Clinical characteristics of acute acquired concomitant esotropia among different age groups / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the clinical characteristics of acute acquired concomitant esotropia(AACE)in patients among different age groups.METHODS: Retrospective analysis of clinical data. A total of 112 non-Swan type AACE patients who underwent surgery at Peking University People's Hospital from January 2015 to December 2022 were retrospectively analyzed. Clinical data were collected and the characteristics were compared, including gender, age, diopter, duration of disease, daily time spent on near work, angles of deviation before and after surgery, stereopsis, etc. According to age, patients were divided into three groups: <18 years old group(22 cases), 18-45 years old group(67 cases), and >45 years old group(23 cases). The clinical characteristics of patients were compared in each group.RESULTS: A total of 112 patients were included in the study, comprising 56 males and 56 females, with a median age of 29.50(19.25, 41.75)years old. Among them, 97 patients had myopia(86.6%). There were 93 patients(83.0%)who spent more than 8 h on near work. The age group <18 years old had the shortest duration before surgery, with a median time of 1.00(0.50, 1.00)a, the minimum negative diopter, with a median diopter of -0.75(-3.19, -0.56)D in the right eye and the diopter of -1.25(-2.81, -0.75)D in the left eye, and the maximum preoperative near angle of deviation, with a median angle of 30.00(18.50, 80.00)PD, and the maximum preoperative distant angle of deviation, with a median angle of 35.00(23.75, 80.00)PD. All these differences were statistically significant compared with other two groups(both P<0.05). For the age group from 18 to 45 years old, the median near angle of deviation was 20.00(14.00, 30.00)PD, and the median distant angle of deviation was 25.00(20.00, 35.00)PD, both of which were higher than those in the age group >45 years old(both P<0.05). For the age group >45 years old, the median near angle of deviation after surgery was -4.50(-7.50, 0)PD, and the median distant angle of deviation after surgery was 4.50(0, 9.50)PD, which were smaller than those in other two groups(all P<0.05). The age group >45 years old had the hiughest surgical success rate(100%). The preoperative stereopsis was better in age group >45 years old than the group <18 years old(P<0.05). The postoperative stereopsis of the age group of 18 to 45 years old and the age group >45 years old was better than age group <18 years old(both P<0.05).CONCLUSION: Surgical patients with AACE are mainly in the age group from 18 to 45 years old. The characteristic of angle of deviation is that distant angle of deviation is greater than near angle of deviation. The patients <18 years old have larger preoperative angles of deviation than adults, while their stereoacuity is worse than adults in the early postoperative period. It is recommended that augmented-dose surgery should be performed in AACE patients who are in the age group of 18 to 45 years old(5-10 PD). A conservative surgery should be designed for hyperopia young children without established binocular vision.

Relatively anterior lens position in primary angle-closure glaucoma eyes with long axial length

Purpose: To evaluate the refractive status and ocular biometric parameters in primary angle?closure glaucoma (PACG) eyes with different axial lengths (ALs). Methods: In total, 742 Chinese PACG subjects with complete ophthalmic examinations were enrolled. The refractive status was categorized as myopia (spherical equivalent [SE] ??0.5 D), emmetropia (?0.5 D < SE < +0.5 D), and hyperopia (SE ?+0.5 D), whereas the AL was divided into short (AL <22.5 mm), regular (22.5 ? AL <23.5 mm), and long (AL ?23.5 mm). The refractive status and ocular biometric parameters were compared among different AL groups. Results: The mean AL of the PACG eyes was 22.53 ± 0.84 mm (range: 19.68–25.57 mm). The refractive status was significantly different among different AL groups (P < 0.001). Also, 92.6% of hyperopic PACG eyes showed AL <23.5 mm, and 19.0% of myopic PACG eyes showed AL ?23.5 mm. The SE showed significant differences among different AL groups only in the hyperopic subjects (P = 0.012). The AL was significantly longer in myopic eyes (P < 0.001). The PACG eyes with longer AL exhibited lower keratometry, longer central anterior chamber depth and corneal diameter, and lens position and relative lens position closer to the anterior (P < 0.001). Conclusion: Axial hyperopia was common in PACG eyes, and axial myopia was not uncommon. Relatively anterior lens position could explain the occurrence of PACG in the eyes with long AL.

Influence of the duration of orthokeratology lens cessation on patients' refractive status and corneal endothelial cells / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the influence of the duration of orthokeratology lens cessation on patients' refractive status and corneal endothelial cells.METHODS: Adolescent myopia patients who wore orthokeratology lens from July 2019 to July 2020 and recently planned to stop wearing the lens were divided into mild group and severe group according to spherical equivalent. Refractive status, corneal morphology, corneal endothelial cells, and visual quality were measured at cessation and 1, 2 and 3mo after cessation.RESULTS: The corneal flat K values, steep K values and mean K values in the two groups were lower at cessation than those before wearing lenses. These values returned to the level before wearing lenses at 2mo after cessation(P&#x0026;#x003E;0.05). The corneal astigmatism, surface regularity index and surface asymmetry index in each group showed no statistically significant difference before wearing lenses and at 1, 2 and 3mo after cessation(P&#x0026;#x003E;0.05). There was no significant change in corneal endothelial cell density of the two groups at 1, 2 and 3mo after cessation compared with those before wearing lenses(P&#x0026;#x003E;0.05). The proportion of hexagonal cells in the two groups was lower at cessation than that before wearing lenses, and it returned to the level before wearing lenses at 1mo after cessation(P&#x0026;#x003E;0.05).CONCLUSION: Corneal morphology and corneal endothelial cells can be restored to the level before wearing orthokeratology lens at 3mo after cessation.

Clinical characteristics and treatment of patients with acute acquired concomitant esotropia in different refractive status / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the clinical characteristics and treatment of patients with acute acquired concomitant esotropia(AACE)in different refractive status.METHODS: A retrospective analysis was conducted on 110 patients with non-type I AACE treated from January 2020 to January 2022. The non-myopic group(30 cases, spherical equivalent&#x003E;-0.5D)and the myopic group(80 cases, spherical equivalent≤-0.5D)were divided according to the refractive status. The degree of deviation, accommodative convergence and accommodation ratio(AC/A), visual function, and surgical methods were observed. RESULTS: The non-myopic group had no difference in the degree of near deviation [(47.13±23.54)△] and the degree of distant deviation [(48.90±22.59)△](P&#x003E;0.05); near deviation [(40.49±26.09)△] of myopic group was less than distant deviation [(50.09±25.41)△](P&#x003C;0.001); and there was no difference in the same distance between the two groups(P&#x003E;0.05). AC/A in the non-myopic group(5.40±2.23)was higher than that in the myopic group(3.14±3.10; P&#x003C;0.05). Patients in the myopic group had better near stereopsis than the non-myopic group(P&#x003C;0.05). The non-myopic group had a variety of surgical methods, while the myopic group mostly used lateral rectus resection or/and medial rectus recession.CONCLUSION: AACE can occur in different refractive status. Non-myopic patients have the same degree of distant and near strabismus, high AC/A, and varied surgical methods. However, myopic patients have less degree of near deviation than distant deviation and have normal AC/A and better near stereopsis, and lateral rectus resection or/and medial rectus recession are commonly used.

A Study of Changes in Refractive Status Pre and Post Pterygium Surgery among Patients of Tertiary Care Hospital of Ahmedabad City

Background : Pterygium is a fibrovascular subconjunctival tissue also called Tenon’s Capsular growth occurring mostly in the palpebral fissure area from the nasal aspect towards the limbus over the Cornea and in this process the Corneal Pathology is changed especially the epithelium and bowman’s layer of the cornea are destroyed1. A major problem seen in most of postpterygium surgery is the complication of recurrence and it is usually seen in young patients with fleshy large pterygium1. This issue is addressed by Pterygium Surgery with either Conjunctival Autograft (CAG) or Amniotic Membrane Graft (AMG)1. Stem cells are present in limbal conjunctiva and in amniotic membrane, which provide a barrier between cornea and conjunctiva, preventing regrowth and also provide a smooth regular surface to the eyeball2. another reason and technique to prevent recurrence is by excising the pathological part of conjunctiva and resecting tenon’s capsule up to far periphery2. Aims and Objectives : The aim of the study is to investigate pre-operative and postoperative difference between the amount of astigmatism prior to the surgery and after the Pterygium Excision Surgery with either CAG or AMG. Materials and Method : A prospective cross-sectional study was undertaken of 26 cases, who underwent Pterygium Surgery under local anaesthesia with Conjunctival Autograft or Amniotic Membrane Graft for a period of one year in a Tertiary Healthcare Hospital. Pre-operative Best Corrected Visual Acuity, Anterior Segment Examination, Slit Lamp Examination, Dilated Retinoscopy and Fundus examination, Keratometry and Post mydriatic refraction was done. Then the patient underwent Pterygium Excision Surgery with Conjunctival Autograft or Amniotic Membrane Graft under local anaesthesia. All patients were re-examined 1 month after the surgery for final Refraction and Keratometry. Result : Among total of 26 patients, the comparison between pre- and postoperative values of Refraction and of Corneal Astigmatism was performed using z test. The pre-operative Mean for Astigmatism was 1.70 and SD was 0.43. The postoperative mean for Astigmatism was 0.57 and SD was 0.26. The pre-operative Keratometry mean was 2.73 and SD was 0.14. The Post operative Keratometry Mean was 1.50 and SD was 0.55. (p value, 0.0001) Conclusion: Pterygium is a lesion which also affects the ocular surface, thus leading to one of the causes for ocular surface abnormality. Pterygium surgeries results in elimination of the Pulling Factor and Corneal Curvature thus reducing or eliminating Astigmatism and thereby providing better visual restoration and cosmetic outcome

Influence of eye movement on precision of corneal ablation and refraction status in SMILE / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the influence of slight eye movement during laser scanning on femtosecond laser precision of corneal ablation and postoperative refractive status in small incision lenticule extraction(SMILE). METHODS: Totally 32 patients(62 eyes)who underwent SMILE surgery in our hospital from January 2019 to March 2021 were included and divided into the movement group and the fixation group according to whether the eyeballs were slightly moved during the operation, and select patients with slightly moved monocular eyeballs for binocular pairing. The actual difference of absolute value of corneal absolute cutting error(ACE), astigmatism error(AE), absolute refractive error(ARE)and absolute visual error(AVE)was compared between the movement group and the fixation group and the two eyes of the patients with slight ocular movement in one eye at 1mo after surgery, and the surgical images were quantified to analyze the correlation between the amplitude of ocular movement and AE, and to compare the effects of the area, layer and direction of slight eye movement on ACE.RESULTS: There were no differences in all observed results between movement group and fixation group(P&#x003E;0.05). Patients with slight movement of one eye had a difference in binocular AE(0.57±0.31D vs 0.33±0.27D, P&#x003C;0.05), and the amplitude of movement was positively correlated with AE at 1mo after surgery(r=0.564, P&#x003C;0.05). There was no statistical differences in ACE at 1mo after surgery in patients with slight ocular movement in different regions(central/peripheral), layers(upper/lower lens)and direction(nasal/temporal)(all P&#x003E;0.05).CONCLUSION:The slight eye movement during laser scanning in SMILE has no significant influence on precision of corneal ablation. It mainly causes decentered ablation and the changes of corneal astigmatism, which has little effect on the spherical equivalent and visual acuity.

Influence of bandage contact lens on corneal refractive status and postoperative complications in patients with pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the influence of bandage contact lens on corneal refractive status and postoperative complications in patients with pterygium. <p>METHODS: Totally 116 patients with pterygium treated in the hospital between January 2018 and December 2019 were recruited in the study. They were divided into control group and observation group by random number table method, 58 cases in each group. The control group received extended pterygium resection and autologous corneal limbal stem cell transplantation. On this basis, the observation group was treated with bandage contact lens. The best corrected visual acuity(BCVA), surface asymmetry index(SAI)of corneal topography, surface regularity index(SRI), corneal refractive power and postoperative complications in the two groups were compared. <p>RESULTS: Compared with preoperation, the BCVA of the two groups was significantly higher 1mo and 3mo after operation(<i>P</i><0.05), without statistically significant difference between the groups(<i>P</i>>0.05). Corneal horizontal and vertical curvature of the two groups were significantly higher, while corneal astigmatism was significantly lower at 1mo and 3mo after surgery. Meanwhile, the observation group had significantly lower corneal astigmatism than the control group(<i>P</i><0.05). SAI and SRI of the two groups significantly decreased, which were significantly lower in the observation group than in the control group(<i>P</i><0.05). No complications such as infection, poor healing of grafts and subconjunctival cysts were observed. The incidence of eye irritation was significantly lower in the observation group than in the control group, and lower at 2wk than at 1wk before operation(<i>P</i><0.05).<p>CONCLUSION: Extended pterygium resection combined with autologous corneal limbal stem cell transplantation and bandage contact lens is more conductive to the improvement of corneal refraction in patients with pterygium, which also can reduce the incidence of eye irritation.

Analysis of visual acuity and refractive status of kindergarten children and primary and middle school students in a community in Shanghai 2015-2018 / 公共卫生与预防医学

Objective To analyze the visual acuity and refractive status of kindergarten children and primary and middle school students in Xinhong Community of Shanghai from 2015 to 2018, and to provide basis and reference for the prevention and control of students' myopia. Methods The data of 3 904 person-times of complete visual acuity and refraction records from 2015 to 2018 was derived from the "Shanghai Residents' Eye Health Information Service System". Results From 2015-2018, the total detection rate of poor vision of kindergarten children and primary and middle school students was 60.86%, and the detection rate of poor vision in kindergarten, primary school and middle school was 29.90%，62.63% and 87.26% respectively，showing an increasing trend with the education stage (χ2=727.206，P2=19.949, P2=1099.978, P<0.05). In terms of growth rate, the increase in myopia in the first grade of primary school was the largest. Conclusion The myopia rate of primary and secondary school students was higher than that of kindergarten children, and showed an increasing trend with the education stage. The critical period of myopia prevention and control should be advanced to the kindergarten stage.

Comparison of femtosecond laser or a mechanical microkeratome to create corneal flaps in LASIK for myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the clinical effect, safety and visual outcome after laser <i>in situ</i> keratomileusis(LASIK)using femtosecond laser or a mechanical microkeratome. <p>METHODS: By retrospective study, 120 cases(240 eyes)of myopia patients had refractive surgery from July 2016 to June 2017. There were 62 cases(124 eyes)were treated with traditional LASIK, and 58 cases(116 eyes)were treated with LASIK using femtosecond laser to create corneal flaps. Visual acuity,corneal flap thickness and aberration were evaluated at 1, 6 and 12mo. <p>RESULTS: The corneal flap was successfully made in all patients, and the operation was successfully completed. There were no obvious complications during and after the operation. There were no statistical differences between the two groups about visual acuity or refractive error after operation(<i>P</i>>0.05). However,the result of corneal flap thickness in the Femto-LASIK was better than the result in the traditional LASIK(<i>t</i>=26.67, <i>P</i><0.01). In addition, the added values of spherical aberration, coma aberration and total higher-order aberrations in the Femto group were smaller than those in the traditional group(<i>t</i>=-4.16, -4.92, -22.19; <i>P</i><0.01). The post operative surface regularity index(SRI)of traditional LASIK was higher than that of Femto-LASIK(0.31±0.09 <i>vs</i> 0.25±0.04; <i>t</i>=6.59, <i>P</i><0.01). <p>CONCLUSION: Femtosecond laser made corneal flap is more accurate than lamellar knife flap. Aberrations of femtosecond laser flap LASIK surgery are smaller than the traditional LASIK.Femto-LASIK may provide relatively better visual quality. However, both of the different surgery can result in satisfactory visual acuity.

Refractive change after mydriasis optometry combined with amblyopia treatment in children with mixed astigmatism and amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of mydriasis optometry combined with amblyopia treatment on refraction and amblyopia changes in children with mixed astigmatism and amblyopia.METHODS: Totally 163 children (289 eyes) of mixed astigmatism and amblyopia from January 2010 to May 2011 were treated.All of the patients received mydriatic optometry and spectaculars with amblyopia therapy and were followed up for 5a to observe amblyopia efficacy and refractive status changes.RESULTS: With 5a, main diameter diopter at distant vision decreased year by year, average decline in the first year was 0.55DS, 0.56DS in the second year, 0.72DS in the third year, 0.95DS in the fourth year, 1.89DS in the fifth year.The spherical equivalent changed from 1.12DS at distant to 0.78DS at near.The corrected visual acuity of all the patients at first visit was 0.2-0.8 with varying degrees amblyopia.After a 5-year treatment, it was effective in 268 eyes (92.7%), in which 165 eyes (57.1%) improved, 103 eyes (35.6%) cured, the results was better as the period of spectaculars wearing was longer.There was 36 eyes (37.5%) improved and 60 eyes (62.5%) cured in 1.50-2.50DC group;118 eyes (74.2%) improved, 41 eyes (25.8%) cured in 2.50-3.50DC group;11 eyes (32.3%) improved, 2 eyes (5.9%) cured, 21 eyes (61.8%) useless in >3.50DC Group.The differences of efficacy among the groups were significant (all P<0.05).CONCLUSION: Appropriate spectaculars is the basic for amblyopia treatment.It is effective for most children with mixed astigmatism and amblyopia to take mydriasis optometry and amblyopia treatment.

Effects of continuously using eyes at near on eyes with different refractive status / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To investigate the changes of nearwork induced transient myopia ( NITM ) in different refractive status after continuous near tasking.?METHODS:Prospective study. Thirty subjects ( aged 18-24, average 20. 9 ± 2. 1, 12 males and 18 females) were recruited in this study. They were divided into 3 groups according to the subjective refraction: 10 with hyperopia (H), 10 with emmetrope (E) and 10 with myopia (M). All the subjects with soft contact lens watched videos on a panel computer at near distance (33cm ~ 40cm). Five measurements of distance refraction in the right eye were performed by using an infrared optometer before, after 30min and 60min sustained viewing task, and the mean of 5 refractive values was recorded as spherical equivalent. Then distance refraction of right eyes was done every 5s followed by stopping near tasking until NITM was disappeared completely and the decay time of NITM was recorded for each subject. The value of NITM was the difference of refractive values between before and after near tasking. Paired-t test was used to compare the changes of refractive values in the same group. ANOVA was used to determine the differences of NITM and its decaying time among three groups.?RESULTS: Compared with pre - task, no significant refractive changes were found in hyperopic group ( t =1. 627,P= 0. 138 ); While subjects with emmetropia and myopia showed more myopic shifts at the two time points (tE = 2. 699, PE = 0. 024;tM = 4. 930, PM = 0. 001 ). With continuous viewing until the 30th min and 60th min, significant differences of averaged NITM were found between myopic group and other 2 groups (P0. 05). Significant differences of the decay time of NITM can be seen among the three groups after near tasking (F=787. 983,P<0. 001).? CONCLUSION: Subjects with myopia are more susceptible to produce NITM than other 2 groups during sustained nearwork for the same time and the decaying time of NITM is longer in myopia group after near tasking, thus it is suggesting that NITM might be attributed to the development and progression of myopia.

Research on refractive status characteristics and anterior chamber depth after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To study the refractive status characteristics aftser cataract surgery and the correlation between preoperative anterior chamber depth ( ACD) and refractive status.METHODS: Ninety-six cases of patients with cataract were randomly divided into two groups. The patients in phacoemulsification group were treated with phacoemulsification combined intraocular lens ( lOL ) implantation while the patients in small incision group were treated by small incision extracapsular cataract extraction combined with lOL implantation. Changes in ACD and postoperative refractive status and refractive fully corrected value were counted and the correlation of them were analyzed .RESULTS: ACD of the phacoemulsification group s deepened 0. 74mm while that of the small incision group deepened 0. 78mm after treatment and there was no significant difference (P>0. 05). After operation, the ACD of two groups significantly deepened ( P0. 05). CONCLUSlON: ACD is significant deepened after operation. Surgeon needs full consideration of changes to improve the refractive lOL calculation accuracy.