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.11 Published 2020-12-25

	Orignal Article Case Report Review

Orignal Article

	801	Normative Values of Macular and Optic Nerve Head Parameters in Childhood: A School-Based Study with Optical Coherence Tomography
		Zongrong Yu1,Zhenghua Lin1,Lun Pan1,Longbo Wen1,Xiaoning Li1,Weizhong Lan1, 2, Zhikuan Yang1
		Objective: To determine the normative values of macular and optic nerve head parameters measured by optical coherence tomography (OCT) in healthy schoolchildren and to analyze the possible influence of individual factors on the main parameters of OCT. Methods: This cross-sectional study was part of a cohort study on refractive development in children and adolescents. Nine hundred thirteen students from the age of five to fifteen were recruited at three schools in Liling City, Hunan Province, and Yichang City, Hubei Province. Retinal thickness, retinal nerve fiber thickness (RNFL) and optic nerve head parameters were measured by OCT (DRI OCT Triton, Japan, Topcon). The normal value range was defined by P2.5-P97.5 or Mean±1.96 SD. Then the relationships between age, sex, refractive error, axial length and the main parameters were analyzed by a Spearman's correlation and multiple linear regression analysis. Results: The EDTRS for the foveal region, the normal values of retinal thickness and RNFL thickness in the central area were 193.72-262.68 μm and 0.67-8.18 μm, respectively. In the inner ring region, the retina was thickest in the superior quadrant (288.07-340.29 μm), followed by the nasal (283.89-340.53 μm) and inferior quadrants (283.85-337.21 μm), then the temporal quadrant (275.32-326.32 μm), while the RNFL was thickest in the inferior (24.40-33.01 μm) and superior quadrants (24.52-33.24 μm), followed by the nasal (20.89-28.35 μm) and temporal quadrants (20.54-24.45 μm). In the outer ring region, the retina was thickest in the nasal quadrant (266.97-323.27 μm), followed by the superior (254.81-305.03 μm) and inferior quadrants (241.54-292.42 μm), then the temporal quadrant (238.45-286.59 μm), while the RNFL was thickest in the nasal quadrant (42.38-63.03 μm), followed by the inferior (36.35-53.74 μm) and superior quadrants (36.19-53.64 μm), then the temporal quadrant (21.37-26.52 μm). In the optic disc, the retina was thickest in the superior (286.13-378.29 μm) and inferior quadrants (283.20-375.82 μm), followed by the temporal quadrant (256.90-325.30 μm), then the nasal quadrant (235.40-309.79 μm). The RNFL was thickest in the inferior quadrant (122.07-193.79 μm), followed by the superior (113.48- 188.28 μm), temporal (71.51-146.15 μm), and nasal quadrants (45.99-112.26 μm). The normative values of the disc area (DA), rim area (RA), cup volume (CV), C/D area ratio (CDAR), linear C/D ratio (LCDR) and vertical C/D ratio (VCDR) were 1.37-3.16 mm2 , 0.79-2.64 mm2 , 0.01-0.51 mm3 , 0.03- 0.64, 0.17-0.80 and 0.15-0.78, respectively. Multiple linear regression analysis showed that the spherical equivalent refractive error was correlated with the RNFL thickness of the macular central area, the nasal quadrant of the outer ring, the nasal quadrant of the optic disc, the inferior quadrant of the optic disc and DA, CV, VCDR (r=-0.197, -0.317, 4.458, 1.633, 0.069, 0.020, 0.040, all P<0.05). A significant negative correlation was found between age and the RNFL thickness of the macular central area, DA, CV, VCDR (r=-0.099, -0.020, -0.005, -0.007, all P<0.05), and a positive correlation was found between age and the RNFL thickness of the nasal quadrant of the outer ring (r=0.141, P=0.046). A positive correlation was found between the axial length and RNFL thickness of the macular central area and the nasal quadrant of the outer ring and CV, VCDR (r=0.414, 1.486, 0.022, 0.045, all P<0.001), and a negative correlation was found between the axial length and inferior quadrant of the optic disc (r=-2.192, P=0.012). Moreover, there was no correlation between gender and the other parameters, except for the RNFL thickness of the nasal quadrant of the outer ring (r=-1.066, P=0.002). Conclusions: This study provides the normative values of macular and optic nerve head parameters in healthy children. Meanwhile, we find that gender, age, refractive error and axial length all have a certain influence on the examination results of OCT. Thus, these factors should be taken into account when using OCT to evaluate and diagnose the fundus diseases of young children in clinical practice.
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		2020 Vol. 22 (11): 801-808 [Abstract] ( 258 ) [HTML 1KB] [ PDF 2848KB] ( 2909 )

	809	A Study of the Characteristics of Candida with In Vitro and In Vivo Confocal Microscopy
		Xiaofeng Li, Xiaoyu Zhang, Man Du, Li Zhang, Xiaolin Qi, Hua Gao
		Objective: To use in vivo laser confocal microscopy (IVCM) to observe the in vitro culture and living characteristics of candida spores and pseudohyphaes, and to provide abasis for the early diagnosis of candida keratitis. Methods: The data of 26 patients (26 eyes) who were diagnosed with candida keratitis in the Eye Hospital of Shandong First Medical University from January 2016 to December 2019 was collected. At the same time, candida albicans and candida parapsilosis were taken for laboratory fungal culture, and the typical morphology of candida spores and pseudohyphae in vitro and in vivo were observed by IVCM. Results: Candidaspores in vitro and in vivo presented uniformly in the shape of round spots with a diameter of 2-5 μm and a clear boundary. Pseudohyphae have a highly reflective linear structure. The reflection of spores was significantly enhanced in vivo. Eighteen eyes showed a scattered arrangement of spot-like, strongly reflective structure, and 11 eyes showed a dense fog structure. The morphology of pseudomycelia varied greatly. The mycelia in 2 eyes were slender, the spore structure was present in 5 eyes, and branches were visible. In 1 eye, an irregular thin and long rod shape with high contrast was observed, and in another eye, an irregular thin and long rod shape and spore structure could be observed simultaneously. Candida albicans pseudohyphae were relatively slender, with a length of 20-150 μm and a diameter of 2-10 μm. Pseudohyphae of candida parapsilosis were short and thick, with a length of about 30-100 μm and a diameter of 2-5 μm. Part of the branch spore structure was highlighted. Conclusions: Candida keratitis showstypical spore and pseudohyphae structures with IVCM. The morphology of candida keratitis spores in vitro and in vivo are consistent with observations under IVCM, but the morphology of pseudohyphaes are relatively different. IVCM can be used for the early diagnosis of candida keratitis.
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		2020 Vol. 22 (11): 809-814 [Abstract] ( 304 ) [HTML 1KB] [ PDF 5151KB] ( 2884 )

	815	Methotrexate in the Treatment of Ocular Cicatricial Pemphigoid
		Caiyun You, Tiangeng He, Shufang Yang, Xiangda Meng, Hua Yan
		Objective: To evaluate the effectiveness and safety of methotrexate (MTX) for the treatment of patients with ocular cicatricial pemphigoid (OCP). Methods: This was a retrospective case series study. A review of patient records with OCP who received treatment with MTX in the Department of Ophthalmology of Tianjin Medical University General Hospital from September 2016 to August 2019 were analyzed. Five patients were involved, 2 males and 3 females. OCP inflammation and progression and the adverse reaction of MTX were evaluated. Results: Mean age at the onset of OCP was 51.8 years (range, 38-66 years). Mean age at the initiation of immunotherapy was 54.4 years (range, 39-68 years). Six eyes in 3 patients achieved quiescence, 2 eyes in 1 patient presented with partial activity, and 2 eyes in 1 patient presented with disease activity after being treated by MTX for 6 months. At 12 months of MTX treatment, 8 eyes in 4 patients achieved quiescence, and 2 eyes in 1 patient presented with disease activity and continuous progression over stage one of OCP. This patient received rituximab in combination with MTX at 12 months after MTX initiation. Adverse events included gastrointestinal reaction in 2 patients, mild liver enzyme elevation in 1 patient, and virus infection of the cornea of 1 eye in 1 patient after being treated with MTX for 10 months. No other severe adverse events were noted during the follow-up period. Conclusions: These retrospective data suggest that MTX is efficacious and well tolerated when included early in the treatment of OCP.
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		2020 Vol. 22 (11): 815-820 [Abstract] ( 277 ) [HTML 1KB] [ PDF 6590KB] ( 2586 )

	821	Efficacy of an Autologous Neurosensory Retinal Transplant for Recurrent Macular Hole Retinal Detachment in Highly Myopic Eyes
		Yanzi Li, Changzhong Xu, Yong Liu, Xueqin Kang, Jianhua Wu
		Objective: To study the clinical effect of autologous neurosensory retinal transplants in the treatment of recurrent macular hole retinal detachment (MHRD) in highly myopic eyes. Methods: This was a prospective clinical study. An open qualitative response one-way sequential test method was used. Seven patients (7 eyes) with recurrent macular hole retinal detachment in highly myopic eyes were admitted to Aier Eye Hospital of Wuhan University, and underwent autologous neurosensory retinal transplantation combined with silicone oil tamponade. The follow-up period was at least 3 months after silicone oil removal. The main outcomes included retinal anatomical reattachment rate, best corrected visual acuity (BCVA) and postoperative complications. A sequential test diagram was plotted based on the test results. The pre-BCVA and post-BCVA were compared using a paired t-test. Results: Anatomical reattachment succeeded in 6 cases and failed in 1 case. The test line for the 7th case reached the upper boundary U. The retinal anatomical reattachment rate was 86%. At the last follow-up, the mean BCVA (1.35±0.34) logMAR was significantly improved over the pre-BCVA (2.06±0.33) logMAR (t=5.977, P=0.001). There were no serious complications such as vitreous hemorrhage, endophthalmitis, proliferation or the hole reopening at the retinal resection site. Two patients experienced transient intraocular hypertension, and intraocular pressure returned to normal within one week after antihypertensive drug treatment. Conclusions: Autologous neurosensory retinal transplants can treat recurrent MHRD effectively in highly myopic eyes and can significantly improve BCVA.
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		2020 Vol. 22 (11): 821-827 [Abstract] ( 312 ) [HTML 1KB] [ PDF 6986KB] ( 2217 )

	828	Hemorrhagic Characteristics Associated with the Prognosis of Polypoidal Choroidal Vasculopathy with Subretinal Hemorrhage
		Zuhua Sun, Yating Yang, Ying Huang, Bing Lin, Tingye Zhou, Xiaoling Liu
		Objective: To investigate the hemorrhagic characteristics associated with the treatment prognosis of polypoidal choroidal vasculopathy (PCV) with subretinal hemorrhage. Methods: This was a prospective study. Patients who were included had been diagnosed with naïve PCV from January 2015 to December 2017 in the Eye Hospital, Wenzhou Medical University, and were followed up for at least 3 months after the treatment. The logarithm of the minimum angle of resolution (logMAR) visual acuity during the follow-up after treatment were compared with baseline in different groups: A hemorrhage area of >4 disc area (DA) or less, whether or not there was foveal involvement, and the location of the center of the subretinal hemorrhage based on the Early Treatment Diabetic Retinopathy Study (ETDRS) ring. Data were recorded and analyzed by mixed linear models. Results: One hundred twenty-two patients (124 eyes) were enrolled, including 84 males and 38 females. The mean age was 64.9±9.8 years. Subretinal hemorrhage was present in 69 eyes (55.6%) at baseline. Among them, a larger hemorrhage area (>4 DA) in 34 eyes (49.3%) showed poorer visual improvement during the follow-up period than a smaller hemorrhage area (≤4 DA) in 35 eyes (50.7%). The fovea was involved in 59 eyes (85.5%) and showed poorer visual improvement during the follow-up than 10 eyes without foveal involvement (F=3.92, P=0.01). Among the 59 eyes with foveal involvement, 25 eyes (42.4%) with the center of the hemorrhage located within ETDRS ring 1 showed poorer visual improvement than eyes with the central hemorrhage ring at 2 or beyond (F=2.23, P=0.05). Conclusion: Large area, foveal involvement, and proximity to the fovea are risk factors for the poor prognosis of PCV with subretinal hemorrhage.
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		2020 Vol. 22 (11): 828-835 [Abstract] ( 290 ) [HTML 1KB] [ PDF 1528KB] ( 2386 )

	836	Comparison of the Objective Optical Quality in Keratoconus Patients after Penetrating Keratoplasty versus Lamellar Keratoplasty
		Xiaoyun Wang1,Dongfang Li1,Jianhong Jiang1,Rufei Yang1,Xianli Du1,Ting Liu1, 2
		Objective: To evaluate the optical quality of keratoconus patients after penetrating keratoplasty (PKP) or lamellar keratoplasty (LKP) using a dual-channel optical quality analysis system (OQAS). Methods: This was a prospective study. A total of 40 keratoconus patients in Qingdao Eye Hospital were involved in this study from January 2016 to December 2017. And they were divided into a PKP group (23 patients, 24 eyes) or LKP group (17 patients, 19 eyes), depending on the surgical selection. Visual acuity, astigmatism, the density of the corneal endothelium cells, objective scatter index (OSI), predicted visual acuity (PVA), modulation transfer function cut-off frequency (MTF cutoff), Strehl ratio (SR) and tear film analysis of the mean OSI with a dual-channel optical quality analysis system were compared. Data were analyzed using χ2 test and independent t test. Results: There was no statistically significant difference between the PKP group and the LKP group for best corrected visual acuity, and spherical and cylindrical powers. But there was a significant difference between the two groups in the density of the corneal endothelium cells (t=3.91, P<0.001). In addition, there were statistically significant differences between the PKP and the LKP groups for the MTF cutoff and PVA100 (t=2.58, P=0.01; t=2.66, P=0.01). There was also a statistically significant difference between the PKP group and the LKP group in the tear film analysis mean OSI (t=3.48, P<0.001). Conclusions: The objective optical qualities of keratoconus patients after PKP measured by OQAS are better than after LKP, and the MTF cutoff and contrast vision are also better.
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		2020 Vol. 22 (11): 836-841 [Abstract] ( 290 ) [HTML 1KB] [ PDF 2654KB] ( 2706 )

	842	Comparison of Visual Virtual Reality Training and Traditional Treatment for Childhood Amblyopia
		Wei Zhang, Aihua Yu, Xiaojun Cai
		Objective: To compare the clinical effects of a visual virtual reality training system and a traditional method for amblyopia in children. Methods: This was a prospective, randomized, controlled study. A total of 90 children (146 eyes) from 3 years to 12 years of age underwent treatment for amblyopia for the first time. They were divided into an experimental group (45 cases, 74 eyes) and control group (45 cases, 72 eyes). Children in the experimental group had treatment with a visual virtual reality training system, and the control group had conventional integrated therapy. Visual tests were conducted every month, and a stereopsis examination was conducted after 3 months. The efficacy and safety of the visual virtual reality training method was evaluated by comparing the effects for the two groups. Data were analyzed using t test, rank sum test, Chi-square test and Fisher exact test. Results: The total effective rate for the experimental group was 87%, and was 68% for the control, and the difference was significant (χ2 =7.086, P=0.008). The results were significantly different for the patients in the 3 to 6 age group (91% vs. 74%, χ2 =4.652, P=0.031). For mild amblyopia, the effective rate was 92% in experimental group, which was significantly better than the 75% in control group (χ2 =2.908, P=0.018). For anisometropic children the effective rate in the experimental group was significantly better than the rate in the control group (85% vs. 57%, χ2 =3.840, P=0.045). When the effective rates for the two treatments were compared at 1, 2 and 3 months, the effective rates in the experimental group (43%, 54% and 87%) were significantly better than the rates in the control group (24%, 40% and 68%) (χ2 =6.308, P=0.012; χ2 =2.779, P=0.016; χ2 =7.086, P=0.008). When stereopsis was compared after 3 months, stereopsis in the experimental group (72%) was better than that in the control group (61%)(χ2 =8.214, P=0.004). Conclusions: The efficacy of visual virtual reality training is better than traditional treatment, especially for children 3 to 6 years of age and for anisometropia amblyopia. Visual virtual reality training cannot only improve visual acuity, it helps to improve stereopsis as well.
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		2020 Vol. 22 (11): 842-846 [Abstract] ( 319 ) [HTML 1KB] [ PDF 733KB] ( 2655 )

	847	Comparative Study on Cycloplegia with Cyclopentolate Alone and Cyclopentolate Combined with a Tropicamide Compound
		Lihua Wang, Wei Chen, Jianing Pu, Jingjing Feng
		Objective: To study cycloplegia using 1% cyclopentolate alone and 1% cyclopentolate combined with a tropicamide compound in children aged 6-12 years. Methods: In this prospective randomized controlled study, 98 children aged 6-12 years with ametropia were randomly divided into two groups: One group was given 1% cyclopentolate 3 times, the other group was given 1% cyclopentolate 3 times and a tropicamide compound 2 times. The spherical equivalent and pupil diameter were measured before and 30 min, 45 min and 75 min after the first eyedrop. The baseline data of the 2 groups were compared by an independent-samples t test. ANOVA of repeated measures was used to analyze the influence of the different methods on the sphericity equivalent (SE) and pupil diameter at different times. The correlation between the degree of cycloplegia and mydriasis was analyzed by Pearson correlation analysis. Results: The negative sphericity of the two groups decreased rapidly within 30 minutes after the first drop, the best effect was achieved in 45 minutes, and remained stable from 45 minutes to 75 minutes. The cycloplegia between different time points were statistically different (F=57.06, P<0.001) but there was no significant difference between the 2 methods. As time progressed, the difference in cycloplegia between the 2 methods was not significant. The pupil diameter of the 2 groups increased with the progression of time and was statistically significant (F=502.87, P<0.001). The pupil diameter of the group with the compound was larger than that of the single group (F=30.63, P<0.001), and as time progressed, the difference was also statistically significant (F=13.53, P<0.001). There was no correlation between the decrease in the negative SE and the increase in pupil diameter in the 2 groups. Conclusions: In children aged 6-12 years, the cycloplegia effect, onset time and duration of 1% cyclopentolate combined with a tropicamide compound are not better than that of 1% cyclopentolate alone, but mydriasis with the compound is significantly greater than 1% cyclopentolate alone.
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		2020 Vol. 22 (11): 847-851 [Abstract] ( 361 ) [HTML 1KB] [ PDF 955KB] ( 2394 )

	852	Analysis of Visual Acuity and Refractive Screening Results of the Spot Vision Screener in Preschoolers
		Jingjing Feng, Xinli Liu, Wei Chen, Lihua Wang, Huan Tong, Jianing Pu, Shanshan Xing
		Objective: To investigate visual acuity in preschoolers and the application value of refractive screening with the Spot Vision Screener. Methods: In this cross-sectional study, 5 866 preschool children in the Haidian District of Beijing were selected for noncycloplegic visual and refractive examinations. The visual acuity distribution was analyzed by the likelihood-ratio Chi-square test. The refractive results of children with normal vision were tested by a rank sum test. The Kruskal-Wallis H test was used to analyze the differences in refractive values and anisometropia for different age groups. A two-way comparison between any two groups was performed using a Wilcoxon rank test. Medians (Q1, Q3) were used to describe the distribution characteristics of each refraction and anisometropia. The cut-off points for refractive screenings were calculated by percentiles. Results: The respective incidences of visual abnormalities were 4.25% and 17.29% based on the two methods. The differences between different age groups were statistically significant (P<0.05). The differences in spherical values, cylindrical values and spherical anisometropia values in children with normal vision were statistically significant among different age groups (P<0.05). Hyperopia and astigmatism values decreased as age increased. The values of spherical equivalent (SE), cylindrical anisometropia and SE variability were not statistically significant among different age groups (P>0.05). P2.5 and P97.5 of the spherical value and SE were 0 D, +1.50 D, -0.25 D, and +1.00 D, respectively. P5 for the cylinder value was -1.25 D. P95 for spherical and cylindrical anisometropia was 0.75 D. Conclusions: The Spot Vision Screener is considered a useful device in large-scale refractive screening work with children. The cut-off points of refractive screening and visual acuity can be used for referral.
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		2020 Vol. 22 (11): 852-857 [Abstract] ( 294 ) [HTML 1KB] [ PDF 744KB] ( 4086 )

	858	Continuous Suture Reattachment Surgery for Traumatic Cyclodialysis and an Observation of Its Effect
		Haijian Wu, Dejian Xu, Honghui Duan, Tao Guan, Zhiwei Xu, Lingjie Zhang
		Objective: To evaluate the clinical effects of internal continuous suture reattachment surgery for traumatic cyclodialysis. Methods: This was a retrospective case series study. Thirteen patients (13 eyes) with traumatic cyclodialysis that was complicated by other internal trauma of the eye underwent internal continuous suture reattachment surgery with lentectomy and vitrectomy. Analysis was performed on the clinical curative effect, advantages of surgery and matters that needed attention. Results: Ultrasound biomicroscopy and gonioscope examination showed that the ciliary bodies were reattached well and ultrasound B and ophthalmoscope examination showed that there was no retinal detachment during the postoperative follow-up period. IOP was normal in all eyes during the postoperative follow-up period except for 2 eyes with symptoms of transient high IOP 2-3 days postoperatively. BCVA improved to varying degrees postoperatively. There was no case with related complications during or after surgery. Conclusions: The internal continuous suture reattachment surgery for cyclodialysis is a less traumatic surgery and is effective. It can be performed simultaneously with surgery of the iris, lens, vitreous, etc.
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		2020 Vol. 22 (11): 858-863 [Abstract] ( 299 ) [HTML 1KB] [ PDF 1107KB] ( 2478 )

Case Report

	864	Noninvasive Fungal Sphenoid Sinusitis Complicated with Neuromyelitis Optical Spectrum Disorder: A Case Report


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		2020 Vol. 22 (11): 864-867 [Abstract] ( 329 ) [HTML 1KB] [ PDF 4417KB] ( 2395 )

	868	Adie's Pupil Syndrome Accompanied by Bilateral Suspensory Ligament Relaxation: A Case Report


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		2020 Vol. 22 (11): 868-870 [Abstract] ( 334 ) [HTML 1KB] [ PDF 6829KB] ( 2511 )

Review

	871	Research Progress on the Correlation between High Myopia and Ocular Biological Parameters
		Qianru Wang, Xue Li, Lei Huang
		High myopia has become a public problem in China due to serious complications and the onset at a young age. A number of studies have shown that the biological parameters of the eye can change with the development of high myopia. In order to further explore the pathogenesis of high myopia, this article reviews the relationship between high myopia and ocular biological parameters, so our clinical work can be a better guide for more accurate and specific prevention and treatment.
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		2020 Vol. 22 (11): 871-874 [Abstract] ( 368 ) [HTML 1KB] [ PDF 670KB] ( 2932 )

	875	Research Progress on Sensory Eye Dominance
		Hongting Liu1, 2, Fengju Zhang1
		When analyzing and synthesizing visual information from both eyes into a three-dimensional image at the visual neural center of the brain, the visual information from the two eyes is not processed equally. There is competition and inhibition between the eyes during this binocular visual process. One eye usually has a larger, weighted contribution to the vision neural network than the contralateral eye, and it is the neural basis of sensory eye dominance. Observers with strong sensory eye dominance (SED) tend to have abnormal binocular vision. Sensory eye dominance can be quantitatively measured in the laboratory using psychophysical methods. It can also be manipulated through refractive correction, occlusion or perception learning. Research progress in sensory eye dominance will provide a new treatment approach for clinical binocular disorders, especially in the fields of amblyopia and laser refractive surgery.
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		2020 Vol. 22 (11): 875-880 [Abstract] ( 365 ) [HTML 1KB] [ PDF 713KB] ( 2785 )

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