Impact of glaucoma on vision-specific quality of life in monocular glaucoma patients using the Indian vision function questionnaire

Purpose: To evaluate the determinants affecting the quality of life in monocular glaucoma patients using the Indian vision function questionnaire. Methods: In this prospective cross?sectional study, total of 196 patients were divided into two groups: cases and controls. Indian Vision Function Questionnaire (IND?VFQ) was administered and analyzed. One hundred twenty?nine (58.6%) patients who had lost their vision in one eye due to glaucoma were included as cases and 67 (30.4%) patients who had lost their vision due to other causes were taken as controls. Results: Median composite score of subscales was 54.62 (29.7–74.7) in group 1 and 45.38 (23.7–76.7) in group 2. The psychosocial impact scale was the most affected scale, the median scores were 33.02 (0 to 60.0) and 19.07 (0 to 53.0) in groups 1 and 2, respectively. Among all dimensions of IND?VFQ, the highest score was for color vision 100.0 (0–100.0) and 100.0 (0–100.0), and the lowest median score was found in mental health and dependency in both the groups. Multiple linear regression analysis demonstrated that visual acuity was associated with a low score (P < 0.001). Female gender was significantly associated with the overall score in the univariate model (P = 0.006). Conclusion: Monocular glaucoma patients have a poor general and vision?related quality of life. Depression associated with monocularity and the perception of dependency and being a burden on their family members greatly impacted the mental health of the participants

Observation on the curative effect of horizontal rectus transposition combining recess-resect treatment on monocular elevation deficiency with horizontal strabismus

Purpose: To explore the clinical effect of horizontal rectus transposition combining recess and resect treatment on monocular elevation deficiency (MED) with horizontal strabismus. Methods: Ten patients (10 eyes) scheduled to undergo horizontal rectus transposition combining recess?resect surgery to treat MED with horizontal strabismus in the ME Department of Ophthalmology of the First Affiliated Hospital of Guangxi Medical University between July 2016 and February 2022 were included in the study. The degree of vertical and horizontal prism strabismus, the grading of upper movement of the paralyzed eye, and the improvement of binocular vision were evaluated before and after the surgery. Results: Horizontal rectus transposition combined with recess and resect treatment was used to treat 10 patients with MED combined with horizontal strabismus. A good curative effect was seen in eight patients. The differences in the degree of vertical strabismus, the degree of horizontal strabismus, and the movement function of the paretic eyes before and after surgery were significantly different (all P < 0.05). The binocular haplopia function in six patients was reconstructed in the primary position after surgery. Conclusion: Horizontal rectus transposition combining recess?resect is easy to perform, and the number of recti involved in the surgery is small. This approach can effectively correct the eye position, improve eye movement, and reconstruct binocular vision in patients with MED by combining horizontal strabismus

Advances in the treatment and prevention of acute retinal arterial ischemia / 国际眼科杂志(Guoji Yanke Zazhi)

Acute transient or permanent retinal arterial ischemia is ocular and systemic emergency requiring immediate diagnosis and treatment. Transient monocular vision loss is transient retinal arterial ischemia which leaves no permanent deficits. Central retinal arterial occlusion and branch retinal arterial occlusion lead to permanent visual function deficits in the majority of patients. Current treatment include lowering intraocular pressure, dilating blood vessels, hyperbaric oxygen therapy, intravenous or intra-arterial thrombolysis and so on, but there is still no standard treatment procedure. High risk groups should receive primary prevention measures in order to reduce the incidence of the disease. Patients with acute retinal arterial ischemia are at high risk of subsequent stroke and adverse cardiovascular events. Relevant risk factors should be identified in time, the primary disease should be treated actively, and appropriate secondary prevention measures should be taken to improve the prognosis. This review summarizes the recent treatment and prevention procedures of acute retinal arterial ischemia, to provide references for the management of these diseases.

Efectividad de la cirugía monocular en la exotropía sensorial de gran ángulo / Effectiveness of the surgery monocular in the sensorial exotropia of great angle

La exotropía sensorial se define como una desviación ocular divergente unilateral o bilateral, dada por anomalías oculares congénitas o adquiridas; es más frecuente en adultos. El objetivo de la cirugía de estrabismo en el adulto es restablecer la visión binocular, reduciendo la diplopía y al lograr el alineamiento ocular, mejorar su estética, por lo que antes de realizar la cirugía se debe tratar la causa que provoca la baja visión. El procedimiento quirúrgico de elección es la cirugía monocular, pero si la desviación es grande se realizará cirugía binocular. Se presenta una paciente femenino de 25 años de edad portadora de lentes de contacto por miopía elevada del ojo derecho (9,00 -0.75 x 105º con 0,2 de agudeza visual mejor corregida), exotropía de más de 25º por Hirschberg, limitación de aducción del ojo derecho y por método de oclusor y prismas a 6 metros sin cristales y con sus lentes de contacto, ambos ojos 50 ∆ b interna, no estereopsia y suprime ojo derecho. Por todas las ventajas que presenta la cirugía monocular, se decidió realizarla en el ojo derecho, se colocó anestesia local peribulbar, se realizó recesión amplia del recto lateral a 12 mm y se realizó 8 mm de resección del recto medial; en el postoperatorio se logró 10 ∆ b interna y por momentos ortotropia; refirió diplopía post quirúrgica que resolvió espontáneamente. Los resultados quirúrgicos en la exotropía sensorial son menos alentadores ya que con el tiempo pueden evolucionar hacia la hipercorrección o hacia la recurrencia(AU)

Sensory exotropía is defined as a unilateral or bilateral divergent ocular deviation, given by congenital or acquired ocular anomalies, and is more frequent in adults. The objective of the strabismus surgery in adults is to reestablish binocular vision, reduce diplopía, improve ocular alignment and enhance quality of life; before performing surgery the cause of low vision should be treated. The preferred surgical procedure is a monocular approach, but if there is a large deviation a binocular procedure should be performed. The case presented Is a 25 year-old female with high myopia of the right eye (-9.00 -0.75 x 105º with 0.2 of best corrected visual acuity), exotropía of more than 25º for Hirschberg, limitation of aducción of the right eye and with both the oclusor method and prisms to 6 meters without glasses and with her contact lenses, both eyes have 50∆ of internal base, no estereopsia and suppression of the right eye. For its advantages a monocular approach (of the right eye) was preferred, with peribulbar anesthesia: recession to 12mm of the lateral rectus combined with 8 mm of resection of the medial rectus; in the postoperative she presented a 10∆ intern base deviation and for moments ortotropia; she referred diplopia that solved spontaneously. The surgical results in sensory exotropía are less encouraging since they have higher hypercorrection and recurrence rates(AU)

Comparison of myopia progression in anisometropic children on the effect of orthokeratology with different degrees of unilateral myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the progress of binocular myopia with orthokeratology lens in different degrees of unilateral myopia in anisometropic children for 1a.METHODS:Retrospective case-control study. The data of 60 unilateral myopic anisometropia children, 8-12-year-old patients who fitted with orthokeratology lens in Xi'an No.1 Hospital from June 2018 to June 2019 were collected. The binocular spherical equivalent(SE)difference ≥2.5D was found in 30 cases in the high anisometropia group, and 1.0D≤ binocular SE difference &#x003C;2.5D was found in 30 cases of the low anisometropia group. The patients in the two groups were observed and compared after wearing lens for 6mo and 1a of the changes of binocular axial length(AL)and SE without-lens eyes.RESULTS: At the follow-up at 6mo and 1a, the growth of AL in the high anisometropia group with orthokeratology lens was less than that in the low anisometropia group(P&#x003C;0.001). The amount of growth of AL without-lens eyes and the growth of SE were greater than that in the low anisometropia group(all P&#x003C;0.001), and the shortening range of the binocular AL in the high anisometropia group was greater than that in the low-degree anisometropia group(P&#x003C;0.05). The correlation analysis showed that the anisometropia and the shortening of axial difference were correlated(F=0.293, 0.458, all P&#x003C;0.001).CONCLUSION: In anisometropia children with unilateral myopia, after wearing the orthokeratology lens, the progression in high anisometropia group was slower than low anisometropia after wearing the orthokeratology lens, but the progression of AL without-lens eyes and SE was faster than low anisometropia. Wearing orthokeratology lens can effectively reduce anisometropia, and the greater degree of the anisometropia the more binocular axial difference was narrowed, the more binocular axial difference was narrowed.

Clinical characteristics and surgical outcomes of school-age pediatric monocular retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the underlying aetiology and clinical characteristics of retinal detachment(RD)in school-age pediatric monocular RD.METHODS:Patients with RD and contralateral blind(monocular RD)aged 7-14 years, from November 2015 to May 2021 in our hospital were retrospectively reviewed. Demographic characteristics and etiology of RD, clinical type, surgical modality, type of intraocular tamponade, pre-and postoperative visual and anatomical outcomes were recorded and evaluated.RESULTS: There were 27 children(27 eyes)with monocular RD at least 6mo follow-up. The average age at presentation was 10.63±2.30 years. Familial exudative vitreoretinopathy(FEVR)(11/27, 41%), postoperative congenital glaucoma(6/27, 22%)and Stickler syndrome(3/27, 11%)were main underlying etiologies. Among them, rhegmatogenous retinal detachment(RRD)comprised 78%(21/27)of the patients, of which 81% patients(17/21)had proliferative vitreoretinopathy(PVR)C3 or worse. Pars plana vitrectomy(PPV)was done in 85%(23/27)of the patients, of which 83%(19/23)received silicone oil tamponade. Best corrected visual acuity(BCVA, LogMAR)worse than 1.7 was seen in 78%(21/27)of the patients at final visit, and 82%(22/27)had reattached retina, but 41%(11/27)of the patients remained status of silicone oil tamponade at last visit.CONCLUSION:School-age pediatric monocular RD is often associated with underlying congenital or hereditary conditions, and often presented with severe RD and severe PVR reaction which needed vitrectomy combined with silicon oil tamponade, and with poor visual and anatomical short-term prognosis.

A comparison of binocular and monocular surgery on the effect of eye-covering pretreatment on emergence delirium after general anesthesia in pre-school aged children / 中国实用护理杂志

Objective:To evaluate the effect of eye-covering pretreatment on acute delirium in ophthalmology preschool-age children who underwent binocular and monocular surgery by general anesthesia.Methods:The 300 preschool-age children who underwent general anesthesia of elective ophthalmic surgery in the Second Affiliated Hospital, Zhejiang University School of Medicine, from August 2019 to February 2021 were selected as the research object. They were divided into control group and blindfold group with 150 cases each by random number-table. Children in the control group received regular education on cartoon animation videos before surgery; children in the blindfold group received eye-covering pretreatment on the basis of cartoon animation videos(monocular surgery with monocular cover, binocular surgery with binocular cover). The Modified Yale Preoperative Anxiety Scale (m-YPAS) , the Nursing Delirium Screening Scale(NU-DESC), the incidence rate of delirium and the score of postoperative nursing difficulty were compared between two groups.Results:The 271 cases were completed in this study, including 129 cases(monocular surgery 66 cases, binocular surgery 63 cases) in the blindfold group and 142 cases (monocular surgery 73 cases, binocular surgery 69 cases) in the control group. The preoperative m-YPAS score, the postoperative NU-DESC score, the incidence rate of acute delirium and postoperative nursing care difficulty score of monocular surgery in the blindfold group , monocular surgery was (40.28 ± 15.02) points, 1.00 (0.00, 2.00) points, 27.3%(18/66), 1.00 (1.00, 2.00) points,and binocular surgery was (41.69 ± 16.35) points, 1.00 (0.00, 2.00), 39.7%(25/63), 1.00(1.00, 2.00); in the control group, monocular surgery was (46.28 ± 15.76) points, 2.00 (1.00, 3.00) points, 67.1% (49/73), 2.00 (1.00, 3.00) points, and binocular surgery was (47.77 ± 14.82) points, 3.00 (2.00, 4.00) points, 82.6% (57/69) and 2.00 (1.50, 3.00) points respectively. The difference between the two groups was statistically significant ( t= -2.29, -2.24, Z values were -5.74 - -2.95, χ2= 32.94, 25.78, all P<0.05). The preoperative m-YPAS score, the postoperative NU-DESC score, the incidence rate of acute delirium and postoperative nursing care difficulty score of monocular surgery patients in the blindfold group had no significantly statistical difference with that of binocular surgery patient (all P>0.05) . Conclusions:Monocular/ binocular eye-covering pretreatment can effectively decrease the preoperative m-YPAS score, the postoperative NU-DESC score, incidence rate of acute delirium and the postoperative nursing care difficulty in preschool-age children who underwent general anesthesia both monocular or binocular surgery. There was no difference in the application effect of monocular or binocular surgery.

Human detection and motion recovery based on monocular vision / Detecção humana e recuperação de movimento com base na visão monocular / Detección humana y recuperación de movimiento basada en visión monocular

ABSTRACT Objective: Provides interactive games and human animation real motion data and technical options. Therefore, how to complete the position, attitude detection, and motion recovery under monocular vision has become an important research direction. Methods: This paper improves the part-based human detection algorithm and uses the AdaBoost multi-instance learning algorithm to train the part detector. Results: The results show that obtaining blood pressure waveform based on monocular vision pulse wave is feasible and has generalization. Conclusions: The results show the feasibility and accuracy of the gait motion detection, motion recovery and analysis system for human lower limbs based on monocular vision. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Objetivo: Fornece jogos interativos e dados de movimento real de animação humana e opções técnicas. Portanto, como completar a posição, detecção de atitude e recuperação de movimento sob visão monocular tornou-se uma importante direção de pesquisa. Métodos: este artigo aprimora o algoritmo de detecção humana baseado em partes e usa o algoritmo de aprendizado de múltiplas instâncias AdaBoost para treinar o detector de partes. Resultados: Os resultados mostram que o método de obtenção da forma de onda da pressão arterial com base na onda de pulso de visão monocular é viável e se pode generalizar. Conclusões: Os resultados mostram a viabilidade e precisão do sistema de detecção, recuperação e análise do movimento da marcha para membros inferiores humanos com base na visão monocular. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Objetivo: Proporciona juegos interactivos y animación humana, datos de movimiento real y opciones técnicas. Por lo tanto, cómo completar la posición, la detección de actitud y la recuperación de movimiento bajo visión monocular se ha convertido en una importante dirección de investigación. Métodos: este documento mejora el algoritmo de detección humana basado en piezas y utiliza el algoritmo de aprendizaje de instancias múltiples AdaBoost para entrenar el detector de piezas. Resultados: Los resultados muestran que el método de obtención de la forma de onda de la presión arterial basado en la onda de pulso de visión monocular es factible y se puede generalizar. Conclusiones: Los resultados muestran la viabilidad y precisión del sistema de detección, recuperación y análisis del movimiento de la marcha para miembros inferiores humanos basado en visión monocular. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Study on the cortical synaptic density and visual function in monocular form deprivation rats with amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the effect of monocular form deprivation(MD)on the synaptic density in the visual cortex of the amblyopic rats during the critical period of visual development, the visual cortical synaptophysin(SYN)expression and significance of its expression, as well as the relationship between the synaptic density and the visual function. This research will provide mechanisms underlying the pathogenesis and clinical treatment of amblyopia.<p>METHODS: Normal newborn Long Evans rats were randomly divided into normal control group and amblyopia model group, each with 16 rats. Both groups of rats were raised in the same environment. The normal control group did not receive any treatment. On the 13d after birth, the amblyopic model group received monocular suture to establish a classic monocular form deprived amblyopic model. Both groups of rats were received Visual evoked potential(F-VEP)detection on the 51d. Samples were taken immediately after the detection. The transmission electron microscope and Image J image analysis software were used to observe and analyse the synaptic density in the V1M of the primary visual cortex of the two groups of rats. Frozen sections of visual cortex were stained by immunofluorescence histochemical staining by bleaching method and the expression of SYN positive neurons was observed and quantitatively analyzed. <p>RESULTS: F-VEP examination showed that compared with the normal control group, the P2 latency of the deprived eyes in the amblyopic group was significantly long, and the amplitude of P2 wave was significantly lower than that of normal eyes(<i>P</i><0.05); Transmission electron microscopy results showed that the synaptic density of the bilateral visual cortex of the amblyopic model group was significantly reduced compared with the normal control group(<i>P</i><0.05), the contralateral visual cortex of the amblyopic eye decreased more significantly(<i>P</i><0.05); immunofluorescence staining results showed that the brain slices in the visual cortex of the two groups were intact and the tissue structure was clear under the microscope. Compared with the normal control group, the expression intensity of SYN positive neurons in the amblyopic group was significantly reduced(<i>P</i><0.01).<p>CONCLUSION: There is structural synaptic plasticity during the critical period of visual development. Monocular form deprivation can reduce the synaptic density, SYN expression and the visual function in the primary visual cortex of the amblyopic rats.

Curative efficacy of different surgical procedures in the treatment of congenital unilateral monocular oblique paralysis and its effects on binocular vision function / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the curative efficacy of different surgical procedures in the treatment of congenital unilateral monocular oblique paralysis and its effects on binocular vision function.<p>METHODS: Totally 82 children of congenital unilateral monocular oblique paralysis who received therapy from May 2016 to 2019 in our hospital were selected as research objects, operative plan was determined by the degree of hyperfunction of the inferior oblique muscle, the movement of the eyeball and the vertical obliquity of the eye position, the inferior oblique muscle tendon amputation(3 cases), partial inferior oblique muscle resection(63 cases), inferior oblique muscle recession(6 cases), posterior rectus muscle repair(4 cases), inferior oblique muscle weakening+contralateral/ipsilateral rectus muscle operation(5 cases), upper oblique folding(1 cases). The effects of different surgical procedures and the changes of binocular visual function, corrected visual acuity and compensatory head position before and after surgery were compared. <p>RESULTS: Compared with before surgery, the fusion function, hyperstereopsis, myopia, corrected visual acuity and compensatory head position were significantly improved after operation(<i>P</i><0.05); there was no significant difference in stereopsis between children with or without compensatory head position after operation(<i>P</i>>0.05). <p>CONCLUSION: Choosing different surgical methods according to the severity of congenital superior oblique paralysis has positive significance, which can improve the vision and compensating head position of children, and it's helpful to rebuild binocular vision function.

Effect on the accommodation function of monocular orthokeratology in anisometropic children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the changes of binocular eye accommodation function in correcting anisometropia by monocular orthokeratology in anisometropic children, and to explore the mechanism of regulation in the progression of myopia control by orthokeratology.<p>METHODS: It was a prospective self-control study. A total of 22 anisometropic children(44 eyes), aged 8-13 years, who wore an orthokeratology lens in only one eye were enrolled in the outpatient clinic of Hainan Provincial Eye Hospital from September 2016 to September 2018. The eyes with an orthokeratology lens had a mean spherical equivalent refraction of -2.751±1.16 diopter(D), and fellow eyes without a lens had a refraction of -0.10±0.32D. The eyes wearing orthokeratology lens were used as the lens wearing group, and the fellow eyes without a lens were used as non-wearing lens group. During the follow-up period,we measured changes of diopter difference, monocular accommodative amplitude(MAA), monocular accommodative facility(MAF)and accommodative response(AR)before wearing the lens and wearing the lens for 12mo.<p>RESULTS: The monocular accommodative amplitude and monocular accommodative facility of the wearing group before wearing the lens were lower than those of the non-wear group(<i>P</i><0.01), and the accommodative lag were higher than that of the non-wear group(<i>P</i><0.05). The monocular accommodative amplitude 15.63±1.66D after wearing the lens for 12mo was higher than that before wearing the lens 11.25±3.15D(<i>t</i>=3.63, <i>P</i><0.01), and the difference was not statistically significant(<i>t</i>=0.75, <i>P</i>=0.46)compared with the non-wearing group. The monocular accommodative facility 14.63±1.58 cyc/min after wearing the lens for 12mo was higher than that before wearing the lens 9.25±3.38cyc/min(<i>t</i>=2.83, <i>P</i>=0.01), and the difference was not statistically significant(<i>t</i>=0.38, <i>P</i>=0.71)compared with the non-wearing group. The accommodative lag 0.62±0.29D of the wearing group after 12mo was reduced compared with that before wearing the lens 1.35±0.26D(<i>t</i>=2.57, <i>P</i>=0.02),and compared with the non-wearing group, the difference was not statistical significance(<i>t</i>=0.61, <i>P</i>=0.55). The mean equivalent diopter of the non-lens group was -0.75±0.35D after 12mo, and the number of diopter group increased by -0.65±0.39D(<i>t</i>=4.24, <i>P</i><0.01). The diopter of the wearing group increased by -0.15±0.22D(<i>t</i>=2.90, <i>P</i><0.001), there was a statistically significant difference in the change of diopter between the two groups(<i>t</i>=5.30, <i>P</i><0.01). There was no statistically significant difference in the change of the accommodation before and after 12mo in the non-wear group(<i>P</i>>0.05).<p>CONCLUSION: The accommodation function of anisometropic children in correcting anisometropia by monocular orthokeratology was significantly improved compared with that before wearing the lens and was consistent with the contralateral eyes without lens group. The refractive state of the group wearing orthokeratology lens was more stable, and the contralateral eyes without lens gradually showed mild myopia refractive state, but the accommodation did not change significantly.

Effect on the accommodation function of monocular orthokeratology in anisometropic children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the changes of binocular eye accommodation function in correcting anisometropia by monocular orthokeratology in anisometropic children, and to explore the mechanism of regulation in the progression of myopia control by orthokeratology.<p>METHODS: It was a prospective self-control study. A total of 22 anisometropic children(44 eyes), aged 8-13 years, who wore an orthokeratology lens in only one eye were enrolled in the outpatient clinic of Hainan Provincial Eye Hospital from September 2016 to September 2018. The eyes with an orthokeratology lens had a mean spherical equivalent refraction of -2.751±1.16 diopter(D), and fellow eyes without a lens had a refraction of -0.10±0.32D. The eyes wearing orthokeratology lens were used as the lens wearing group, and the fellow eyes without a lens were used as non-wearing lens group. During the follow-up period,we measured changes of diopter difference, monocular accommodative amplitude(MAA), monocular accommodative facility(MAF)and accommodative response(AR)before wearing the lens and wearing the lens for 12mo.<p>RESULTS: The monocular accommodative amplitude and monocular accommodative facility of the wearing group before wearing the lens were lower than those of the non-wear group(<i>P</i><0.01), and the accommodative lag were higher than that of the non-wear group(<i>P</i><0.05). The monocular accommodative amplitude 15.63±1.66D after wearing the lens for 12mo was higher than that before wearing the lens 11.25±3.15D(<i>t</i>=3.63, <i>P</i><0.01), and the difference was not statistically significant(<i>t</i>=0.75, <i>P</i>=0.46)compared with the non-wearing group. The monocular accommodative facility 14.63±1.58 cyc/min after wearing the lens for 12mo was higher than that before wearing the lens 9.25±3.38cyc/min(<i>t</i>=2.83, <i>P</i>=0.01), and the difference was not statistically significant(<i>t</i>=0.38, <i>P</i>=0.71)compared with the non-wearing group. The accommodative lag 0.62±0.29D of the wearing group after 12mo was reduced compared with that before wearing the lens 1.35±0.26D(<i>t</i>=2.57, <i>P</i>=0.02),and compared with the non-wearing group, the difference was not statistical significance(<i>t</i>=0.61, <i>P</i>=0.55). The mean equivalent diopter of the non-lens group was -0.75±0.35D after 12mo, and the number of diopter group increased by -0.65±0.39D(<i>t</i>=4.24, <i>P</i><0.01). The diopter of the wearing group increased by -0.15±0.22D(<i>t</i>=2.90, <i>P</i><0.001), there was a statistically significant difference in the change of diopter between the two groups(<i>t</i>=5.30, <i>P</i><0.01). There was no statistically significant difference in the change of the accommodation before and after 12mo in the non-wear group(<i>P</i>>0.05).<p>CONCLUSION: The accommodation function of anisometropic children in correcting anisometropia by monocular orthokeratology was significantly improved compared with that before wearing the lens and was consistent with the contralateral eyes without lens group. The refractive state of the group wearing orthokeratology lens was more stable, and the contralateral eyes without lens gradually showed mild myopia refractive state, but the accommodation did not change significantly.

Estimation Dynamic Distance Direct Ophthalmoscopy (eDDDO): A novel, objective method for the quantitative assessment of accommodation in young children

Purpose: To describe estimation dynamic distance direct ophthalmoscopy (eDDDO) and compare it with the monocular estimation method of dynamic retinoscopy (eDR) for the assessment of accommodation in children. Methods: In this prospective observational cohort study, an ophthalmologist performed eDDDO followed by eDR in children with normal eyes, and then under the partial effects of cyclopentolate and tropicamide to assess performance of eDDDO with eDR under the condition of pharmacologically induced accommodation failure. Only one eye of each child was recruited in the study. To study the inter-observer variation, two masked pediatric ophthalmology fellows performed eDDDO in the similar manner. Results: For the comparison of eDDDO with eDR, 60 eyes of 60 patients were recruited. The mean age of the patients was 10.4 years. The mean accommodation on eDDDO was 3.0D, 5.1D, 9.8D, and 11.3D at 40 cm, 25 cm, 10 cm, and 8 cm, respectively and 3.0D, 5.0D, 9.5D, and 11.0D on eDR. The eDDDO overestimated accommodation by a mean 0.17D (95% CL 0-0.48D, P = 0.5). The correlation of eDDDO with eDR was excellent (Pearson r 0.98, T value 76.0). The inter-observer difference with eDDDO was not significant (mean 1D, 95% CL 0-2.6D, P = 0.9) and the correlation between two observers was excellent (Pearson r 0.9, T value 12.7). The eDDDO and eDR were also performed on 12 eyes of 6 children with a mean age of 8.5 years (range 8-12 years) under the partial effect of cyclopentolate and tropicamide, where eDDDO overestimated the accommodation by a mean 0.3D (95% CL 0- 1.2D, P = 0.7) and the correlation was excellent (Pearson r 1.0, T value 45). Conclusion: eDDDO is a simple, reliable, quantitative, and objective technique of accommodation assessment for children. Further studies with larger sample are required to assess its performance in disorders of accommodation affecting younger children and in children with ocular comorbidities.

Deficiencia monocular de la elevación con esotropía / Monocular elevation deficiency with esotropia

RESUMEN La deficiencia monocular de la elevación se define como la limitación de la elevación del ojo afectado desde cualquier posición de la mirada, con ducciones normales en todas las demás posiciones. La pseudoptosis se puede presentar en posición primaria de la mirada; sin embargo, el 25 por ciento de los casos puede mostrar una ptosis verdadera. Se presenta un paciente masculino de 11 años de edad con antecedentes de estrabismo hacia adentro desde que nació, quien llevó tratamiento con oclusiones y cristales desde el primer año de edad. Al examen oftalmológico presentaba una agudeza visual mejor corregida de 1,0/0,4; a 6 metros en el ojo derecho 30 ∆ b externa ~18 ∆ b superior y en el ojo izquierdo 30 ∆ b externa ~18 ∆ b inferior; a 33 centímetros en el ojo derecho 30 ∆ b externa ~25 ∆ b superior y en el ojo izquierdo 30 ∆ b externa ~25 ∆ b inferior y limitación de la elevación en todas las posiciones horizontales de la mirada en el ojo derecho. Se realizó la prueba de ducción forzada y se encontró una restricción del recto inferior derecho, por lo que se decidió retroinsertar este músculo y ambos rectos medios. Se indicó la corrección óptica y la rehabilitación con oclusiones que mejoró la visión a 1,0/0,7. La cirugía correctiva logró la ortotropía y la mejoría de la agudeza visual(AU)

ABSTRACT Monocular elevation deficiency is defined as a limitation in the elevation of the affected eye from any position of gaze with normal ductions in all other positions. Pseudoptosis may occur in the primary position of gaze, but 25 percent of the cases are true ptosis. A case is presented of a male 11-year-old patient with a history of inward strabismus since birth, treated with occlusions and lenses as of his first year of life. At ophthalmological examination, best corrected visual acuity was 1.0/0.4; at 6 meters in the right eye 30 ∆ b outer ~18 ∆ b upper, and in the left eye 30 ∆ b outer ~18 ∆ b lower; at 33 centimeters in the right eye 30 ∆ b outer ~25 ∆ b upper, and in the left eye 30 ∆ b outer ~25 ∆ b lower, and elevation limitation in all horizontal gaze positions of the right eye. The forced duction test revealed a restriction in the lower right rectus muscle. It was thus decided to insert back the right rectus muscle and both medial rectus muscles. Optical correction and rehabilitation with occlusions improved the patient's vision to 1.0/0.7. Corrective surgery achieved orthotropy and improved visual acuity(AU)

Interesting case of sudden unilateral blindness in a teenager: role of psychological intervention in psychogenic visual loss

Visual loss complaints are commonly encountered by treating physicians, neurologist and ophthalmologists. More specifically a presentation of non-organic (psychogenic) blindness is less frequently seen but does exist and requires proper evaluation and specific skills for it to be properly managed. This case is of a 19 years old male who presented with acute monocular blindness post trauma whom he also had past psychiatric history. Post thorough assessment, no organic cause was identified, and a diagnosis of psychogenic blindness was made. Psychological therapy was beneficial in aiding return of his vision.

Intermittent exotropia evaluation using the propedeutics proposed by Kushner: a 25-year study / Avaliação de exotropia intermitente usando propedêutica proposta por Kushner: estudo de 25 anos

ABSTRACT Purpose: To evaluate the clinical and surgical impacts of phenomena that could occur in intermittent exotropia. Methods: The medical records of intermittent exotropia cases from 1991 to 2014 were retrospectively reviewed. All patients underwent a series of measures, including a protocol to assess monocular occlusion based on the propedeutics proposed by Kushner. Results: Outdoor sensitivity was observed in 31% of patients with an undercorrection rate of 44% vs. 18% of cases with no outdoor sensitivity. After 1 h of monocular occlusion, 41% of all patients achieved an increase in deviation with an undercorrection rate of 40%, whereas 25% did not. Conclusion: The results show the importance of complete propedeutics, since there is a higher rate of late undercorrection in cases with outdoor sensitivity and increased deviation after occlusion.

RESUMO Objetivo: Avaliar os impactos clínico e cirúrgico dos fenômenos que podem ocorrer na exotropia intermitente. Métodos: Os prontuários de casos de exotropia intermitente de 1991 a 2014 foram revisados retrospectivamente. Todos os pacientes foram submetidos a uma serie de medidas incluindo o protocolo com oclusão monocular com base na propedêutica proposta por Kushner. Resultados: Outdoor sensitivity foi observada em 31% dos pacientes com taxa de subcorreção de 44% vs. 18% dos casos sem outdoor sensitivity. Após 1 hora de oclusão monocular, 41% de todos os pacientes apresentaram um aumento no desvio com uma taxa de subcorreção 40%, enquanto 25% não. Conclusão: Os resultados demonstram a importância da propedêutica completa, uma vez que há maior taxa de subcorreção tardia nos casos de outdoor sensitivity e maior desvio após a oclusão.

Effects of long-term monocular orthokeratology on the ocular surface / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To study the effects of long-term wearing monocular orthokeratology on ocular surface.<p>METHODS: A retrospective study was conducted in patients with unilateral myopia(The contralateral eye of each patient was emmetropic.)who used orthokeratology lens for more than half a year. The patients were recruited from January 2013 to December 2015, in ophthalmological clinic, 101 Hospital of PLA, Wuxi. The tear break-up time(BUT), basal tear secretion, central corneal thickness, corneal endothelial cell density, conjunctival congestion and corneal epithelium fluorescein staining were observed before wearing orthokeratology and at different time points during wearing orthokeratology.<p>RESULTS: Fifty-three young patients(53 eyes)with long-term wearing a monocular orthokeratology lens were observed, whose ages were 10.43±1.70 years old and their spherical equivalents(SEs)were -3.37±1.50D. For the myopic eyes, after 1-week treatment of monocular orthokeratology, the BUT was shortened, but there was no significant difference compared with those after 1-month, 3-month, 6-month treatment of monocular orthokeratology(<i>P</i>>0.05). For the emmetropic eyes, there was no significant difference in changing the BUT at above different time points(<i>P</i>>0.05). There was no significant difference in the value of basal tear secretion at those time points between two different kinds of eyes(The myopic eyes with orthokeratology and the emmetropic eyes without orthokeratology)(<i>P</i>>0.05). Compared with before wearing orthokeratology lens, there was no significant difference in both corneal center thickness and corneal endothelial cell density at those time points after wearing orthokeratology lens(<i>P</i>>0.05). After wearing orthokeratology lens, the corneal epithelial stain was mostly Ⅰ dyed. After 1wk, 1, 3 and 6mo respectively, the Ⅰ dyed amounts were 10 eyes(19%), 6 eyes(11%), 8 eyes(15%), 6 eyes(11%),the Ⅱ dyed amounts were 1 eye(2%), 0, 0, 1 eye(2%). The conjunctival congestion(score 1)showed up on 10 patients after wearing the orthokeratology lens. After all the 10 cases stopping wearing orthokeratology lens, but taking some antibiotics and corneal repair agents, the corneal epithelium stain disappeared and the conjunctival congestion faded away. For the emmetropic eyes, no obvious conjunctival congestion was observed during the observation period, and the corneal epithelial stain was 0.<p>CONCLUSION: Continuous wearing orthokeratology can cause the decrease of the stability of tear film. And it also affects the conjunctiva and corneal epithelium by degrees. But it has no significant effect on tear secretion, corneal thickness and corneal endothelial cells. There will be no apparent ocular surface damage on non-wearing eyes.

Binocular lateral rectus recession versus monocular recess-resect procedure for basic intermittent exotropia:a Meta analysis of randomized controlled trials / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the curative effect between monocular lateral rectus recession(BLR)and Binocular recession resection(R & R)for basic intermittent exotropia.<p>METHODS:A literature review using the MEDLINE, EMBASE, The Cochrane Library, Web of Science, Clinical Trial, CBM, Wanfang Databases and paper collections of conferences was performed. Randomized controlled trials comparing the effects of BLR and R & R for basic intermittent exotropia with a duration of follow-up at least half a year were eligible for inclusion. The methodologic quality of included studies was evaluated independently by 2 authors. Statistical analysis was performed by using the STATA 14 software(StataCorp Texas USA).<p>RESULTS:Five prospective random controlled clinical trials involving 529 patients were included. Compared with R & R procedure,the BLR procedure group showed lower successful rate(<i>RR</i>:0.85; 95% <i>CI</i>:0.72-0.99; <i>P</i>=0.043)and postoperative undercorrection(<i>RR</i>:3.975; 95% <i>CI</i>:2.097-7.537; <i>P</i><0.01). The <i>P</i> value of long-term postoperative corrected rate in Meta analysis was decreased near to 0.05 when the included references increased. There was no significant difference in overcorrection rate between the BLR and R & R procedures(<i>RR</i>:0.336; 95% <i>CI</i>:0.049-2.294; <i>P</i>=0.266).<p>CONCLUSION:Current evidences suggested that BLR procedure is related to lower successful and higher undercorrection rates for basic intermittent exotropia compared to conventional R & R procedure.

Surgical treatment of presbyopia I

Presbyopia is an age-related condition that progressively decreases the ability to focus on near objects. Minimally invasive surgical techniques have been developed to improve near vision, including laser in situ keratomileuses (LASIK) and corneal inlay. Most have similar approaches using monovision or increasing the depth of focus. Monovision laser refractive surgery is a combination of conventional LASIK, LASIK which creates a multifocal cornea (central near or peripheral near) and aspheric micro-monovision LASIK with a special ablation profile, which develops spherical aberration. Conductive keratoplasty is a method that uses radiofrequency energy to shrink the mid-peripheral corneal stromal tissue. However, it is not used because of regression. A corneal inlay is a small device that is implanted in the corneal flap or pocket made by a femtosecond laser. It is inserted into the non-dominant eye. There are various inlays such as the Flexivue Microlens (refractive), Raindrop (corneal shape-changing), and KAMRA (small-aperture) inlays. However, the safety and effectiveness of these inlays have not been proven over a long follow-up period, so care is required when performing inlay implantation. All presbyopia treatments can improve near vision but also have limitations and side effects such as reduced far vision, contrast sensitivity, or increased glare. Therefore, it is essential to select patients carefully. Mechanisms associated with presbyopia are not fully understood, and presbyopia remains challenging for ophthalmologists.