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.4 Published 2021-04-26

	Orignal Article Case Report Review

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		2021 Vol. 23 (4): 0- [Abstract] ( 227 ) [HTML 1KB] [ PDF 38250KB] ( 1395 )

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		2021 Vol. 23 (4): 0- [Abstract] ( 223 ) [HTML 1KB] [ PDF 611KB] ( 1888 )

Orignal Article

	241	Comparison of Two Kinds of Decentration Methods for Measuring Changes after Wearing Orthokeratology Lenses
		Minfeng Chen, Xinting Liu, Miaoran Zheng, Qian Wang, Xinjie Mao
		Objective: To compare the difference between two kinds of decentration methods for measuring changes after wearing orthokeratology lenses. Methods: In a retrospective analysis, about 77 children who met the criteria and insisted on wearing orthokeratology lenses for 24 months were recruited from August 2016 to October 2018 in the Eye Hospital, Wenzhou Medical University. Corneal tangential topography was used to compare changes from before wearing orthokeratology lenses to after wearing them for 3 months. The changes in angle kappa distance before wearing orthokeratology lenses and after wearing them for 3 months were compared. The degree of decentration on the tangential difference map was analyzed with MATLAB. There were two decentration measurement methods (method 1: The decentration distance from the corneal vertex to the center of the optical zone; method 2: The decentration distance from the pupil center to the center of the optical zone) and the difference between the measurement methods was compared. A paired t-test was used to analyze the corneal flat radial refractive power (Kf), the corneal steep radial refractive power (Ks), the angle kappa distance, and the decentration distance of decentration 1 and decentration 2 between baseline and after wearing orthokeratology for 3 months. An independent sample t-test was used to analyze the differences in the two measurement methods in different decentration directions (superior, temporal, inferior, nasal). Pearson correlation analysis was used to analyze the relationship between axial length and decentration distance. Results: There was a statistically significant difference in axial elongation between baseline and after wearing orthokeratology lenses for 2 years (25.25±0.81 mm vs. 25.63±0.76 mm; t=-10.014, P<0.001). The baseline flat radial refractive power (Kf: 42.80±1.23 D) and steep radial refractive power (Ks: 44.09±1.40 D) were significantly higher than the Kf (41.00±1.73 D) and Ks (42.85±1.93 D) measured after wearing orthokeratology lenses for 3 months (tKf=8.893, PKf<0.001; tKs=5.903, PKs<0.001). But there was no statistically significant difference in angle kappa distance between the baseline and after wearing orthokeratology lenses for 3 months (0.27±0.21 mm vs. 0.29±0.21 mm). The decentration distance in decentration 1 showed no statistically significant difference from the distance in decentration 2 (0.64±0.31 mm vs. 0.63±0.35 mm). The direction of the decentration was mainly turned to the temporal side in both methods. Both the decentration distance of decentration 1 (r=-0.332, P=0.003) and the distance of decentration 2 (r=-0.310, P=0.006) showed a negative correlation with axial length during orthokeratology lens wear for 2 years. Conclusions: After wearing orthokeratology lenses, the angle kappa does not show a significant change. The decentration distance measured from the corneal vertex to the optical center shows no statistically significant difference with the decentration distance from pupil center to optical center.
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		2021 Vol. 23 (4): 241-246 [Abstract] ( 329 ) [HTML 1KB] [ PDF 1412KB] ( 2736 )

	247	Treatment of Large-Diameter Idiopathic Macular Hole with Internal Limiting Membrane Transposition and Air Tamponade Surgery
		Wenjuan Luo, Ming Tao, Yan Li, Fanglan Li, Jing Tian
		Objective: To evaluate the clinical effect of 25G vitrectomy combined with internal limiting membrane (ILM) transposition and air tamponade surgery in the treatment of large-diameter idiopathic macular hole (IMH). Methods: A retrospective analysis was conducted on 15 consecutive patients (16 eyes) with large-diameter IMH (hiatus diameter >700 μm) who were treated in the Ophthalmology Department of the Second Hospital of Lanzhou University from October 2018 to March 2019. All patients underwent 25G vitrectomy combined with ILM transposition and air tamponade surgery. Best-corrected visual acuity (BCVA), slit lamp microscopy, mydriatic fundus examination, spectral-domain optical coherence tomography (SD-OCT), and MP-3 microperimetry tests were performed preoperation and 1 week and 1, 3, and 6 months postoperation. The changes in BCVA, macular hole diameter, degree of visual deformation, mean retinal sensitivity (MS) in the macular area, fixation stability and fixation position before and after surgery were observed. Data were analyzed by a t-test, χ2 test and Spearman correlation analysis. Results: At the last follow-up, the macular hole was closed in all 16 eyes (100%) and the postoperative BCVA of 14 eyes was improved (accounting for 87%). No patient had a decreased visual acuity. Over all BCVA improved significantly compared to preoperative BCVA (t=4.08, P=0.001). No complications occurred in any patients during the follow-up period. The deformity in 10 eyes had significantly improved compared to preoperation, and had completely disappeared in 4 eyes. Seven eyes had central fixation before the operation and 14 eyes had central fixation after the operation. Five eyes had stable fixation before the operation and 12 eyes had stable fixation after the operation. Comparisons of fixation position and stability before and after surgery showed statistically significant differences (χ2 =9.000, P=0.029; χ2 =9.863, P=0.016). The MS before the operation was 13.7±2.8 dB and was 16.5±3.6 dB after the operation, which was significantly higher than that before the operation (t=16.072, P=0.003). Patients with better fixation stability before surgery had significantly improved postoperative corrected vision (r=0.518, P=0.040). Conclusions: 25G vitrectomy combined with ILM transposition and air tamponade surgery for the treatment of largediameter idiopathic macular hole can safely and effectively promote the healing of the macular hole and further improve the visual function of patients. It is a recommended minimally invasive surgical method for a larger idiopathic macular hole diameter.
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		2021 Vol. 23 (4): 247-253 [Abstract] ( 274 ) [HTML 1KB] [ PDF 5278KB] ( 2260 )

	254	Changing Trends during the Past Decade in the Types of Corneal Laser Refractive Surgery in the Eye Hospital (Wenzhou Branch), Wenzhou Medical University
		Lele Cui1, 2, Weihe Zhou1, 2, Xiaoxuan Zhu1, 2, Kai Yang1, 2, Yunfan Xiao1, 2, Shihao Chen1, 2, Ye Yu1, 2, Chenchen Xu1, 2, Liang Hu1, 2, Qinmei Wang1, 2
		Objective: To investigate the changing trends in the types of corneal laser refractive surgury in the Eye Hospital (Wenzhou Branch), Wenzhou Medical University, from 2010 to 2019. Methods: This was a retrospective case series study. Data for 35 902 patients (70 766 eyes), 22 372 men (43 973 eyes), 13 530 women (26 793 eyes); age range (median), 16-62 (22) years, who underwent corneal laser refractive surgery from January 1, 2010 to December 31, 2019 in the Eye Hospital (Wenzhou Branch), Wenzhou Medical University, were collected. Data for age and gender distribution of corneal laser refractive surgical cases and the changing trends in surgical quantity and type, and the seasonal trends were analyzed by SPSS 21.0 and R4.0.3. Results: The number of corneal laser refractive surgical cases increased compared with the previous years except for 2012 and 2014. The proportion of photorefractive keratectomy fluctuated between 0.10% and 0.19% from 2010 to 2012. The ratio of epipolis-laser in situ keratomileusis increased from 7.68% in 2010 to 8.71% in 2011, and then decreased to 0.03% (χ2 =1367.475, P<0.001) in 2016. The proportion of transepithelial photorefractive keratectomy increased from 3.20% in 2012 to 36.87% in 2019 (χ2 =4388.776, P<0.001). The rate of laser in situ keratomileusis was accounted for 92.21% in 2010, and then decreased to 0.22% in 2018 (χ2 =23052.398, P<0.001). The ratio of femtosecond laser-assisted laser in situ keratomileusis increased from 29.35% in 2011 to 72.90% in 2016 (χ2 =3635.744, P<0.001), but decreased to 31.41% in 2019 (χ2 =1107.074, P<0.001). The ratio of femtosecond laser small incision lenticule extraction increased between 2016 and 2019 from 4.11% to 31.72% (χ2 =2021.33, P<0.001). The big seasonal peak was from June to August every year, and the small peak was February. Conclusions: The quantity of corneal laser refractive surgery in the Eye Hospital (Wenzhou Branch), Wenzhou Medical University, showed a gradually increasing trend compared with the previous year except for the decrease in the early stage. Lamellar laser surgery was still the main stream surgical procedure, and the trend of surface laser surgery to regress was becoming more and more prominent. There were three main kinds of corneal laser refractive surgery in recent years: Transepithelial photo refractive keratectomy, femtosecond laser-assisted laser in situ keratomileusis and femtosecond laser small incision lenticule extraction. June to August and February were the months in which operations were concentrated every year.
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		2021 Vol. 23 (4): 254-259 [Abstract] ( 308 ) [HTML 1KB] [ PDF 1491KB] ( 2471 )

	260	Comparison of the Efficacy and Safety of Different Regimens of Intravitreal Conbercept Injections for Wet Age-Related Macular Degeneration
		Peng Zhang1,Lei Gao1,Shujing Wang2,Yixiao Li3,Hong Wang4
		Objective: To assess the clinical effectiveness of an intravitreal injection of conbercept using two different strategies, the 3+PRN and 3+Q3M strategies, for the treatment of wet age-related macular degeneration (AMD). Methods: Prospective clinical study. Patients at Qilu Hospital, Shandong University who were confirmed to have exudative AMD from August 2018 to August 2019 were included. Exudative lesions of choroidal neovascularization (CNV) in the macular area were found in all 106 eyes of these patients. The international standard decimal visual acuity chart was used to measure best corrected visual acuity (BCVA). This was converted to the logarithm of the minimum angle of resolution (LogMAR) for the analysis. Optical coherence tomography (OCT) was used to measure central retinal thickness (CRT). For all eyes, an intravitreal injection of 0.5 mg of conbercept was administered with one of two strategies: 55 eyes received once monthly injections for the first 3 months, then 3+prore nata (3+PRN), and 51 eyes received once monthly injections for the first 3 months, followed by one injection every 3 months (3+Q3M). The patients were followed up for 12 months after the treatment. Routine examinations of BCVA, intraocular pressure (IOP), and OCT were conducted at 1 and 2 weeks after the operation, then these examinations were conducted every month. FFA examination was conducted every 3 months after the operation.The changes in BCVA, CRT and exudation of CNV lesions of the eyes were measured before and after treatment. Repeated measures analysis of variance was used to compare the groups and show the time effect, while the LSD t-test was used for comparisons among different time points within the same group. Results: The mean BCVA in both groups improved significantly at 1, 3, 6, 9 and 12 months after the operation, compared to the levels before treatment (3+PRN: t=7.202, 11.178, 9.914, 9.869, 10.587, respectively, P<0.001; 3+Q3M: t=5.548, 9.780, 9.358, 11.884, 11.622, respectively, P<0.001). In addition, the BCVA of the eyes was also significantly better in the 3+Q3M group than in the 3+PRN group at 9 and 12 months after the operation (t=2.304, P=0.023; t=2.058, P=0.042). The mean CRT of the eyes was significantly lower at 1, 3, 6, 9 and 12 months after treatment, compared to the level before treatment (3+PRN: t=12.28, 17.041, 17.615, 15.739, 16.171, P<0.001; 3+Q3M: t=10.221, 15.598, 16.297, 16.984, 17.275, P<0.001). In addition, the CRT of the eyes was significantly lower in the 3+Q3M group than in the 3+PRN group at 9 and 12 months after the operation (t=2.032, P=0.045; t=2.092, P=0.039). The FFA and ICGA examinations at the last follow-up showed that the exudation of CNV lesions in the macular area disappeared, reduced, or increased in 31(56%), 18(33%), and 6(11%) eyes in the 3+PRN group, and in 32(63%), 15(29%), and 4(8%) eyes in the 3+Q3M group, respectively. The Chi-square test shows the difference has no significance. There were no serious treatment-related ocular complications, such as retinal detachment, retinal tear, persistent intraocular pressure increase, or endophthalmitis, as well as serious systemic adverse responses found during the follow-up. Conclusions: Both strategies, namely the 3+PRN and 3+Q3M strategies, of intravitreal injection of conbercept are effective in treating wet AMD. However, the 3+Q3M strategy needs more injections but is more effective for improving visual acuity, reducing macular CRT thickness, and decreasing the exudation area of CNV, than the 3+PRN strategy.
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		2021 Vol. 23 (4): 260-266 [Abstract] ( 278 ) [HTML 1KB] [ PDF 734KB] ( 2250 )

	267	Myopia Progression in Children Wearing Peripheral Defocus Modifying Lenses: Four Years of Retrospective Analysis
		Yin Guo1,Feifei Tian2,Min Wu1,Yi Feng1,Ping Tang1,Yanyun Lu1
		Objective: To review myopia progression over 4 years in children who wore peripheral defocus modifying lenses (PDMLs), and assess its efficacy of myopia control. Methods: This was a retrospective, nonrandomized controlled trial at a tertiary referral center (Tongren Eye Care Center, Beijing Tongren Hospital). Data from 217 children aged 8-14 years who wore PDMLs or single vision lenses (SVLs) consecutively for 4 years (from 2011 to 2014) were collected from electronic medical records. Information such as age, gender, refraction, and type of spectacle lenses were included. PDML is an asymmetric design in which myopia progression was slowed using peripheral vision control technology. Final subjects were 88 children who were included after propensity score matching, with 44 children in each group. Only data of right eyes were included using a generalized estimation equation (GEE) model. Independent t tests and Chi-square tests were used to determine whether myopia progression differed between the two groups. Results: Annual myopia progression was -0.85±0.43 D, -0.60±0.35 D, -0.64±0.26 D and -0.53±0.28 D in the PDML group, and was -0.82±0.42 D, -0.79±0.44 D, -0.61±0.40 D and -0.58±0.33 D in the SVL group, respectively. 59%(26/44) in the PDML group progressed lower than 2.00 D, slightly higher than that of 50.0%(22/44) in the SVL group (χ2 =2.06, P=0.12). After stratification by age and baseline refraction, there was also no significant difference in myopia progression between the two groups. In the GEE model, annual myopia progression was associated with age (β=0.06; standard error: 0.01; 95%CI: 0.03, 0.09; P<0.001) and treatment (β=-0.09; standard error: 0.05; 95%CI: -0.19, -0.01; P=0.04). Conclusions: Compared to single vision lenses, peripheral defocus modifying lenses can moderately slow myopia progression. However, the effect is not remarkable in clinical practice.
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		2021 Vol. 23 (4): 267-271 [Abstract] ( 310 ) [HTML 1KB] [ PDF 737KB] ( 3046 )

	272	Correlation between Amount of Myopia and Macular Blood Flow in Myopic Children and Adolescents
		Lingli Lin, Xiaohan Zhang
		Objective: To investigate the relationship between amount of myopia and blood flow density and foveal avascular zone (FAZ) in the macular area in myopic children and adolescents. Methods: This was a case series study. The clinical data of 50 cases and 100 eyes of children and adolescents who were tested for myopia in the optometry clinic of Ningde City Hospital Affiliated to Ningde Normal University from July 2019 to January 2020 were collected for analysis. All subjects were examined for height, uncorrected visual acuity, refractive error, and corrected visual acuity. The eye axial length and OCTA in the macular area were also tested. Patients were divided into two groups according to the size of the equivalent spherical refractive error (SE): A low myopia-to-emmetropia group (-3.0 D<SE<+0.5 D) with 66 eyes and a moderate-to-high myopia group (SE≤-3.0 D) with 34 eyes. The differences in blood flow vascular density (VD), perfusion density (PD) and FAZ between the two groups were observed, as well as their correlations with the child's height and eye axial length. Analysis of variance, rank and inspection, and Pearson correlation analysis were used to test results for the macular blood flow, eye axial length and the child's height. Results: There was no statistically significant difference between the two groups in the vascular density of a 1 mm diameter area (VD1), the perfusion density of a 1 mm diameter area (PD1) and the perfusion density of a 6 mm diameter area (PD4) centered at the macular shallow layer. VD4 and FAZ were significantly different (t=3.870, P=0.031; t=6.237, P=0.014), FAZ was negatively correlated with eye axial length and age (r=-0.333, P=0.001; r=-0.289, P=0.042). Conclusions: The VD4 and FAZ of children and adolescents with low myopia are both larger than those with moderate-to-high myopia, and FAZ is negatively correlated with eye axial length and age, but the causal relationship needs further study.
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		2021 Vol. 23 (4): 272-276 [Abstract] ( 347 ) [HTML 1KB] [ PDF 2568KB] ( 2224 )

	277	Prevalence of Amblyopia among Primary and Secondary School Students in Motuo County, Tibet
		Suhua Zeng, Na Yao, Yue Cai, Dongcui Chen, Xia Gong, Wenyong Huang, Linxing Chen, Jingyi Lin
		Objective: To investigate the prevalence of amblyopia and its influencing factors among primary and secondary school students in Metuo County, Nyingchi City, Tibet Autonomous Region. Methods: This was a cross-sectional survey. In May 2017, a total of 833 students from urban primary and middle schools in Metuo County were surveyed for visual acuity survey and basic eye examinations, including visual acuity, refractive, anterior segment, fundus and eye position examination, etc. A questionnaire was used to survey the students diagnosed with amblyopia and the causes were analyzed. Fisher's exact test, Chi-square test and logistic regression were used to analyze the data. Results: A total of 833 primary and secondary school students in Motuo county participated in the survey, among whom 22 had amblyopia. The prevalence of amblyopia was 2.6%. And the cause of amblyopia included anisometropia in 10 cases, accounting for 45%; 6 cases of refractive error, accounting for 27%; 3 cases of strabismus occurred in 3 patients, accounting for 14%. There were 2 patients with form deprivation, accounting for 9% and 1 other patient, accounting for 5%. Gender and age were not the influencing factors for the prevalence of amblyopia. Conclusions: The prevalence of amblyopia among primary and secondary school students in Motuocounty is higher than prevalence of whole China. Anisometropia and refractive error are the main causes of amblyopia.
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		2021 Vol. 23 (4): 277-280 [Abstract] ( 354 ) [HTML 1KB] [ PDF 738KB] ( 2318 )

	281	Shenyang Eye Disease Screening Program: Distribution and Related Factors of Intraocular Pressure
		Lin Wang1,Junhong Jiang2,Chi Liu1,Haishuang Lin2,Yuanbo Liang2,Shaodan Zhang2
		Objective: To investigate the distribution and influencing factors of intraocular pressure (IOP) in healthy people suspected to have ocular hypertension or glaucoma in a screened population in Shenyang. Methods: Cross sectional investigation study. From March 1st to September 30th, 2016, local urban residents aged 30 and over who had made an appointment for a physical examination at the Fourth People's Hospital of Shenyang were invited for this screening. Stratified random sampling was conducted according to the registered domicile of those screened. Enrolled participants underwent a bilateral examination of habitual visual acuity, noncontact pneumotonometry, and non-mydriatic fundus photography. Ocular hypertension was defined as IOP >21 mmHg (1 mmHg=0.133 kPa) in either eye with a normal fundus in both eyes. Suspected glaucoma was diagnosed if two or more glaucomatous optic nerve changes were detected. Distribution of intraocular pressure was analyzed in the different gender and age groups in the sample. Results: A total of 15 303 subjects were enrolled and final data from 12 374 participants were used for analysis according to the exclusion criteria, including 11 296 healthy persons (91.3%), 801 persons suspected to have ocular hypertension (6.5%), and 277 persons suspected to have glaucoma (2.2%). Mean age of the healthy individuals was 50±13 years, and the IOP was 16.2±2.2 mmHg. IOP in the left eye (16.3±2.3 mmHg) was higher than that in the right eye (16.0±2.3 mmHg) (t=-19.813, P<0.001). Women (16.1±2.3 mmHg) had a higher IOP than men (15.9±2.3 mmHg) (t=-3.264, P=0.001), and older individuals had lower IOP than the youngers (F=29.729, P<0.001). IOP for people suspected to have ocular hypertension (mean age, 49±13 years) was 21.7±2.3 mmHg. IOP (18.0±4.0 mmHg) in people suspected to have glaucoma (mean age, 56±13 years) was significantly higher than that in healthy people, but lower than those suspected to have ocular hypertension (F=2300, P<0.001). Only 16.6% of these glaucoma suspects showed an IOP of 21 mmHg or higher. Age and gender did not exert influence on the IOP in people suspected to have ocular hypertension or glaucoma. Conclusions: IOP decreases with age in the adult population in Shenyang. IOP in females is higher than that in males. The value of IOP measurement itself in glaucoma screening is very limited. A combination with fundus photography is highly recommended.
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		2021 Vol. 23 (4): 281-286 [Abstract] ( 323 ) [HTML 1KB] [ PDF 701KB] ( 2226 )

	287	Clinical Observations and Treatment of Lens Residue after Femtosecond Laser Small Incision Lenticule Extraction
		Mengjun Fu, Haorun Zhang
		Objective: To investigate clinical treatment for lens residue after femtosecond laser small incision lenticule extraction (SMILE). Methods: Retrospective cases series study. A total of 288 patients (557 eyes) who underwent SMILE surgery in Weifang Eye Hospital from August 1 to 29, 2020 were selected for routine perioperative management. The lenticule residual retained was recorded postoperatively. Results: Two hundred eighty-eight patients (557 eyes) underwent surgery. Uncorrected visual acuity 1 day after surgery was -0.2-0.2, with an average of -0.026±0.075 (LogMAR). One month after surgery, the visual acuity of the naked eye was -0.2-0.2, with an average of -0.062±0.055 (LogMAR). The residual spherical equivalent refractive errors were -1.00-+1.00 D on the 1st day after surgery, with an average of +0.11±0.43 D. The residual spherical equivalent refractive errors were -1.00-+1.00 D one month after surgery, with an average of +0.20±0.36 D. There was lenticule residual retention in 6 eyes (1%). Among the cases with lenticule residual retention, 4 eyes had good visual acuity and the residual was in a short strip close to the peripheral area. The visual acuity of one naked eye was 1.0, but the postoperative residual refractive index was large. Pentacam showed corneal irregularity and the lenticule residual retention could be observed with anterior segment optical coherence tomography (AS-OCT). Then a secondary extraction was performed. One eye lost suction when the lenticule edge cut was completed; suction was restored immediately and laser scanning was completed. However, the lenticule separation and removal was difficult. The visual acuity of the naked eye was poor postoperatively. Pentacam showed corneal irregularity and AS-OCT showed the lenticule residual retained. The patient refused further treatment and was followed up. Conclusions: SMILE has a low incidence of partially retained lenticule. Satisfactory results can still be obtained by proper disposal of residual lenses.
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		2021 Vol. 23 (4): 287-291 [Abstract] ( 303 ) [HTML 1KB] [ PDF 5015KB] ( 2554 )

	292	Effect of ICL-V4c Implantation in Treatment of Ultra-High Myopia
		Ying Xiong, Xiuli Sun, Yingyan Mao, Jing Li, Kai Cao, Jingshang Zhang, Jinda Wang, Xiuhua Wan
		Objective: To observe the safety and effectiveness of ICL-V4c implantation in the treatment of ultra-high myopia over -10 D, and to explore the relationship and rules between the improvement of vision (△LogMAR) and preoperative spherical diopter (SD). Methods: This was a retrospective study. Eight hundred and two patients (1 380 eyes) with ultra-high myopia were treated by ICL-V4c implantation in Beijing Tongren Hospital from December 2016 to January 2020. The preoperative SD was -23.50 D≤SD≤-6.00 D (mean -11.54±3.59 D). The patients were divided into group A (-10 D<SD≤-6 D) and group B (-23.5 D ≤SD≤-10 D) according to their preoperative SD. Group B was further divided into five sub groups: B1 (-13 D<SD≤-10 D), B2 (-16 D<SD≤-13 D), B3 (-19 D<SD≤-16 D), B4 (-22 D<SD≤-19 D) and B5 (-23.5 D≤SD≤-22 D). The preoperative and postoperative visual acuity at 1 week and 2 months and improvement in visual acuity and intraocular pressure of the patients were analyzed by Kruskal-Wallis test and Chi-square test. Results: The postoperative SD and best corrected visual acuity (BCVA) of patients in group B were significantly improved (P<0.001). Both mean safety and effectivity indices were >1. There was a significant correlation between △LogMAR and group (P<0.001). △LogMAR in the B3 and B4 groups was significantly higher than that in A, B1 and B2 groups (adjusted, P<0.001). The intraocular pressure (IOP) in group B was higher than that in group A (P<0.001), and the proportion of postoperative high IOP was higher (P=0.008). Conclusions: ICL implantation is safe and effective for patients with ultra-high myopia over -10 D, but the long-term effect needs further explorations. The improvement of BCVA in patients with -22 D≤SD≤-16 D was higher than that of patients with -16 D<SD≤-6 D.
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		2021 Vol. 23 (4): 292-297 [Abstract] ( 289 ) [HTML 1KB] [ PDF 806KB] ( 2183 )

	298	Countermeasures of the Ultra-Widefield Scanning Laser Ophthalmoscope in Patients with an Abnormal Iris Structure
		Hui Zhang, Nan Wang
		Objective: To study how to use the ultra-widefield scanning laser ophthalmoscope and the operator to move the position to perform fundus examinations on patients with an abnormal iris structure whose iris is incomplete and whose iris has other visual markers. Methods: In this case series study, twenty-nine patients (29 eyes), who underwent ultra-widefield scanning laser ophthalmoscopy in the First Affiliated Hospital of China Medical University from March 27, 2020 to August 11, 2020, were examined with the eye position adjustment method. Among the 29 cases, there were 8 cases (8 eyes) after trabeculectomy, 10 cases (10 eyes) after laser rhizotomy, 7 cases (7 eyes) after vitrectomy and 4 cases (4 eyes) with iris pigmented nevus. Results: After adjusting the eye position of the patients, so that the direction of the iris reconstruction structure is on one side of the examination surface, and the pupil is on the main body of the examination surface, fundus images were successfully acquired in all 29 patients (29 eyes) with abnormal iris. And the average number of quadrants of fundus images of all four diseases was 2.93, and the images reached the approximate wide-angle range (about 60°-100° fundus range), that can basically satisfy the needs of a clinical fundus examination. Conclusions: The method of adjusting the eye position by the operator can be used for ultra wide angle fundus examination of patients with abnormal iris structure, and the range of fundus image obtained is higher than that of ordinary fundus examination, which expands the scope of indications of orburg examination.
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		2021 Vol. 23 (4): 298-302 [Abstract] ( 288 ) [HTML 1KB] [ PDF 5442KB] ( 2305 )

Case Report

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		2021 Vol. 23 (4): 303-305 [Abstract] ( 274 ) [HTML 1KB] [ PDF 8630KB] ( 2144 )

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		2021 Vol. 23 (4): 306-309 [Abstract] ( 259 ) [HTML 1KB] [ PDF 7395KB] ( 1925 )

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		2021 Vol. 23 (4): 310-311 [Abstract] ( 265 ) [HTML 1KB] [ PDF 2331KB] ( 2237 )

Review

	312	Expression and Detection of the MMP-2 Protein in the Eye
		Run Jiang1, 2, Jibo Zhou1, 2
		Matrix metalloproteinase-2 (MMP-2) is one of the matrix metalloproteinase proteins. Its abnormal expression has been proven to be related to the occurrence and development of various ophthalmic diseases in recent years. We summarize the expression and detection of MMP-2 in the eye and the effects of MMP-2 in ophthalmic diseases.
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		2021 Vol. 23 (4): 312-316 [Abstract] ( 324 ) [HTML 1KB] [ PDF 680KB] ( 2407 )

	317	Research Progress on Visual Fatigue after Corneal Refractive Surgery
		Yue Zhang, Yan Wang, Lin Zhang
		Corneal refractive surgery, one of the most important treatments for refractive error, has been confirmed by numerous studies for its high safety, efficacy and stability. However, in the clinic, there were a few patients who were complaining about symptoms of visual fatigue, such as blurred near vision and eye strain for near work. These symptoms usually last for a short time and have a relatively low incidence rate but still have an effect on patient satisfaction after refractive surgery. Furthermore, the underlying mechanism for visual fatigue is complicated and variable. This review summarizes the research status, potential reasons and appropriate therapy for visual fatigue after refractive surgery.
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		2021 Vol. 23 (4): 317-320 [Abstract] ( 270 ) [HTML 1KB] [ PDF 676KB] ( 2362 )

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