Chinese Journal of Optometry Ophthalmology and Visual science

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Chinese Journal of Optometry Ophthalmology and Visual science

	2020 Vol.22 Issue.10 Published 2020-10-25

	Orignal Article Case Report Review

Orignal Article

	721	The Correlation between Caregiver's Knowledge of Vision and Its Impact on Seeking Vision Health Care for Their Children
		Jiaqi Zhu, Tianli Yang, Kang Du, Hongyu Guan, Lili Li
		Objective: To study the impact that the cognitive level and knowledge of vision has on parents seeking vision health services for their children. This can provide a scientific basis for effectively preventing and controlling poor vision in students. Methods: This was a cross-sectional investigation. The study was based on the survey data of 5 236 students from 252 rural primary schools in Shaanxi and Gansu provinces. A multivariate logistic regression model was used to analyze the impact that varying knowledge and cognitive levels have on parents seeking vision health services for their children. Propensity matching was used to test the results for robustness. Results: Based on the overall sample of 5 236 students, the myopia rate among students in the sample area was as high as 46.31%, of which 74.54% of students had not undergone a vision exam. Of the 2 425 myopic students, only 15.09% wore eyeglasses. Parents had a big misunderstanding of vision problems. The correct answer rates for parents on visual health knowledge in the full sample and myopic samples were low, respectively. Logistic regression analysis indicated that parental knowledge of vision health has a significant impact on seeking vision health services for their children. Some misunderstandings included the following: Myopia and its causes (OR=1.15, 95%CI: 1.00-1.33, P=0.043; OR=1.20, 95%CI: 1.03-1.41, P=0.023), wearing glasses will make vision worse (OR=1.23, 95%CI: 1.06-1.46, P=0.007), students should check their eyesight (OR=1.40, 95%CI: 1.15-1.69, P=0.001) and students should not wear glasses (OR=1.05, 95%CI: 0.91-1.22, P<0.001). These misunderstandings have a significant effect on whether parents take their children for vision checkups. Parents know that myopia cannot see far away (OR=1.35, 95%CI: 1.04-1.76, P=0.024) and that learning is affected if myopes do not wear glasses (OR=1.54, 95%CI: 1.16-2.05, P=0.003) but feel that primary school students should not wear glasses (OR=1.61, 95%CI: 1.23-2.10, P=0.001). All of these factors have a significant effect on whether or not children wear glasses. Conclusions: Poor eyesight among students in rural areas of China has become a serious problem because parents have big misunderstandings about vision problems. Since parents make decisions for their children, their perceptions and knowledge of vision health can influence their behavior in seeking vision services for their children.
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		2020 Vol. 22 (10): 721-727 [Abstract] ( 280 ) [HTML 1KB] [ PDF 742KB] ( 2442 )

	728	Impact of Ocular Residual Astigmatism on Visual Outcomes of Myopic Astigmatism Correction after Small Incision Lenticule Extraction
		Yuehao Lu, Likun Xia, Yong Yu, Lu Liu, Ling Chen, Guixin Zhang
		Objective: To calculate ocular residual astigmatism (ORA) by vector analysis and to evaluate the impact of ocular residual astigmatism on refractive and visual outcomes after correction of myopic astigmatism by small incision lenticule extraction (SMILE). Methods: In this prospective case-series study, 115 eyes with myopic astigmatism were treated with SMILE from Jauary 2019 to August 2019 at Refractive Center of Ophthalmology Department, Shengjing Hospital, China Medical University. ORA was calculated by vector analysis and patients were divided into two groups according to the magnitude of ORA: high ORA group (ORA≥1.00 D) with 42 eyes and low ORA group (ORA<1.00 D) with 73 eyes. The follow-up period was 3 months after the operation. Uncorrected visual acuity (UCVA) and pythagorean length were measured and compared after the operation. The following measurements were compared: refractive outcomes, total higher order aberrations (tHOAs), vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, and vertical quadrafoil. Contrast sensitivity was compared between the high and low ORA groups under either 85 cd/m2 or 3 cd/m2 illumination from 1.5 c/d to 18 c/d. The data were analyzed by an independent-samples t test and Mann-Whitney U test to compare the differences between the two groups. Results: Three months postoperatively, refractive outcomes showed that postoperative residual astigmatism in the high ORA group was significantly higher than in the low ORA group (t=3.293, P=0.001). Vector analysis showed that the error vector (EV), absolute error of angle (absolute EA) and index of success (SI) were higher in the high ORA group (t=-3.235, P=0.001; t=-2.326, P=0.020; t=-2.587, P=0.010). After SMILE，all cases had achieved a desirable visual acuity: high ORA group: -0.15±0.05, low ORA group: -0.15±0.05. There were no statistically significant differences in visual acuity, pythagorean length, tHOAs, vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, or vertical quadrafoil between the two groups. An obvious difference was found in contrast sensitivity, which showed a higher contrast sensitivity at a spatial frequency of 18 c/d with 85 cd/m2 in the low ORA group than in the high ORA group (t=-2.877, P=0.005), but this tendency was not present at 3 cd/m2 . Conclusions: Ocular residual astigmatism impacts the precision of SMILE in correcting myopic astigmatism. This leads to a tendency of more residual astigmatism in refractive outcomes, and reduces contrast sensitivity at high spatial frequencies. However, it does not affect the outcome of obtaining good visual quality in both visual acuity and higher order aberrations.
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		2020 Vol. 22 (10): 728-737 [Abstract] ( 305 ) [HTML 1KB] [ PDF 1318KB] ( 2776 )

	738	The Relationship between the Posterior Chamber Position and Vault after Implantation of the Implantable Collamer Lens
		Hongxia Wang, Yanli Peng, Zhongxiu Zhao, Xialu Liu
		Objective: To study the relationship between the posterior chamber position and vault after implantation of the implantable collamer lens (ICL). Methods: This was a retrospective case series study. From June 2017 to June 2019, 32 cases of middle and high myopia with ICLs in the horizontal or vertical position were selected in Chongqing Aier Maige Ophthalmology Hospital because the vault of one eye was higher than 750 μm and an ICL at the same length was placed in the vertical position in the contralateral eye. The preoperative examination included the measurement of white-to-white (WTW) diameter under a slit lamp microscope, anterior chamber depth (ACD), sulcus-to-sulcus (STS) horizontal diameter, STS vertical diameter and lens thickness (LT) measured by ultrasound biomicroscopy (UBM). The vault was also measured by UBM. The data were analyzed by a paired t test,multiple linear regression and the receiver operating characteristic (ROC) curve. Results: The vault of the ICL in the vertical position decreased significantly (280±205 μm) compared with that in the horizontal position (t=5.375, P<0.001), and the horizontal-vertical diameter difference in the STS in both eyes was 0.42±0.21 mm. Multiple linear regression showed that the difference in vault was significantly related to the difference in the STS horizontal-vertical diameter (adjusted R2 =0.545, F=10.30, P<0.001), but not related to WTW, ACD or LT. The ROC curve was drawn for the horizontal-vertical diameter difference in STS in both eyes according to the standard of the vertical ICL vault falling into the ideal range (250-750 μm). The area under the curve (AUC) was 0.917, 95%CI 0.764-0.985, P<0.001. The optimal cut-off value was 0.3, the sensitivity was 83.33%, and the specificity was 100%. The ROC curve was drawn for the horizontal-vertical diameter difference in STS in both eyes according to the standard of vault difference in both eyes 100, 200 and 300 μm and above: AUC≥100 μm was 0.859, P≥100 μm=0.007, the optimal cut-off value was 0.3, sensitivity was 76.92%, specificity was 100%; AUC≥200 μm was 0.778, P≥200 μm=0.008,the optimal cut-off value was 0.36, sensitivity was 77.78%, specificity was 71.43%; AUC≥300 μm was 0.754, P≥300 μm=0.015, the optimal cut-off value was 0.36, sensitivity was 85.71%, specificity was 66.67%. Conclusions: In the case of a high vault in the horizontal position, if the horizontal-vertical diameter difference is STS>0.3 mm, there is a high probability that the vault of the ICL in the vertical position can be reduced to the ideal range.
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		2020 Vol. 22 (10): 738-743 [Abstract] ( 292 ) [HTML 1KB] [ PDF 747KB] ( 2716 )

	744	Design and Application of a Subconjunctival Implant Injection Device
		Chao Lin, Jinlei Ma, Dongmei Wang, Daguan Ke, Kaihui Nan
		Objective: To design a subconjunctival implant injection device; to test its performance on rabbits in vivo as the model animal. Methods: A subconjunctival implant injection device was manufactured. Gelatin film was injected via the device into the left eye of rabbits (as the test group), the right eye as the control group just repeat the puncture and insertion actions without implantation of the film. After the implantation, 2 rabbits were selected to be sacrificed at the time points of 0, 1, 2 and 3 d. The eyeballs were removed and the wound healing was observed with hematoxylin-eosin staining. Results: The device with a curvature radius of the 8 mm needle and an inner diameter section of 1.96 mm×0.38 mm. No bleeding at the injection site and no translocation of the gelatin film were observed after injection with this device. The wound healing degree in the same time period between the experimental group and the control group was almost identical without any obvious difference. Conclusions: The injection device is simple and time-saving during film implantation, effectively overcoming the trauma of conventional implant surgery, which might provide new assistance for the clinical application of novel, sustained drug-release formulations.
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		2020 Vol. 22 (10): 744-749 [Abstract] ( 315 ) [HTML 1KB] [ PDF 9687KB] ( 2150 )

	750	The Effect of a Comprehensive Treatment Regimen for Deep Stromal Fungal Keratitis
		Siteng Wu1,Zelin Zhao1,Yu Pan2,Wei Chen1
		Objective: To evaluate the efficacy and safety of a comprehensive treatment regimen based on intrastromal voriconazole injection in the treatment of deep stromal fungal keratitis in which the lesion has infiltrated more than half of the corneal stroma. Methods: This was a retrospective study. Sixty-two patients (62 eyes) with deep stromal fungal keratitis who underwent intrastromal voriconazole injection were selected at the Eye Hospital, Wenzhou Medical University from March 2013 to July 2017. Age, the diameter of the ulcer, cure rate, recurrence rate, complications, etc., were measured. All the patients were followed up for at least 6 months. Sixty-two patients were divided into an effective group (EGII) and an ineffective group (IGII) based on the effect of the pure intrastromal voriconazole injection. The data were analyzed by an independent samples t-test and Chi-square test. Results: The 62 patients had ulcer diameters ranging from 2.8 to 11.0 (5.5±2.1)mm. The time from onset to treatment for the 62 patients ranged from 2 days to 2 years (44.2±98.6)days. Six patients sought treatment more than half a year after onset, and the remaining 56 patients had an onset time of 21.2±13.6 days. All patients were followed up for 6 to 36 (10.5±7.5)months. Forty-two patients (42 eyes) were cured by pure intrastromal voriconazole injection, 1 patient (1 eye) underwent a corneal transplant to improve vision after intrastromal voriconazole injection was effective; 19 patients (19 eyes) underwent conjunctival flap coverage after the injection failed. Combined with conjunctival flap coverage, 11 eyes were cured, 8 eyes required corneal transplants, and 2 patients relapsed after corneal transplants. The cure rate of the comprehensive treatment regimen was 85.5%, and the recurrence rate was 3.2%. The EGII group had a smaller ulcer diameter than the IGII group, and the difference between the two groups was statistically significant (t=-2.199, P=0.032). There were no complications during or after the operation. Conclusions: Intrastromal voriconazole injection has a safe and beneficial effect on deep stromal fungal keratitis that does not respond to conventional drugs. For eyes with a wide range of lesions, the effect of pure intrastromal voriconazole injection was not good, but the cure rate can be improved when treatment is combined with conjunctival flap coverage.
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		2020 Vol. 22 (10): 750-755 [Abstract] ( 285 ) [HTML 1KB] [ PDF 7272KB] ( 2283 )

	756	A Study of Panoramic Ultrasound Biomicroscopy and Anterior Segment Optical Coherence Tomography Measurements of the Horizontal Rectus Muscle Insertion in Strabismus
		Rui Duan1,Jiwen Yang1, 2, Jia Liu2
		Objective: To evaluate the feasibility and accuracy of panoramic ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) in measuring the distance of the limbus to the horizontal extraocular muscle (EOM) insertion in strabismus patients. Methods: This was a case series study. We compared the panoramic UBM and AS-OCT measurements of muscle insertions to the gold standard intraoperative measurement and to each other. The Friedman test, Mann-Whitney U test, Spearman's rank correlation, Kendall's coordination coefficient and Bland-Altman plots were used to analyze data. Results: A total of 133 unoperated horizontal muscles of 73 patients at Shenyang Aier Eye Hospital were measured from March 2018 to September 2018, and 72 lateral rectus muscles and 61 medial rectus muscles were analyzed. The mean limbus-insertion distances of the lateral rectus and medial rectus measured with UBM were 6.60(5.34-8.28)mm and 5.41(4.16-7.48)mm, with AS-OCT were 6.59(5.10- 8.80)mm and 5.17(3.44-7.41)mm, and with a caliper were 7.0(5.0-8.5)mm and 5.0(3.5-7.0)mm. When comparing the 3 methods for detecting unoperated muscles, there was no significant difference between them regarding limbus-insertion distance measurements except that both the UBM gave higher preoperative limbus-insertion distances for the medial rectus than the caliper (P=0.017). Spearman correlation analysis indicated that there were strong correlations between UBM and the caliper and AS-OCT and the caliper (r=0.656, P<0.001; r=0.608, P<0.001) and there was a medium correlation between UBM and AS-OCT measurements of the lateral rectus (r=0.530, P<0.001). There were medium correlations between UBM and the caliper, and AS-OCT and the caliper (r=0.597, P<0.001; r=0.458, P<0.001), and there was a weak correlation between UBM and AS-OCT measurements of the medial rectus (r=0.379, P=0.003). Kendall's nonparametric consistency test and the Bland-Altman diagram suggested good agreements between the three methods. Conclusions: Both the panoramic UBM and AS-OCT are sensitive tools in identifying horizontal rectus muscle insertions in primary strabismus surgeries.
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		2020 Vol. 22 (10): 756-763 [Abstract] ( 302 ) [HTML 1KB] [ PDF 1479KB] ( 2589 )

	764	Effect of Binasal Occlusion in Children with Concomitant Esotropia
		Xue Yin, Hui Yang, Yajuan Chen, Zheng Fu, Na Wang
		Objective: To investigate the effect of binasal occlusion in the treatment of children with concomitant esotropia. Methods: In this propective clinical study, 21 children aged 3 to 10 years with nonaccommodative esotropia or partly accommodative esotropia who had more than +20△ esotropia after full refraction correction for 6 to 9 months at Xiamen Children's Hospital from January 2019 to July 2019 were examined. All the children were given binasal occlusion. Vision function and strabismic degree were re-examined every month. Data were analyzed by single factor analysis of variance. Results: The average strabismus was +33△±13△ before binasal occlusion. After binasal occlusion for 3 months, average strabismus was +21△±15△. Three cases were markedly corrected, 11 cases were effectively corrected, 7 cases were invalid. After binasal occlusion for 6 months, average strabismus was +18△±12△. Five cases were markedly corrected, 13 cases were effectively corrected, 3 cases were invalid. The difference was statistically significant (F=8.316, P=0.001). Conclusions: Binasal occlusion can effectively assist the treatment of concomitant esotropia in children.
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		2020 Vol. 22 (10): 764-768 [Abstract] ( 399 ) [HTML 1KB] [ PDF 1266KB] ( 3352 )

	769	Analysis of Oxygen Therapy and Related Diseases in Severe Active Retinopathy of Prematurity
		Dianqiang Guo, Fan Zhang, Guiping Tong, Yi Duan, Ruobing Shan
		Objective: To analyze the oxygen therapy and neonatal-related diseases in severe, active retinopathy of prematurity (ROP). Methods: This was a case control study. Preterm infants born in the neonatal medical center of Qingdao Women and Children's Hospital from November 2017 to October 2019 were enrolled, and their fundus examination and oxygen therapy were recorded at 4-6 weeks after birth or 32 weeks of corrected gestational age. Patients were divided into a mild group and severe group based on the severity of the disease. A χ2 test was used to compare the incidence between the two groups, and a t test or MannWhitney U test was used to compare the measurement data between the two groups. Results: A total of 464 preterm infants were included in the study; 426 infants (91.8%) were in the mild group with normal or mildly active ROP, and 38 infants (8.2%) were in the severe group with severely active ROP. In the 337 premature infants receiving oxygen therapy, the duration of oxygen therapy in the severe group was significantly longer than that in mild group (Z=-7.074, P<0.001). There was no significant difference in oxygen concentration or oxygen inhalation mode between the two groups. However, the use of mechanical ventilation was more frequent in the severe group (Z=4.114, P=0.043). By analyzing the diseases of all premature infants, we found that the incidence of neonatal respiratory distress syndrome (NRDS), and neonatal bronchopulmonary dysplasia (NBPD) was higher in the severe group (χ2 =14.515, P<0.001; χ2 =4.601, P<0.032). Multivariate regression analysis showed that the duration of oxygen therapy was an independent risk factor (χ2 =18.127, P<0.001). Conclusions: A longer duration of oxygen therapy and frequent use of mechanical ventilation increased the incidence of severe, active ROP. Neonatal asphyxia, NRDS and NBPD were more common in severe ROP. The duration of oxygen therapy, oxygen supply mode and oxygen concentration were the risk factors for serious, active ROP.
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		2020 Vol. 22 (10): 769-774 [Abstract] ( 289 ) [HTML 1KB] [ PDF 718KB] ( 2542 )

	775	Analysis of Refractive Status and Thickness of Retinal Nerve Fiber Layer in Children with or without Retinopathy of Prematurity
		Min Liu, Lianhong Pi, Lijuan Ouyang, Jing Yang, Xiaohui Zhu, Yang Wang, Rulian Zhao, Xinke Chen, Qing Liu, Ning Ke, Yong Li
		Objective: To compare the refractive status and retinal nerve fiber layer thickness (RNFLT) in pre-term children with or without retinopathy of prematurity (ROP) at 8 years old, and to investigate the effects of pre-term birth and ROP on refractive status and RNFLT. Methods: This was a prospective study. From January 2009 to February 2011, premature babies (average gestational age: 33.6±4.1 weeks, average birth weight: 2 099±779 g) who underwent fundus screening in the Department of Ophthalmology, Children's Hospital of Chongqing Medical University, were divided into an ROP group and pre-term ROP group (pre-term group), and full-term babies of the same age were used as controls. A total of 112 children (222 eyes) were enrolled, including 24 in the ROP group (47 eyes), 55 in the pre-term group (110 eyes), and 33 in the full-term group (65 eyes). The RNFLT, axial length (AL), and retinoscopy were examined in the three groups at the age of 8. The incidence of refractive error and the difference in RNFLT were compared. Data were analyzed using Chi-squsure test and ANOVA. Results: The incidence of myopia (χ2 =8.062, P=0.018; χ2 =3.671, P=0.036) and astigmatism (χ2 =7.758, P=0.023; χ2 =3.710, P=0.034) in the ROP group and pre-term group were higher than those in the full-term group. There was no significant difference in the incidence of hyperopia (χ2 =4.910, P=0.250). The AL of the ROP group and pre-term group was shorter than that of the full-term group (both P<0.001). The average RNFLT of the pre-term group was thinner than that of the full-term group (F=2.593, P=0.030). The temporal quadrant RNFLT of the pre-term group was thinner than that of both the full-term group (P<0.001) and ROP group (P<0.001). Conclusions: The pre-term children and children with ROP have a shorter AL at 8 years of age, and are more prone to myopia and astigmatism. ROP and prematurity affect their refractive status, but prematurity plays a major role. Prematurity and ROP have different effects on RNFLT, especially in the temporal quadrant. The abnormalities of RNFLT caused by other diseases need to be identified during the follow-up period.
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		2020 Vol. 22 (10): 775-780 [Abstract] ( 289 ) [HTML 1KB] [ PDF 835KB] ( 2492 )

	781	Effects of Nerve Growth Factor in the Treatment of Non-Arteritic Anterior Ischemic Optic Neuropathy
		Kai Chen, Hongwei Zhou
		Objective: To observe the effects of nerve growth factor (NGF) in the treatment of non-arteritic anterior ischemic optic neuropathy (NA-AION). Methods: This was a prospective, randomized, controlled study. Fifty-eight NA-AION patients (58 eyes) admitted to Lianshui County People's Hospital from July 2016 to June 2019 were selected, and then were divided into a control group and an observation group based on the random numerical table method. The control group (29 patients with 29 eyes) were given glucocorticoid hormones, Huoxue Tongluo granules and an anisodine compound. While the observation group (29 patients with 29 eyes), were treated with NGF in addition to the treatment plan previously described. The total effective rate, best corrected visual acuity (BCVA), the 30-degree visual-field examination mean deviation (MD) and the disc retinal nerve fiber layer (RNFL) thickness of the two groups were compared. Data were analyzed by the Fisher's exact test, a t test and a non-parametric test. Results: After treatment, the total effective rate for the observation group was significantly higher than that for the control group (P=0.04), the percentage of BCVA above 0.1 in the observation group was significantly higher than that in the control group (P<0.001), and both the MD and RNFL thickness in the observation group were significantly lower than those in the control group (t=2.59, P=0.01; t=4.86, P<0.001). There were no obvious adverse reactions for either group after treatment. Conclusions: The treatment of NA-AION with NGF can obtain a better effective rate, improve the patient's vision, improve the visual field and reduce RNFL thickness.
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		2020 Vol. 22 (10): 781-785 [Abstract] ( 287 ) [HTML 1KB] [ PDF 743KB] ( 2452 )

Case Report

	786	Systemic Lupus Erythematosus Secondary Antiphospholipid Syndrome Combined with Central Retinal Artery Occlusion


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		2020 Vol. 22 (10): 786-788 [Abstract] ( 274 ) [HTML 1KB] [ PDF 3776KB] ( 2390 )

Review

	789	Progress of Application of OCTA in Evaluating Fundus Morphology and Microvasculature Changes in High Myopia
		Jinxiang Luo1, 2, Manyi Xiao1,Xuanchu Duan1, 2, 3
		Myopia, a leading cause of blindness, and the pathogenesis is unclear, is considered to be a public health problem worldwide. High myopia and its fundus complications seriously impair visual function. Optical coherence tomography angiography (OCTA) is an automatic and accurate delamination of the retina and choroid, which can qualitatively and quantitatively detect the retina and choroid by quantifying the microvasculature area. OCTA can be used to detect the pathogenesis of high myopia at the microvascular level of the retina. This review summarizes the morphological changes of the fundus in high myopia and the application of OCTA in evaluating the changes in fundus structure, function and microvasculature density in high myopia.
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		2020 Vol. 22 (10): 789-795 [Abstract] ( 315 ) [HTML 1KB] [ PDF 714KB] ( 4237 )

	796	Progress on the Role of HtrA1 Serine Protease in the Pathogenesis of Polypoidal Choroidal Vasculopathy
		Zhe Zhu, Chenchen Zhang, Jun Xiao
		Polypoidal choroidal vasculopathy (PCV) is a kind of choroidal neovascular lesion characterized by reddish-orange subretinal nodule, serous or hemorrhagic pigment epithelial detachment. The exact pathogenesis of PCV is still unclear. Previous studies have found that HtrA1 serine protease plays an important role in the pathogenesis of PCV. The exploration of the role of HtrA1 in the pathogenesis of PCV is helpful to guide the clinical treatment of PCV. This paper reviews the relative research progress.
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		2020 Vol. 22 (10): 796-800 [Abstract] ( 295 ) [HTML 1KB] [ PDF 696KB] ( 2630 )

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