Volume 54 · Issue 10 · 2018

This issue focuses on refractive surgery. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Li Ying.

In China, laser refractive surgery has been applied and followed up in clinics for 25 years. It is becoming more and more widely accepted due to its safety, efficacy, strong predictability and long-term stability, which has now become the leading choice to correct refractive errors in adults. Especially with the development of new surgical methods of transepithelial photorefractive keratectomy and small incision lenticule extraction in the recent 6 years, it is becoming safer, more accurate, causes less harm to the cornea and achieves faster recovery after surgery, resulting in a rapid increase in the number of surgery in China. With the improvement of experience and equipment, patients also increase their expectations. Many patients believe that there should be no discomfort and complications since the surgery is very fast and the equipment is more advanced. Besides, some doctors are not well-prepared for surgical complications, leaving themselves not capable of giving prompt treatment for patients with poor vision after surgery. Therefore, it is very necessary to keep an eye on surgical complications and learn the way to deal with them, especially those severe complications, during the rapid development of laser refractive surgery. (Chin J Ophthalmol, 2018, 54: 721-725)

The refractive surgery is improved and updated with time. In recent years, the phakic intraocular lens has been continuously modified and innovated in materials and design. With advantages such as less high-order aberrations, reversible lens and good visual quality, it has led to a new trend of refractive surgery, which attract an increasing number of high myopic persons received phakic intraocular lens implantation instead of corneal refractive surgery, particularly to further expand the applying for moderate and low myopia. This article focuses on the rational selection of moderate and low myopia to receive laser correction vision or phakic lens, and elaborates the different characteristics with advantages and disadvantages of corneal refractive surgery and phakic intraocular lens implantation, which suggest to perform the phakic intraocular lens implantation for moderate and low myopia cautiously and standardize surgical indications strictly. It is necessary to continuously strengthen the standardization and safety of laser corneal refractive surgery and phakic intraocular lens implantation in order to improve the visual quality and satisfaction further for myopic patients in clinic. (Chin J Ophthalmol, 2018, 54: 726-728)

femtosecond laser small incision lenticule extraction (SMILE), as a new technology, has been widely promoted in clinical practice in recent years. The promulgation of the Expert Consensus on femtosecond laser small incision lenticule extraction (2016) has played an important guiding role. With the improvement of technology and the continuous update of software, the relevant understanding is gradually deepened, and the scope of surgical indications is also broadened. In order to better guide clinical work, the Optometry Group of Ophthalmology Branch of Chinese Medical Association, based on the latest research results and after full discussion, partially revised the surgical indications (correctable diopter) and contraindications (thyroid disease-related eye diseases, etc.) of SMILE, and refined the definitions and treatment methods of some surgical complications, making the new consensus more scientific and rigorous for clinicians' reference.

To explore nerve fiber regeneration and subjective visual quality of patients undergoing small incision lenticule extraction (SMILE) surgery, femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) and transepithelial photorefractive keratectomy (T-PRK), and study their correlation.

This is a prospective cohort study including 55 patients (6 male, 49 female, age 25.6±7.3, in total 109 eyes) who chose refractive surgery in Peking Union Medical College Hospital. They are subdivided into 3 groups: 35 patients in SMILE (4 male, 31 female), 9 patients in FS-LASIK (1 male, 8 female) and 11 patients in T-PRK (1 male, 10 female). All surgeries were conducted by the same surgeon. Patients underwent confocal microscopy examinations and filled in subjective visual quality questionnaires before surgery and 7 days, 30 days and 90 days after surgery. ACCMterics V.2 was used for nerve analysis. One-way analysis of variance, Kruskal-Wallis H test and Pearson correlation study was adopted for data analysis on SPSS 22.0.

Corneal nerve fiber density is lowest at 7 days after surgery. The nerve fiber length (8.53 (7.32), 9.33 (6.47), 10.98 (4.85) mm/mm², χ ²=9.21, 8.15, 6.54; P<0.05), density (12.50 (12.50), 12.50 (12.50), 18.75 (14.06)/mm², χ ²=6.54, 9.02, 7.01; P<0.05) and total branch density (18.75 (31.25), 24.99 (29.69), 31.25 (32.81)/mm², χ ²=10.23, 7.63, 10.01; P<0.05) of SMILE group are significantly higher than the other 2 groups at 7 days, 30 days and 90 days after surgery. The subjective visual quality scores are (4.13±0.61), (3.54±0.71), (4.03±0.70) and (4.20±0.58) respectively at each visit, with 7 days being the lowest (F=1.51, P=0.23), but there is no statistically significant difference between each group at each visit. At 7 days after surgery, the nerve fiber length (CNFL) and nerve fiber density (CNBD) show strong positive correlation with overall subjective visual quality (r=0.378, 0.504; P<0.05), while there exists no significant correlation between nerve fiber parameters and subjective visual quality 30 days and 90 days after surgery.

SMILE shows better results in corneal nerve fiber regeneration. Corneal nerve fiber density of early post-operational period is positively correlated with overall subjective visual quality. (Chin J Ophthalmol, 2018, 54: 737-743)

To investigate the effect of different medication time prior to corneal refractive surgery on tear film stability.

Prospective cohort study. A total of 60 patients (60 eyes), including 38 males (63.3%) and 22 females (37.7%) with an average age of (24.2±5.1) years (form 18 to 37 years), who had planned for corneal refractive surgery with normal ocular surface disease index score were included in this study. The patients were divided into 1d group (medication of 1 day, 30 eyes) and 3d group (medication of 3 days, 30 eyes) randomly. The first tear break up time (FBUT), the average tear break up time (AVBUT) and the dry eye grade score were recorded on the examination day and the operation day with Keratograph 5M. The difference of FBUT and AVBUI between the two groups was compared with the independent sample t test. The difference of FBUT and AVBUT between the examination day and the operation day was compared with the paired t test. The difference of the dry eye classification between the two groups was compared using chi-square test.

The FBUT and AVBUT of 1d group and 3d group were (10.89±5.19)s and (10.88±6.82)s, (16.24±3.62)s and (16.21±4.74)s respectively in preoperative examination, and (10.65±6.03)s and (8.14±5.75)s, (15.14±5.30)s and (12.86±5.92)s respectively in operation day. There was no significant difference in FBUT and AVBUT between the two groups (t=0.01, 1,47, 0.02, 1.44; P>0.05). However, in the 3d group, the AVBUT of operation day decreased as compared with that of the examination day, and the difference was statistically significant (t=2.31, P<0.05). There was no significant difference in the distribution of dry eye classification between the two groups (χ²=0.07, 3.36; P>0.05).

Both of medication of 1 day and medication of 3 days prior to corneal refractive surgery can provide a similar tear film stability, however more attention should be paid to the medication for patients with asymptomatic but abnormal BUT. (Chin J Ophthalmol, 2018, 54: 744-747)

Correlation analysis of visual acuity, wavefront aberrations and contrast sensitivity in myopia.

Retrospective study. One hundred and twelve patients with myopia(209 eyes) from April 2013 to August 2015 were enrolled in our study. All subjects were divided into various groups to investigate the relationship between wavefront aberrations and contrast sensitivity in myopic eyes.The correlations between ocular aberrations and contrast sensitivity(4 spatial frequency) in myopia eyes were analyzed using multivariate stepwise regression.

The AULCSF in the BCVA 1.2 were 1.32±0.10,1.30±0.12 respectively in the light and dark conditions,, which were higher than those in the BCVA 1.0 (t=-3.58 and-2.48, P<0.05). There was no significant difference between AULCSF in dark glare condition.At 4mm and 6mm pupil diameters,The difference in Z^-₃₃ of ocular higher-order aberrations between the BCVA 1.0 and the BCVA 1.2 was statistically significant (t=2.09, P=0.04; t=-2.05, P=0.04). Differences between the other ocular higher-order aberrations and corneal aberrations were not statistically significant.The spherical aberrations of the low contrast sensitivity group were (0.019±0.010), (0.136±0.117) and(0.006±0.003)μm separately under the condition of bright light, dark light and dark glare light, which were higher than other groups (0.013±0.006) , (0.083±0.054) , (0.004±0.002) μm (t=1.10, 2.65, 2.44, P<0.05). The values of AULCSF for the larger spherical aberrations under dark light and dark glare light conditions were 1.281±0.126 and 1.216±0.154 respectively which were lower than the AULCSF 1.281±0.126, 1.216±0.154 of the another spherical aberrations group (t=2.14, 1.98, P<0.05). It was found that the S_All RMS and spherical aberrations under different frequencies and illuminating conditions were negatively correlated with CS.Vertical coma was positively correlated with CS.

Better BCVA may achieve better visual quality.In the case of the same BCVA, there are differences in visual quality.Higher order aberrations are the main factor affecting this result, especially the spherical aberrations.Total aberrations and spherical aberration had a negative correlation with visual quality.Vertical coma had a positive affects with visual quality. (Chin J Ophthalmol, 2018, 54: 748-755)

To investigates the visual condition and myopia status in primary school students of grade 1 to 3 in Hubei province and to further analyze the influencing factors of myopia, so as to provide theoretical basis for prevention and control of myopia.

Cross-sectional study. A total of 18 532 primary school students from grade 1-3 in 26 primary schools from 17 prefecture-level cities in Hubei province were included in the study from March 2017 to July 2017, by using a random stratified cluster sampling method. In this study, 16 955 people were actually surveyed, with a response rate of 91.49%. All students' Visual acuity was measured, a further retinoscopy refraction test after application of Cyclopentolate Hydrochloride Eye Drops was conducted for those whose visual acuity was less than 5.0. The general situation and eye behavior of all students were investigated by questionnaires. Chi-square test was used to compare the prevalence of myopia between different grades, different regions and different genders, as well as the distribution of myopia correlation between different regions, and Logistic regression model was used to analyze the correlation between myopia and related factors.

The prevalence of myopia among primary school students of grade 1 to 3 in Hubei province is 24.15% with 12.67% in the first grade, 24.91% in the second grade, 34.95% in the third grade, and the difference was statistically significant (χ²=862.28, P<0.05). According to the study, mild myopia is the most prevailing condition among myopia students, with the prevalence rate of mild myopia, moderate myopia and severe myopia being 19.21%,4.29%, and 0.64% respectively, and the difference is statistically significant (χ²=155.62, P<0.05). In addition, the prevalence of myopia is different in each region, which was highest in provincial capitals, followed by non-provincial cities, and the lowest in rural areas, with statistically significant difference (χ²=539.57, P<0.05). Myopia is generally related to multiple factors, such as the grade, parents' myopia, outdoor activities, continuous closing reading, exposure to electronic products, and extracurricular reading time are related to myopia (P<0.05).

Children's myopia is a public health problem that should not be ignored. The prevalence of myopia among 1-3 grade pupils is 24.15% with an increasing tendency with grade. The occurrence of myopia is related to heredity and eye behavior.(Chin J Ophthalmol, 2018, 54:756-761)

To evaluate the tear film function of diabetic patients using the Keratograph 5M and to analyze its related factors.

Case-control study. A total of 89 inpatients (174 eyes) diagnosed with diabetes in the Department of Endocrinology at our hospital were recruited. According to the fundus fluorescein angiography results, subjects were divided into two groups, diabetic retinopathy (DR) group and none-DR group. All subjects were examined for duration of diabetes, glycosylated hemoglobin, creatinine, 24-hour urinary protein, and 24-hour urinary microalbumin/urinary creatinine, and by electromyography. The Keratograph 5M was used to obtain the first and average tear film break-up time (BUTf and BUTav), tear meniscus height, the upper and lower meibomian gland loss scores. The data were analyzed by SPSS.

Compared to the non-DR group, the BUTf and the BUTav in the DR group were shorter [(8.42±4.71) s vs. (10.24±5.32) s, (11.20±5.25) s vs. (12.67±5.52) s; P=0.000]. There was no significant difference in the tear meniscus height between the three groups (P=0.067). The tear meniscus height were negatively related with glycosylated hemoglobin, and not related with duration of diabetes, 24-hour urinary microalbumin/urinary creatinine, creatinine, 24-h urinary protein, and electromyography results. As the duration of diabetic longer, the upper and lower meibomian gland loss scores added(Z=19.514, 15.342, P<0.05). Patients with EMG abnormal, the lower meibomian gland loss scores added(Z=-2.312, P<0.05).

The Keratograph 5M can directly evaluate the tear film condition of diabetic patients.Diabetic patients with retinopathy and higher glycosylated hemoglobin tend to suffer tear film dysfunction. (Chin J Ophthalmol, 2018, 54:762-766)

To study the relationship between genetic typing and the antibiotic susceptibility of staphylococcus aureus (SA) isolated from keratitis or conjunctivitis patients.

Experimental study. Thirty-four (34) strains of Staphylococcus aureus were isolated from 34 cases of keratitis or conjunctivitis. The genomic DNA was extracted and amplified with PCR. With the method of multi locus sequences typing (MLST), gene fragments from 7 house-keeping genes were amplified and the products were sequenced. The results were submitted to the MLST website (www.pubmlst.org). In comparison with the allele of the corresponding gene, the allele spectrums of the strain were obtained with 7 housekeeping genes. At last, the MLST genotypes of the isolated strains were determined. With the START software, the evolutionary tree was established with UPGMA method. With the microdilution method, the MIC₉₀ of 13 antimicrobial agents was determined. The MIC₉₀ value of antimicrobial agents among different genotypes of Staphylococcus aureus was comparatively analyzed.

Ten (10) genotypes were obtained from 34 strains of Staphylococcus aureus. The dominant types were ST239, ST2592 and ST188. The clustering of genotyping was relatively concentrated, mainly in group Ⅰ (25 strains of SA, 83.3% of the total), and followed by group Ⅱ (5 strains of SA, 16.7%). The conjunctival isolates were distributed in the subgroup A of group Ⅰ. The cornea isolates were concentrated in subgroup B and group Ⅱ. With the exact probability method, the R×C chi square tests were used as statistic analysis method. The difference between the bacterial genotyping of two sources was statistically significant (P=0.011). Twenty-four strains of SA in group Ⅰ was sensitive to Vancomycin, Rifampicin and Amikacin (sensitivity ratio was 24/24, 20/24 and 20/24, respectively), and was generally resistant to other antibiotics. The values of MIC₉₀ of ciprofloxacin, ofloxacin, gatifloxacin and moxifloxacin to Staphylococcus aureus in subgroup A (0.16±0.07, 0.51±0.42, 0.31±0.14, 0.22±0.33) were significantly lower than the values in subgroup B(0.74±0.11, 0.84±0.45, 0.67±0.03, 0.68±0.26). The difference was statistically significant (P=0.004, 0.026, 0.034, 0.001). There was no significant difference between the MIC₉₀ values of the other 9 kinds of antibiotics in the subgroup A and in the subgroup B of Staphylococcus aureus (P value 0.047-0.561).

The genotype of Staphylococcus aureus of corneal isolations and conjunctival isolations were different. The conjunctival isolates were distributed in the subgroup A of group Ⅰ and the corneal isolates were concentrated in subgroup B and group Ⅱ. There is a significant correlation between the MLST genotypes and antibiotic sensitivity. (Chin J Ophthalmol, 2018, 54:767-774)

To analyze the relationship between genotype and phenotype of different types of hereditary retinopahty caused by ABCA4 gene.

Three (3) pedigrees that carried mutations on ABCA4 gene as determined through the second generation sequencing technology were selected from the patients diagnosed with hereditary retinal disease in Ningxia Eye Hospital between Januaryand September 2016. The clinical features of patients and other family members of them were collected and analyzed with complete ophthalmic examinations including visual acuity, best corrected visual acuity, fundus examination, macular OCT, fundus fluorescein angiography and electroretinogram (ERG). The relationship between genotype and phenotype was analyzed.

All the 3 pedigrees were autosomal recessive families. Four mutations on ABCA4 gene were detected, the CRD pedigree and the RP pedigress carried a homozygous frameshift mutation respectively. The Stargardt pedigree carried two heterozygous mutations. The onset age of the patients were less than 10 years. The best corrected visual acuity was lower than 0.1 and the macular OCT indicated different levels of macular area atrophy, and the visual electrophysiological changes varied from completely normal to significantly reduced visual stem cell function in different cases.

The patients with hereditary retinal disease that carried ABCA4 gene mutations were featured with characteristics of early onset age, rapid progress and severe visual impairment. The second generation sequencing technique has the advantages of rapidness and high efficiency in the diagnosis of hereditary retinal disease. (Chin J Ophthalmol, 2018, 54:775-781)

To evaluate the high-risk histopathologic features of retinoblastoma eyes enucleated as primary treatment.

Retrospective case series study. An analysis was carried out on the high-risk histopathologic features of 482 primarily enucleated retinoblastoma eyes in Beijing Tongren Eye Center during December 2011 and December 2016. The high-risk histopathologic features included post lamina cribrosa invasion, massive choroidal invasion, anterior segment invasion and extraocular invasion. According to the neovascularization of iris (NVI) in the tissue specimen, the patients were divided into the NVI positive group and negative group. The rates of high-risk histopathologic features in the NVI positive group and negative group were analyzed using the chi-square test.

Among 482 children with retinoblastoma, 280 (58.1%) were males and 202 (41.9%) were females. The median age at enucleation surgery was 24 months (range, 1-84 months). Of the 482 primarily enucleated eyes, 184 (38.2%) were classified as high-risk histopathologic features, including 148 (30.7%) with post lamina cribrosa invasion, 15 (3.1%) with optic nerve transection invasion, 66 (13.7%) with massive choroidal invasion, 35 (7.3%) with anterior segment invasion, and 5 (1.0%) with extraocular invasion. NVI was detected in 257 (53.3%) cases and there was a significant relation between high-risk histopathologic features and NVI. The rate of high-risk histopathologic features was significantly higher in the NVI positive group (123 cases, 47.9%) than the NVI negative group (61 cases, 27.1%) (χ²=21.883, P=0.001). The rate of post lamina cribrosa invasion was significantly higher in the NVI positive group (110 cases, 42.8%) than the NVI negative group (38 cases, 16.9%) (χ²=37.860, P=0.001).

In this large sample of patients, about 1/3 of retinoblastoma eyes has high-risk histopathologic features. The NVI positive retinoblastoma is more likely to have high-risk histopathologic features or post lamina cribrosa invasion than the NVI negative retinoblastoma. (Chin J Ophthalmol, 2018, 54: 782-786)

患者男性，64岁，林业工人。因发现颌面部、颈部、双上肢、双下肢紫红色斑块20余年，双眼新生物渐进性长入"黑眼珠"伴视力逐渐下降5年，于2016年4月就诊于吉林大学第一医院眼科中心。患者20余年前于森林阴冷潮湿环境中守林3 d后发现颌面部、颈部、双手背、右侧腕关节、双侧肘关节及双膝关节出现大小不等暗紫红色结节及斑块，未进行特殊治疗。5年前发现双眼角膜新生物形成并逐渐增生，伴有视物模糊、眼红、异物感、流泪等不适症状，局部应用地塞米松滴眼液等治疗后间断缓解，但视力逐渐下降。2013年5月因病情加重就诊于皮肤科，经皮肤病变组织病理学检查后，确诊为持久性隆起性红斑（erythema elevatum diutinum，EED）。全身系统应用糖皮质激素后，皮肤症状和体征好转，但停药后出现反复。本次住院后全身检查各系统未见异常，肺部听诊清音，全身浅表淋巴结未触及肿大。皮肤病变表现：颌面部、颈部、双手背、右侧腕关节、双侧肘关节、双膝关节可见大小不等暗紫红色结节及斑块，部分皮损表面有结痂（图1）。眼科检查：右眼视力50 cm指数，眼压15 mmHg（1 mmHg=0.133 kPa），眼睑闭合良好，眼睑无内翻及外翻，睫毛排列整齐，睑缘钝圆，充血肥厚，睑板腺开口阻塞，可见栓子形成，上睑结膜可见白色线状瘢痕，结膜充血，右眼颞下方球结膜与睑结膜黏连，鼻侧及颞下方球结膜增生，侵入角膜缘内7 mm，遮盖瞳孔区，增生结膜组织头部与角膜接触处角膜灰白色全层混浊，新生血管形成，前房深度正常，其后方可见虹膜，虹膜纹理视不清（图2中A）。左眼视力：指数50 cm，眼压14 mmHg，眼睑闭合良好，眼睑无内翻及外翻，睫毛排列整齐，睑缘钝圆，充血肥厚，睑板腺开口阻塞，可见栓子形成，上睑结膜可见白色线状瘢痕，结膜充血，鼻侧球结膜增生，侵入角膜缘内约5 mm，余角膜周围新生血管形成伴混浊，角膜中央可见全层灰白色混浊，直径约5 mm，前房深度正常，其后方可见虹膜，虹膜纹理视不清（图2中B）。实验室检查及辅助检查：眼部B超显示双眼玻璃体混浊，巩膜无异常。血、尿、便常规未见明显异常，肝肾功能未见异常，抗核抗体（-），抗中性粒细胞胞质抗体（-），红细胞沉降率：27 mm/1h（参考值0~15 mm/1h），风疹病毒IgG抗体：3.696 S/C0（参考值<1.00）。胸部X线检查结果示双肺纹理增强；心电图无异常，全身浅表淋巴结及肝脾超声未见异常。皮肤病变处组织病理学检查：真皮内小血管壁轻度纤维蛋白样变性，周围多数中性粒细胞为主的炎细胞浸润，并可见胶原纤维硬化，符合EED特征（图3）。临床诊断：双眼假性胬肉、双眼睑球黏连、双眼角膜白斑、EED。双眼给予1%环孢素A滴眼液（华北制药集团制剂有限公司）4次/d点、1%氟米龙滴眼液（参天制药株式会社）3次/d、氧氟沙星眼膏（参天制药株式会社）3次/d。口服雷公藤多苷片（贵州汉方制药有限公司）3次/d，每次20 mg、依巴斯汀片（杭州澳医保灵药业有限公司）1片/d；外用糖酸莫米松乳膏（湖北恒安药业有限公司）1次/d。患者为提高视力强烈要求角膜移植术，拟择期准备手术治疗过程中出现肺部感染并合并结核，遂转入吉林大学第一医院急诊内科治疗，后患者病情稳定，未行眼科手术治疗出院。出院检查半年后随诊，患者未遵医嘱局部应用糖皮质糖皮质激素、免疫抑制剂及抗生素，但长期口服甲泼尼龙。眼科可见双眼眼表炎性反应减轻，角膜混浊范围无扩大，假性胬肉无显著进展（图4）。

The patient was a 93-year-old female. Because of the painless progressive decline of visual acuity in both eyes for half a year, he went to the Department of Ophthalmology of Peking University First Hospital. The patient was previously in good health. The whole body examination showed no obvious abnormalities. Eye examination: the visual acuity is 0.2 in the right eye and 0.3 in the left eye, and the visual acuity of both eyes cannot be corrected; IOP normal; The corneas of both eyes were transparent, the anterior chamber was deep, the iris texture was clear, the pupil of the right eye was atresia, and the intraocular structure was invisible (Quintessence Picture 1A), a pore of approximately 1.0 mm ×0.5 mm can be seen in the center of the iris of the left eye, and the intraocular structure is not clear (Quintessence Picture 1in B); After using compound tropicamide eye drops in both eyes, the iris pores were slightly enlarged, and the lens was opaque. Clinical diagnosis: congenital pupil abnormalities in both eyes; Senile cataracts of both eyes.

In the 1980s, a new treatment of aphakia and keratoconus with keratophakia thrived because of its simple, effective and reversible characteristics. However, due to the limited cornea resources and the unpredictability of long-term treatment effects, epikeratophakia has not been widely accepted. Refractive lenticule extraction is a type of corneal refractive surgery with minimal invasiveness, accuracy and good refractive stability and has got great clinical attention and promotion. The removed refractive stromal lenticules as good graft materials can be applied for treatment of keratoconus and hyperopia based on the epikeratophakia principle. This review describes the history and development of keratophakia and the basic research and clinical effect of refractive lenticule transplantation. (Chin J Ophthalmol, 2018, 54: 792-796)

October 13-15, 2017, organized by the Chinese Medical Association Ophthalmology Branch, the Chinese Association of Pediatric Ophthalmology and Strabismus (CAPOS) and the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) The 17th National Academic Conference on Strabismus and Pediatric Ophthalmology and CAPOS-AAPOS Joint Academic Conference co-sponsored were held in Shanghai. More than 1,000 domestic and international delegates (including 130 international delegates) from 30 countries on 5 continents attended the conference. At the meeting, Zhao Kanxing of Tianjin Eye Hospital and Yan Shaoming of Department of Ophthalmology of Naval General Hospital gave memorial lectures of Professor Liu Jiaqi and Professor He Yushi respectively. The conference awarded the CAPOS Friendship Golden Award to 12 professors including David Robbins Tien of Brown University in the United States, who have made outstanding contributions to the development and internationalization of strabismus and pediatric ophthalmology in China (Table 1）。