Volume 45 ·  Issue 10 ·  2009

International ophthalmological societies and World Health Organization (WHO) have recognized the severity of glaucoma problem and the importance for promoting the glaucoma control worldwide. WHO has taken some measures to reinforce the global prevention of blindness from primary glaucomas. The rationale to deal with the glaucoma problem is that glaucomas produce a significant global public health burden at present, and glaucoma can be effectively treated once detected according the evidenced-based practice protocols for glaucoma management. Taking the glaucoma control as the priority for prevention of blindness means not only apply the clinical path, but also apply public health path and integrate various levels of ophthalmic manpower to deal with glaucoma problem. That is a great change in the prevention and management of glaucomas. Screening and early detection of glaucoma cases is very important in glaucoma control. At present, enhancing opportunistic case detection has been used to find more undiagnosed and untreated glaucoma cases, since evidence regarding the benefits of population-based screening is currently lacking. The scope of intervention strategies for glaucoma control should be matched with the local socio-economic status, thus the initiative for glaucoma control can be smoothly developed and progressed.

Optical coherence tomography (OCT), Heidelberg Retinal Tomography (HRT-Ⅱ) and GDx have been used widely in glaucoma diagnosis for many years, but it is still uncertain in their practical value and clinical significance.Therefore, it requires an evaluation for the usefulness of each instrument in the diagnosis of glaucoma.The evaluation must be correct, standardized and strict in methodology, with emphasis on the early diagnosis and the concrete analysis of each parameter given by the different imaging instruments.Only if clinical application of these devices is combined with the practical evaluation, can these techniques make real progression and solve the clinical problems in the early diagnosis of primary open angle glaucoma.

Evaluation of the optic disc and retinal nerve fiber layer measurements (RNFL) with sterephotography is the current "gold standard" for the diagnosis of early primary open angle glaucoma (POAG), but it is still subjective and is dependent too much upon an experienced observer.Substantial variability exists in the interpretation of optic disc change over time.There are consistent evidences that image analysis devices such as optical coherence tomography (OCT) and Heidelberg retina tomograph (HRT-Ⅱ) can detect early to moderate glaucoma as well as expert assessment of stereoscopic optic disc and RNFL photographs.Optic disc and RNFL defect can be quantitatively measured by these devices.But the sensitivity and specificity of the measurements obtained with these devices are not good enough for the early diagnosis of POAG at this time due to several reasons, such as individual variety of the structure parameters in normal subjects, lack of powerful normative database, lack of diagnostic parameters which are good enough both in sensitivity and specificity for detecting early glaucoma damage.However,information obtained from these image analysis devices might be helpful in early POAG diagnosis if clinicians can understand the advantages and limitations of these instruments.

Glaucoma is one of the major ocular diseases that lead to blindness.It is characterized by optic disk cupping and visual field loss.Glaucoma is a multifactorial group of diseases with many different causes but one common endpoint, progressive loss of retinal ganglion cells.Hence most studies of glaucoma focused on retinal ganglion cells and their nosogenesis.But recent studies have showed that neuroglia cells,as another major kind of cells of nerve system, also undergo an activation process in glaucoma.Their activation is closely connected with the changes of retinal ganglion cells as well as the development of the disease.Therefore, more and more attention is focused on the changes of these cells.This review is a summary about the recent studies on the pathological changes of these four different kinds of neuroglia cells in human glaucoma and in several animal models of experimental glaucoma.

Corneal endothelial dysfunction can severely affect visual acuity.In order to deal with this morbidity, ophthalmologists used to perform penetrating keratoplasty, in which the complications, such as postoperative astigmatism and graft rejection,led to poor visual recovery.If only the Descemet's membrane and endothelium is transplanted, the corneal injury of recipients caused by surgeries would be reduced and better visual acuity recovery might be guaranteed.In the past few years, the advantages of sutureleas deep lamellar endothelial keratoplasty have been brought to the attention by more and more ophthalmologists worldwide.However, the challenging techniques of performing DLEK limits its chnical application.Other kind of, DSEK, by stripping Descemet's membrane and endothelium from the recipient cornea, has produced excellent outcomes.This article outlined and analysed surgery techniques, clinical results and complications of DSEK.

Yolk sac tumor, also known as endodermal sinus tumor in the past, is a malignant germ cell tumor that occurs from yolk sac, mostly occurs in ovary or testis, rarely occurs outside the gonads, and rarely occurs in the head and neck.

Kimura's disease is a rare chronic vascular inflammation, the ocular region is a rare site of involvement, and bilateral orbital involvement is very rare.

At present, there are more and more eye drops in clinical practice, which provide many choices for clinical treatment. Because physicians do not understand the characteristics of drugs comprehensively, and some drugs need to be used for a long time or even for life, the toxic effects of ocular surface caused by medication can not be ignored.

In order to comply with the development trend of network and digitalization of journals and provide high-quality services for authors and readers, the Journal of Chinese Medical Association has developed a remote manuscript management system. The system is designed according to the business requirements of manuscript processing process, editing and processing specification, manuscript review system and management specification of Chinese Medical Association series magazines. It adopts advanced database and network technology, and has strong data processing and analysis ability.

In order to strengthen the overall brand publicity of Chinese Medical Association series magazines, expand the influence of Chinese Medical Association series magazines, do a good job in journal subscription, open up new distribution and subscription channels, and facilitate the subscription of readers, Chinese Medical Association Magazine has set up an "Online Subscription and Online Payment Platform for Chinese Medical Association Series Magazines" on China Medical Network, which has been officially opened. Online subscription not only changes the original single post office subscription channel, but also has greater advantages compared with traditional post office subscription,

The Chinese Journal of Ophthalmology was founded on October 1, 1950. It was sponsored by the Chinese Medical Association and edited by the Editorial Committee of the Chinese Journal of Ophthalmology. The editorial committee is composed of nearly 100 well-known ophthalmologists in China. The current editor-in-chief Zhao Jialiang and the editorial director Huang Yibin. The main readers of this journal are ophthalmologists across the country, and it is publicly distributed at home and abroad. China Standard Issue Number: ISSN0412-4081, CN11-2142/R;

The "fast track" paper must be innovative, important and scientific, and the early publication of the paper will have a significant impact on clinical and scientific research work. Requirements for "fast track" paper submission: (1) When the author submits a manuscript online, he should provide application materials explaining the reasons why the paper needs to be published through the "fast track". (2) The author provides the "novelty search report" issued by provincial and above libraries or medical information research institutes.

In order to implement the policy of combining popularization and improvement, Chinese Journal of Ophthalmology, while reporting major clinical and basic research results at home and abroad, pays attention to the actual needs of the majority of ophthalmologists and strengthens the practicality of the journal. In 2009, it continued to open the column "Test Questions Analysis". This column invites authoritative ophthalmologists in China to make an accurate and in-depth analysis of all kinds of test questions in the ophthalmology question bank. Readers are welcome to pay attention to this ~ column, actively read, and put forward suggestions and opinions.

1. Statistical symbols: According to the relevant provisions of GB3358-1982 ((Statistical Nouns and Symbols), all statistical symbols are printed in italics. Commonly used: (1) The arithmetic mean of the sample is in English lowercase x (the median is in English lowercase M); (2) The standard deviation is in English lowercase s;

The book "In vivo confocal microscope of ocular surface" (edited by Professor Xu Jianjiang), one of the "Application Series of New Ophthalmology Technologies" edited by Professor Sun Xinghuai of Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, has been published by Fudan University Press. In vivo confocal microscope of ocular surface is a new type of high precision and high magnification microscope which has appeared in recent years. As a clinically practical auxiliary diagnostic device, ocular surface in vivo confocal microscope can perform non-invasive,

According to the latest edition of Xinhua Dictionary and Modern Chinese Dictionary, the use specifications of the words "sticky" and "sticky" are as follows: when pronouncing "nián", the word "sticky" is always used, such as mucosa, mucus, slime mold, adhesive, etc.; When pronouncing "zhān", use the word "sticky", such as intestinal adhesion, paste, etc. Regarding the use of the words "Wei" and "Wei", both words mean only, only, etc., but they are used in only, only, only, fear, obeying orders,

With the development of society and economy, visual quality has obviously affected the quality of life of patients, which is increasingly concerned by the society. The rapid development of science and technology has laid the foundation for the continuous renewal of ophthalmic equipment and drugs, and improved the level of clinical diagnosis and treatment. Bausch & Lomb Eye Surgery Products Company of the United States continues to provide professional medical equipment for ophthalmology clinics. Among them, the excimer laser 2172100 refractive correction system has a relatively comprehensive individualized treatment technology, and its clinical effect has been recognized by ophthalmologists and patients;

With the development and improvement of clinical diagnosis technology, the role of all kinds of ophthalmology clinical pictures in disease diagnosis has been paid more and more attention. In order to encourage clinical accumulation of relevant data, promote experience exchange, improve clinical diagnosis and treatment technology, provide a new platform for academic exchange for readers, and at the same time enrich the content and form of this journal to better serve the majority of ophthalmologists, Chinese Journal of Ophthalmology continued to open the "Picture Essence" column in 2009. The submitted pictures can be arranged according to the type of case or diagnostic technique, with relevant instructions,

Approved by the General Administration of Press and Publication of the State, Chinese Journal of Clinical Nutrition officially became one of the series of journals of the Chinese Medical Association in March 2009, and was renamed as Chinese Journal of Clinical Nutrition (CN11-5822/R).

As a journal with strong academic strength and extensive academic influence in the field of ophthalmology in China, in order to better serve the majority of ophthalmologists in China, strengthen clinicians' cognition of various ophthalmological surgical concepts, surgical standards and surgical effects, and thus promote the development and improvement of clinical surgical skills in China, Chinese Journal of Ophthalmology will hold a series of select activities of ophthalmological surgery in Chinese Journal for ophthalmologists all over the country.

In order to promote the scientific and technological journals sponsored by CAST and its affiliated national societies to better serve the independent innovation of science and technology, strengthen the function of academic exchange, promote the implementation of the strategy of fine scientific and technological journals, improve the core competitiveness of scientific and technological journals, and improve the ability of national societies to serve the strategy of rejuvenating the country through science and education and strengthening the country through talents, CAST has organized and implemented the application and evaluation of projects funded by fine scientific and technological journals since 2006.

The statutory unit of measurement of this journal implements the "Statutory Unit of Measurement of the People's Republic of China" promulgated by the State Council in February 1984, and is represented by unit symbols. For specific use, refer to the book "Application of Statutory Unit of Measurement in Medicine" edited by the Editorial and Publishing Department of Chinese Medical Association in 1991. Note that the unit name and the unit symbol should not be mixed,

Conjunctivalochalasis is a common age-related ocular surface disease in the elderly. With the accelerating aging of the population, the number of people with conjunctiva relaxation will increase day by day. Severe conjunctival relaxation requires surgical treatment. In order to standardize the surgical treatment plan and prevent iatrogenic ocular surface damage, Professor Zhang Xingru combined his more than 10-year research results on surgical treatment of this disease (including key technologies such as indications for surgical treatment, standardized surgical operation, prevention and treatment of surgical complications) with literature and materials to make a CD.

Following the successful "First Chinese Ophthalmology Young and Middle-aged Forum" held by the editorial board of Chinese Journal of Ophthalmology of Chinese Medical Association in 2009, at the request of the majority of ophthalmologists, the "Second Chinese Ophthalmology Young and Middle-aged Forum (and Organizing Meeting)" sponsored by this journal will be held in Shanghai (tentatively) in June 2010. The content of this forum integrates the rational application of ophthalmic drugs and the promotion of new technologies and new equipment, focusing on comprehensively improving the diagnosis and treatment level of ophthalmologists.

In clinical work practice, ophthalmologists' understanding of various neuro-ophthalmic diseases is constantly improving. They no longer only focus on local changes in the eye, but pay more attention to its relationship with systemic diseases, especially nervous system-related diseases. Overall observation, diagnosis and treatment. However, because there are still few ophthalmologists engaged in this specialty in China, and they are only concentrated in a few large ophthalmology institutions, and there is still a lack of professional systematic training as a whole, ophthalmologists' understanding of neuroophthalmology diseases is insufficient, which often leads to clinical misdiagnosis and misdiagnosis.

The academic symposium on 3D coherence optical tomography was held in Beijing Topcon Trading Co., Ltd. located in Beijing Economic and Technological Development Zone on July 31st, 2009, with the theme of "Joining hands with OCT to create a new vision". Zhang Chengfen, Li Xiaoxin, Zhao Kanxing, Sun Xinquan and other well-known ophthalmologists in North China, as well as young and middle-aged ophthalmologists, were invited to attend the conference. Experts and delegates at the meeting discussed the diagnosis and interpretation of 3D coherence optical tomography, the principle, clinical application,

The treatment of refractory glaucoma has always been one of the thorny problems in the clinical work of ophthalmology. After conventional trabeculectomy, the filtration channel is easy to scar, and it is difficult to establish an effective aqueous humor filtration channel, and the success rate of operation is low. In 1969, Molteno ~ [1] invented the implantation of aqueous humor drainage device for glaucoma and applied it to the treatment of refractory glaucoma.

Objective To investigate the distribution of the CYP1B1 (Cytochrome P450, family 1, subfamily B, polypeptide 1)gene mutations in primary congenital glaucoma (PCG)in Hunan Province.Methods Case-control study.Thirteen cases of PCG from different districts of Hunan province were collected in this study.Direct sequencing was used to evaluate the ceding and the promoter regions of the CYP1B1 gene in PCG patients.Results A novel pathogenic mutation(c.C319G,L107V)was identified in a PCG patient in our study and it was a missense mutation in exon 2.Additionally, four single nucleotide polymorphisms(SNPs) were found in PCG patients, including R48G, A119S, V432L and D449D.Conclusion A novel CYP1B1 gene mutation(L107V) may be the cause for primary congenital glaucoma in Hunan Province.

Objective To evaluate the efficacy of surgical treatment for encapsulated cystic blebs around the plate after Ahmed glaucoma valve implantation.Methods This was a retrospective observational case series.Thirteen cases with elevated intraocular pressure (IOP) induced by fibrous proliferation around Ahmed valve were retrospectively studied.The intraocular pressure increased at 3 weeks to 5 months post-operation (2 months in average).The plates and tubes of Ahmed valve were in good position.No obstruction was seen in the tubes.Localized, encapsulated, cystic blebs were found in the equator of eyeball in which the plates were located.All cases underwent encapsulated cysts resection combined with mitomycin-C usage under conjunctival flaps.The excised tissues were sent for pathological examination.The changes of IOP and the outcome of the diseases were observed.Results IOP was normal one month after surgery in all cases.The success rate was 100%.In the 3-20 months follow-up period, the IOP level kept normal in 3 cases without any anti-glaucoma medications.The IOP level was in normal range in 6 cases using two or three different kinds of anti-glaucoma medications.Three cases needed further surgical treatment because of uncontrolled IOP even with anti-glaucoma medications.Among them, the complete success rate was 75% (3/4) in patients more than 57 years old, while the complete success rate was 0 (0/8) in patients less than 37 years old.Conclusions It was considered an effective method of surgical treatment for encapsulated blebs around Ahmed glaucoma valve.The result was better in elderly patients than in younger patients relatively.

Objective To investigate the clinical features of Sturge-Weber syndreme-associated glaucoma and its surgical treatment.Methods A retrospective case series study.The general clinical data and related ocular manifestations in 16 patients (21 eyes) with Sturge-Weber syndrome-associated glaucoma in our hospital from January 2003 to December 2007 were analyzed retrospectively.Results Age of the patients ranged between 1 month to 31 years old, and the median age was 11 years.Bilateral facial angiomas were present in 8 patients, and two of them had extensive hemangioma.Eleven cases had unilateral glaucoma and 3 of them had bilateral facial angiomas.Five patients had bilateral glaucoma and all of them had bilateral facial angiomas.Open anterior chamber angle was found in all affected eyes by goniescopy.B-scan ultrasonography was performed in 21 eyes and diffused occupying lesions in the choroid were found in 8 eyes (38.1%), Posterior bowing of the iris, low echo in ciliary body and shallow ciliary body detachment were found by ultrasound biomicroscopy.Anti-glaucoma surgeries including trabeculotomy, trabeculectomy, non-penetrating deep sclerectomy, valve implantation and cyclocryotherapy were performed in 18 eyes.Eighty percent of the eyes which underwent trabeculectomy developed choroidal detachment after operation.Ten patients (11 eyes) were followed-up for 22 months on average.Intraocular pressure was significantly lower than that before the operation (t=5.3956, P<0.01).Intraocular pressure in all followed-up eyes was controlled at ≤21 mm Hg(1 mm Hg=0.133 kPa).Conclusions The clinical features of Sturge-Weber syndrome-associated glaucoma include facial angiomas, open anterior chamber angle and choroidal hemangioma.Anti-glaucoma surgery can reduce the intraocular pressure effectively.

Objective To investigate the clinical features of congenital ectropion uveae (CEU) and the relationship between CEU and secondary glaucoma.Methods This is a retrospective case series.Clinical features and treatments of 11 patients with CEU were summarized.Combined with the literatures review of CEU, the pathogenesis and therapeutic results of secondary glaucoma were analyzed.Results Among these 11 patients, there were 10 patients with secondary glaucoma and one patient with ocular hypertension.There were 4 patients complicated with congenital ptosis, 2 patients with ocular proptosis,1 patient with congenital cataract, 1 patient with lens subluxation, 3 patients with ankylodactylia and 1 patient with Rieger's syndrome.The intraocular pressure of 9 patients was controlled after the trabeculectomy.Conclusions CEU is a rare, nonprogressive anomaly accompanied other ocular abnormalities and various systemic disorders.The pathogenesis of secondary glaucoma is related to iridotrabecular dysgenesis.It is essential to detect and to treat the secondary glaucoma as early as possible.

Objective To observe the anterior chamber angle changes occurred in compound Carbomer-induced chronic high intraocular pressure (IOP) model in rabbit eyes.Methods It was an experimental study.Thirty two rabbits were randomly divided into eight groups.Compound Carbomer (0.3%, 0.3 ml) was injected into the left anterior chamber.A group of rabbits were randomly killed after 1,2, 3, 4, 6, 8, 10 and 12 weeks.The anterior chamber of the rabbit eye specimens was observed.Results IOP increased slowly following the application of the drug, high IOP lasted for 3 months.The drug-induced changes of anterior chamber angle consisted of early inflammatory response and late fibrous changes.Inflammatory response occurred in early stage and reduced or disappeared after 3 weeks.Fibrous degeneration and adhesion obstruction occurred in the anterior chamber angle after 4 weeks.Under the electron microscope, the trabecular was expanded and deformed, with hyperplasia of collagen and elastic fibers.Endothelial cells were separated from the trabecular, and showed the morphology of lymphocytes,with the function similar to the macrophages.Phagocytized Carbomer particles were transported through the vacuoles of Schlemm's canal endothelial cells.Large vacuoles gradually reduced.Excessive Carbomer particles were accumulated in the endothelial cells and obstructed the Schlemm's canal.This induced the fibrous proliferation and the destruction of anterior chamber angle structures.Conclusions The obstruction of aqueous humor outflow induced by compound Carbomer in rabbit high IOP model is caused mainly by the changes in trabecular endothelial cells.

Objective To investigate the effect of clear corneal phacoemulsification on filtering bleb morphology and filtering function in glaucoma eyes with functional filtering blebs.Analysis the risk factors of intraocular pressure (IOP) increasement after phacoemulsification.Method It was a prospective series case study.Twenty-five eyes of 20 Chinese patients who had undergone clear corneal phacoemulsification after trabeculectomy were enrolled, lOP and the numbers of antiglaucoma medicine before and 1 month,3 months, 6 months, 12 months and 24 months after phacoemulsification were recorded.Ultrasound Biomicroscopy was conducted preoperatively, 1 month and 24 months postoperatively.Compare the IOP and the numbers of antiglaucoma medicines before and after phacoemulsification by student t test.Risk factors were evaluated for association with loss of IOP control requiring additional medications or further glaucoma surgery, using Kaplan-Meier survival analysis.Results The IOP was (15.8±5.1)mm Hg(1 mm Hg=0.133 kPa), (13.7±3.6)mm Hg, (13.6±3.3)mm Hg, (14.4±4.1)mm Hg, (14.2±3.6)mm Hg,(13.8±3.5) mm Hg (P=0.007, 0.004, 0.021,0.033, 0.004) before and at 1,3,6,12,24 months after phacoemulsification.The numbers of antiglaucoma medicine were 0.2±0.6 and 0.3±0.7 before and after phacoemulsification (P=0.265).Log-rank analysis the risk factors include IOP higher than 15 mm Hg before phacoemulification (P=0.042), bleb height decreased more than 10% 1 month after phacoemulification (P=0.037) and the intrableb reflectivity increase (P=0.001).Conclusions Phacoemulsification on eyes with functional filtering bleb did not affect the filtering function.Risk factors of loss of IOP control include IOP higher than 15 mm Hg before phacoemulification,bleb height decreased more than 10% and the intrableb reflectivity increase in a short term after phacoemulification.

Objective To investigate the normal values and related factors of blue on yellow perimetry (BYP) in the central 30 degree.Methods A cross sectional study design was performed on this study.BYP was performed in a Humphery750 Ⅱ-I perimetry with 30-2 procedure and Fastpac strategy.The study samples consisted of 116 eyes of 58 normal subjects.The visual field indices were calculated and their related factors were analyzed.SPSS 13.0 software package was used for experiment data analysis.Comparison of three blue-on-yellow visual indices, including mean sensitivity (MS), mean defect (MD) and pattern standard deviation ( PSD), were investigated by multi-way ANOVA with randomized block design method among four age groups.Relationship between age and visual field index was described and interpreted by calculating Pearson preduct-moment correlation coefficient and linear regression.Chi-square test was applied to determine the distribution of population and gender among four age groups.Significance level was set to α=0.05.Results Values of the three different visual indices, MS, MD and pattern PSD,in central 30 degree of BYP were (21.23±2.96)dB, (-3.94±2.20) dB and (3.13±0.72) dB,respectively.The differences of MS, MD and PSD values between right eye and left eye were not statistically significant (F=0.488, 0.833, and 0.677, with P=0.487, 0.482 and 0.414, respectively).No differences in these three indices could be detected between male and female (F=0.149,0.547 and 1.948,with P= 0.702,0.463 and 0.169, respectively).Significant difference in three visual field indices was identified among four different age groups ( F=48.160,54.250 and 9.329, with P=0.000, 0.000 and 0.032, respectively ).The light average sensitivity in four quadrants showed statistically significant difference in all age groups (F value for quadrant factor was 81.544, P=0.000).The MS value decreased 2.5 dB and the MD value increased-0.932 dB with the 10-year-old increasing.The average sensitivity in different eccentric ranges had a significant statistical difference(F value for eccentricity factor was 48.257,P=0.000).Conclusions The gender and the laterality do not affect the MS, MD and PSD in the BYP of normal subjects.The light average sensitivity is asymmetry in the four different quadrant, decreases in a linear decline with age and declines with the eccentricity.

Objective To study the changes of anterior chamber and chamber angle structures after implantable contact lens (ICL) implantation in high myopia by using ultrasound biomicroscopy (UBM).Methods A prospective series case study was conducted on 15 high myopia patients (30 eyes) treated with ICL implant.These patients were followed for one year postoperatively.Intraocular pressure (IOP) was measured by Goldmann applanation tonometer after surgery.All eyes were examined by UBM one year after the surgery.Central anterior chamber depth (ACD), trabecular-iris angle (TIA), the distance between the posterior surface of ICL and the lens and the distance between peripheral surface of ICL and the lens were measured.Nonparametric test was used to compare TIA.One-way ANOVA was used to assess the distance between peripheral surface of ICL and the lens.Repeated Measure ANOVA and Bonferroni test was performed to compare the IOP level before and after surgery.Paired t-test was used to compare ACD.Results Intraocular pressure changed from (13.75±2.27) mm Hg(1 mm Hg=0.133 kPa) preoperatively to (14.27±1.70), (14.70±2.07), (14.07±2.24), (14.00±2.69) and (13.97±2.95) mm Hg at 1 week, 1,3, 6 and 12 months after the surgery, respectively.There was a statistically significant increase of the IOP one month after the surgery, which was normalized completely at 3 months after surgery.The distances between central posterior surface of the cornea to the ICL and the lens were (2.24±0.21 ) and (2.97±0.11) mm, respectively.There was significant difference between these two data (t=20.63, P< 0.01).TIA was measured in 12: 00, 3: 00, 6:00 and 9: 00.There were no statistically differences between them.TIA was greater than 30 degree in 55.8% of cases.The distance between the central anterior surface of the ICL to the lens (central section) was (0.63±0.16)mm.No contact was found between the ICL and the crystalline lens.Conclusions Posterior chamber phakic intraccular lens implantation for the surgical correction of high myopia is a safe procedure as evaluated with immediate visual and refractive results.We found that the iridocorneal angle and the anterior chamber depth are decreased after the surgery.There is no contact between the crystalline leas and ICL.The ICL contacts with the posterior iris surface.

Objective To estimate the accuracy of posterior curvature method in corneal power calculation after LASIK surgery.Methods Corneal power calculation in 11 eyes that underwent Intraccular Lens (IOL) implantation after LASIK surgery (10 cases of Phaco + IOL, 1 case of IOL displacement), all of which used posterior curvature method, was analyzed retrospectively.The differences between post-operative stable refraction and target refraction were calculated, the actual corneal powers were deduced, and the expected refractive errors using other corneal power evaluation methods (auto-keratometry, corneal topography, spherical equivalent method, anterior curvature method, Equivalent K Reading method provided by Pentacam) were analyzed.In addition, refraction of 23 eyes underwent LASIK surgery were done on their 6 months follow-up.The theoretical corneal powers were deduced by subtracting the change of refraction before and after LASIK surgery from the pre-operative corneal powers.The differences between calculated corneal powers using posterior curvature method and the theoretical corneal powers were analyzed, and were compared with other corneal power evaluation methods.Results The mean uncorrected post-operative visual acuity of IOL implantation eyes using posterior curvature method was 0.8±0.2, with mean absolute refractive error from target of (0.36±0.36) D(-0.63 to +0.85 D).The ratio of eyes with absolute error within 0.25 D, 0.50 D, and 1.00 D was 55%, 73%, and 91% respectively.This result was significantly lower than that of the auto-keratometry (2.50±1.08) D, corneal topography (1.90±0.88) D, and those obtained from spherical equivalent method(2.09±1.62)D(P<0.01 ) or anterior curvature method (1.45±1.10) D(P<0.05).It also showed less bias(-1.13 to 0.85 D) when compared to the Equivalent K Reading (-1.10 to 1.80 D), but the difference was not significant (P > 0.05 ).For the 23 post LASIK eyes, the absolute difference between the corrected corneal power using posterior curvature method and theoretical power was (0.67±0.45)D, also showed least bias compared with other methods.Conclusion It is a practical and accurate way to calculate the corneal power after LASIK surgery using posterior curvature method.

Objective To evaluate the wound healing mode of rabbit corneal epithelium after Epi-LASIK(epipolis laser in-situ keratomilensis ) and Flap-free Epi-LASIK (Flap-free epipolis laser in-situ keratomileusia).Methods Twenty-four New Zealand white rabbits(48 eyes) were randomly divided into four groups.There were six rabbits in every group, which were randomly treated with Epi-LASIK in one eye and Flap-free Epi-LASIK in the other by VISX20/20 excimer laser.Other three rabbits(6 eyes) without any treatment were used as control.The corneal epithelium wound healing mode was observed at 1,2,4,7 days after surgery by light microscope and electron microscope.The number of keratocytes cells in the central anterior stroma were counted by hematoxylin-cesin-stained.The expression of basic fibroblast growth factor (bFGF) in corneal stroma were assessed by Immunohistochemistry staining.Cornea stromal cell apoptosis was evaluated by terminal deoxyribonuc1eotidyl transferase-mediated deoxynuridine triphosphate nick end labeling (TUNEL) assay.All the data was analysised by t-test to evaluate the different of wound healing mode after Epi-LASIK and Flap-free Epi-LASIK.Results The findings of light microscope and electron microscope investigation demonstrated that, at the first day after surgery, there was one layer of neogenesis of the corneal epithelial cells covering the area of surgery in Flap-free Epi-LASIK specimens.It would increase gradually after 7 days.At the first day after the surgery, the base membrane of the corneal epithelium was tightly attached to the stroma in Epi-LASIK specimens.At the second day after the surgery, there was edema observed on the epithelium flap in the Epi-LASIK specimens.There were more keratocytes cells found at 4 days after surgery in Flap-free Epi-LASIK group (33.85±3.39) than that in Epi-LASIK group (t=-2.315,P<0.05).The expression of bFGF in Flap-free Epi-LASIK group at 2,4 days after surgery were 101.75±8.07 and 110.56±9.00, which were more than Epi-LASIK (t=-2.339,-2.396, P<0.05).There was less keratocyte apoptosis cells in Flap-free Epi-LASIK group than Epi-LASIK group at 2,4 days after surgery (t=3.332,2.989,P<0.05).Condusions Due to the specific way of the epithelium removal resulting in the more rapid epithelium healing, the Flap-free Epi-LASIK technique is advantageous in reducing the stimulative symptoms after the surgery.It's also beneficial for the corneal wound healing.