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

	2021 Vol.23 Issue.2 Published 2021-02-25

	Orignal Article Case Report Review

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		2021 Vol. 23 (2): 0- [Abstract] ( 221 ) [HTML 1KB] [ PDF 2834KB] ( 1507 )

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		2021 Vol. 23 (2): 0- [Abstract] ( 184 ) [HTML 1KB] [ PDF 575KB] ( 1630 )

Orignal Article

	81	Therapeutic Effect of Spirulina Polysaccharide Extract Eye Drops on Staphylococcus Aureus Keratitis in Rabbits
		Yao Wang1, 2, Ting Liu1, 2, Yang Yu1, 2, Xin Wang2,Fangying Song1, 2, Lingling Yang1, 2
		Objective: To observe the therapeutic effect of the local application of polysaccharide extract from spirulina platensis (PSP) on experimental Staphylococcus aureus keratitis in rabbits. Methods: In this experimental research, PSP was extracted from the powder of Spirulina platensis and 0.01% PSP eye drops were prepared. In 45 experimental rabbits, 5 μl of Staphylococcus aureus bacterial solution [ATCC25923, 100 corneal forming units (CFU)] was injected into the central cornea stroma with a matrix injection needle. Eight hours after corneal stroma injection, the rabbits were randomly divided into three groups: basal control group, 0.9% sodium chloride solution group and PSP group. The 0.9% sodium chloride solution group and the PSP group were given the 0.9% sodium chloride solution or PSP eye drops, respectively, once every 15 minutes, 5 consecutive times, then changed to once every 30 minutes, 14 consecutive times. One hour after the last eye drops, the corneal epithelial defects were evaluated under a slit lamp using fluorescein sodium staining and clinical scores were calculated. Then the corneas were acquired and CFU was determined. Three eyeballs in each group were randomly selected for histopathological observation, and real-time quantitative PCR was used to detect the expression of inflammatory factors in the cornea. The independent sample t test was used for comparison between groups. Results: The corneal epithelial defect was serious in the 0.9% sodium chloride solution group and less serious in the PSP group. Compared with the 0.9% sodium chloride solution group, the clinical score of the PSP group was significantly lower, and the difference was statistically significant (t=5.293, P<0.001). Compared with the 0.9% sodium chloride solution group, the quantity of Staphylococcus aureus bacteria and CFU in the PSP group decreased significantly (t=4.383, P<0.001). Histopathological results showed significant inflammatory cell infiltration in the 0.9% sodium chloride solution group. Compared with the 0.9% sodium chloride solution group, the PSP-treated group had relatively good ocular structure and less inflammatory cell infiltration. Real-time quantitative PCR results showed that the expression of interleukin-6, interleukin-1β, tumor necrosis factor-α was significantly lower in the PSP-treated group than that in the 0.9% sodium chloride solution group. Conclusions: 0.01% PSP eye drops can significantly reduce the severity and corneal bacterial load of Staphylococcus aureus keratitis, suggesting that PSP may have potential therapeutic value for Staphylococcus aureus keratitis.
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		2021 Vol. 23 (2): 81-88 [Abstract] ( 300 ) [HTML 1KB] [ PDF 12200KB] ( 1948 )

	89	Differentiating Glaucoma from Physiological Optic Disc Cupping with Optical Coherence Tomography Angiography
		Junyi Ouyang1, 2, Fen Nie3,Dan Zhou2,Yanhong Liu2,Yinjie Guo3,Dengming Zhou3,Xuanchu Duan1, 2
		Objective: To evaluate the ability of optical coherence tomography angiography (OCTA) for detecting large physiological disc cupping (LPC) from primary open-angle glaucoma (POAG) in highly myopic eyes. Methods: In this case control study, 20 highly myopic eyes with mild primary open-angle glaucoma, 22 highly myopic eyes with large disc cupping and 16 normal, non-highly myopic eyes were included. All of the patients were recruited from Changsha Aier Eye Hospital in 2019. Vessel density (VD) and retinal nerve fiber layer (RNFL) parameters were measured by OCTA. A one-way analysis of variance and Pearson coefficients were used. The areas under the receiver operating characteristic curve (AUC) were calculated. Results: The control group compared with the LPC group as follows: The RNFL thickness of the SN and IN regions was greater than that in the LPC group (all P<0.05); the VD in the deep macular layer of the entire image, including the parafovea, perifovea, and peri-N regions, were greater than that in the LPC group (all P<0.05). The LPC group compared with the POAG group as follows: The RNFL thickness of the ST, SN, IT and TI regions and the average RNFL thickness were greater than that in the POAG group (all P<0.05), the disc and peripapillary VD of the entire image, including the capillary, the entire peripapillary, and peripapillary-capillary regions, were higher than that in the POAG group (all P<0.05); the VDs of the most superficial macular regions were higher than that in the POAG group (all P<0.05). The diagnostic efficacy of the parameters between the POAG and LPC groups showed the following: The highest AUC of the disc and peripapillary disc VD was in the peripapillary-capillary region (0.90, 95%CI: 0.80, 0.99); the AUC (0.74±0.65) of the superficial capillary density in the macular area was higher than that in the AUC (0.61±0.37) of the macular deep capillary density, and the difference was statistically significant (F=8.32, P<0.001). Conclusions: OCTA parameters can be used for early diagnosis of the differences between POAG and LPC in highly myopic eyes.
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		2021 Vol. 23 (2): 89-97 [Abstract] ( 288 ) [HTML 1KB] [ PDF 3443KB] ( 2710 )

	98	Comparison of Angle Kappa and Angle Alpha When Measured by a Visual Function Analyzer and Swept-Source Optical Coherence Tomography Biometer in Cataract Patients
		Jianheng Liang1,Xi Feng1,Yali Xu1,Yong Wang1, 2
		Objective: To evaluate the difference, correlation, agreement and repeatability of angle kappa and angle alpha measured by a visual function analyzer and swept-source optical coherence tomography biometer. Methods: A series of case study was designed. One hundred sixty-four patients undergoing cataract surgery in our hospital from October 2018 to October 2019 were included. Data from their right eyes were selected for analysis in all patients. Angle kappa, angle alpha, and the corresponding pupil diameter and corneal diameter were measured by the iTrace visual function analyzer and IOLMaster 700 sweptsource optical coherence tomography biometer. Three repeated measurements were taken for each patient. A paired t test and Wilcoxon symbolic rank test were used to analyze the differences in measurement results. The Pearson correlation coefficient and Spearmen correlation coefficient were used to analyze the correlation. The 95% limits of agreement (LoA) of angle kappa and angle alpha measured by the two devices were calculated by the Bland-Altman method. The repeatability of angle kappa and angle alpha for the two devices was evaluated by the intraclass correlation coefficient (ICC). Results: The angle kappa, angle alpha, pupil diameter and corneal diameter were 0.26 mm (0.18, 0.38), 0.35±0.14 mm, 4.70 mm (4.22, 5.42) and 10.85±0.36 mm (iTrace), and were 0.23 mm (0.15, 0.34), 0.42±0.19 mm, 4.43 mm (3.74, 4.87) and 11.73±0.43 mm (IOLMaster 700), respectively. The angle kappas of the two devices showed no significant difference, while the angle alpha, pupil diameter and corneal diameter showed significant differences (t=-5.541, Z=-9.117, t=-49.463, all P<0.001). The angle kappa was above 0.5 mm in 5.4% of eyes in both devices. The angle alpha was above 0.5 mm in 14.0% (iTrace) versus 32.9% (IOLMaster 700) of eyes. The angle kappa and angle alpha measured by the two devices were moderately correlated (ρ=0.607, r=0.553, P<0.001). The 95%LoA of angle kappa and angle alpha of the two devices was 0.0164(-0.3032-0.3361 mm) and -0.0718(-0.3970-0.2534 mm), respectively. The ICC (95%CI) of angle kappa and angle alpha for iTrace was 0.771(0.689-0.832) and 0.771(0.688-0.832), respectively, and that of IOLMaster 700 was 0.823(0.759-0.870) and 0.863(0.814-0.899), respectively. Conclusions: Angle kappa measured by the two devices shows no difference. However, it is not directly interchangeable considering the difference in pupil diameter between the two devices. There is a significant difference in terms of angle alpha between the two devices, which is larger in IOLMaster 700. The angle alpha of iTrace is not directly interchangeable with that of IOLMaster 700.
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		2021 Vol. 23 (2): 98-103 [Abstract] ( 333 ) [HTML 1KB] [ PDF 2207KB] ( 3031 )

	104	Ocular Biometric Parameters and Refraction in Children with Congenital Fibrovascular Pupillary Membranes
		Xiaohui Deng, Fan Zhang, Zhangliang Li, Yun'e Zhao
		Objective: To investigate the clinical characteristics, ocular biometric parameters and refraction of congenital fibrovascular pupillary membrane (CFPM) patients. Methods: This retrospective study included 15 eyes of 13 CFPM patients (11 unilateral cases, 2 bilateral cases) who underwent surgical treatment from July 2016 to December 2019 at the Eye Hospital, Wenzhou Medical University (Hangzhou). Age at surgery, concurrent eye anomalies, ocular biometric parameters, surgical approaches and refraction 1 week after surgery were recorded. Ten unilateral CFPM patients (1 patient excluded for secondary glaucoma) were divided into the CFPM group and the contralateral control group. Axial length (AL), corneal power and postoperative refraction were compared between the two groups. A paired t test was used to compare the differences in biological parameters between the CFPM group and the contralateral healthy eye group. Results: The concurrent eye anomalies of 13 CFPM patients included congenital cataract, persistent pupillary membrane (PPM), strabismus and secondary glaucoma (the data of one eye of a bilateral case excluded for did not undergo surgery). The AL of the CFPM group (19.87±2.01 mm) was shorter than that of the control group (20.38±1.76 mm), and the postoperative spherical equivalent (3.41±2.29 D) was higher than that of the control group (2.24±1.49 D), but the differences were not statistically significant. Corneal power was close between the two groups (mean corneal power 42.31±2.75 D vs. 42.40±1.05 D, t=-0.096, P=0.926). Conclusions: CFPM maybe accompanied by other concurrent eye anomalies. Compared to the contralateral healthy eye, CFPM eyes present a shorter axial length and higher hyperopia. Clinicians should pay attention to the ocular biometric parameters of CFPM patients preoperatively and refraction postoperatively, treating amblyopia and strabismus in a timely manner.
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		2021 Vol. 23 (2): 104-108 [Abstract] ( 291 ) [HTML 1KB] [ PDF 732KB] ( 2420 )

	109	Analysis of the Visual Outcomes and Clinical Risk Factors for the Occurence of Intraocular Foreign-Body Related Endophthalmitis
		Yifeng Gan1,Jiarong Cao2,Guangwei Song2,Haihua Zheng2,Zhizhang Dong2
		Objective: To investigate the risk factors of intraocular foreign-body (IOFB) related endophthalmitis and the factors that influence visual outcomes. Methods: This was a retrospective study. From January 2009 to October 2019, cases of IOFB injury were included from the Department of Ophthalmology in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and the cases of IOFB-related endophthalmitis were selected. The medical history, cause and time of injury, clinical manifestations and the best corrected visual acuity were recorded. The foreign-body related information such as materials, size, location and surgical information were recorded and routine ophthalmologic examinations, intraocular sample cultures and identification were carried out. All results were documented and analyzed by Chi-square test and multivariate logistic regression. Results: Forty endophthalmitis cases were diagnosed in 338 patients with IOFB injury, indicating an incidence rate of 11.8%. Twenty-nine males and 11 females were included, with an average age of 34.0±22.7 years, and approximately 62.5% of patients were between 21 and 45 years old. Twenty-three cases of trauma occurred in factories and 11 cases at home. There were 25 cases of metallic foreign bodies, and 15 nonmetallic cases (4 plant-based cases). Diameter of IOFB >5 mm in 14 cases, 3-5 mm in 17 cases, <3 mm in 9 cases. Positive microbial culture was found in 12 intraocular samples, including staphylococcus epidermidis in 3 cases, bacillus subtilis in 3 cases, and pseudomonas aeruginosa in 2 cases, while there was negative culture in 20 cases, and 8 cases failed. Statistical analysis demonstrated that the character of foreign body material and wound length were not correlated risk factors for the development of endophthalmitis (χ2 =0.57, P=0.45; χ2 =4.73, P=0.094), while the foreign body diameter, the timing of the primary repair and IOFB removal within 24 hours were demonstrated as protective factors (χ2 =10.83, P=0.001; χ2 =5.80, P=0.016). Ninty percent of patients with IOFB-related endophthalmitis had a final vision lower than 0.05, nearly 50% of eyes had light perception or below after injury, 47.5% of eyes achieved a final visual outcome with light perception or below after treatment, and 12 eyes were blinded with non-light perception. Statistical analysis with a Chi-square test indicated that the location and size of the foreign body and the wound length were prognostic factors for visual outcomes (χ2 =3.23, P=0.023; χ2 =4.14, P=0.041; χ2 =3.72, P=0.037), while the timing of the primary repair and IOFB removal within 24 hours had no obvious correlation with visual prognosis (χ2 =0.63, OR=0.97, P=0.92). Conclusions: IOFB-related endophthalmitis frequently occurs in young and middleaged male workers and results in severe visual functional impairment. The location and size of the foreign body, the timing of the primary repair and IOFB removal within 24 hours were independent risk factors for the occurrence of endophthalmitis, while visual prognosis was closely related to the location and size of the foreign body and wound length.
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		2021 Vol. 23 (2): 109-115 [Abstract] ( 283 ) [HTML 1KB] [ PDF 746KB] ( 2458 )

	116	Evaluation of the Impact of Tear Film Stability on Adolescent Visual Quality by the Optical Quality Analysis System
		Huiqin Cheng, Duan Wang, Liangyan Yi, Man Song
		Objective: To evaluate the impact of tear film stability on adolescent visual quality by using the Optical Quality Analysis System (OQAS-II), and to provide relevant data for clinical research. Methods: In this case series study, 32 adolescent patients with short break-up time (BUT<10 s) and thirty control subjects (BUT≥10 s) were enrolled from the outpatient clinic of Fuzhou Hospital of Traditional Chinese Medicine from March to October 2019. The OQAS-II system was used to detect the modulation transfer function cut off frequency (MTF cutoff), objective scattering index (OSI) and OQAS values with contrasts of 100%, 20% and 9% (OV100%, OV20% and OV9%) in the natural state. Meanwhile, the dynamic changes of OSI were detected during 20-second intervals with the eye open continuously, and the mean value and standard deviation of OSI (SD-OSI) in this dynamic process were obtained. Differences in the parameters were compared between the two groups using independent t test. Spearman rank correlation analysis was used to analyze the correlation between the data. Results: There were no statistically significant differences between the two groups in terms of age, spherical degree or astigmatic degree. BUT was 5.90±2.16 s in the study group, which was significantly less than that in the control group (11.53±2.06 s). This difference (t=-10.473, P<0.001) was statistically significant. MTF cutoff, OSI, OV100%, OV20%, OV9% were compared between the 2 groups, and the differences were not statistically significant. The mean values of OSI and SD-OSI in the study group were higher than those in the control group, and the difference was statistically significant (t=2.259, P=0.028; t=0.359, P=0.036). There was no correlation between MTF cutoff, OSI, OV100%, OV20% and BUT (all P>0.05) but the value of OV9% was positively correlated with BUT (r=0.273, P=0.032). The mean value of OSI in 20-second period was negatively correlated with BUT (r=-0.276, P=0.002), while SD-OSI was not correlated with BUT. Conclusions: The instability of adolescent tear films can lead to a decline in retinal image quality, and it is related to the degree of BUT. There is a high value of OQAS-II in evaluation of adolescent tear films.
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		2021 Vol. 23 (2): 116-119 [Abstract] ( 291 ) [HTML 1KB] [ PDF 706KB] ( 2184 )

	120	Application of the Inferior Oblique Muscle Belly Transposition in V-Pattern Exotropia
		Mingyu Si, Xinxiang Shao, Keshun Fan
		Objective: To investigate the effect of the application of the inferior oblique muscle belly transposition (IOBT) in V-pattern strabismus with mild-to-moderate inferior oblique overaction (IOOA). Methods: This was a prospective study. From January 2018 to April 2020, 40 patients (80 eyes) with V-pattern exotropia with minimal-to-moderate IOOA who underwent IOBT or inferior oblique myectomy (IOMYE) in Xuzhou No.1 People's Hospital were randomly divided into two groups: An IOBT group (n=20) and an IOMYE group (n=20). In addition to horizontal strabismus correction, the patients underwent IOBT in the IOBT group and inferior oblique myectomy (IOMYE) in the IOMYE group. There was a 6-month follow-up period. Horizontal deviation (HD), V pattern, foveal disc angle (FDA) and inferior oblique action (IOA) were analyzed before and after the operation. Data were analyzed using paired t test and independent t test. Results: Seventeen (85%) patients were cured in the IOBT group and 14(70%) in the IOMYE group. There was no significant difference (t=1.313, P=0.205) in FDA before and after surgery in the IOBT group. The differences in changes in FDA, IOA and V pattern between the two groups were statistically significant (t=-11.788, P<0.001; t=-3.701, P=0.001; t=-8.519, P<0.001). Postoperatively, the IOBT group achieved satisfactory results, without overcorrection to an A pattern. In the IOMYE group, 6 patients were overcorrected to A pattern and 8 patients had mild underaction of the inferior oblique. Conclusions: IOBT can successfully treat the V pattern in patients with mild- to-moderate IOOA. It is a supplement to traditional inferior oblique muscle weakening.
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		2021 Vol. 23 (2): 120-127 [Abstract] ( 270 ) [HTML 1KB] [ PDF 8447KB] ( 2070 )

	128	Analysis of Relevant Factors in Demodex Folliculorum Infection in Sjögren's Syndrome Patients
		Qin Zhang, Ziting Huang, Fangting Li, Gong Cheng, Yaobin Cheng, Yuebo Jin, Jing He, Mingwei Zhao
		Objective: To investigate the infection of demodex folliculorum in patients with Sjögren's syndrome (SS), and to determine the correlative relationship between demodexin eyelashes and the ocular surface characteristics. Methods: In this case control study, 22 patients (44 eyes) with SS (SS group, study group) and 21 dry eye patients (42 eyes) without SS (non-SS group, control group) were recruited from Peking University People's Hospital from January to June 2019. The 5-item dry eye questionnaire (DEQ-5), ocular surface disease index, non-invasive tear meniscus height, non-invasive break up time, corneal staining score, the drop out of the upper meibomian gland and the number of demodex in eyelashes were examined in both groups. A t test was used to compare the continuous variables differences between the two groups, a Chi-square test and Fisher's exact test were used to compare the categorical variables between the two groups, and Spearman correlation analysis was used to determine the correlation between the continuous variables of the 2 different groups. Results: The number of mites in the non-SS group was significantly higher than that of the SS group (Z=-2.41, P=0.021). The number of mites in the SS group was correlated with the score on the DEQ-5 scale (r=0.40, P=0.02) and the drop out of the upper meibomian gland (r= -0.70, P=0.02), while the number of mites in the non-SS group was only correlated with the score on the DEQ-5 scale (r=0.63, P=0.04). There was a significant difference in the drop out of the upper meibomian gland between the Demodex positive group and Demodex negative group (Z=3.214, P=0.002). Conclusions: The number of demodex in the SS group is lower than that in the non-SS group. The score on the DEQ-5 scale and the drop out of the upper meibomian gland are correlated with demodex in the eyelashes.
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		2021 Vol. 23 (2): 128-133 [Abstract] ( 279 ) [HTML 1KB] [ PDF 711KB] ( 2544 )

	134	Toric Intraocular Lens Implantation and Traditional IOL Implantation Combined with Peripheral Corneal Relaxing Incisions in the Correction of Age-Related Cataract with Corneal Astigmatism: A Meta-Analysis
		Suo Guo1,Hailong He1, 2, Ziyao Xia1,Jun Wang1
		Objective: To systematically evaluate by meta-analysis the effectiveness, safety and visual function of toric intraocular lens (IOL) implantation and traditional IOL implantation combined with peripheral corneal relaxing incisions (PCRI) in the correction of age-related cataract with ≤3 diopters (D) of corneal astigmatism. Methods: In this evidence-based medical research. PubMed, EMBASE, Cochrane library, Clinicalkey, Web of Science, CNKI, Wanfang, and VIP databases were searched for studies investigating the effect of the toric IOL in the treatment of cataract and corneal astigmatism. Meta-analysis was performed using RevMan 5.3 software to analyze the uncorrected distance visual acuity (UCDVA), residual astigmatism and astigmatism correction between the toric IOL and traditional IOL. Visual acuity was recorded in the form of the LogMAR visual acuity chart. Results: A total of 510 eyes of 352 cataract patients in 8 randomized, controlled trials were included. Meta-analysis results showed that: (1)the mean deviation (MD) of postoperative uncorrected distance visual acuity (logMAR UDVA) at 3 and 6 months was better in the toric intraocular lens group; (2)astigmatism correction at 3 and 6 months after implantation was better in the toric IOL group; (3)postoperative residual astigmatism at 1 month and; (4)at 3 and 6 months was lower for the toric intraocular lens; and (5)there was no significant difference in contrast sensitivity between the toric IOL group and the PCRI group at 3 months. The following data analyses support these findings: (1)MD=-0.04(95%CI: -0.07- -0.01, P=0.005); (2)MD=0.56(95%CI: 0.36- 0.76, P<0.001), standard mean deviation (SMD)=0.94(95%CI: 0.47-1.40, P<0.001); (3)at one month: MD= -0.13(95%CI: -0.21- -0.04, P=0.003), SMD=-0.34(95%CI: -0.59- -0.10, P=0.007); (4)at 3 and 6 months: MD=-0.30(95%CI: -0.51- -0.10, P=0.004), SMD=-0.84(95%CI: -1.42- -0.25, P=0.005); (5)MD=-0.01(95%CI: -0.08- 0.11, P=0.77). Conclusions: Toric IOL is superior to traditional IOL implantation combined with PCRI in correcting ≤3 D of corneal astigmatism in cataract patients. The toric IOL has a slight advantage in improving UCDVA, but the difference may not be clinically important. So far, there was no significant difference between the toric IOL and traditional IOL implantation combined with PCRI in postoperative visual function and vision-related quality of life.
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		2021 Vol. 23 (2): 134-141 [Abstract] ( 303 ) [HTML 1KB] [ PDF 974KB] ( 2488 )

Case Report

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		2021 Vol. 23 (2): 142-145 [Abstract] ( 274 ) [HTML 1KB] [ PDF 13388KB] ( 1863 )

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		2021 Vol. 23 (2): 146-147 [Abstract] ( 326 ) [HTML 1KB] [ PDF 652KB] ( 2353 )

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		2021 Vol. 23 (2): 148-149 [Abstract] ( 310 ) [HTML 1KB] [ PDF 2154KB] ( 2244 )

Review

	150	Advances in OCTA Measurement of Retinal Vascular Density and the Foveal Avascular Zone in Myopia
		Xueqing Wang, Likun Xia
		Optical coherence tomography angiography (OCTA) is a new technology that has been developing in recent years. It can provide high-resolution fundus retinal imaging that is noninvasive and quick. Since the quantitative value of retinal vascular density and the foveal avascular zone can be achieved, this can provide great help for research on early fundus lesions in myopia. This paper reviews the history of OCTA, and summarizes measurement with OCTA and progress in myopia research on fundus retinal blood flow changes and the factors that influence it in detail, including progress on the diagnosis of pathological myopia.
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		2021 Vol. 23 (2): 150-155 [Abstract] ( 305 ) [HTML 1KB] [ PDF 679KB] ( 3412 )

	156	The Development and Application of Visual Perceptual Learning
		Longtang Xie1,Hongsheng Bi1, 2
		Visual perceptual learning is a method to improve the perceptual ability of the visual system to process external information through specific visual perceptual task training. Visual perceptual learning has relative specificity, migration and time-related aspects, which makes it effective in treating amblyopia, strabismus and other eye diseases. In recent years, new applications of visual perceptual learning have been developed for examining and promoting visual function. Meanwhile, with the application of functional magnetic resonance imaging technology, new progress has also been made in exploring brain regions of visual perceptual learning. The development, neural mechanism, learning method, functional application and influencing factors of visual perceptual learning are reviewed in this article.
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		2021 Vol. 23 (2): 156-160 [Abstract] ( 325 ) [HTML 1KB] [ PDF 686KB] ( 2741 )

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