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.8 Published 2020-08-25

	Orignal Article Case Report Review

Orignal Article

	561	Comparison of the Stability of Two-Haptic and Four-Haptic Intraocular Lenses in Highly Myopic Eyes
		Yu Du, Wenwen He, Yi Lu, Xiangjia Zhu
		Objective: To compare the stability of two-haptic and four-haptic intraocular lenses (IOL) in high myopic eyes. Methods: In this retrospective case-control study, 148 high myopic patients who received uneventful phacoemulsification with the implantation of a two-haptic IOL (Tecnis ZCB00, AMO) or four-haptic IOL (MC X11 ASP, HumanOptics) during October 2016 to June 2017 at the Eye & ENT Hospital of Fudan University were selected. Of these, 54 were in the two-haptic IOL group, and 94 in the four-haptic IOL group. Follow-up was planned for six months after surgery, including routine postoperative examinations. An OPD-Scan III aberrometer was used to evaluate the decentration and tilt of the IOL, higher-order aberrations, and modulation transfer function. Comparisons of IOL decentration and tilt, and visual qualities were conducted between the two groups. An independent-sample t-test, Mann-Whitney U-test, χ2 test, and Spearman correlation test were used in statistical analyses. Results: No statistically significant difference in terms of age, gender, or best-corrected visual acuity was seen between the two groups. However, significant differences were seen between the decentration of the two-haptic IOL group and the four-haptic IOL group when they were divided into subgroups of axial lengths between 26 mm and <28 mm, and between 28 mm and <30 mm [0.26(0.15, 0.33)mm vs. 0.18(0.10, 0.24)mm, Z=-2.81, P=0.005; (0.42±0.28)mm vs. (0.18±0.07)mm, t=2.96, P=0.01]. Meanwhile, significant correlations were found between decentration and axial length in both the two-haptic IOL group (r=0.304, P=0.027) and four-haptic IOL group (r=0.366, P<0.001). Under conditions of a pupil size of 7 mm, better ocular and intraocular higher-order aberrations and coma were seen in the four-haptic IOL group (all P<0.05). Conclusions: For high myopic eyes, the four-haptic IOL seems to be better than the two-haptic IOL in terms of long-term IOL stability and visual quality, especially in low-light conditions.
		2020 Vol. 22 (8): 561-567 [Abstract] ( 307 ) [HTML 1KB] [ PDF 2404KB] ( 3369 )

	568	Collagen Cross-Linking for the Treatment of Fungal Keratitis
		Shunrong Luo, Huping Wu, Zhirong Lin
		Objective: To evaluate whether corneal collagen cross-linking improves the outcome of fungal keratitis. Methods: This was a retrospective clinical study. Patients (n=82) with fungal infected eyes were treated at Affiliated Xiamen Eye Center of Xiamen University, from November 2011 to December 2017. Corneal cross-linking was performed using the standard protocol after a multi-antifungal drug treatment failed to resolve the infection in patients. Main outcome measures: Clinical symptoms and corneal healing were examined using a slit lamp biomicroscope and an in vivo laser confocal microscope. Visual acuity improvement was also evaluated. Results: After 6 months to 3 years of follow-up, corneal scars eventually developed in 71 of 82 eyes. In 52 of 82 eyes, visual acuity improved. However, corneal melting was exacerbated and uncontrolled in 8 patients who immediately underwent corneal transplant surgery. In one patient, self-conjunctival transplantation was performed, and two others received a therapeutic corneal transplant due to recurrent inflammation and melting. Conclusions: Our results demonstrate that corneal collagen cross-linking is an effective procedure to manage patients afflicted with fungal keratitis.
		2020 Vol. 22 (8): 568-574 [Abstract] ( 288 ) [HTML 1KB] [ PDF 6803KB] ( 2683 )

	575	Efficacy and Safety of Aspherical Orthokeratology Lens for the Correction of Myopia
		Jun Jiang1,Xiaomei Qu2,Xiao Yang3,Ye Shen4,Manyi Xiao5,Longqian Liu6,Fangfang Lan7,Jiaqi Zhou2,Binglan Fang3,Wei Ma6
		Objective: To evaluate the clinical efficacy and safety of the NOR aspherical orthokeratology lens for the correction of myopia. Methods: This was a prospective randomized controlled study. Subjects over 8 years of age with binocular myopia were randomly assigned to a study group or a control group. The study group wore a NOR aspherical orthokeratology lens, and the control group wore a Euclid orthokeratology lens (model: Night-wear). Follow-up was performed at 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, 9 months, and 1 year after wearing the lenses. Uncorrected distance visual acuity, refractive error, keratometry value (K value), slit lamp examination results, lens condition, endothelial cell count, corneal thickness and intraocular pressure were recorded. Data analysis was performed using statistical methods such as an independent samples t test, Wilcoxon rank sum test, and Chi-square test. Results: A total of 291 subjects (143 subjects in the study group and 148 subjects in the control group) completed the initial wear. At each follow-up time after wearing the lenses, there were no statistically significant differences in the left and right eyes between the two groups (P>0.05) for visual acuity, refractive error or changes from baseline. There were no statistically significant differences in changes in the flat K value of both eyes or the steep K value of the right eyes (P>0.05). The differences in the changes in the steep K value of the left eye were not statistically significant except for 1 day and 9 months after wearing the lenses. There were no statistically significant differences in corneal thickness, endothelial cell count, intraocular pressure or their changes from baseline in the two groups (P>0.05) at 6-month and 1-year visits. At each follow-up time point, there were no serious complications in the two groups and there was no statistically significant difference in the incidence of complications between the two groups (P>0.05). At 1 year after wearing the lenses, the two groups of OK lenses were in good condition and were well fitted, and the comparison between the two groups showed no statistically significant difference (P>0.05). Conclusions: The NOR aspheric orthokeratology lens and the night-wearing orthokeratology lens are effective and safe for correcting myopia. The two orthokeratology lenses have the same efficacy and both have high security.
		2020 Vol. 22 (8): 575-581 [Abstract] ( 401 ) [HTML 1KB] [ PDF 796KB] ( 3453 )

	582	Evaluation of Dry Eye after Minimal in Situ Conjunctival Incision for Segmental Scleral Buckling Surgery
		Ning Gao, Yuhong Cheng, Anming Xie, Ming Zhang, Zhao Liu
		Objective: To compare dry eye signs and symptoms after minimal in situ conjunctival incision for segmental scleral buckling surgery. Methods: In this prospective clinical study, consecutive patients, enrolled in the Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, from May 2015 to April 2017, who had minimal in situ conjunctival incision or standard segmental scleral buckling surgery were assessed. Dry eye markers including the ocular surface disease index (OSDI) and subjective symptom questionnaire, tear-film assessment using Keratograph 5M corneal topography, Schirmer Ⅰ testing, and fluorescein staining were sequentially evaluated preoperatively and at 1 day, 1 week, and 1 month postoperatively. A Chi-square test, Student's t-test or Mann-Whitney U test was used to compare differences between the two groups. Results: Seventy-eight patients (78 eyes) with similar baseline characteristics were recruited. Most patients developed dry eye postoperatively. Subjective symptoms and fluorescein staining scores elevated from baseline, tear break-up time and Schirmer Ⅰ testing values decreased postoperatively, which peaked at 1 day and did not return to baseline within 1 month. There were no significant differences between the 2 groups (all P>0.05) at 1 day and 1 week except for the higher tear meniscus height (Z=1.04, P=0.041), noninvasive first tear break-up time and average break-up time (t=2.51, P<0.001), and Schirmer Ⅰ test values (Z=2.34, P=0.043), in the minimal in situ conjunctival incision group at 1 month postoperatively. OSDI scores and subjective symptoms were lower in the minimal in situ conjunctival incision group at 1 week and 1 month postoperatively (OSDI: t1 week=2.54, P=0.012; Z1 month=-1.03, P=0.020; subjective symptoms: t1 week=3.04, P=0.011; t1 month=3.94, P<0.001). Sub group analysis using flouesecein staining showed obvious worsening 1 day, 1 week and 1 month postoperatively in patients with preoperative dry eye (Z=-2.42, P<0.001; Z=-1.54, P=0.034; Z=-1.83, P=0.041). Conclusions: Segmental scleral buckling surgery can induce or aggravate dry eyes. Compared with standard procedures, minimal in situ conjunctival incision segmental scleral buckling surgery can improve and shorten the ocular surface discomfort in the early postoperative period, especially in patients with dry eyes before surgery.
		2020 Vol. 22 (8): 582-588 [Abstract] ( 317 ) [HTML 1KB] [ PDF 2896KB] ( 2619 )

	589	The Status of Reduced Vision among Primary and Middle School Students in Hangzhou during the 2013-2017 Academic Years and the Relevance of the Classroom Environment
		Li Hao, Bing Zhu, Wenying Shi, Hui Liu, Xuhui Zhang, Li Li, Zhangping Yang
		Objective: To describe the status and classroom environment and factors related to reduced vision (RV) among students in Hangzhou. Methods: This was a cross-sectional study using the Chinese National Survey on Students' Constitution and Health for reference. Three schools (one primary school, one middle school and one high school) were randomly selected in each administrative district of Hangzhou by stratified cluster random sampling method in 2013-2017 academic year. A Chi square test and trend Chi square test were used to compare the distribution and severity of visual impairment among different genders, urban and rural areas and school grade levels. A rank correlation analysis was used as the basis for relevance between the qualified rate of the classroom environmental index and the rate of reduced vision. Results: Forty-eight schools and 244 338 students in Hangzhou were included as the subjects of interest. In the past 5 years, the average rate of RV among students in Hangzhou has been 76.44%. The RV rate for females in each grade was higher than males (χ2 =546, P<0.001). The RV rates in the suburbs and counties were higher than in the urban areas (χ2 =5 313, P<0.001). Also, rate was directly proportional to the school grade level. The RV rate in high schools was higher than the rate in junior high schools, which was higher than the rate in primary schools (P<0.001). There was a significant correlation between the chair height compliance rate and the RV rate in the classroom environment with significant differences (r=-0.581, P=0.029). Conclusions: The RV rate among students in Hangzhou is considered to be high. Students in primary schools were at the key stage of developing vision-related problems. Females and county schools need to be of concern.
		2020 Vol. 22 (8): 589-595 [Abstract] ( 265 ) [HTML 1KB] [ PDF 773KB] ( 2721 )

	596	Evaluation of the Keratometric Index by the Pentacam
		Jianxiong Cao1,Pingjun Chang2,Jin Li2,Tianlin Xiao3
		Objective: To calculate the total corneal power and the keratometric index based on actual measurements of the anterior and posterior corneal surfaces and the central corneal thickness by Pentacam and evaluate the accuracy of this keratometric index in estimating total and posterior corneal powers. Methods: This was a series case study. Four hundred and nineteen patients (a total of 419 eyes) who had undergone preoperative examination and laser in situ keratomileusis (LASIK) surgery or cataract surgery from February to October 2017 at the Xiangtan Central Hospital and Eye Hospital, Wenzhou Medical University were chosen for the study. The radius of the best-fit sphere for the anterior corneal surface (Ra) and posterior corneal surface (Rp), and central corneal thickness (CCT) were obtained. The ratio of Ra to Rp (AP ratio), anterior corneal power, posterior corneal power and keratometric index were calculated, and the total corneal power in each eye was calculated using the Gaussian optics formula. A paired-samples t-test was used to compare the difference in K values. Results: The means for Ra, Rp, Rsimk, CCT and SimK were 7.73±0.27 mm, 6.34±0.24 mm, 7.73±0.27 mm, 537±33 μm, and 43.65±1.52 D, respectively. The mean calculated AP ratio was 1.220±0.026. The mean calculated keratometric index (Ncal) was 1.328±0.001. Conclusions: The Pentacam-derived keratometric index improves the predictive accuracies of total and posterior corneal powers.
		2020 Vol. 22 (8): 596-601 [Abstract] ( 380 ) [HTML 1KB] [ PDF 703KB] ( 3283 )

	602	Ocular Biometry Parameters and Factors in Early Stages of Premature Infants
		Jimeng Lao, Jianbo Mao, Lin Zhu, Yirun Shao, Caiyun Zhang, Xueting Yu, Zhe Lu, Yiqi Chen, Lijun Shen
		Objective: To study the development of the ocular biometry parameters and evaluate the relationship between axial length with gestational age and birth weight during 32 to 40 weeks of postnatal age. Methods: Premature infants screened for retinopathy of prematurity at Women's Hospital School of Medicine Zhejiang University and Eye Hospital, Wenzhou Medical University were included from March to December 2018. Infants were divided into groups based on age, gestational age (GA) <30 weeks and GA ≥30 weeks, and birth weight, birth weight (BW) <1 500 g and BW ≥1 500 g. They were examined between 32 to 40 weeks of postnatal age (PA). Anterior chamber depth (ACD), lens thickness (LT), vitreous length (VL) and axial length (AL) were measured with an A-scan biometer. BW and GA were recorded. Pearson correlation analysis was used to study the relationship between refractive system parameters and GA. The independent-samples t test was used to compare the AL between the two groups. Results: A total of 1 385 readings were recorded from 496 infants. The ACD (r=0.384, P<0.001), LT (r=0.295, P<0.001), VL (r=0.723, P<0.001) and AL (r=0.782, P<0.001) were all positively correlated with PA. There were no statistically significant differences in AL in the two groups from 32 to 40 weeks of PA (P>0.05). The average AL differed significantly from 38 to 40 weeks of PA in the two groups based on birth weight (t=2.195, P=0.030; t=2.504, P=0.015; t=1.989, P=0.048). Conclusions: In the early postnatal period of premature infants, gestational age has little effect on AL, however infants with low birth weight have a shorter AL.
		2020 Vol. 22 (8): 602-606 [Abstract] ( 310 ) [HTML 1KB] [ PDF 730KB] ( 2824 )

	607	Study of the Curative Effect of Two Different Suture Methods in the Treatment of Pterygium
		Daikun Lei, Xiaoyun Dong, Xia Li, Yi Liu, Ying Zhou, Peng Li
		Objective: To study the clinical effect of two different suture methods in the treatment of primary pterygium. Methods: This was a prospective study of 128 patients (128 eyes) with pterygium who were hospitalized and underwent surgery in the 474 Hospital of the People's Liberation Army from April 2015 to April 2018. Patients were randomly divided into two groups: The experimental group and the control group. The experimental group was treated with pterygium resection combined with a continuous suture of autograft conjunctival flap, while the control group was treated with pterygium resection combined with an intermittent suture of autograft conjunctival flap. Pain and corneal irritation in the two groups were monitored on the 1st, 3rd and 7th day after the operation. The amount of time for the corneal epithelium to heal completely was determined by corneal fluorescence staining. The complete healing of the conjunctiva, scar fiber hyperplasia and pterygium recurrence were recorded during a 6-month followup period. An independent samples t test was used to compare the indexes between the two groups; a Chisquare test was used to compare the rates between the two groups (direct calculation of the P value with the aid of an accurate probability method if necessary). Results: Scores for pain and corneal stimulation symptoms in the experimental group were lower than for those in the control group on the 1st and 3rd day after the operation (scores for pain: t=-40.477, P<0.001; t=-23.376, P<0.001; scores for corneal stimulation symptoms: t=-18.431, P<0.001; t=-7.894, P<0.001). Comparisons were made preoperatively and on the 7th day after the operation. There was no significant difference between the two groups. Corneal fluorescence staining 7 days after the operation showed that the experimental group had a higher complete healing rate for the corneal epithelium than the control group (χ2 =4.354, P=0.037; χ2 =13.333, P<0.001). There was no significant difference between the two groups. The healing rate of the experimental group was higher than that for the control group (χ2 =8.848, P=0.003), but the scar healing rate of the experimental group was slower than that of the control group (χ2 =8.214, P=0.004). There was no significant difference in the recurrence rate of pterygium between the two groups. Sutures were removed sooner in the experimental group than in the control group (t=-32.686, P<0.001). The pain score of the experimental group was lower than that of the control group (t=-26.580, P<0.001). Conclusion: For pterygium excision combined with continuous suture and conjunctival flap autograft for the treatment of primary pterygium, postoperative eye pain, irritation and inflammatory reaction are slight, corneal epithelial healing is faster, scar formation can be significantly reduced, postoperative suture removal is earlier, time is shorter and pain is slighter.
		2020 Vol. 22 (8): 607-612 [Abstract] ( 383 ) [HTML 1KB] [ PDF 6211KB] ( 2862 )

	613	Changes in Choroidal Thickness in Myopic Adolescents after Monocular Orthokeratology Treatment
		Ruiqi Zhang1,Jiwen Yang1, 2
		Objective: To observe the changes in choroidal thickness (CT) and axial length (AL) before and after wearing orthokeratology lenses and to investigate the role of the choroid in slowing the progression of myopia. Methods: This was a self-control study. From August 2018 to June 2019, in which 26 monocular myopic adolescents (52 eyes) who were treated with orthokeratology lenses in Shenyang Aier Eye Hospital were recruited. The eyes fitted with orthokeratology lenses served as the experimental group, while the fellow eyes without treatment served as the control group. AL and CT were measured in both groups at baseline and the 6-month visit. A paired t-test was used to analyze AL and CT before and after wearing orthokeratology lenses and the changes were compared between the 2 groups. Results: After 6 months of wearing orthokeratology lenses, the CT of the experimental group increased in all positions (all P<0.05), and the CT of the control group decreased in all positions (all P<0.05). There was a statistically significant difference in the changes in CT between the 2 groups before and after wearing orthokeratology lenses (all P<0.05). The AL in both groups increased significantly (both P<0.05). AL elongation was 0.09±0.15 mm in the experimental group and 0.26±0.16 mm in the control group, and there was a statistically significant difference between the 2 groups (t=-4.024, P<0.001). Conclusions: For myopic adolescents, wearing orthokeratology lenses can thicken the choroid and slow axial growth, which may be one of the reasons for using orthokeratology lenses to control the progression of myopia.
		2020 Vol. 22 (8): 613-617 [Abstract] ( 339 ) [HTML 1KB] [ PDF 729KB] ( 3495 )

	618	Clinical Characteristics and Surgical Effects of Type Ⅲ Acute Acquired Concomitant Esotropia
		Aixia Yao, Chenghu Wang
		Objective: To investigate the clinical characteristics and surgical effects in type Ⅲ acute acquired concomitant esotropia (AACE Ⅲ). Methods: This was a retrospective self-control study. Thirty-one AACE Ⅲ patients, aged 14 to 39 years, who underwent routine strabismus surgery at the Affiliated Eye Hospital of Nanjing Medical University, were enrolled from July 2016 to July 2019. The following data were collected: Onset time, binocular ametropia, time of near work, the attachment point of the internal rectus muscle, pre- and postoperative deviation, fusion range, and distance and near stereopsis. The followup period ranged from 6 months to 12 months (7.4±2.6 months). A Wilcoxon signed rank test was used to compare the difference in esodeviation and binocular fusion range before and after strabismus surgery. Preand postoperative distance stereopsis were analyzed by the traditional paired Chi square test, while pre- and postoperative near stereopsis was analyzed by the enhanced paired Chi square test. Results: Among the 31 patients with AACE Ⅲ, 3 patients (10%) had high myopia, 25 patients (81%) had moderate myopia, 2 patients (6%) had low myopia, and only one patient (3%) had emmetropia. All patients had performed nearwork with an average time of 7.8±1.1 hours per day. The average distance between the attachment point of the internal rectus muscle and the corneal limbus was 4.9±0.1 mm. The median pre-operative esodeviation at near (33 cm) was 35 PD, and at distance (6 m) was 40 PD. The difference between them was statistically significant (Z=-3.136, P=0.002). In this study, all patients underwent a successful strabismus operation and at the time of the final follow-up, whether it was at 33 cm or 6 m, the median degree of postoperative strabismus was 0 PD. Compared with the pre-operative degree of strabismus at the same distance, the postoperative degree was significantly smaller (both Z=-4.865, both P<0.001). The median of pre- and postoperative binocular fusion range was 14° and 19°, respectively, and the difference between them was statistically significant (Z=-3.149, P=0.002). Compared with distance and near stereopsis before strabismus surgery, 16(84%) patients recovered distance stereopsis and 19(95%) patients recovered near stereopsis after the surgery. Both distance and near stereopsis significantly improved when comparing stereopsis before and after surgery. The difference was statistically significant (χ2 =14.063, 24.000, respectively; P<0.001, P=0.001, respectively). Conclusions: Prolonged near work, the forward attachment point of the internal rectus muscle and moderate myopia appear to be important risk factors for AACE Ⅲ. Strabismus surgery to establish the proper angle can significantly diminish the degree of esotropia and improve the binocular fusion range and stereopsis in AACE Ⅲ patients.
		2020 Vol. 22 (8): 618-622 [Abstract] ( 330 ) [HTML 1KB] [ PDF 688KB] ( 2913 )

Case Report

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		2020 Vol. 22 (8): 623-626 [Abstract] ( 271 ) [HTML 1KB] [ PDF 8950KB] ( 2649 )

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		2020 Vol. 22 (8): 627-629 [Abstract] ( 301 ) [HTML 1KB] [ PDF 4604KB] ( 2931 )

Review

	630	Progress on Intraocular Lens Surface Modification for Posterior Capsular Opacification Prevention
		Ya Zhou, Xu Xu, Quankui Lin
		Cataract is the main cause of blinding diseases. Phacoemulsification combined with intraocular lens (IOL) implantation is a commonly used clinical treatment. Visual acuity recovers well after the operation. However, since the IOL is an extrinsic implant, a high incidence of complications may occur postoperatively. In addition to acute inflammation, long-term in vivo biocompatibility problems-posterior capsular opacification (PCO, which is also called a secondary cataract) may occur over time and decrease vision again. The improvement of surgical methods and the design and processing of the IOL can reduce the incidence of PCO. However, PCO still occurs due to the intrinsic compatibility of the IOL materials. This review summarizes the IOL surface modifications used to inhibit PCO from the perspective of the science of materials.
		2020 Vol. 22 (8): 630-636 [Abstract] ( 320 ) [HTML 1KB] [ PDF 721KB] ( 3176 )

	637	The Various Axes and Angles of the Human Eye and Their Application in Refractive Surgery
		Shuaifei Li, Xiaoshan Zhang, Changtao You, Yujun Li
		Because the human eye is not a perfect optical system, the axes and angles such as the optic axis, visual axis, line of sight, pupillary axis and angle α, angle κ, angle λ are defined to study the optical properties of the human eye. With the development of refractive surgery technology, the influence of these axes and angles is becoming more and more prominent, so it is essential to understand and apply them correctly. Therefore, this review mainly focuses on the various axes and angles and their application in refractive surgery.
		2020 Vol. 22 (8): 637-640 [Abstract] ( 285 ) [HTML 1KB] [ PDF 667KB] ( 3286 )

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