Chinese Journal of Optometry Ophthalmology and Visual science

Objective: To observe and study the efficacy of parallel direct puncture of orbicularis oculi muscle

combined with periocular acupuncture in the treatment of patients with partial side hemifacial spasm,

and to provide a theoretical basis for this treatment. Methods: This was a serial case study. Sixty patients

diagnosed with partial side hemifacial spasm in the Eye Hospital, Wenzhou Medical University from

December 2018 to December 2020 were randomly divided into a treatment group and control group

according to the random number table method, with 30 patients in each group. The treatment group

were treated with parallel direct puncture of the orbicularis oculi muscle combined with periocular

acupuncture, while the control group was treated with tiapril hydrochloride tablets, ginkgo biloba capsules

Objective: To observe the effect of a parallel prick of the orbicularis oculi muscle in the treatment of

benign idiopathic blepharospasm. Methods: This is a series of case studies. A total of 70 patients with

benign idiopathic blepharospasm were collected from the TCM Ophthalmology, Eye Hospital of Wenzhou

Medical University from January 2019 to December 2020. Patients were randomly divided into the

observation group and the control group. The observation group underwent parallel acupuncture of the

orbicularis oculi muscle on the affected side and conventional acupuncture such as BL2, TE23, EX-HN5,

and GB20, while the control group was underwent just acupuncture of periocular acupuncture points. The

Chi-square test was used to compare the number and severity grade of the spasms, the frequency grade

of the spasms and curative effect. Results: In the observation group of 35 cases, results show that the

procedure clinically cured 3 cases, was significantly effective in 12 cases, was effective in 17 cases, and

was ineffective in 3 cases, with a total effective rate of 91%. In the control group, the procedure clinically

cured 1 case, was significantly effective in 5 cases, was effective in 18 cases and ineffective in 11 cases,

with a total effective rate of 69%. There was a statistically significant difference in the treatment outcomes

between the two groups (χ2=8.48, P=0.037). Conclusion: Parallel acupuncture of the orbicularis oculi

muscle combined with periocular point acupuncture for benign essential blepharospasm is more effective

than periocular point acupuncture alone.

Clinical Observation of Dihuangchufengyisuntang Combined with Flumilone Eye Drops on Improving Ocular Surface State after Pterygium Operation

Objective: To observe the clinical treatment of Dihuangchufengyisuntang (self-made prescription)

combined with flumilone eye dropson improving the ocular surface state after pterygium surgery. Methods:

In this serial case study, select 60 patients who have made pterygium surgery, and randomly divided them

into treatment group 30 cases (38 eyes) and control group 28 cases (38 eyes). The treatment group was

treated with Dihuangchufengyisuntang combined with 0.1% flumilone eye drops, while the control group

was treated with 0.1% flumilone eye drops only, and the treatment lasted for 6 weeks. Corneal sodium

fluorescein staining (FL), SchirmerⅠ test (SⅠT) and break-up time (BUT) were performed at 2, 4 and 6

weeks of treatment, respectively. Eye pain, eye itching, eye discharge, lacrimation, dryeye, conjunctival

congestion, photophobia scores of Traditional Chinese Medicine treatment (TCM) clinical sympotoms

were determined according to Guidelines for Clinical Research of TCM New Drugs. All test indicators and

symptom scores were recorded. Data were analyzed by repetitive measurement deviation analysis, t text,

rank sum test and chi-square test. Results: After 2 weeks of treatment, there was statistically significant

difference in symptoms scores between the two groups (t=2.97, P=0.01). While there was no significant

difference in FL, SⅠT, BUT. At 4, 6 weeks of treatment, symptoms scores, FL, SⅠt, BUT were significantly

different between the two groups (after 4 weeks of treatment, t values are -4.03, -4.42, 5.10, 4.16; after 6

weeks of treatment, t values are -2.18, -2.02, 2.08, 2.31; P<0.05). Conclusion: Dihuangchufengyisuntang

combined with flumilone eye drops can obviously improve the ocular surface irritation symptoms after

pterygium operation, reduce corneal fluorescein sodium staining, prolong the tear film rupture time,

increase the tear secretion, and the clinical effect is significant and stable.

Objective: To investigate the protective effect of microglia on acutely light-induced retinal degeneration

in the mouse. Methods: This was an animal experimental study. Thirty male ICR mice were randomly

divided into a control group, light-damaged group and a microglia depletion group. The control group did

not receive any treatment. The light-damaged group was exposed to 15 000 lx white light for 20 hours. The

microglia depletion group was intraperitoneally injected with the small molecule inhibitor PLX5622 for 5

days before white light irradiation, followed by 15 000 lx white light irradiation for 20 hours, and then the

PLX5622 injection was continued for 3 more days. Retinal function was measured by the electroretinogram

on day 5 after light exposure. Then the eyes were removed, and the eye cup or whole-mount retina was

prepared. Immunohistochemistry and TUNEL staining were used to observe the degree of retinal damage

and the morphology and function of microglia. The experimental data were analyzed by one-way analysis

of variance (ANOVA). Results: In this study, mice were exposed to 15 000 lx white light for 20 hours to

obtain a stable model of retinal dysfunction and photoreceptor apoptosis. The amplitudes of the a and b

waves of the ERG response showed that photoreceptors and bipolar cells were dysfunctional in the
lightdamaged group, and TUNEL positive cells increased significantly compared to the control group (P=0.035).

Activated microglia also increased significantly (P<0.001). Immunohistochemical results showed that

microglias in the outer nuclear layer and outer plexiform layer were significantly reduced in the microglia

depletion group compared to the light-damaged group (P=0.027). The CtBP2 signal and PKC-α signal

were enhanced, and the outer segment length remained at a normal level (P<0.001), but there was no

statistically significant differences between the ERG response b wave amplitude and TUNEL positive cells.

Conclusion: The depletion of microglia can reduce photoreceptor apoptosis and save retinal function in the

very short term.

Comparing the Clinical Application Outcomes between the NGENUITY Three-Dimensional and Binocular Microscope Visualization Systems in Posterior Chamber Implantable Collamer Lens Implantation

Objective: To evaluate the operation and clinical applications of the NGENUITY® 3D-guided system

and the binocular microscope visualization system for posterior chamber implantable collamer lens

implantation (ICL). Methods: This was a randomized controlled study. A total of 60 patients (60 eyes) who

underwent ICL or Toric ICL (TICL) surgery in the Xi’an Aier Eye Hospital from October to November

2020 were enrolled and randomly divided into two groups that included 30 patients (30 eyes) in the 3D

group and 30 patients (30 eyes) in the microscope group. The following observation indexes were obtained

during this study: the operation indicators included the minimum light illuminance, ICL implant time, TICL

posit time and total operation time and the clinical outcome indicators that included changes in the patients’

intraocular pressure, visual acuity, manifest refraction spherical equivalent (MRSE), the average off-axis

rotation axial deviation and the rate of subconjunctival hemorrhage. The t test and Chi square test were used

for statistical analysis. Results: There were no significant differences between two groups in age, MRSE

or TICL proportion at baseline. There was a statistically significant difference between the microscope

group and the 3D group in the minimum light illuminance (10 800±1 300 lux, 5 000±1 500 lux),

the ICL implant time (12.6±3.7 s, 8.7±2.4 s), the TICL posit time (32.4±5.4 s, 16.3±2.4 s), and the

total operation time (415.4±43.3 s, 331.0±33.7 s). All differences were statistically significant (t=7.31,

P=0.003; t=6.32, P=0.001; t=8.34, P=0.001; t=5.83, P=0.002). The differences in intraocular pressure

changes 3 hours after surgery (5.24±3.42 mmHg, 3.12±2.15 mmHg) and the average off-axis rotation axial

deviation (5.68±0.18°, 3.23±0.13°). Comparisons were both statistically significant (t=2.82, P=0.002;

t=3.22, P=0.002). There were no significant differences between groups after the operation in the rate of

subconjunctival hemorrhage, uncorrected visual acuity, best corrected visual acuity or residual refractive

error. Conclusions: Compared with the binocular microscopy system ICL, the intraoperative light

illuminance, operative time and the average off-axis rotation axial deviation can be reduced more by the

NGENUITY® 3D-guided system ICL.

Objective: To compare the effects on dry eye symptoms from phacoemulsification (phaco) combined

with intraocular lens (IOL) implantation, phaco-IOL-goniosynechialysis and phaco-IOL-trabeculectomy.

Methods: This was a retrospective control study. Ninety-two patients were recruited from June 2019

to June 2020 in the Department of Ophthalmology at Qingdao Municipal Hospital. Group A (40 eyes)

underwent phacoemulsification, group B (38 eyes) underwent phaco-IOL-goniosynechialysis, and group

C (40 eyes) underwent phaco-IOL-trabeculectomy. Noninvasive first tear film break-up time (NIFBUT),

noninvasive average tear film break-up time (NIA-BUT), tear meniscus height (TMH), meibomian

gland loss scores, basal tear secretion, and corneal perception were analyzed and compared at 1 day

preoperatively and 3 days, 1 week, 1 month, and 3 months postoperatively using the Oculus Keratograph

5M, SchirmerⅠ test (SⅠT) and Cochet-Bonnet Asthesiometer. Quantitative data consistent with normal

distribution were analyzed by repeated measures ANOVA. The LSD-t test was used for intra-group

comparison and one-way ANOVA was used for inter-group comparison. Kruskal-Wallis H test was used

to compare the data that did not conform to normal distribution. Results: From postoperative 3 days to 3

months, the NIF-BUT and NIA-BUT of group C dropped more significantly than those of the other two

groups (P<0.05). NIF-BUT and NIA-BUT both returned to preoperative levels at 1 month after surgery in

groups A and B. TMH and SⅠT in group C increased at 3 days and 1 week postoperatively (P<0.05), and

returned to preoperative levels at 1 month postoperatively. At each time point postoperatively, TMH and

SⅠT of groups A and B were not significantly different compared to baseline. At 3 months postoperatively,

meibomian gland loss scores increased significantly, and there was a statistically significant difference in

group C (t=-9.48, P<0.001). At each time point postoperatively, meibomian gland loss scores were not

significantly different compared to baseline between groups A and B. The corneal perception of each group

receded and the perception in group C was more serious and different than the other two groups from 3

days to 1 month postoperatively (P<0.05). At 3 months postoperatively, corneal perception in group C

returned to the preoperative level and there was no statistically significant difference. It was restored to the

preoperative level at 1 month postoperatively and there was no statistically significant difference between

group A and B. Conclusions: Phaco-IOL-trabeculectomy has a great influence on SⅠT and corneal

perception. Corneal perception recovered at 3 months postoperatively, but tear film stability and meibomian

gland loss was still lost.

Objective: To evaluate the value of using the Pentacam anterior segment analyzer to measure ocular

anterior segment parameters in the selection of initial lens sagittal depth (LSD) for scleral lenses (SL).

Methods: Retrospective serial case study. Thirty-two patients (53 eyes) with irregular corneal astigmatism

or dry eye disease were enrolled and fitted with SL in the Affiliated Eye Hospital of Nanjing Medical

University from October 2020 to June 2021. All patients underwent general ophthalmic examinations

before the initial SL fitting evaluation. Pentacam was used to obtain the ocular anterior segment parameters,

such as flat keratometry (Kf), steep keratometry (Ks), corneal astigmatism, aspheric factor (Q-value),

central corneal thickness (CCT), corneal diameter, and anterior chamber depth (ACD). In addition, the

built-in caliper of the Pentacam was used to measure corneal sagittal height (CSH) at a 13.50 mm chord

length. A Pearson or Spearman correlation analysis was used to evaluate the relationship between the

modified LSD and above-mentioned parameters measured by Pentacam, and a linear regression model

was created. Results: All patients completed the first SL fitting evaluation.The CSH measured in the

Scheimpflug images of the Pentacam were 3 746±187 μm under a 13.50 mm chord length, and the modified

LSD was 3 622±206 μm after fitting. The results of a correlation analysis showed that the modified LSD

was positively associated with Kf, Ks, corneal astigmatism, ACD and CSH (r ranged from 0.36 to 0.84, all

P<0.05). The modified LSD was negatively correlated with CCT (r=-0.35, P=0.011). However,there was

no correlation between the Q-value or corneal diameter and the modified LSD. Defining the modified LSD

as a dependent variable, the linear regression model showed that CSH measured by Pentacam was highly

correlated with the modified LSD after correcting for the other covariates. The linear regression equation

is LSD=416.996+0.854×CSH (adjusted R2=0.63, F=89.17, P<0.001). Conclusions: Some ocular anterior

segment parameters measured by Pentacamare correlated with the modified LSD, and CSH can be used as

an important reference for the selection of LSD inthe process of SL fitting.

Objective: To analyze the visual effect of an improved multifocal contact lens fitting method to correct

presbyopia. Methods: A prospective analysis was performed on 20 presbyopia participants (Add: +1.00 D-

+2.00 D) who met the criteria from January to December 2018 in Eye Hospital, Wenzhou Medical

University. Three methods for them to correct presbyopia, included multifocal method (both eyes wearing

multifocal soft lens), single visual method (one eye wearing single visual soft lens for distance, one eye

wearing single visual soft lens for near) and improved multifocal method (single visual soft lens for the

dominant eye, multifocal soft lens for the non-dominant eye). Each correction method would be used for

1 week and there would be 1 week between each method to stop wearing the lens as the washout period.

Analyzed the binocular correct vision of these 20 participants among these 3 correct methods, and use

VFQ-25 Chinese version of the visual quality table to evaluate the visual effect for these 3 correct methods.

ANOVA was used to analysis the difference of binocular correct vision among these correct methods.

Results: The binocular correct vision of multifocal method was statistical lower than the single visual

spectacle (t=3.91, P=0.001) and improved multifocal method (t=2.94, P=0.008) of distance correct vision.

Different contrast of binocular correct vision at 50 cm of these three 3 correct methods were all higher

than single visual spectacle, included the same binocular correct of multifocal method (100%: t=-4.76,

P<0.001; 10%: t=-4.22, P<0.001), improved multifocal method (100%: t=-4.22, P<0.001; 10%:

t=-3.90, P=0.001) and single visual method (100%: t=-3.50, P=0.002; 10%: t=-4.76, P<0.001). And

different contrast of binocular correct vision at 30 cm of these three 3 correct methods were also higher than

single visual spectacle, included the same binocular correct of multifocal method (100%: t=-4.36, P<0.001;

10%: t=-5.48, P<0.001), improved multifocal method (100%: t=-5.67, P<0.001; 10%: t=-3.93, P=0.001)

and single visual method (100%: t=-7.43, P<0.001; 10%; t=-4.03, P=0.001). In all subjects there were 1

subject considered the single visual spectacle was the best, 7 participants felt the multifocal method was

the best, 2 subjects chose single visual method and 10 participants liked the improved multifocal method.

Conclusion: The improved multifocal method which combined multifocal method and single visual method

could achieve a good presbyopia correction effect, the binocular vision and visual quality of multifocal

method was not weak of other two methods, and this method was easier to be accepted by participants.

Objective: To understand the prevalence of myopia among school-age children in Jiaocheng county,

Shanxi province; to analyze its epidemic characteristics, and explore its possible influencing factors, so as

to provide a scientific basis for the establishment of a local, comprehensive myopia prevention and control

system. Methods: Cross-sectional investigation. In March 2019, a cluster random sampling method was

adopted to select students from 3 primary schools and 3 middle schools in Jiaocheng County (2 classes

in each grade) for visual acuity and refractive error examination. The developmental trend of myopia in

schoolchildren of different ages was compared by a Chi-square trend test, and the influencing factors were

analyzed by logistic regression. Results: A total of 3 927 school-age children, aged from 6 to 14 years old,

with an average age of 10.3±0.6 years, were investigated, and the male to female ratio was 1.13:1. The total

rate of poor vision and myopia was 76.24% and 80.14%, respectively. The detection rate of medium and

high myopia increased gradually with an increase in age (χ2

for trend=294.84, P<0.001). Logistic regression

analysis showed that female gender was a risk factor for myopia. For students aged 9-11 and 12-14, more

than 2 hours of homework was a risk factor for myopia. More than 2 hours of outdoor activities, adequate

sleep, and at least 2 or more eye health check-ups per year were protective factors for myopia. Conclusion:

The incidence of reduced visual acuity and myopia among school-age children in Jiaocheng county of

Shanxi province is at a higher level in China. It is necessary to take necessary measures of intervention as

soon as possible, build a comprehensive myopia prevention and control system, and raise an awareness of

myopia prevention and control among the entire population.

Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA). The

commonest form of uveitis seen in JIA is recurrent chronic antetior uveitis with insidious onset and

complications, which can lead to ocular structural damage and vision loss. Interleukin-6 (IL-6) is a

pleiotropic cytokine and it can promote inflammatory response and immune regulation and other processes.

Tocilizumab, a humanized interleukin-6 receptor (IL-6R) monoclonal antibody, can competitively binds to

IL-6 receptor, which blocks the biological effects of endogenous IL-6. For JIA associated uveitis (JIAU)

patients who failed glucocorticoid, methotrexate and 2 monoclonal antibody TNFi at above-standard dose

and/or frequency, tocilizumab becomes a new treatment option for JIAU. This paper mainly summarizes

the mechanism, application and safety of tocilizumab in the treatment of JIAU in order to provide reference

for clinical decision-making.

Cyclodialysis refers to the rupture of the ciliary body longitudinal muscle attached to the scleral process.

The separation of the ciliary body from the scleral process leads to the connection between the anterior

chamber and the supra ciliary body, which creates abnormal aqueous humor drainage and causes

persistently low intraocular pressure and other ocular diseases. Hypotony produces secondary complications

such as cataract, refractive changes, optic disc oedema and a series of retinopathies. Therefore, timely and

accurate intervention is needed. When the cause is complex, there may be more than one cleft, or even

other eye injuries. At present, ultrasonic biological microscopy, optical tomography of the anterior segment,

magnetic resonance imaging and the tracer dye method can be used in the diagnosis of cyclodialysis.

Conservative therapies such as drugs, laser photocoagulation, and ciliary body cryotherapy can be used to

close a small range of dissociation but most cases are treated surgically. This paper mainly reviews recent

research progress on cyclodialysis both domestically and abroad.