopathy (LR) group of 10 patients (17 eyes) and a non-lupus retinopathy group of 24 patients (45 eyes). At the same time, 35 healthy subjects (35 eyes) who were  matched by age and sex with the disease groups were recruited as a control group. All subjects had  a 3 mm×3 mm area of the macula scanned by OCTA to obtain superficial and deep retinal microvascular  images of the macular area, and retinal blood flow density maps were skeletonized and analyzed  by a custom automated algorithm. The total annular zone (TAZ), with a diameter of 2.5 mm, was  obtained after excluding the foveal avascular zone (FAZ, 0.6 mm), and the superficial and deep retinal  skeletonized capillary densities (RCD) of the TAZ were further divided into 4 regions (S, T, I, N). In  addition, disease activity of the patients was assessed using the SLE disease activity index (SLEDAI).  Data analysis was performed using a t test and analysis of variance. Results: The RCD of the superficial  retinal capillary plexus (SRCP) were found to be significantly lower in the NLR and LR groups than  in the control group, and the LR group was even lower than the NLR group and the difference was  significant (P<0.05). In the deep retinal capillary plexus (DRCP), the difference between the three  groups was not as obvious as that in the superficial layer. Only the RCD of the LR group in the N region  was significantly lower than that in the NLR group (P=0.022), which were also lower than those in  the control group (P<0.05) except for the T region. In addition, the score of SLEDAI in the LR group was  significantly higher than in the NLR group (P=0.006), and the incidence of SLE complications such as lupus  nephritis and neuropsychiatric SLE were higher in the LR group (50% vs. 25%, 10% vs. 4% respectively).  Conclusions: OCTA can effectively detect early changes in macular microvascular morphology in the  patients with SLE. In patients with SLE without significant fundus and visual impairment, the RCD of  SRCP is significantly altered, suggesting that it may be used as an early biomarker for monitoring SLE  retinal damage.

Objective: To investigate the effect of overnight orthokeratology (OOK) on the ocular surface and changes  in meibomian gland morphology in children and adolescents with myopia. Methods: In this prospective  cohort study, choosing myopia children from the Second Affiliated Hospital of Zhejiang Chinese Medical University, sixty myopic patients (60 eyes) with OOK were selected as the OOK group, and 60 patients (60  eyes) with eye glasses were selected as the glasses group. The following tests were performed before OOK  and eyeglass wear and after 1, 3, 6 and 12 months of wear. Tests included ocular surface disease index  (OSDI) questionnaire, noninvasive tear break-up time (NIBUT), tear meniscus height (TMH), corneal  epithelial staining (CSF), and meiboscore using noncontact meibography. The effect of OOK wear on the  ocular surface and changes that occurred were evaluated and summarized by comparing the differences  between these two groups. Results: There were no significant differences in the OSDI score or tear  meniscus height between these two groups. The NIBUT of the OOK group showed a significant decrease  after 6 and 12 months of lens wear (both P<0.05). There were no statistically significant differences at other  time points. Corneal fluorescence staining in the OOK group increased after wearing the lenses (χ2 =19.511,  P=0.013), but there were no statistically significant differences at the other time points. The score of the  meibomian gland orifice in the OOK group was slightly increased before wearing the lenses and after 1, 3  and 6 months, but the differences were not statistically significant. The final 12 months were significantly  higher than before wearing eye glasses and 1 month after wearing eye glasses, and the difference was  statistically significant (P<0.05). Conclusions: It is relatively safe to wear OOK lenses overnight. Shortterm wear of OOK will not cause discomfort and it will not reduce tear meniscus height or the amount of  tear secretion in the short term, however, it reduces the stability of the tear film and increases the corneal  fluorescence staining score. OOK lens wear affected meibomian gland function. In particular, the upper  meibomian gland changed first.

Objective: To establish a correlation model between static refraction and the main refractive parameters  of children aged 3-12 years. Methods: This cross sectional study was divided into two parts. In part  one, in Changsha Aier Eye Hospital from July 2014 to June 2016, 245 children were randomly selected  and measurements were taken of their axial length (AL), corneal curvature (Km) and anterior chamber  depth, spherical equivalent refractive (SE) and calculated lens power (LP). The correlations between  refraction and the refractive parameters were analyzed to establisha correlative mathematical model. In part two, in Changsha Aier Eye Hospital from July to December 2016, 43 children were randomly  selected to measure the above refractive parameters and their cycloplegic refraction (SEmeasured). The lens  power and static refraction (SEcalculated) were calculated. The consistency between SEmeasured and SEcalculated was compared by Bland-Altman analysis. Results: The correlation model was established as follows:  The correlation coefficients between SE and AL, Km and LP were -0.95, -0.83 and -0.62, respectively  (all P<0.001). SE=110.56-2.51×AL-0.97×Km-0.44×LP (R2 =0.95, F=2534.52, P<0.001). There was a  significant correlation between SEmeasured and SEcalculated (r=0.97, P<0.001), the 95% limit of agreement was  -1.00-0.63 D, average error was -0.19 D (95% consistency limit: -0.28 to -0.10 D), and 81.40% of the  data points were within the clinically acceptable range (-0.55 to 0.55 D). Conclusions: The axial length is  the most important factor in refraction besides corneal curvature and lens power. The refraction correlation  model can accurately estimate the static refraction of children from 3 to 12 years old.

Objective: To explore the clinical application value of a preset marking line in lacrimal endoscopic surgery  and evaluate its effect on surgical complications. Methods: This was a prospective analysis of clinical  data from 60 patients (60 eyes) with lacrimal duct obstruction who had lacrimal endoscopic surgery in  Changshu No.2 People's Hospital from June 2015 to December 2018. All patients were divided into two  groups, a control group or observation group according to the even or odd numbers assigned to hospital patients. The control group (odd numbers) had no intra-surgery preset marking line. The observation group  (even numbers) had an intra-surgery preset marking line. The complications of lacrimal duct mucosa injury,  hemorrhage, perforation (false passage), eyelid edema and postoperative hemorrhage were observed and  recorded. The data were analyzed by a Chi-square test. Results: In the observation group, the number  of preset marking lines could be clearly observed during surgery, and combined with the position of the  lacrimal endoscope, could be determined by the anatomical characteristics of the lacrimal passage. One  marker line could be observed in the lacrimal canaliculi. The convergence of two marker lines could  be observed in the common canaliculus. Two marker lines with an enlarged space could be observed in  the lacrimal sac. Two marker lines with mucosal folds could be observed in the nasolacrimal duct. The  incidence of lacrimal mucosal injury was 16% (χ2 =8.543, P=0.003), hemorrhage incidence was 13%  (χ2 =8.718, P=0.003) and eyelid edema incidence was 10% (χ2 =4.069, P=0.044) in the observation group,  which were significantly lower than the incidences in the control group (52%, 52% and 35%, respectively).  One case of perforation (false passage) occurred in the control group, which was not statistically significant  compared with the observation group (χ2 =0.001, P=0.973). There was no statistically significant difference  in the incidence of postoperative hemorrhage between the groups (χ2 =1.898, P=0.168). Moreover, all  patients in the two groups had a small amount of hemorrhage, which did not affect the operation after  intraoperative water injection. Patients with a small amount of postoperative hemorrhage stopped bleeding  within 2 days. Conclusions: The application of preset marking lines for lacrimal endoscopic surgery can  better control the endoscopic examination and surgery, and can accurately identify the location site of the  surgery, which can reduce the incidence of surgical complications.

A series of ophthalmic changes can occur after astronauts enter the microgravity environment. If these  changes are not intervened or treated in a timely manner, it will cause long-term or permanent visual  impairment to astronauts, which will not only affect the execution of flight missions, but also threaten the  personal safety of astronauts. Although the precise mechanism of these ophthalmic changes in astronauts  is still unclear, related studies have found that when astronauts enter the microgravity environment, there  is intracranial pressure elevation, nervous system changes, biochemical changes, and lymphoid and venous  circulation disorders, which may be involved in the occurrence and development of the disease. This  paper summarizes these ophthalmic changes over a period of the last 50 years at home and abroad and  their possible mechanisms after astronauts enter the microgravity environment. We want to identify the  preventive and treatment measures for these ophthalmic changes, and provide relevant theoretical support  for the screening and training of astronauts.