Chinese Journal of Optometry Ophthalmology and Visual science

中华眼视光学与视觉科学杂志

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Chinese Journal of Optometry Ophthalmology and Visual science

	2020 Vol.22 Issue.5 Published 2020-05-25

	Orignal Article Case Report Review

Orignal Article

	321	A Treatise by Cheng Jinguo, Chief Physician, on the Treatment of Tic Disorders in Children Based on Chronic Infantile Convulsions
		Shengjin Xiang, Lewei Tang, Xiaohan Jiang, Na Tang, Jinguo Cheng
		Tic disorders are frequently sent first to the department of ophthalmology for consultation because of their clinical characteristics. Chief physician Cheng Jinguo believes that tic disorders in children, especially chronic tic disorders, Tourette's syndrome, and chronic infantile convulsions have the same etiology and pathogenesis in Chinese medicine. All of these have the basic pathogenesis of spleen deficiency and hyperactivity of the liver-YANG; the formation of phlegm and respiration are the main pathological manifestations. Tic disorders and convulsions are the specific forms. At the same time, Cheng Jinguo believes that the treatment of tic disorders can also be used to treat chronic infantile convulsions, either treating with a custom formula to soothe the liver and strengthen the spleen, eliminating phlegm and calming respiration, or a flexible formula based on the pathogenesis to achieve good results. This article summarizes the clinical features of tic disorders and the experience of chief physician Cheng Jinguo in treating the disease.
		2020 Vol. 22 (5): 321-325 [Abstract] ( 322 ) [HTML 1KB] [ PDF 764KB] ( 2513 )

	326	Treatment of Eye Diseases with Yang Sheng Therapy as Practiced by Professor Hu Zhen
		Na Tang, Xiaohan Jiang, Lewei Tang, Shengjin Xiang, Zhen Hu
		Yang sheng therapy is a commonly used treatment for ophthalmic diseases, which can be flexibly applied by reinforcing qi, invigorating the spleen, dispersing the liver, promoting blood circulation, diuresis, heat clearing, toning the kidney, etc. With clinical medications that include shengma, gegen, qianghuo, fangfeng, chuanxiong, chaihu etc. The curative effect has been obtained in the diagnosis and treatment of dry eye combined with blepharospasm, central serous chorioretinopathy, uveitis, and oculomotor nerve palsy. The experience of Professor Hu is summarized in treating ophthalmic diseases with clinical medication characteristics using Yang sheng therapy. It shows that Yang sheng therapy is widely used in traditional Chinese medicine in the treatment of ophthalmic diseases, and its effect is significant.
		2020 Vol. 22 (5): 326-332 [Abstract] ( 335 ) [HTML 1KB] [ PDF 9816KB] ( 2408 )

	333	Comparison of the Actual Optical Zones after SMILE and FS-LASIK for Myopia
		Wan Chen1,Li Li1,Shengxu Liu2,Yijun Hu2,Zheng Wang1, 2
		Objective: To compare the actual diameter, asphericity and higher order aberrations (HOAs) of the optical zone after small incision lenticule extraction (SMILE) and femtosecond-assisted laser in situ keratomileusis (FS-LASIK) using the SCHWIND Amaris1050 and WaveLight EX500 excimer laser platforms for myopia. Methods: This was a retrospective study that included 91 patients (113 eyes) from January 2018 to January 2019 in the Refractive Surgery Center, Guangzhou Aier Eye Hospital. The patients were divided into a SMILE group (42 eyes), an Amaris1050 (25 eyes) and and an EX500 group (46 eyes). The postoperative optical zone was measured using two different maps. A tangential curvature map was generated with a placido corneal topographer (Topolyzer) and a tangential curvature difference map was generated with a Scheimplfag tomographer (Pentacam) for each eye 1 month and 3 months after surgery. The Q value and HOAs were also obtained with the Topolyzer. The postoperative optical zone, Q-value and HOAs among the three groups were analyzed with a one-way analysis of variance with Bonferroni-adjusted post hoc comparisons. The optical zones measured with the two maps were analyzed with a paired-samples t test. Results: The mean optical zones measured on the two maps were 6.90±0.12 mm and 5.17±0.15 mm with SMILE, 6.58±0.19 mm and 5.00±0.10 mm with Amaris1050, 6.56±0.16 mm and 4.86±0.15 mm with EX500 at 3 months postoperatively. The postoperative optical zones of SMILE were larger than Amaris1050 and EX500 in both maps (P<0.001), the optical zone of Amaris1050 was larger than EX500 in the tangential curvature difference map (P=0.003); the optical zone measured in the tangential curvature map was significantly larger than in the tangential curvature difference map (t=64.836, 34.146, 63.927, P<0.001). The postoperative Q-values of the cornea in the 5 mm and 6 mm areas of SMILE were both smaller than Amaris1050 and EX500 (5 mm: P=0.017, 0.013; 6 mm: P=0.004, 0.005). No significant difference was found between Amaris1050 and EX500 (P=1.000). As for the postoperative HOAs of the cornea in a 6 mm pupil diameter, the spherical aberrations of SMILE were larger than for both Amaris1050 and EX500 (P=0.004, 0.017). There was no significant difference between Amaris1050 and EX500 (P=0.793). Conclusions: When there is a same programmed optical zone, SMILE achieves a larger and a better aspheric shape of the optical zone than FS-LASIK, and induces fewer spherical aberrations after surgery. Whereas there was also a deeper ablation depth with SMILE and Amaris1050 than with EX500, thus consuming more corneal tissue.
		2020 Vol. 22 (5): 333-340 [Abstract] ( 417 ) [HTML 1KB] [ PDF 2121KB] ( 2688 )

	341	Therapeutic Effect of Ranibizumab Combined with Triamcinolone Acetonide on Wet Age-Related Macular Degeneration and Its Effect on Interleukin
		Xiaohong Sheng1,Xiangyang Xin1,Liming Wang1,Yan Sun1,Xiaohua Li2
		Objective: To observe the clinical efficacy of Ranibizumab combined with Triamcinolone acetonide in the treatment of wet age-related macular degeneration (AMD), and to explore its effects on interleukin (IL)-1β, IL-2, IL-6. The impact of IL-8 levels. Methods: This is a retrospective study. A total of 86 cases (102 eyes) of wet AMD patients admitted to Inner Mongolia Baogang Hospital from November 2017 to October 2018 were randomly divided into Ranibizumab group (43 cases, 50 eyes) and combination group (43 cases, 52 eyes). The patients in the Ranibizumab group were treated with intravitreal injection of Ranibizumab, and the combined group was treated with Triamcinolone acetonide with the same method on the basis of intravitreal injection of Ranibizumab. The intraocular pressure values of the two groups before treatment, 2 weeks, 1 month and 3 months after treatment were compared. The central retinal thickness (CMT) and visual acuity of the two groups before treatment, 1 month, 3 months and 6 months after treatment were compared. The serum levels of IL-1β, IL-2, IL-6 and IL-8 were compared between the two groups before treatment and 1 month after treatment. The complications during treatment were counted and compared. Two-sample measurement data using t test. Repeated measurement variance analysis using repeated measurement data, further comparison using LSD-t test. χ 2 test was used for two count sample data. Results: There were no significant differences between the two groups (Fgroups=1.275, P=0.496; Ftime=1.810, P=0.211; Finteraction=1.772, P=0.335). There was no significant difference in CMT and visual acuity between the two groups before treatment (t=0.042, P=0.967; t=0.720, P=0.473). At one month, three months and six months after treatment, CMT of combined group was lower than that of Ranibizumab group (t=2.086, P=0.039; t=3.398, P=0.001; t=2.987, P=0.004), and visual acuity of combined group was higher than that of Ranibizumab group at different time (t=3.265, P=0.001; t=2.217, P=0.029; t=2.519, P=0.013). The CMT decreased (tbefore treatment vs. 1 month after treatment=6.210, 4.218, P<0.001; t1 month after treatment vs. 3 months after treatment=16.772, 15.865, P<0.001; t3 months after treatment vs. 6 months after treatment=4.472, 4.848, P<0.001) and visual acuity increased (tbefore treatment vs. 1 month after treatment=4.527, 8.395, P<0.001; t1 month after treatment vs. 3 months after treatment=5.369, 5.349, P<0.001; t3 months after treatment vs. 6 months after treatment=3.335, 3.730, P<0.001) with time in both groups. Compared with before treatment, the serum levels of IL-1β, IL-6 and IL-8 in 1 month after treatment were lower in the 2 groups (tcombined group=10.544, 32.169, 33.156, all P<0.001; tRanibizumab group=8.996, 25.687, 30.754, all P<0.001), and the combined group were lower than those in the Ranibizumab group (t=2.894, P=0.005; t=5.997, P<0.001; t=3.934, P<0.001). Compared with before treatment, the serum IL-2 level in the 2 groups were higher that 3 months after treatment (t=20.067, 9.091, all P<0.001), and the combined group was higher than that in the Ranibizumab group (t=7.705, P<0.001). There were no significant difference in the rates of bleeding, intraocular foreign body sensation, transient intraocular hypertension and total complications between the two groups (correction χ2 =0.001, P=0.972; correction χ2 =0.221, P=0.638; Fisher's exact test P=0.116; correction χ2 =0.004, P=0.951). Conclusions: Intravitreal injection of Ranibizumab combined with triamcinolone acetonide can effectively improve the visual function of wet AMD, reduce CMT, relieve inflammation, and it is safe and reliable.
		2020 Vol. 22 (5): 341-346 [Abstract] ( 318 ) [HTML 1KB] [ PDF 827KB] ( 2376 )

	347	Correlation between Outer Retinal Thickness and Visual Acuity in Patients with Parkinson's Disease
		Yihong Chen1,Yue Zhou1,Shuling Ye1,William Robert Kwapong1,Hua Ye2,Meixiao Shen1,Jia Qu1
		Objective: To detect changes in the outer retinal structure using optical coherence tomography and to study the correlation between outer retinal thickness and visual acuity in patients with Parkinson's disease (PD). Methods: This case-series study included 35 cases of PD and 39 age- and gender-matched healthy participants. Images of the outer plexiform layer (OPL), outer nuclear layer (ONL) and photoreceptor layer (PRL) were obtained by SD-OCT. The average thickness of each layer was analyzed by an automated layering software. A generalized estimating equation (GEE) was used to compare the differences in the thickness of the three layers (OPL, ONL, PRL) between patients with Parkinson's disease and healthy controls (HCs). Pearson correlation analysis was used to study the correlation between outer retinal thickness and best corrected visual acuity (BCVA). Results: Thirty-five patients with Parkinson's disease (63 eyes included) and the 39 HCs (75 eyes included) were included in final analysis. The BCVA was worse in PD patients than in HCs (P<0.001). The thickness of the OPL and ONL was thinner in PD patients (P=0.011, P=0.008, respectively). The thinning of the ONL thickness was correlated with worse BCVA (r=0.283 , P=0.026). Conclusions: The visual system and outer retinal structures in patients with Parkinson's disease are damaged. The index for the outer nuclear layer structure may be used as an image indicator to monitor the damage to the visual system in patients with Parkinson's disease.
		2020 Vol. 22 (5): 347-353 [Abstract] ( 325 ) [HTML 1KB] [ PDF 4919KB] ( 2460 )

	354	Retinal Vessel Density in Adolescent Myopia Based on OCTA: An Observational Study
		Jun Zeng1, 2, Longqian Liu1
		Objective: To investigate the correlation between myopia and superficial retinal vascular density (SRVD) and retinal thickness in adolescent myopia using optical coherence tomography angiography (OCTA). Methods: This study was a prospective cross-sectional study. A total of 105 myopia patients (193 eyes) aged 7-14 years who visited the Department of Ophthalmology, West China Hospital, Sichuan University, from May 2018 to November 2018 were included. All patients were examined by optical coherence tomography (OCT) and OCTA. Patients were divided into three groups based on the degree of myopia:mild, moderate and severe. One-way analysis of variance was performed on the macular foveal retinal thickness and SRVD at various sites. Pearson correlation was performed between the retinal thickness and superficial retinal vessel density by Pearson correlation analysis. Spearman correlation was performed between the spherical equivalent (SE) and the SRVD and between the macular foveal retinal thickness and the SRVD at various sites. Results: The differences in the parafovea, outer ring and the entire 6 mm diameter of the SRVD in the mild, moderate and high myopia groups were statistically significant (F=11.651, 14.499, 14.232, P<0.001). There was a weak positive correlation between age and macular foveal retinal thickness (r=0.187, P=0.011), but there was no correlation between age and SRVD at any site. The SE was correlated with the parafoveal SRVD (r=-0.301, P<0.001), the curve was correlated with the SRVD outer ring and the entire SRVD area (r=-0.319, P<0.001; r=-0.307, P<0.001). However, there was no significant correlation between the SE and the foveal SRVD and macular foveal retinal thickness. The macular foveal retinal thickness was correlated with the foveal SRVD (r=0.691, P<0.001), but no correlation with parafoveal, outer ring and entire SRVD. Conclusions: The degree of myopia in adolescents is negatively correlated with the parafovea, outer ring and the entire SRVD. The macular foveal retinal thickness is positively correlated with age and the foveal SRVD.
		2020 Vol. 22 (5): 354-359 [Abstract] ( 406 ) [HTML 1KB] [ PDF 2637KB] ( 2536 )

	360	Correlation Analysis between Refractive Error and the Risk of Drusen Based on a Deep Learning Model
		Hong Gu, Zhaomeng Shen, Zhiguo Li
		Objective: To classify drusen size in color fundus photographs by using an automated deep learning model and to investigate the association between refractive error and drusen. Methods: This was a casecontrol study. There were 2 055 color fundus photographs and refractive status were obtained from 1 035 participants aged 50 years and older who underwent physical examinations in Ningbo Medical Center, Lihuili Hospital from January 2017 to December 2017. DeepSeeNet, a deep learning mode, was used to detect drusen size from color fundus photographs. Three hundred ninety-two fundus photographs were randomly selected and assessed manually by one retinal specialist. Cohen's kappa was used to evaluate the consistency between the DeepSeeNet and the retinal specialist. The spherical equivalent refraction was calculated as adiopter (D) according to the computer optometry data, and classified as emmetropia (-0.5- +0.5 D), mild myopia (-3.0--0.51 D) or hyperopia (+0.51-+3.0 D), and moderate to severe myopia (<-3.0 D) or hyperopia (>+3.0 D). Statistical analysis was performed using R statistical software, and a logistic regression model was used to analyze the association between refractive error and drusen size. Results: The classification results of the deep learning model were highly consistent with those of the retinal specialist (κ=0.67, P<0.001). After adjustment for confounding factors, the increase in spherical equivalent was associated with an increased risk of large drusen (OR=1.03, 95%CI: 1.01-1.04, P<0.001). Compared with emmetropia, moderate to high myopia was associated with a lower OR of large drusen (OR=0.89, 95%CI: 0.82-0.97); moderate to high hyperopia was associated with a higher OR of large drusen (OR=1.20, 95%CI: 1.03-1.39). Conclusions: Refractive error is associated with the development of drusen. These results indicate that the use of a deep learning model not only enhances the speed and accuracy of clinical diagnosis, but also provides clues for age-related macular disease related scientific research.
		2020 Vol. 22 (5): 360-366 [Abstract] ( 309 ) [HTML 1KB] [ PDF 1732KB] ( 2580 )

	367	Efficacy of 25G Minimally Invasive Vitrectomy Assisted by Chandelier Illumination in the Treatment of Ocular Toxocariasis
		Xiao Yang, Suyan Li, Qing Xu, Yalu Liu, Zhengpei Zhang, Haiyang Liu, Sujuan Ji
		Objective: To investigate the efficacy of 25G minimally invasive vitrectomy assisted by chandelier illumination in the treatment of ocular toxocariasis (OT), and to analyze the postoperative complications. Methods: This was a retrospective case series study. Twenty-seven patients (27 eyes) who were diagnosed with ocular toxocariasis in Xuzhou Municipal Hospital from December 2014 to February 2019 were included in the study. All patients underwent 25G minimally invasive vitrectomy assisted by chandelier illumination after systemic and local corticosteroid treatment for 1-2 months. The perfusion tube and chandelier illumination were placed away from the peripheral lesions and the vitreous and drawstring were removed. Laser photocoagulation, gas-liquid exchange, or filling the vitreous cavity with air, C3F8 or silicone oil were performed during the operation according to the retinal condition. Some of the procedures were combined with lens extraction and/or scleral buckling. Clinical features, optical coherence tomography and fundus photography examinations were analyzed as well as treatment conditions and postoperative complications. The recurrence rate of uveitis and the one-time anatomical retinal reduction rate during the postoperative follow-up period were calculated. Data were analyzed by a t test. Results: Among the 27 patients, 11 eyes had peripheral granuloma, 11 eyes had posterior granuloma and 5 eyes had endophthalmitis. Thirteen eyes underwent vitrectomy for tractional retinal detachment (TRD), 23 eyes for epiretinal membrane (ERM), and 11 eyes for TRD combined with ERM. Postoperative followup was conducted for 6-44 months (17.6±11.0). Four eyes (15%) had low intraocular pressure in the early postoperative period and 1 eye (4%) had high intraocular pressure in the late postoperative period. Anatomical reduction was achieved in 11 of the 13 eyes with TRD after a single operation, and the onetime retinal reduction rate was 85%. ERM recurred in 2 of 23 eyes (9%). Retinal detachment occurred after surgery in 2 of 15 TRD eyes (15%), and 3 eyes had cataract after surgery (11%). In the 27 eyes, 4 eyes (15%) had recurrent inflammation 1-5 months after the operation. In one eye, inflammation disappeared after the second operation. In the other 3 eyes, the inflammation was controlled within 2 months after systemic and local corticosteroid treatment. The best corrected visual acuities (logMAR) preoperatively and at the last postoperative follow-up were 1.46±0.66 and 1.13±0.66. Postoperative visual acuity improved compared to preoperative visual acuity (t=4.009, P<0.001). Conclusions: 25G minimally invasive vitrectomy assisted by chandelier illumination can effectively control uveal inflammation and a relatively satisfactory curative effect can be achieved.
		2020 Vol. 22 (5): 367-373 [Abstract] ( 308 ) [HTML 1KB] [ PDF 13471KB] ( 2094 )

	374	Comparative Observation on Improving Eyeshade Covering Compliance after Atropine was Applied to Healthy Eyes
		Huade Wang, Xiaona Pei, Lan Shen, Lin Wei
		Objective: To observe whether healthy eye treated with atropine can improve children's compliance with eye occlusion. Methods: This was a prospective study. From February 2015 to February 2017, 136 eyes of 136 amblyopic children aged 7 to 9 years who were treated in Puyang Eye Hospital and were prescribed glasses for the first time, with a corrected vision of ≤0.3 in amblyopia, and whose age met the criteria for cover therapy were selected. The data from three months, six months and one year after treatment were statistically analyzed. During the observation period, the patients were divided into two groups based on the occlusion treatment method: the observation group (group A, 68 cases) was covered with an eyepatch for not less than 6 hours per day on the basis of atropine's healthy eyes on Mondays and Wednesdays. The control group (group B, 68 cases) was simply covered with an eye patch for not less than 6 hours per day. Parents and teachers were asked to closely observe the removal and wearing of the blindfolds and compare the compliance and improvement of visual acuity of the two groups after three months, six months and one year. Chi-square test and independent t test were used. Results: The treatment compliances of group A (94%, 87%, 78%) and group B (75%, 65%, 57%) were significantly different (χ2 =9.517, P=0.002; χ2 =9.003, P=0.002; χ2 =6.585, P=0.010). The effective treatment rate for group A (44%, 63%, 76%) was significantly different from group B (28%, 12%, 59%)(χ2 =3.860, P=0.049; χ2 =5.785, P=0.016; χ2 =4.838, P=0.028). The corrected visual acuity of amblyopia in group A was better than that in group B 3, 6, 12 months after treatment (t=-2.355, P=0.011; t=-3.619, P=0.002; t=-4.922, P<0.001). One year later, the total cure rates for group A and group B were 56% and 38%, which were statistically significant (χ2 =4.250, P=0.039). The actual cure rates were 72% and 67% which were not statistically significant (χ2 =0.269, P=0.604). Conclusions: For amblyopia patients who need occlusiontherapy, atropine can significantly improve compliance and the effectivityrate, and the total cure rate is significantly better than that of simple occlusion.
		2020 Vol. 22 (5): 374-378 [Abstract] ( 284 ) [HTML 1KB] [ PDF 805KB] ( 2403 )

	379	Factors Affecting the Comfort of Patients Undergoing Cataract Surgery: A Systematic Review and Meta-Analysis
		Hailong He1,Xinyu Zhao2,Di Chang3,Jinda Wang1,Kai Cao1,Chunyuan Zhou4,Xintong Liang1,Yanan Guo1,Xiuhua Wan1
		Objective: The factors affecting the comfort of patients undergoing cataract surgery were systematically evaluated in order to provide a reliable basis for improving surgical comfort. Methods: The following databases were searched: China National Knowledge Infrastructure (CNKI), the Wanfang Database, the Vip Database, PubMed, Embase and Cochrane Library. Two researchers extracted data and independently assessed the quality of the articles. Meta-analysis was performed using RevMan 5.3 software. Results: A total of 12 911 patients undergoing cataract surgery in 52 randomized controlled trials were included in this study. The factors affecting cataract surgery were classified and nursing methods, types of anesthetics and location where surgery was performed were also classified. Factors that could not be classified as above were divided into preoperative factors like oral sedation, intraoperative factors like auxiliary oxygen inhalation and postoperative factors such as postoperative eye pads and so on. Meta-analysis showed that compared with conventional nursing, collaborative nursing could improve the comfort of cataract patients with RR=1.21 (95%CI: 1.13, 1.30, P<0.001). There was no significant difference in anesthetic effect or comfort between lidocaine and other topical anesthetics, MD=-0.69 (95%CI: 1.51, 0.14, P<0.001). Compared to a balanced salt solution, an intravenous infusion of fentanyl could significantly reduce the frequency of pressing and administration of a patient-controlled analgesia device, which indicated that fentanyl could improve the comfort of patients, MD=-1.77 (95%CI: 2.19, -1.39, P<0.001). The anesthetic effect and patient comfort were better in the sub-Tenon's group than in the topical anesthesia group, MD=1.02 (95%CI: 1.33, 0.71, P<0.001). Due to a lack of research literature or statistical results, it was difficult to perform other factors in meta-analysis, however, a systematic review was done. Conclusions: There are many factors affecting the comfort of cataract patients undergoing surgery which can be gradually promoted and applied in the clinic to improve the comfort of cataract surgery and the quality of life of patients.
		2020 Vol. 22 (5): 379-389 [Abstract] ( 298 ) [HTML 1KB] [ PDF 1143KB] ( 2502 )

Case Report

	390


		2020 Vol. 22 (5): 390-391 [Abstract] ( 305 ) [HTML 1KB] [ PDF 3263KB] ( 2488 )

Review

	392	Research Progress of Customized Corneal Refractive Surgery
		Yuwen Hsiao1, 2, Jibo Zhou1, 2
		Customized corneal refractive surgery is the most widely used treatment to correct ametropia. It provides better postoperative visual acuity and visual quality comparing to traditional corneal refractive surgery, the follower only focus on correcting lower order aberrations but not the irregular cornea, and might bring out iatrogenic higher order aberrations, increasing night visual troubles and decreasing visual quality. Customized corneal refractive surgery was designed to consider correction of the irregular cornea, corneal thickness and patient demands. Customized corneal refractive surgery serves as the first correction of the ametropia and the enhancement to the previous refractive surgery with different indications and symptoms leads by irregular cornea or increased higher order aberrations. This review summarized the following characteristics of customized refractive surgery: The desingn principles, indications, clinical application, complications, surgical results and patient satisfaction.
		2020 Vol. 22 (5): 392-396 [Abstract] ( 441 ) [HTML 1KB] [ PDF 772KB] ( 2920 )

	397	Research Progress on Focal Adhesion Kinase in Common Ophthalmic Diseases
		Wenquan Tang1, 2, Mengdan Cao1,Dengming Zhou1,Zheng Pan1,Xuanchu Duan1, 3
		Focal adhesion kinase (FAK) is a non-receptor tyrosine kinase, widely distributed in the cytoplasm of cells in the body. It can transmit signals from cell membrane receptors and intercellular growth factors, and participate in the regulation of cell growth and differentiation, adhesion and migration, proliferation and apoptosis, and other important biological processes. FAK is at the intersection of many signal transduction pathways in cells, and researchers have confirmed that it plays an important role in many systemic diseases. This review summarizes the general characteristics of FAK and its functions in ophthalmic diseases.
		2020 Vol. 22 (5): 397-400 [Abstract] ( 301 ) [HTML 1KB] [ PDF 770KB] ( 2329 )

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