Volume 52 · Issue 07 · 2016

This issue focuses on the research progress of refractive surgery. Professor Zhang Fengju is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.

With the improvement and application of excimer laser and femtosecond laser equipment in clinical ophthalmology, the diversified strategies for corneal refractive surgery candidates have been provided. Based on the trend of " all-laser treatment", it is very necessary to take the domestic situation into consideration when a standard and customized choice is made according to the indications of each specific surgical type. The characteristics and limitations of various surgeries are elucidated and commented here in order to provide some reasonable treatment options for refractive surgery.(Chin J Ophthalmol, 2016, 52: 481-485)

laser treatment for open-angle glaucoma was first proposed by Wise and Witter in 1979 as argon laser trabeculoplasty (ALT)^[1]。 American scholar Latina found that trabeculoplasty using Q-switched 532 nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser^[2], can reduce intraocular pressure without causing coagulative damage to the trabecular meshwork, and clinical pre-trial results were published in 1998. This method was named selective laser trabeculoplasty (SLT)^[3]。 SLT has no local thermal coagulation damage to trabecular tissue, but produces biological effects through selective photopyrolysis, which activates endothelial cells in trabecular tissue and secretes some cell active factors, such as IL-1 and TNF, which activates trabecular meshwork cell redifferentiation and induces macrophages in trabecular meshwork to exert digestive transport or phagocytosis effects on extracellular substances deposited in trabecular meshwork space, thus remodeling trabecular meshwork extracellular matrix and reducing aqueous humor outflow resistance^[4,5]。 At present, SLT has become the most common method to replace ALT in the treatment of early open-angle glaucoma due to its unique safety and operational advantages.

In 2007, the International Dry Eye Workshop (DEWS) made a detailed review on the definition, classification and diagnosis of Dry Eye, which laid the foundation for in-depth research on Dry Eye in recent years. In the past eight years, some scholars have challenged the misunderstandings of dry eye in the past through research, among which the symptoms and signs of dry eye and their relationship are particularly prominent and become the focus topic.

To investigate changes in posterior corneal elevation after small incision lenticule extraction (SMILE) and related factors.

Retrospective case series study. Eighty-three eyes of 44 myopic patients undergoing SMILE were examined with the Pentacam preoperatively, and at 1 day, 1 month, 3 months, and 6 months postoperatively. Posterior corneal elevation at the corneal apex and 0°, 45°, 90°, 135°, 180°, 225°, 270° and 325° points of the 2 mm and 6 mm diameter (total, 17 points) was analyzed.

The changes in posterior corneal elevation at 1 day, 1 month, 3 months, and 6 months were(-1.72±2.59), (-0.98±2.37), (-0.45±1.81) and (-0.25±2.20) μm, respectively, at the corneal apex. The results were statistically significant ( t=6.07, 3.75, 6.07; P<0.05), except 6 months. The changes in posterior corneal elevation were (-1.42±2.06),(-0.69±1.86), (-0.30±1.50) and(-0.22±1.58) μm, respectively, in the 2 mm circle. The results of 1 day and 1 month were statistically significant ( t=6.28, 6.28, P<0.05). The changes in posterior corneal elevation were (1.48±1.47),(0.98±1.32),(0.90±1.31) and (0.90±1.16) μm, respectively, in the 6 mm circle .The results were totally statistically significant ( t=6.28, 6.28, P<0.05). There were statistically significant differences between 1 month and 1 day postoperatively in the corneal apex, 2 mm and 6 mm circles. The changes were (0.75±2.55),(0.73±1.97) and(-0.50±1.60) μm. There were statistically significant differences between 3 months and 1 month postoperatively in the corneal apex and 2 mm circle. The changes were (0.53±2.22) and (0.39±1.80) μm. No significant change was found in the 6 mm circle. Between postoperative 6 months and 3 months, there were no statistically significant differences. The spherical equivalent, intraocular pressure, ablation depth, residual bed thickness, corneal hysteresis, and corneal resistance factor had no obvious correlation with the changes in posterior corneal elevation.

After SMILE, the surrounding cornea was slightly forward, while the central posterior cornea was slightly backwards, and returned gradually. The spherical equivalent, intraocular pressure, ablation depth, residual bed thickness, corneal hysteresis, and corneal resistance factor had no obvious correlation with the changes in posterior corneal elevation. (Chin J Ophthalmol, 2016, 52: 494-498)

To compare visual acuity, refractive outcome, high order aberrations, contrast sensitivity and subjective symptom of myopia with laser in situ keratomileusis (LASIK) centered on the coaxially sighted corneal light reflex (CSCLR group) and the conventional ablation of line of sight (LOS group).

With prospective, double-blind, randomized, controlled trial, the right eyes of patients were included and divided into two groups according to random stratified grouping. Two hundred and ten myopic eyes were treated with centration on the coaxially sighted corneal light reflex and 210 myopic eyes treated with centration on pupil center(line of sight). The parameters of visual acuity, refractive outcome, ablation center distance from visual axis, corneal high order aberrations, subjective discomfort glare and shadowing incidence rate, contrast sensitivity between the two groups were measured and compared up to 6months post operation. Consistent with the measurement data, normal distribution using the group t-test, non-normal distribution of measurement data using the group wilcoxon rank-sum test and count data using chi-square test.

The data of postoperative UCVA, BCVA, MRSE efficacy index and safety index showed no statistical difference between the CSCLR and the LOS group up to 6months post operation(P> 0.05). 3% lost one line or more of BCVA in the CSCLR group,and 9% in the LOS group postoperatively, χ ²= 6.38, P=0.01. The ablation center deviation was (0.19±0.15) mm from visual axis(pentacam system default setting) in CSCLR group and (0.43±0.22) mm in the LOS group. Ablation center deviation was statistically significantly shorter in the CSCLR group (t=-2.59, P<0.01). The postoperative increased total cornea higher order aberrations was 0.150 μm in CSCLR group and 0.193 μm in LOS group, the difference was statistically significant, Z=3.21, P=0.03. The increased corneal vertical coma of CSCLR group was 0.321 μm,smaller than in the LOS group(0.464 μm), Z=4.33, P<0.01. The increased horizontal coma was 0.242 μm in CSCLR group and also smaller than the LOS group(0.353 μm), Z=4.54,P<0.01. Subjective discomfort glare and shadowing incidence rates were 8.5% and 17.5% respectively in the CSCLR and LOS group, χ ²=7.16,P< 0.01. The one month postoperative contrast sensitivity visual acuity in the CSCLR was 1.157±0.253, significantly higher than the LOS group (0.797±0.218) on 18 c/d spatial frequency, t=- 2.55, P=0.01, but with no significant difference between the two groups at 3 and 6 months.

Myopic LASIK centered on the CSCLR achieved significant lower induction of lost of BCVA, lower induction of high order aberrations, lower risk of subjective discomfort glare and shadowing and lower decline of early contrast sensitivity by comparison to centration on the LOS, improving the quality of vision after operation. (Chin J Ophthalmol, 2016, 52: 499-506)

To evaluate the morphological changes during corneal wound healing after small incision lenticule extraction (SMILE).

Twenty-one New Zealand white rabbits were randomly divided into 2 groups (group A of 12 rabbits and group B of 9 rabbits) using the toss of a coin. All the right eyes were treated. Group A underwent SMILE, and group B underwent femtosecond laser-assisted in situ keratomileusis (LASIK), with the same refractive corrections of-6.00 DS/-1.00 DC. The surface regularity on the refractive corneal lenticules and flaps was evaluated by scanning electron microscopy. Light microscopy and transmission electron microscopy were applied to observe changes in the cornea on postoperative week 1, months 1 and 3. The contralateral eye of three rabbits served as control.

All the operations were successful, and the postoperative corneal healing was uneventful in both groups. The recovery of corneas was faster in the SMILE group by slit-lamp examination. Light microscopy confirmed the mild edema of corneal stroma with a clear intrastromal crevice in the SMILE group and the adhesion of the flap and stromal bed in the LASIK group on postoperative week 1. The filling of epithelial cells at the flap margin and the irregular arrangement of collagens were demonstrated in both groups. On postoperative month 1, stromal edema was dissipated, and collagens became more regular in both groups. The intrastromal crevice in the SMILE group disappeared on postoperative month 3. Transmission electron microscopy also revealed the edema of keratocyte mitochondria within 1 month, and the keratocytes recovered to normal on month 3. The surface regularity of the front surface was better than that of the back.

Smooth intrastromal lenticules can be safely prepared by femtosecond laser. The corneal healing in the SMILE group was better than that in the LASIK group. The intrastromal crevice in the early postoperative period after SMILE should be paid attention to clinically. (Chin J Ophthalmol, 2016, 52: 507-513)

To investigate the incidence and features of myopia in children aged 7 to 14 years.

Cross-sectional study. A total of 2 226 children (2 226 eyes) aged 7 to 14 years were selected from school during June 2012 and January 2015. Refraction was measured by fast cycloplegic retinoscopy. SPSS16.0 was used to analyze the data. Ocular refractive parameters, including axial length (AL), corneal power, anterior chamber depth, and white to white, were measured by IOLMaster (version 5.0, Carl Zeiss, Germany). Only the right eyes were included in the analysis.

(1) The incidence of myopia in children increased with age. The incidence of myopia in female children was higher than male children with the same age. The overall incidence of myopia in female children was higher than male children (χ²=4.284, P=0.036). The average AL was (23.53±1.12) mm in male children and (23.44±1.08) mm in female children, and there was no statistically significant difference (t=1.502, P=0.134). (2) The change of refractive parameters was as follows. The AL elongated with age ,the average AL located in (22.84±0.87) to (24.49±1.19) mm(F=10.076, P<0.001) . The anterior chamber became deepened with age,the average ACD located in (3.28±0.16) to (3.67±0.24) mm (F=8.059, P<0.001). The white to white reduced slightly with age, the average WTW located in (12.30±0.35) to (12.16±0.54) mm,although there was no significant difference (F=0.469, P=0.857). There was no difference in the corneal power with age ,the average corneal power located in (43.05±1.31) to (43.74±1.20) D(F=0.440, P=0.877). The values of AL, anterior chamber depth in the myopia group were greater than the emmetropia group with the same age (P<0.05). (3) Correlation factor analysis of AL was as follows. Mixed effects model displayed that the age, height, and body weight were related to eye axis. The regression equation of AL was: AL=19.120 4+0.124 2×A+0.019 6×H+ 0.015 3×W. The AL was positively correlated with the body height (r=0.527, P< 0.01) and weight (r=0.47, P< 0.01).

Among children aged 7 to 14 years, the incidence of myopia, AL, and anterior chamber depth increase with age. During the period of rapid physical development, the refraction and AL should be monitored. The prevalence of myopia is relatively high in girls, which may be associated with outdoor activity. (Chin J Ophthalmol, 2016, 52: 514-519)

To observe the accommodative accuracy of children with early-onset myopia at different near-work distances, and discuss the relationship between accommodative accuracy and early-onset myopia.

This was a case-control study. Thirty-seven emmetropic children, 41 early-onset myopic children without correction, and 39 early-onset myopic children with spectacles, aged 7 to 13 years, were included. Measures of refractive errors and accommodative accuracy at four near-work distances, including 50 cm, 40 cm, 30 cm, and 20 cm, were made using the binocular fusion cross cylinder (FCC) of an automatic phoropter.

Most candidates showed accommodative lags, including the children with emmetropia. The ratio of lags in all candidates at different near-work distances was 75.21% (50 cm), 87.18% (40 cm), 92.31% (30 cm), and 98.29% (20 cm), respectively. All accommodative accuracies became worse, and the accommodative lag ratio and values of FCC increased, along with the shortening of the distance. The difference in accommodative accuracy among groups was statistically significant at 30 cm (χ²=7.852, P= 0.020) and 20 cm (χ²=6.480, P=0.039). The values of FCC among groups were significantly different at 30 cm (F=3.626, P=0.030) and 20 cm (F=3.703, P=0.028), but not at 50 cm and 40 cm (P>0.05). In addition, the FCC values of 30 cm and 20 cm had a statistically significant difference between myopic children without correction [(1.25±0.44) D and (1.76±0.43) D] and emmetropic children [(0.95±0.52) D and (1.41±0.58) D] (P=0.012, 0.008). The correlation between diopters of myopia and accommodative accuracy at different nearwork distances was not statistically significant (P>0.05). However, the correlation between diopters of myopia and the accommodative lag value (FCC) at 20 cm was statistically significant (r=0.246, P=0.028).

The closer the near-work distance is, the worse the accommodative accuracy is. This is more significant in early-onset myopia, especially myopia without correction, than emmetropia. Wearing spectacles may improve the threshold and sensitivity of accommodations, and the accommodative accuracy at near-work distances (<30 cm) to some extent. The poor accommodative accuracy at near-work distances may be not related to early-onset myopia, but the value of FCC (20 cm) is related to early-onset myopia. The higher the FCC value is, the higher the diopter is.(Chin J Ophthalmol, 2016, 52: 520-524)

To evaluate the effect of transepithelial corneal collagen cross-linking (CXL) in the treatment of keratoconus.

Prospective study. Sixteen eyes of 16 patients with keratoconus underwent transepithelial CXL, and the fellow eyes were considered as the controls. The mean age was (22.4±6.5) years old. In the CXL group, topical anesthesia (0.1% tetracaine) was given for 15 minutes, and 0.5% riboflavin was applied until saturated in the anterior chamber. Then an ultraviolet A irradiance of 3 mW/cm² on the cornea was performed for 30 minutes. Postoperative corneal reepithelization time was recorded. Preoperative and postoperative examinations included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, topography, corneal biomechanical parameters, thinnest corneal thickness, and endothelial cell density.

The mean corneal reepithelization time was 1.0(1.0 to 2.0) days. In the transepithelial CXL group, at the end of the 12-month follow-up, CDVA and refractive outcomes were significantly improved (P<0.05). Maximum K-value, anterior and posterior elevations were significantly decreased by (-2.23±2.82)D (t=-3.153, P=0.007), (-4.69±4.99) μm ( t=-3.758, P=0.002), and (-13.94±25.81) μm ( t=-2.160, P=0.047), respectively. Corneal hysteresis, corneal resistance factor, thinnest corneal thickness, and endothelial cell density showed no significant difference (P>0.05). The differences in the changes of UDVA, CDVA, spherical equivalent refraction, and maximum K-value between the CXL and control groups were significant at 12 months (P<0.05).

Transepithelial CXL is effective in optimizing the irregular corneal surface of keratoconus, and might halt its progression. (Chin J Ophthalmol, 2016, 52: 525-530)

The bubbles generated by femtosecond laser in the process of making corneal flap will not only appear under the corneal flap, but occasionally some bubbles will migrate to the surrounding tissues. If the bubbles enter the anterior chamber, anterior chamber bubbles will be formed. The effects of anterior chamber bubbles on the inner eye have been observed in some studies, but the results have not found that the production of anterior chamber bubbles will affect the number and morphology of endothelial cells in patients^[1,2]。 In January 2015, a patient with loss of corneal endothelial cells after anterior chamber bubbles occurred in Jinan Mingshui Eye Hospital with femtosecond laser flap, which is reported as follows.

The patient was a 78-year-old male. In 2015, he was first diagnosed in Tianjin Eye Hospital due to the growth of remaining meat in his right eye with no vision for 2 years and aggravation for 2 months. The left eye had undergone left eye pterygium resection 40 years ago, and there was no pathological examination after operation. A history of hypertension with a history of cerebrovascular disease for more than 20 years. Ocular examination: The visual acuity of the right eye was manual before the eye, the conjunctiva was not congested, and the subconjunctival tissue was hyperplasia and hypertrophy in the bulbar conjunctiva of the palpebral fissure, showing a wedge-shaped fibrovascular membrane, which traversed the whole cornea, about 17 mm ×5 mm. Clear borders on both sides, smooth surface, soft texture, poor mobility, tight adhesion to underlying tissues, no tenderness (Figure 1）。 The posterior segment of the eye is invisible, indicating that the intraocular pressure measured is normal, and the external turnover of the eyeball is limited. The visual acuity of the left eye was 0.8, the nasal subconjunctival fibrovascular tissue proliferated into the limbus 2 mm, the lens cortex and nucleus were opaque, the intraocular pressure was 15 mmHg (1 mmHg =0.133 kPa), and the rest were not abnormal. Preoperative B-ultrasound showed mild vitreous opacity in both eyes, but no obvious abnormality in retina (Figure 2）。 First diagnosis: corneoconjunctival mass of the right eye. In November 2015, I underwent right eye corneal conjunctival mass resection combined with conjunctival transplantation + corneal multilayer amniotic membrane transplantation under local anesthesia. During the operation, it was found that the tumor adhered tightly to the anterior elastic layer of the cornea and invaded the superficial stromal layer. The conjunctival defect was transplanted with an upper conjunctival sheet, and the corneal wound was covered with 3 layers of amniotic membrane, and a therapeutic bandage lens was given after operation (Figure 3), 0.5% levofloxacin eye drops 4 times/d, prasifen, epidermal growth factor eye drops 4 times daily eye drops to prevent infection and promote wound healing. The resected tissue was sent to pathological examination, and the results showed irregular hyperplasia of conjunctival epithelium, hyperplasia of subconjunctival fibrovascular tissue, striated muscle tissue with differentiated mature adipose tissue (Figure 4)。 Immunohistochemical staining confirmed that the tumor tissue mainly contained adipose tissue, striated muscle tissue, abnormal thick-walled blood vessels and a large number of new blood vessels (Figure 5，Figure 6，Figure 7）。 Pathological diagnosis: corneal maltumas.

患者女性，33岁。因头皮下注射洁霉素＋扑尔敏后突发左眼视物不见8 h，于2015年5月26日急诊来天津市眼科医院就诊。患者曾因染发后"头皮发炎"，先前于当地诊所先后行2次头皮下注射洁霉素＋扑尔敏治疗，本次为第3次治疗。所用药物剂量为洁霉素2 ml(0.6 mg）＋扑尔敏1 ml (10 mg），依次在距颅顶中心约3 cm的前、后、左、右方向分4次行头部皮下注射。第3次治疗是在行最后左侧部位皮下注射时眼部发病。患者述皮下进针后刚推注药液即感左眼瞬间黑矇。发病后该诊所立即予以654-2球后注射、罂粟碱及地塞米松静滴治疗，效果不明显，遂转来津市眼科医院。入院查体：右眼视力1.0，左眼无光感。左眼结膜无充血，角膜透明，色素性房水闪光（＋），瞳孔直径5 mm，直接光反射消失，玻璃体透明，眼底：视乳头色泽正常，边界清晰，视网膜后极部弥漫性水肿，中周部视网膜深层散在片状水肿灶，黄斑区"樱桃红"外观不显，伴黄斑前数处小片出血，视网膜动脉细，部分血管内散在白色有光泽的"结晶"样物质，致动脉呈节段状外观。眼压18 mmHg(1 mmHg=0.133 kPa）。FFA检查提示：臂-视网膜循环时间正常（14 s），脉络膜散在扇形或小片状荧光缺损区，视网膜动静脉充盈时间延长，部分动脉节段状荧光缺损，缺损段近端有点状高荧光染色。吲哚青绿脉络膜血管造影结果提示：散在脉络膜扇形或小片状荧光缺损区。颈动脉彩色多普勒检查提示：未见明显异常血流信号。脑部MRI检查提示：未见明显异常。入院诊断：左眼视网膜中央动脉阻塞，睫状后动脉阻塞，中毒性视网膜脉络膜病变。入院后予以按摩眼球、吸氧、降眼压及静脉滴注小牛血去蛋白提取物、灯盏花素等改善循环及神经营养支持治疗，同时应用甲泼尼松龙静脉滴注。患者于2015年6月12日出院。出院时眼部情况：左眼视力：颞侧0.1。角膜透明，色素性房水闪光存（＋），瞳孔直径5 mm，直接光反射迟钝，眼底：视乳头颜色苍白，边界清晰，视网膜及脉络膜水肿明显减轻，黄斑区残存少许出血。视网膜动脉细，血管"结晶样物质"大部分消失。FFA检查提示：臂-视网膜循环时间正常（14 s）,颞上方睫状动脉最早充盈，视网膜动脉内点状荧光染色物质大部分消失，脉络膜荧光缺损区缩小，黄斑区可见小片无灌注区（图1，图2，图3，图4，图5，图6，图7，图8）。

The patient, a 23-year-old female, was seen in the ophthalmology clinic of Peking University First Hospital in December 2014 due to 4-month fundus bleeding in her right eye. Four months ago, the patient had sudden occlusion of vision in his right eye without obvious trigger, accompanied by dark shadows fluttering in front of his eyes. He went to a local hospital. The physical examination corrected the visual acuity of 0.8 in the right eye and 1.0 in the left eye, and the intraocular pressure of 12 mmHg (1 mmHg =0.133 kPa) in the right eye and 15 mmHg in the left eye. No abnormalities were found in the anterior segment examination of both eyes. Fundus photography showed hemorrhage in the vitreous cavity and preretinal cavity of the right eye, radial hemorrhage on the surface and around the optic papilla, and an arc-shaped dark red subretinal hemorrhage on the nasal side of the optic papilla (FIG. 1A）。 The left eye papilla was bulged with unclear boundaries, and no abnormalities were observed in the rest (Figure 1D）。 FFA at the onset of the patient shows bleeding in the right eye blocking fluorescence, and strong fluorescence staining at the optic papilla (FIG. 1B,Figure 1C）。 The local diagnosis was "right eye papilla vasculitis", and he was treated with oral glucocorticoid for 3 months. Past physical health, myopia degree of both eyes about-3.75 DS, denied history of trauma, surgery, and family genetic history. For further diagnosis and treatment, the patient went to the ophthalmology department of our hospital. Physical examination at this visit: the corrected visual acuity of both eyes was 1.0, no abnormalities were found in the anterior segment examination of both eyes, and the fundus examination showed that the bleeding on the surface of the optical papilla, pre-retinal and subretinal hemorrhage of the right eye had been absorbed, the optical papilla was small, there was no physiological depression, the nasal side of the optical papilla was red, and it was slightly raised (FIG. 2A）。 Left fundus papilla bulge, unchanged from fundus photography 4 months ago (Figure 2B）。 FFA examination at this visit showed no retinal vascular abnormalities and no fluorescein leakage on the surface of the optic papilla (Figure 2C，Figure 2D，Figure 2E）。 spectral-domain optical coherence tomography (SD-OCT) showed that the retinal nerve fiber layer on the nasal side of the binocular papilla was highly raised, and a type of circular intensely reflected light cluster could be seen below it (Figure 3）。 B-ultrasound examination did not show strong echo shadow in front of optic nerve. In addition, the patient's visual field examination showed no abnormalities. According to the clinical manifestations and the findings of ophthalmic examination, the patient was diagnosed as binocular buried papilla drusen.

The patient was a 30-year-old female. Because the eyelash liquid of the left eye mistakenly entered the eye, the eyes were red and painful for 1 day, and he went to Beijing Tongren Eye Center. There was no history of other disease. Eye examination: 1.0 for right eye and 0.8 for left eye; Massive melanosis in the nasal conjunctiva of the left eye and reactive congestion in the surrounding conjunctiva (Quintessence Picture 1In a); The corneas of both eyes were transparent, and there were no abnormalities in the anterior chamber, pupil, lens and fundus. When a large amount of normal saline was given to rinse the conjunctival sac of the left eye, the melanin on the surface of the conjunctiva was lost, some pigment was deposited under the conjunctiva, and the conjunctiva was reactively congested (Quintessence Picture 1In B). Clinical diagnosis: conjunctival pigmentation of the left eye.

Ocular hypertension is popular among people, with a prevalence of 3% to 10% in those older than 40 years old. Without proper intervention, over 10% of the patients with ocular hypertension would develop glaucoma in the following 5 to 10 years. Glaucoma has become one of the leading causes of blindness all over the world, which makes it essential for us to pay enough attention to the prevention and treatment of ocular hypertension. However, it is not cost-effective to treat all the patients with ocular hypertension. Certain side effects may also be caused with long-term medical treatment. Therefore, it is of great importance for ophthalmologists to identify the right time and use appropriate therapeutic methods. To introduce the knowledge of ocular hypertension, the definition, epidemiology, diagnosis, risk factors and treatment of ocular hypertension are reviewed in this article. (Chin J Ophthalmol, 2016, 52: 542-546)

The fundus disease of high myopia, one of the main reasons leading to visual impairment, includes different types of the retinal, choroidal and scleral changes, and in particular the macular and optic disc lesions. Due to technical limitations, it is relatively difficult to study the characteristics of the sclera and the choroid in humans in vivo. The swept-source optical coherence tomography, with the long wave swept laser as a light source, has less sensitivity roll-off with the tissue depth, which makes it possible to check the choroid and the sclera. The recent studies of the characteristics of the choroid and the sclera in high myopia, and new findings of spinal and vascular systems posterior to the sclera in humans are mainly reviewed in this article. (Chin J Ophthalmol, 2016, 52: 547-550)

Noninfectious uveitis is a kind of recurrent autoimmune disease and a major cause of blindness in clinical practice. Corticosteroids are the conventional medication, but have severe side effects for long-term users, and some refractory patients are treated with immunosuppressive agents. Because the pathogenesis of uveitis is related to the autoimmune imbalance mediated by CD4 + T lymphocytes. The macrophages, lymphocytes and some cytokines are involved. The immunomodulatory therapy is targeted to block the lymphocytes, cytokines or their receptors, so as to control the inflammatory damage or minimize the recurrence of the disease. The biological agents include the anti-tumor necrosis factor agents, interferon-α, interleukin receptor antagonists, cytotoxic T lymphocyte associated antigen fusion proteins and CD20 chimeric antibody. They bring a hope for the treatment of the patients with refractory uveitis. Because of the limited number of randomized clinical trials and patients, the indications, long-term effects, safety and side effects of these biologics need to be observed. In this article, the experiments and clinical trials of these new biologics for the treatment of uveitis in recent years are reviewed.(Chin J Ophthalmol, 2016, 52: 551-556)