Aspectos a considerar para el diagnóstico del queratocono infantil / Aspects to consider for the diagnosis of infant keratoconus

Introducción: Globalmente, existe un aumento de la prevalencia del queratocono y su diagnóstico en edades tempranas. Se notifican un gran número de casos subclínicos y otros con una rápida progresión, condicionada por el inicio precoz de la enfermedad y la asociación a factores de riesgo. Objetivo: Describir los aspectos epidemiológicos, clínicos y el resultado de los medios de diagnóstico implicados en la detección precoz del queratocono infantil. Desarrollo: En niños con ametropía hay elementos que alertan la presencia de un queratocono como causa del defecto refractivo. Desde el punto de vista epidemiológico se encuentran: distribución geográfica, rol de la herencia y factores ambientales. Clínicamente se señalan los antecedentes de enfermedades, tales como las alergias, la presencia de miopía o astigmatismo miópico con inestabilidad refractiva y los signos clínicos relacionados con la progresión del cono. En los pacientes de riesgo es preciso realizar exámenes mediante diferentes medios de diagnóstico según su disponibilidad, siendo primordial el análisis refractivo, queratométrico y topográfico. Conclusiones: En la evaluación de los niños con ametropía se deben tener en cuenta elementos epidemiológicos y clínicos que permiten sospechar y diagnosticar precozmente el queratocono. En la interpretación de los resultados de los medios de diagnóstico involucrados en su detección, se deben considerar los hallazgos más frecuentes en la población infantil según el grado de progresión de la ectasia.

Introduction: Globally, there is an increase of the keratoconus prevalence and its diagnosis in early ages. A great number of subclinical cases and others with a quick progression are notified, conditioned by the early onset of the disease and the association with risk factors. Objective: To describe the epidemiological, clinical aspects and the result of diagnostic means involved in the early detection of infant keratoconus. Development: There are elements that alert the presence of a keratoconus as a cause of the refractive defect in children with ametropia. From the epidemiologic point of view they are: geographical distribution, heredity role and environmental factors. History of previous diseases are clinically pointed out, such as allergies, myopia or myopic astigmatism with refractive instability and the clinical signs related to cone progression. In risk patients it is necessary to carry out exams by means of different diagnostic means according to their availability, being essential the refractive, keratometric and topographic analysis. Conclusions: In the evaluation of children with ametropia, epidemiological and clinical elements should be taken into account that allow to suspect and early diagnose the keratoconus. In the interpretation of results of the diagnostic means involved in their detection the most frequent findings in the infant population, should be considered according to the ectasia degree of progression.

Comparison of corneal refractive power and visual quality after LASEK, TransPRK or FS-LASIK / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the corneal refractive power and visual quality after three kinds of corneal refractive surgery: laser subepithelial keratomileusis(LASEK), transepithelial photorefractive keratectomy(TransPRK)and femtosecond laser assisted in situ keratomileusis(FS-LASIK).METHODS: Retrospective study. A total of 232 patients(464 eyes)who underwent elective corneal refractive surgery in our hospital from January 2021 to December 2022 were selected as the study subjects. They were divided into the LASEK group of 70 cases(140 eyes), TransPRK group of 76 cases(152 eyes), and FS-LASIK group of 86 cases(172 eyes)according to the different surgical choices made by the patients. Uncorrected visual acuity(UCVA), visual quality, biomechanical stability, tear film break-up time(BUT), Schirmer Ⅰ test(SⅠt)and quality of life were compared among the three groups at 1 and 3 mo postoperatively.RESULTS: The UCVA of the three groups significantly improved at 1 and 3 mo postoperatively, the total high-order aberrations, spherical aberration, horizontal coma, and vertical coma of the entire cornea were significantly increased, while the biomechanical stability in all three groups were significantly reduced(all P<0.05). At 3 mo postoperatively, the biomechanical stability in the TransPRK and LASEK groups were higher than those of the FS-LASIK group(all P<0.05), and the TransPRK group had higher quality of life scores than the LASEK group and FS-LASIK group(P<0.05). Furthermore, there was no significant difference in preoperative or postoperative BUT and SⅠt among the three groups(all P>0.05).CONCLUSION:In the treatment of ametropia, LASEK, TransPRK and FS-LASIK all have certain effects, and have similar results in improving UCVA and increasing visual quality. However, TransPRK and LASEK have more stable biomechanical properties than FS-LASIK, and have better efficacy in improving patients' quality of life.

Risk factors of refractive regression after 1 year femtosecond laser assisted in situ keratomileusis correction of moderate and high myopia and its prediction model construction / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the risk factors of refractive regression after correction of moderate and high myopia by femtosecond laser assisted in situ keratomileusis(FS-LASIK)for 1 a, and construct prediction model.METHODS: A retrospective analysis was performed on the clinical data of 400 patients(800 eyes)with moderate and high myopia undergoing FS-LASIK correction in Xi'an Gaoxin Hospital from June 2017 to November 2018, and the patients were randomly divided into modeling group(n=300)and verification group(n=100)according to a ratio of 3:1. The modeling group was divided into regression group and non-regression group according to the occurrence of refractive regression at 1 a after surgery. The changes of corneal curvature and corneal thickness were observed. Logistic regression analysis was used to screen the risk factors of refractive regression in patients with moderate and high myopia at 1 a after FS-LASIK correction, and the prediction model was built based on the regression coefficient. Receiver operating curve(ROC)was used to evaluate model differentiation.RESULTS:Refractive regression occurred in 44 eyes of the modeling group and 15 eyes of the verification group at 1 a after surgery. The anterior corneal surface curvature in the modeling group was lower than that in the regression group at 6 and 12 mo after surgery(all P<0.05). The degree of corneal hyperplasia in the regression group was greater than that in the non-regression group at 1, 3, 6 and 12 mo after surgery(all P<0.05). The regression equation of the probability value of refractive regression in patients with moderate and high myopia corrected by FS-LASIK at 1 a after surgery is as follows:P=1/[1+e-(-5.989+0.127×age+2.019×preoperative diopter-0.022×preoperative central corneal thickness+0.043×depth of cutting-1.569×diameter of cutting optical region)], Hosmer-Lemeshow detected the goodness of fit of the regression equation(P=0.818). Internal verification using the modeling group data showed that the area under ROC curve was 0.890(95%CI: 0.843-0.937), the sensitivity was 81.82%, and the specificity was 84.71%. The area under ROC curve was 0.838(95%CI: 0.717-0.959), the sensitivity was 80.00%, and the specificity was 87.57%.CONCLUSIONS:The established risk model has good discriminating validity and can be used to identify the high-risk group of refractive regression at 1 a after FS-LASIK in patients with moderate and high myopia.

Progress in the application of swept-source optical coherence tomography in corneal imaging / 国际眼科杂志(Guoji Yanke Zazhi)

Advances in imaging technology have revolutionized the field of ophthalmology, changing the understanding, diagnosis, and treatment of ophthalmic diseases. Swept-source optical coherence tomography(SS-OCT)is a non-contact high-resolution imaging technology. It further improves imaging depth and scanning speed, adds new algorithms and features. The application of SS-OCT enables the three-dimensional evaluation of corneal structures, offering curvature and height maps for both the anterior and posterior surfaces of the cornea, as well as precise corneal thickness mapping. These invaluable tools aid ophthalmologists in effectively screening and diagnosing various corneal lesions such as keratoconus, corneal dystrophy, and degeneration. Moreover, the enhanced speed, accuracy, and sensitivity provided by SS-OCT measurements facilitate improved surgical planning and postoperative monitoring for patients undergoing refractive surgery or keratoplasty. This article reviews the development of SS-OCT technology and its potential clinical utility in corneal diseases and surgical application, in order to support more possible future research and clinical treatment.

Accuracy comparison of different formulas in calculating intraocular lens power in cataract patients after corneal refractive surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare and observe the accuracy of five intraocular lens(IOL)power calculation formulas in patients with cataracts who have previously undergone corneal refractive surgery.METHODS: Prospective case series study. A total of 23 cataract patients(34 eyes)with a history of myopic corneal refractive surgery at Jinan Mingshui Eye Hospital from September 2021 to March 2023 were collected, including 1 eye treated with photorefractive keratectomy(PRK)and 22 patients(33 eyes)treated with laser-assisted in situ keratomileusis(LASIK). Preoperative ocular biometry was performed using the IOL Master 700, while corneal true net refractive power(TNP)was measured via Pentacam analyzer. Anterior segment optical coherence tomography(OCT)was used to assesse net corneal power(NCP), posterior corneal refractive power, and central corneal thickness(CCT). The Shammas, Haigis-L, Potvin-Hill Pentacam, OCT, and Barrett True K formulas were utilized for IOL power calculations, with the optimal power selected accordingly. At 1 mo postoperatively, actual refractive outcomes were determined through subjective refraction, based on objective optometry results. The refractive prediction error(RPE)and refractive absolute error(RAE)of each formula were calculated and compared, and the percentage of eyes with RAE ≤0.5 D and ≤1.0 D was counted.RESULTS: No significant statistical difference was found in the RPE of the five formulas when compared to zero(all P>0.05), nor were there significant differences in RPE and RAE among the formulas(F=0.554, P=0.696; H=4.402, P=0.354). The RAE was within ≤0.5 D for 26 eyes(76%)using the Potvin-Hill Pentacam formula and for 24 eyes(71%)using the Barrett True K formula, with both formulas achieving an RAE within ≤1.0D in 33 eyes(97%).CONCLUSIONS: The Barrett True K and Potvin-Hill Pentacam formulas demonstrated high predictive accuracy for IOL power calculations in post-corneal refractive surgery cataract patients. Given the variability in corneal refractive power among these patients, further research on IOL power calculation is warranted. Clinically, it is advisable to consider a range of formulas for optimal outcomes.

Progress of peripheral defocus design framework eyeglasses in myopia control / 国际眼科杂志(Guoji Yanke Zazhi)

Myopia is becoming more and more common all over the world, and the incidence of myopia is gradually increasing. Many treatments have been used to prevent and control myopia, including optics, drugs, environment or behavior, but the results are different and lack standardization. At present, many experiments have proved that peripheral defocus technology has a certain effect on myopia control. Based on this technology, three kinds of framed eyeglass lenses with peripheral defocus design, namely defocus incorporated multiple segments(DIMS), highly aspherical lenslets(HAL)and cylindrical annular reactive elements(CARE), are commonly used in medical and optometry institutions in China. These lenses provide not only clear vision in the central area, but also a certain amount of myopic defocus in the periphery to control the progression of myopia. This paper aims to focus on the design principle and myopia prevention and control effect of the above three peripheral defocus lenses, and evaluate their effectiveness in clinical practice.

Changes in corneal epithelial thickness and optical density and their correlation after smart pulse technology-assisted transepithelial photorefractive keratectomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the changes in corneal epithelial thickness(CET)and corneal optical density(CD)after smart pulse technology(SPT)-assisted transepithelial photorefractive keratectomy(TPRK)and analyze their correlation.METHODS: The prospective study included 60 patients(120 eyes)with myopia and myopic astigmatism who underwent SPT-TPRK in the ophthalmology department at the First Affiliated Hospital of Xinxiang Medical University between February and August 2023. Changes in CET and CD were evaluated preoperatively and at 1 wk, 1 and 3 mo postoperatively.RESULTS: A total of 14 cases(28 eyes)were lost to follow-up, and 3 patients(6 eyes)with postoperative haze were excluded from this study, resulting in a final inclusion of 43 patients(86 eyes). At 1 wk after SPT-TPRK, CET had statistically significantly thickened compared to preoperative levels(P<0.05), particularly in the CET at 0-2 mm central corneal area(P<0.05). At 1 mo after SPT-TPRK, the CET at 0-2 mm area had statistically significantly decreased(P<0.05). At 3 mo after SPT-TPRK, the CET at 0-2 mm had essentially reached preoperative levels. Postoperative CD values increased, with a positive correlation between CET in the 0-2 mm area and CD in the whole 0-2 mm area(r=0.256, P<0.05), and a positive correlation between CET in the 2-5 mm area and CD in the anterior 2-6 mm area(r=0.319, P<0.05).CONCLUSION: Corneal epithelial remodeling takes 3 mo in areas within 2 mm of the central cornea; areas with thinner CET have faster postoperative corneal epithelial remodeling and greater thickening in the early postoperative period; CD increases in the early postoperative period compared to the preoperative value, and in some areas, there is a positive correlation between CET and CD value.

Effect of residual corneal astigmatism on visual acuity of patients undergoing regional refractive intraocular lens implantation / 眼科新进展

Objective To investigate the effect of residual corneal astigmatism on visual acuity after regional refrac-tive intraocular lens(IOL)implantation.Methods A retrospective cohort study was conducted.The medical records and follow-up data of 73 eyes of 57 cataract patients who underwent ultrasound emulsification cataract extraction combined with LENTIS Comfort LS-313 MF15 IOL implantation in the Ophthalmology Department of the Hebei General Hospital from June 2020 to March 2022 were collected.These patients were grouped according to postoperative residual corneal astigmatism:32 patients(40 eyes)with a residual corneal astigmatism of 0.75(exclusive)-1.50 D were taken as the experimental group,and 25 patients(33 eyes)with a residual corneal astigmatism ≤0.75 D were taken as the control group.The uncor-rected distance visual acuity(5 m),uncorrected intermediate visual acuity(80 cm),uncorrected near visual acuity(40 cm),out-of-focus curve,objective visual quality,subjective visual quality,satisfaction degree and lens removal rate of pa-tients in the two groups were recorded 6 months postoperatively.Results The postoperative uncorrected distance visual acuity(logMAR)was 0.10(0.00,0.22),the uncorrected intermediate visual acuity(logMAR)was 0.00(0.00,0.10),and the uncorrected near visual acuity(logMAR)was 0.20(0.10,0.30)and 0.20(0.10,0.20)in the experimental and control groups,with no statistically significant differences(all P＞0.05).The postoperative out-of-focus curves showed that the distance visual acuity of patients with additional spherical equivalent refraction ranged from+2.00 D to-4.00 D in the two groups had no statistically significant difference(all P＞0.05).There were statistically significant differences in to-tal aberration,coma aberration,modulation transfer function and Strehl ratio in the objective visual quality of patients after surgery(all P＜0.05),and there was no statistically significant difference in the total higher-order aberration,spherical ab-erration and cloverleaf aberration(all P＞0.05).There was no statistically significant difference in the subjective visual quality,satisfaction degree and lens removal rate in the two groups(all P＞0.05).Conclusion Residual corneal astig-matism of 0.75 D to 1.50 D after LENTIS Comfort LS-313 MF15 IOL implantation has no effect on higher-order aberration,spherical aberration,and cloverleaf aberration in subjective and objective visual quality,and has an impact on total aberra-tion,coma aberration,modulation transfer function and Strehl ratio in objective visual quality.

Comparison of 1-year postoperative clinical effects between sutureless bridge intrascleral fixation and ciliary sulcus suture suspension of intraocular lens / 眼科新进展

Objective To compare the clinical effects between sutureless bridge intrascleral fixation and ciliary sul-cus suture suspension of intraocular lens(IOL)1 year postoperatively.Methods In this retrospective study,14 patients(14 eyes)who underwent sutureless bridge intrascleral IOL fixation in the No.988 Hospital of Joint Logistic Support Force of PLA from March 2019 to January 2022 were taken as the intrascleral fixation group and 15 patients(15 eyes)who under-went IOL ciliary sulcus suture suspension in the same period were taken as the suture suspension group.During the 1-year follow-up,the preoperative and postoperative uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA)(logMAR),spherical equivalent(SE),endothelial cell count(ECC),intraocular pressure(IOP)and IOL position were compared between the two groups.Results At 1,6 and 12 months postoperatively,the UCVA in both groups significant-ly increased compared with those before surgery(all P＜0.05),and UCVA in the intrascleral fixation group were better than those in the suture suspension group at all postoperative time points(F=4.560,6.411 and5.373;all P＜0.05).At 1,6 and 12 months postoperatively,there was no significant difference in BCVA in both groups compared with those before surgery(all P＞0.05),but BCVA in the intrascleral fixation group were better than those in the suture suspension group at all postoperative time points(F=6.170,6.957 and 10.624;all P＜0.05).After surgery,eyes in the intrascleral fixation group showed hyperopia drift,while eyes in the suture suspension group showed myopia drift.At 1,6 and 12 months post-operatively,the SE of the intrascleral fixation group were(0.59±0.30)D,(0.57±0.27)D and(0.64±0.29)D,respec-tively,and those of the suture suspension group were(-0.75±0.44)D,(-0.72±0.42)D and(-1.12±0.64)D,re-spectively.At 6 months postoperatively,the ECC of both groups were significantly lower than those before surgery(t=8.579 and 21.929;both P＜0.001).The IOP in both groups were within the normal range preoperatively and stable during the follow-up.The IOL were centrally located without obvious decentration or tilt during the follow-up.In addition,there were no vitreous and retinal complications.Conclusion Both sutureless bridge intrascleral IOL fixation and IOL ciliary sulcus suture suspension can obtain a favorable prognosis of visual acuity with refractive shift,while sutureless bridge in-trascleral fixation shows better clinical outcomes.

Bibliometric analysis of scleral lens research trends based on Web of Science / 中华实验眼科杂志

Objective:To analyze the research status of scleral lenses by bibliometric method based on the relevant collection of scleral lenses in the Web of Science database.Methods:Using the scleral lens-related literature collected in the Web of Science Core Collection database in the past 10 years (January 2013 to December 2022) as the object of analysis, bibliometric method and CiteSpace tools were used to conduct visual analysis of the literature.A comprehensive analysis of the volume of literature published, the distribution of countries and institutions, the information of core authors, the distribution of journals, and keyword clustering was performed.Results:A total of 340 articles were retrieved, which were published in 54 journals, with an average of 6.3 articles per journal, involving 301 authors.Research in this area covered 35 countries or regions, and 256 research institutions were involved.Discipline development was mainly in the United States, India, Spain and Australia.The main focus was on scleral lens (scleral contact lens), ocular surface disease, corneal edema, miniature scleral lens, etc.In the past 10 years, the trend of research hot topics in scleral lenses had shifted from the initial study of combining scleral contact lenses with ocular surface diseases to the subsequent study of prosthetic replacement of the ocular surface ecosystem, and the exploration of corneal clearance and shape.From 2013 to 2021, the main focuses were ocular surface diseases, scleral contact lenses, and corneal edema.After 2021, research on ocular surface diseases and keratoplasty declined.From January 2013 to December 2022, emergent keywords related to scleral lens mainly included scleral contact lens, transplantation, anti-host disease, prosthetic device in the first stage, artificial replacement of ocular surface ecosystem and irregular cornea in the second stage, and the research on corneal gap and characteristic shape in the third stage.Optical coherence tomography and corneal topography were commonly used examinations for scleral lens research and fitting.Conclusions:At present, the scleral lens is mainly used for dry eye, corneal diseases, corneal ectasia, keratitis, and corneal transplantation, especially after penetrating keratoplasty and refractive errors.Prosthetic replacement of the ocular surface ecosystem, and the exploration of corneal clearance and shape are the research hotspots in scleral lenses.

Efficacy and safety of refractive surgery combined with prophylactic collagen cross-linking for ametropia / 中华实验眼科杂志

Corneal refractive surgery is a safe and effective way to correct ametropia.Although the biomechanical stability of the cornea is reduced due to the change in corneal tissue integrity after surgery, the vast majority of postoperative corneal structures are safe.Patients with preoperative risk factors, such as high diopters, thin cornea, irregular corneal topography, high astigmatism, binocular asymmetry, allergic constitution, eye rubbing, etc., may experience postoperative refractive regression and corneal ectasia.Corneal collagen cross-linking can enhance the biomechanical properties of cornea and effectively prevent the occurrence and progression of corneal ectasia, keratoconus or other ectatic diseases.In recent years, many researchers at home and abroad have tried a new design of refractive surgery, that is, corneal refractive surgery with prophylactic corneal collagen cross-linking to improve the biomechanical stability of the cornea after refractive surgery, and then potentially prevent corneal ectasia and refractive regression.A number of studies have found that combined surgery has a good visual acuity and refractive prognosis, especially in patients at high risk for postoperative ectasia.This article reviews the efficacy, safety, predictability, stability, and complications of combined surgery.

Efficacy and safety of transepithelial photorefractive keratectomy combined with accelerated corneal cross-linking for refractive error in thin or irregular cornea / 中华实验眼科杂志

Objective:To evaluate the efficacy and safety of transepithelial photorefractive keratectomy (Trans-PRK) combined with accelerated corneal cross-linking (CXL) for refractive error in patients with thin or irregular corneas, excluding keratoconus.Methods:An observational case series study was performed.Fifty-five right eyes of 55 myopic patients diagnosed with thin or irregular corneas, who underwent Trans-PRK combined with prophylactic CXL surgery, were included at Baotou Chaoju Eye Ophthalmic Hospital from August 2017 to July 2018.Uncorrected distance visual acuity (UDVA) of the operated eye was measured using international standard visual acuity charts, and refractive diopters were measured by computer and comprehensive refraction before surgery and at 1 week, 1, 3, 6, and 12 months after surgery.Corneal morphology was assessed with the Pentacam anterior segment analyzer before surgery and at 3, 6, and 12 months after surgery.Intraocular pressure (IOP) was measured with a non-contact tonometer before surgery and at 1, 3, 6, and 12 months after surgery.The incidence of postoperative complications was recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Baotou Chaoju Ophthalmic Hospital (No.btcj-u-1). Written informed consent was obtained from each subject.Results:Preoperative, 1-week, 1-, 3-, 6-, and 12-month postoperative UDVA (LogMAR) were 0.52(0.55, 0.78), 0.22(0.12, 0.17), 0.10(0.04, 0.07), 0.00(-0.04, -0.16), -0.08(-0.05, -0.03) and -0.08(-0.06, -0.04), respectively, showing a statistically significant overall difference ( Z=249.44, P<0.001). UDVA at each postoperative time point was improved compared to preoperative, and UDVA at 3, 6, and 12 months postoperatively was significantly improved compared to 1 week and 1 month postoperatively (all at P<0.001). The spherical diopter at each postoperative time point decreased significantly compared to preoperative, with the spherical diopter at 1, 3, 6, and 12 months postoperatively being lower than that at 1 week postoperatively, and the 12-month postoperative spherical diopter being lower than that at 3 and 6 months postoperatively, showing statistically significant differences (all at P<0.001). The cylindrical degree at 1, 3, 6, and 12 months postoperatively was lower than that at preoperative and 1 week postoperatively, with statistically significant differences (all at P<0.05). After the operation, the spherical equivalent of the operated eye gradually decreased with time, tending toward emmetropia.The spherical equivalent at each postoperative time point decreased compared to preoperative, with the spherical equivalent at 1, 3, 6, and 12 months postoperatively being lower than that at 1 week postoperatively, and the spherical equivalent at 12 months postoperatively being lower than that at 3 and 6 months postoperatively, showing statistically significant differences (all at P<0.001). The corneal K1 and K2 values at 3, 6, and 12 months postoperatively were significantly lower than preoperatively (all at P<0.001), and the corneal K1 and K2 values at 3 months postoperatively tended to stabilize.The IOP of the operated eye at 3, 6, and 12 months postoperatively was significantly lower than preoperatively, and the IOP at 6 and 12 months postoperatively was lower than that at 1 and 3 months postoperatively, with statistically significant differences (all at P<0.001). One eye developed grade 0.5 corneal haze at 1 week postoperatively, which spontaneously resolved to transparency at 1 month postoperatively. Conclusions:Trans-PRK combined with accelerated CXL has good efficacy, stability and safety for refractive error patients with thin or irregular corneas, except for keratoconus.

An interpretation of the new version of Refractive Errors Preferred Practice Pattern? / 中华实验眼科杂志

In September 2022, the American Academy of Ophthalmology released the latest version of Refractive Errors Preferred Practice Pattern? (PPP). It provides authoritative guidance for the diagnosis and treatment of refractive errors based on the best evidence-based medical updates.The new version of Refractive Errors PPP continues the rigorous, comprehensive and detailed features of the 2017 version.Updates have been made to the definition, epidemiology, classification, and diagnosis and correction of refractive errors.For example, the new version of Refractive Errors PPP defines high refractive errors as myopia≥-6.0 D, hyperopia≥+ 3.0 D, astigmatism≥-3.0 D, adds content on myopia prevention and control, recommends outdoor activities for at least 2 hours per day, selects appropriate optical prevention and control methods, and considers the use of low-concentration atropine eye drops to delay the onset and development of myopia.It enriched the evidence-based medical evidence that myopia is an interactive influence of genetic and environmental factors, and emphasized the future pandemic trend of high myopia, and the global public health significance of delaying the progression of myopia.In addition, the new version of Refractive Errors PPP emphasizes for the first time that myopia can cause irreversible visual impairment, suggesting that it is necessary to delay the onset time of myopia in children and slow the speed of myopia progression.This article introduces and interprets the main contents and updates of the new edition of the Refractive Errors PPP.

Features of dominant eye and the significance of ocular dominance switching in the treatment of ocular diseases / 中华实验眼科杂志

The dominant eye is the eye that plays a significant role in visual perception.It plays an essential role in binocular vision and fusion functions with a complex formation mechanism.According to the principle of the dominant eye examination method, ocular dominance can be classified into sighting, motor, and sensory dominance.Changes in visual acuity or visual function due to the unbalanced progression of binocular disease may lead to the switch in the dominant eye, affecting the balance of binocular vision and the therapeutic effect.Therefore, misjudging or neglecting of the dominant eye will change the long-term visual balance between the eyes, which may affect people's visual quality and quality of life.These aspects are mainly represented in the process of refractive error correction, refractive surgery, strabismus correction surgery, amblyopia training methods and cataract intraocular lens measurement.The formulation of medical plans based on the strategy of the dominant eye can remarkably improve the reconstruction good binocular vision and the quality of life of patients.However, the role of the dominant eye in binocular vision is not fully understood, and clinicians are not sufficiently aware of its importance.Therefore, this study will review the latest research progress on the mechanism of dominant eye formation, examination methods, and clinical significance of dominant eye switching.

Astigmatism inclusivity of regional refractive intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of residual astigmatism on visual quality after phacoemulsification combined with regional refractive intraocular lens(IOL)implantation in patients with age-related cataract, and to evaluate the astigmatism inclusivity of regional refractive IOL.METHODS: Retrospective cohort study. The clinical data of 62 cases(73 eyes)of age-related cataract patients who underwent phacoemulsification combined with regional refractive IOL(Lentis Comfort LS-313 MF15)implantation from July 2020 to March 2022 at the ophthalmology department of our hospital were collected. They were grouped according to residual astigmatism at 6 mo postoperatively, taking 35 cases(40 eyes)with residual astigmatism of 0.75 D to 1.50 D as the experimental group, and 27 cases(33 eyes)with residual astigmatism ≤0.75 D as the control group. Visual acuity, defocus curves, objective visual acuity [wavefront aberrations, Strehl ratio(SR), modulation transfer functions(MTF)], subjective visual acuity(national eye institute visual function questionnaire-25), patients' satisfaction, and spectacle independence were compared between the two groups at 6 mo postoperatively.RESULTS:There was a difference in the preoperative astigmatism and the number of postoperative 6 mo residual astigmatism between the two groups(P&#x003C;0.01). At 6 mo postoperatively, there was no difference in uncorrected distance, intermediate, and near visual acuity, objective visual quality, subjective visual quality, satisfaction, and spectacle independence between the two groups(P&#x003E;0.05). The defocus curves showed that there was no difference in visual acuity between the two groups at all points in the +2.00 to -4.00 D defocus range of the additional spherical equivalent(P&#x003E;0.05).CONCLUSION:Lentis Comfort LS-313 MF15 IOL was able to accommodate regular astigmatism of 1.50 D.

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: &#x003C;18 years old group(22 cases), 18-45 years old group(67 cases), and &#x003E;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 &#x003C;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&#x003C;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 &#x003E;45 years old(both P&#x003C;0.05). For the age group &#x003E;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&#x003C;0.05). The age group &#x003E;45 years old had the hiughest surgical success rate(100%). The preoperative stereopsis was better in age group &#x003E;45 years old than the group &#x003C;18 years old(P&#x003C;0.05). The postoperative stereopsis of the age group of 18 to 45 years old and the age group &#x003E;45 years old was better than age group &#x003C;18 years old(both P&#x003C;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 &#x003C;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.

Advances in the effect of ocular hypertension on ocular refraction / 国际眼科杂志(Guoji Yanke Zazhi)

Ocular hypertension(OH)can cause a variety of ocular structural and functional damage, among which the effect on ocular refraction has long been recognized in the clinic. The effect of OH on ocular refraction is related to the transparency and shape of refractive media, as well as the changes of the axial length. Due to the different speed and degree of intraocular pressure(IOP)elevation, the changes of refraction are reversible or irreversible. Irreversible changes in refraction are often accompanied by visual transmission impairment, and have a certain reference value for the evaluation of the latter condition. IOP changes lead to changes in the axial length, which are related to scleral remodeling and choroidal perfusion changes, and have a certain impact on the development of myopia and refractive error after cataract surgery. In this paper, the research progress of the changes of refractive media and axial length caused by OH, as well as the characteristics of the effects on ocular refraction are summarized, hoping to deepen the understanding of the effect of OH on ocular refraction, and provide reference for preventing irreversible ocular refractive changes, guiding the assessment of visual transmission damage and preventing or controlling the development of axial myopia.

Status and trend of refractive disorder burden in China based on a global perspective / 公共卫生与预防医学

Objective Based on the global burden of disease (GBD) study data, to analyze the current situation and changing trend of refractive disorders in China by comparing Japan, India, the United States, the United Kingdom and the world. Methods The prevalence, years lived with disability (YLD) rate of refractive disorders from 1990 to 2019 were obtained from the global health exchange (GHDx）database. The disease burden and change trend of refractive disorders were analyzed using Joinpoint and other software. Results In 2019, the number of refractive disorders in China exceeded 27 million, with the prevalence and YLD rate were 19.18‰ and 89.40/100,000 respectively. From 1990 to 2019, the prevalence and YLD rate of refractive disorders showed an increasing trend globally (except India), with the largest increase in China (up by 53.21% and 53.96% respectively). The age standardized YLD rates in China, Japan, the United States, and the United Kingdom were all lower than the global average level, but China's age standardized YLD rates were higher than the developed countries (Japan, the United States, and the United Kingdom). Conclusion From 1990 to 2019, there was a certain gap between China and developed countries in the control of refractive disorders. Therefore, it is necessary to understand the disease status from a global perspective in order to better prevent and control refractive disorders in the future.

Compliance with spectacle wear among learners with hearing impairment in Ghana

Background: Hearing-impaired learners with refractive problems require correction because poor vision hinders their development and educational pursuits. Objectives: To determine the level of compliance with spectacle wear in learners with hearing impairment in Ghana. Method: A descriptive cross-sectional study design was used to investigate the level of compliance with spectacle wear in hearing-impaired learners with uncorrected refractive errors (URE). The participants were from six schools for the hearing impaired, comprising three schools from each sector (Northern and Southern) of Ghana. Results: Of the 1914 learners screened, 69 (3.61% CI: 2.82­4.54%) had URE. Sixty-two (89.9%) learners with URE had myopia (-0.50 Dioptre Sphere (DS) to -2.00DS), and 7 (10.1%) had hyperopia (+2.00DS to +10.00DS). There were more females (53.6%) with URE than males, and their ages ranged from 8 to 35 years, with a mean of 17.35 ± 5.19 years. Many (56.5%) learners complied with spectacle wear after 3 months of reassessment, with females being more compliant than males, but the difference was not significant (p = 0.544). Learners who complied well with the spectacle wear were those with moderate visual impairment (VI), followed by mild VI, while those with no VI were the least compliant. A significant difference was observed between spectacle compliance and presenting VI (p = 0.023). Conclusion: The spectacle wear compliance level was high compared to a previous study (33.7%) in Ghana. Contribution: This study highlights the importance of addressing URE among learners with hearing impairment in Ghana and Africa.

Visual rehabilitation after LASIK complication: flap amputation, topo-guided surgery, and phacoemulsification

ABSTRACT We present a case of a patient complaining of monocular diplopia due to a decentered ablation after LASIK. The patient underwent a wavefront-guided retreatment, which resulted in an epithelial ingrowth complication. Additionally, the patient developed cataract, with cataract surgery requiring reliable biometric measurements. Therefore, we opted for corneal treatment and corneal surface regularization. Although we attempted to lift the flap and wash the interface initially, the procedure proved unsuccessful, thereby necessitating immediate flap amputation. Once the corneal surface was regularized in the seventh postoperative month, transepithelial photorefractive keratectomy was successfully performed to homogenize the ocular surface, thereby significantly improving the patient's corrected visual acuity and resolving monocular diplopia. The surface and corneal curvature stabilized by the fifth month after the procedure. Phacoemulsification was then performed along with the implantation of a toric monofocal lens, which was selected using an appropriate formula, resulting in an excellent uncorrected visual acuity.