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AIM: To investigate the diagnostic value of ocular morphological parameters under different corneal diameters for early keratoconus.METHODS: A retrospective case-control study. A total of 201 patients(201 eyes)who were treated in our hospital from January 2019 to March 2022 were included. They were divided into 135 cases(135 eyes)in the control group(patients with history of refractive error)and 66 cases(66 eyes)in the subclinical keratoconus group. The Pentacam anterior segment analyzer was used to determine the horizontal central curvature of corneal posterior surface(Kf), posterior vertical central curvature of corneal posterior surface(Ks), average curvature of corneal posterior surface(Km), Posterior I-S ratio, corneal posterior surface height after the thinnest point(PE at the thinnest point), maximum posterior elevation from best fit sphere(MPE from BFS), maximum posterior elevation from best fit toric ellipsoid(MPE from BFTE), posterior asphericity asymmetry index(AAI), thinnest point thickness of the cornea(TCT), central corneal thickness(CCT), depressed corneal thickness(DCT), pachymetric progression index average(PPIavg), Ambrósio relational thickness maximum(ARTmax)and Belin D value. The differences of each parameter between the two groups were analyzed. Receiver operating characteristic(ROC)curves were analyzed to determine the best diagnosis point. The control group was further divided into groups according to the corneal diameter: corneal diameter ≤11.0mm, 11.1mm≤ corneal diameter ≤11.5mm, 11.6mm≤ corneal diameter ≤12.0mm, corneal diameter ≥12.1mm. The differences of each parameter among these groups were compared. Pearson correlation analysis was used to analyze the correlation between corneal diameter and other parameters.RESULTS: There were significant differences in posterior I-S ratio, PE at the thinnest point, MPE from BFS, MPE from BFTE, posterior AAI, TCT, DCT, PPIavg, ARTmax, Belin D value between the subclinical keratoconus group and the control group(P<0.05). Sensitive index of Pentacam to diagnosis subclinical keratoconus were Belin D value, posterior I-S ratio, PPIavg, posterior AAI and MPE from BFTE(AUC≥0.9). In the control group, there was no significant difference in posterior I-S ratio, MPE from BFTE, posterior AAI, TCT, CCT, and DCT among different corneal diameter groups (P>0.05), and there was no significant correlation with corneal diameter(all P>0.05).CONCLUSION: The Belin D value, posterior I-S ratio, PPIavg, posterior AAI, MPE from BFTE obtained by Pentacam are sensitive indicators for the diagnosis of early keratoconus, among which posterior I-S ratio, posterior AAI, MPE from BFTE are less affected by corneal diameter. They play an important role in the early diagnosis of keratoconus under different corneal diameters.
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@#AIM: To evaluate the difference and consistency of pupillary offset measured by the Pentacam anterior segment analyzer and Keratron Scout corneal topographer.<p>METHODS: Three hundred and eleven patients(604 eyes)who underwent excimer laser in situ keratomileusis from November 2017 to February 2018 were randomly selected. Before surgery, the pupillary offset values were measured by Pentacam and Keratron, and the differences and consistency of the values between the two instruments were compared.<p>RESULTS: The pupillary offset values of the right eyes, left eyes, and both eyes between Pentacam and Keratron were statistically different(<i>P</i><0.05). There were no significant statistical differences in the offset orientations of right eyes, left eyes and both eyes between the two instruments(<i>P</i>>0.05). The 95% consistent line(<i>LoA</i>)of offset value and offset orientation in the right eyes, left eyes and both eyes between the two instruments were -0.11-0.19mm and -157.01°-135.35°, -0.12-0.18mm and -150.16°-158.22°, -0.11-0.19mm and -154.30°-147.10°, respectively. <p>CONCLUSION: The pupillary offset measured by the Pentacam was smaller than that measured by the Keratron, but the difference was within the clinically acceptable range. The accurate pupillary offset can be obtained, and be the mutual reference, correction and supplement in the both instruments.
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@#AIM: To observe the safety and efficacy of epithelium-off corneal collagen cross-linking(CXL)combined with rigid gas permeable contact lens(RGPCL)in treatment of progressive keratoconus.<p>METHODS: From January 2015 to January 2017, 51 cases(51 eyes)of patients diagnosed with keratoconus and epithelium-off CXL treatment at the Eye Hospital of Nanjing Medical University were collected. The patients were divided into two groups according to whether they wore RGPCL or not after treatment. Group A: 30 eyes, epithelium-off CXL was removed and wear a framed mirror after treatment; Group B: 21 eyes, epithelium-off CXL was removed and RGPCL was worn after the condition was stable. Observed the best corrected visual acuity(BCVA), spherical equivalent(SE), minimum keratometry of the anterior corneal surface(K1), maximum keratometry of the anterior corneal surface(K2), mean keratometry(Km), maximal keratometry(Kmax), corneal vertex thickness, thinnest corneal thickness(TCT)before and 12mo after treatment.<p>RESULTS: No statistically significant differences were found before the therapy between the two groups in BCVA, SE, K1, K2, Km, Kmax, corneal vertex thickness, and TCT between the two groups(<i>P</i>>0.05). 12mo after treatment, BCVA in group B was significantly higher than that in group A(0.11±0.03 <i>vs</i> 0.26±0.16), the corneal vertex thickness of group B was lower than that of group A(431.8±14.41μm <i>vs</i> 461.38±32.68μm)(<i>P</i><0.05), there was no significant difference in other parameters between the two groups.<p>CONCLUSION: Epithelium-off CXL can effectively delay or control the progression of keratoconus. Wearing RGPCL after treatment can effectively improve BCVA.
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?AIM: To observe the clinical curative effect of the intravitreal injection of anti-VEGF antibody combined with the implantation of Ex-press glaucoma drainage device for neovascular glaucoma ( NG) .?METHODS:A retrospective analysis of 20 patients with NG, who got the intravitreal injection of anti -VEGF antibody combined with the implantation of Ex-press. The visual acuity, intraocular pressure ( IOP ) , iris neovascularization fade and intraoperative and postoperative complications were observed at 1wk, 1, 3 and 6mo postoperatively.?RESULTS:The average IOPs of 20 patients were 47 ± 5.6mmHg, 13.4 ±3.6mmHg, 15.3 ±4.2mmHg, 16.9 ± 5.3mmHg and 18.7 ±6.9mmHg preoperatively and postoperatively 1wk, 1mo, 3mo and 6mo with statistical difference (P<0.05).The intraoperative and postoperative complications of the implantation of Ex-press mainly included early shallow anterior chamber, drainage tube obstruction, filtering bleb scarring. There were 8 eyes with filtering bleb scarring with normal IOP.?CONCLUSION: The intravitreal injection of anti-VEGF antibody combined with implantation of Ex -press is effective for NG, which can significantly reduce the IOP.
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· AlM:To investigate the effect of compound anisodine on fundus blood circulation after vitrectomy with face-down position. · METHODS: Sixty patients ( 60 eyes ) with rhegmatogenous retinal detachment received vitrectomy with silicone oil tamponade operation, who were randomized divided into treatment group ( 30 eyes ) and control group ( 30 eyes ) .The patients in the treatment group received the subcutaneously injection of compound anisodine hydrobromide by the superficial temporal artery once daily for 14d since postoperative first day.Retinal microcirculation blood flow parameters were recorded with Heidelberg retinal flowmeter postoperative 1d, 1 and 2wk, and were compared between two groups. ·RESULTS: The blood flow parameters ( Vol, Flw, Vel) of control group postoperative 1 and 2wk were significantly less than those postoperative 1d.Otherwise the parameters of treatment postoperative 1 and 2wk were significantly more than those postoperative 1d. The parameters between two groups were significant different ( P · CONCLUSlON: Facing down after vitrectomy with silicone oil tamponade may reduce retinal blood supply, consequently lead to retinal ischemia; compound anisodine can effectively improve the retinal and choroidal microcirculation after vitrectomy with face-down posture, reduce retinal ischemia, and enhance the visual function.