Volume 56 · Issue 10 · 2020

Since the founding of the People′s Republic of China, the optometric technology has developed rapidly. Our peers have created breakthroughs in the field exploration and technology evolution, which have made the optometric technology in China reach the highest level in the world. We review the development and driving force of optometric technology in our country. We would like to send congratulations on the 70th anniversary ofChinese Journal of Ophthalmology with this article. (Chin J Ophthalmol, 2020, 56:721-725)

Dry eye is the most common chronic eye disease other than refractive errors. The expert consensus on dry eye has guiding significance in standardizing as well as improving the clinical diagnosis and treatment of dry eye in our country. The development of dry eye consensus needs to be rigorous, while its operability should be the key in clinics. In the routine clinical work, doctors should pay full attention to the guidelines of dry eye consensus, follow the advice in reason, correctly apply new technologies and new methods, and avoid improper applications. On this basis, we also encourage to continue innovations and explorations, which will eventually improve the clinical and research levels of dry eye in China. (Chin J Ophthalmol, 2020, 56:726-729)

Keratoprosthesis implantation as an effective therapeutic method has been a treatment strategy in end-stage corneal blindness, contributing to restore vision and reduce the prevalence of blindness, but it has been restricted because of its high surgical technique and devastating complications. There are a large number of patients with corneal blindness in China, and the rate of high-risk or end-stage corneal blindness is high. It is of great significance to improve the understanding of the indications and contraindications of different kinds of keratoprostheses, as well as relevant technologies and knowledge, cope with the problems and challenges in the development period, and conduct safe and efficient clinical applications and related research, so that the technology of keratoprosthesis implantation in our country can go to the world steadily. (Chin J Ophthalmol, 2020, 56: 730-734)

Autologous serum refers to the pale yellow transparent liquid separated from the plasma after the autologous venous blood is isolated and coagulated, and fibrinogen is removed from the plasma. It is rich in nutrients such as growth factors and vitamins, and has the function of promoting the growth and proliferation of corneal epithelial cells and maintaining the stability of ocular surface microenvironment. The comprehensive therapeutic effect in complex corneal and ocular surface diseases is not available in any commercial drug eye drops at present. However, the preparation method and clinical application of autologous serum eye drops have not been standardized at present. The Keratology Group of Ophthalmology Branch of Chinese Medical Association has formulated this consensus after thorough discussion, in order to provide reference for clinical work.(Chinese Journal of Ophthalmology, 2020, 56:735-740)

How to diagnose dry eye correctly is one of the core links in clinical work of dry eye. In recent years, dry eye examination technology has developed rapidly. In order to standardize the diagnostic process of dry eye and improve the diagnostic efficiency of dry eye, China Branch of Asian Dry Eye Association and other relevant experts organized to comprehensively analyze the clinical significance and value of different diagnostic methods of dry eye on the basis of Expert Consensus on Clinical Diagnosis and Treatment of Dry Eye (2013), update the diagnostic criteria of dry eye, put forward dry eye examination technologies, diagnostic procedures and standards suitable for the development of clinical practice in China, and form new consensus opinions, so as to promote the standardized and orderly development of dry eye diagnosis and treatment in China and improve the diagnosis and treatment level of clinical dry eye.(Chinese Journal of Ophthalmology, 2020, 56:741-747)

Novel coronavirus pneumonia has the characteristics of fast transmission speed, high infection rate and difficult prevention and control. Ophthalmic refractive surgery has a relatively high risk of infection due to the need to work at a close distance, the relatively large number of operations that can generate aerosols, and the high mobility of patients. Based on this, on the basis of the relevant prevention and control norms issued by the state, according to the professional characteristics, and combined with the prevention and control experience of many ophthalmology institutions at home and abroad, the Refractive Surgery Group of Ophthalmologist Branch of Chinese Medical Doctors Association organized relevant professional scholars in China to form this consensus after careful discussion, in order to provide certain epidemic prevention and control guidance for ophthalmology to carry out refractive surgery and minimize or avoid the risk of infection.(Chinese Journal of Ophthalmology, 2020, 56:748-753)

To study the diabetic keratopathy in type 2 diabetes patients with retinopathy by in vivolaser confocal microscopy.

This was a case-control study. Ninety type 2 diabetes patients were involved in this study from May 2015 to December 2019 in Qingdao Eye Hospital. According to the diabetic retinopathy clinical stage, these patients were divided into the non-proliferative diabetic retinopathy (NPDR) group (30 cases), early stage proliferative diabetic retinopathy (PDR) group (30 cases) and intermediate to late stage PDR group (30 cases). Thirty non-diabetic healthy volunteers were included in the control group. The central cornea was observed with an in vivolaser confocal microscope. The corneal nerve fiber density, nerve fiber length, nerve branch density, and nerve fiber tortuosity were compared between groups. The corneal Langerhans cells, epithelial cells, stromal cells and endothelial cells were also compared.

There were more nerve fibers and branches in the control group than the other three diabetic groups. The nerve fiber length in the control group, NPDR group, early stage PDR group and intermediate to late stage PDR group was (21.55±2.57), (14.73±1.56), (11.23±1.40) and (8.02±1.33) mm/mm², respectively, and there were statistically significant differences between the groups (F=316.17, P=0.00). In the nerve fiber density, nerve branch density and curvature, there were statistically significant differences between the groups (F=345.72, 479.46, 167.00, all P=0.00). The basal cell density in the control group, NPDR group, and two PDR groups was (5 761±303), (5 336±367), (4 146±379) and (3 658±365) cells/mm², respectively, and there were statistically significant differences between the groups (F=234.94, P=0.00). The anterior stromal cell density in the four groups was (836±30), (727±57), (544±59) and (360±47) cells/mm², respectively, and there were statistically significant differences between the groups (F=535.08, P=0.00). The hexagonal endothelium cell rate in the four groups was 62.0%±5.5%, 51.1%±3.7%, 40.2%±4.0% and 27.8%±3.9%, respectively, and the Langerhans cell density was (1.5±0.6), (4.2±1.3), (6.8±2.1) and (10.9±2.1) cells/mm², respectively; there were statistically significant differences between the groups (F=342.28, 179.78, all P=0.00). There was no statistically significant difference between the groups in the corneal endothelial cell density (F=1.58, P=0.20).

In type 2 diabetes patients with diabetic retinopathy, the corneal nerve fiber and branch density can be significantly reduced, and the density of the hexagonal corneal endothelial cells, epithelial basal cells and anterior stromal cells can also decrease. Langerhans cells may be involved in the development diabetic keratopathy. (Chin J Ophthalmol, 2020, 56: 754-760)

To investigate the effect of corneal diameter on Belin/Ambrósio enhanced ectasia display (BAD).

Retrospective case series study. The subjects were 6 744 myopic patients, including 3 341 males and 3 403 females, who had undergone corneal refractive surgery or had completed preoperative examination but had not undergone corneal refractive surgery at the Army Medical Center and Chongqing Vision Institute in Chongqing from June 2017 to June 2019. Age was (23.74±5.73) years old. No patients had keratoconus. One eye of each patient was randomly included, and the patients were divided into groups according to the corneal diameter measured by Pentacam. Group A included 630 patients (630 eyes) with corneal diameter ≤ 11.1 mm. In group B, there were 4 063 patients (4 063 eyes) with corneal diameter of 11.2 to 11.8 mm. In group C, there were 2 051 patients (2 051 eyes) with corneal diameter ≥11.9 mm. Preoperative BAD parameters of deviation of front elevation difference map (Df), deviation of back elevation difference map (Db), deviation of average pachymetric progression index (Dp), deviation of minimum thickness (Dt), deviation of Ambrósio′s relational thickness maximum (Da) and overall deviation value (Do) were measured by Pentacam. One-way analysis of variance was used for preoperative BAD parameters comparison between groups. The distribution of normal, suspicious and pathological results of Df, Db, Dp, Dt, Da and Do in each group was tested by chi-square test.

In groups A, B and C, Df was 0.73±1.14, 0.48±1.02, and 0.11±0.91, Db was 1.09±1.07, 0.23±0.83, and-0.34±0.62, Dp was 1.57±0.91, 1.14±0.86, and 0.68±0.75, Dt was -0.11±0.84, -0.2±0.82, and 0.03±0.78, Da was 0.78±0.61, 0.64±0.64, and 0.48±0.64, and Do was 1.65±0.64, 1.24±0.60, and 0.86±0.55, respectively. The BAD parameters of Df (F=129.549), Db (F=829.491), Dp (F=344.373), Dt (F=7.249), Da (F=68.637) and Do (F=524.877) were all significantly different between groups (P<0.01). The proportion of suspicious and pathological BAD parameters [Df (χ²=161.8), Db (χ²=611.75), Dp (χ²=478.84), Da (χ²=44.636), and Do (χ²=553.11)] suggested the distribution in each group was significantly different (P<0.01).

Corneal diameter had a significant influence on BAD. Compared with eyes with large corneas, the false positive rate of BAD was higher in eyes with small corneas.(Chin J Ophthalmol, 2020, 56: 761-767)

To observe the clinical effect of modified conjunctival transplantation and amniotic membrane transplantation combined with use of interferon (IFN) alpha-2b eye drops in the treatment of primary pterygium.

This was a prospective case-control study. Patients with primary pterygium were treated from June 1, 2018 to December 31, 2018 in the Department of Ophthalmology, Beijing Tongren Hospital, and they were divided into two groups (the experimental group and the control group) by the method of randomized block design. Patients in the experimental group received modified conjunctival transplantation and amniotic membrane transplantation combined with use of IFN alpha-2b eye drops, while patients in the control group received pterygium resection combined with conjunctival autograft transplantation. The pterygium type and size were observed before operation, while visual acuity, intraocular pressure and anterior segment details were recorded either. The follow-up was done at 1 week, 2 weeks, 1 month, 3 months, 6 months and 12 months after operation. The visual acuity, corneal epithelial defect, and pterygium recurrence were observed. All data in this manuscript are enumeration data, the expected frequency of pterygium type distribution in the two groups was more than 5, and the chi square test was used, fisher′s exact test was used to compare the other data between the two groups.

Seventy patients (77 eyes) with pterygium were in this study, including 30 males and 40 females, aged from 50-70 years old. There were 35 cases (38 eyes) in the experimental group and 35 cases (39 eyes) in the control group. 12 months after operation there were 54 cases (60 eyes) including 28 cases (30 eyes) in the experimental group and 26 cases (30 eyes) in the control group with complete data. The corneal epithelium defects of 1 eye in each group was repaired within 7-14 days after operation, and the rest eyes were completely repaired within 7 days after operation. There was no significant difference in the distribution of corneal epithelial healing between the two groups (P= 1.00). There was no significant difference between the two groups in the number of eyes distribute with decreased visual acuity (2 eyes in each group), stable visual acuity (15 eyes in the experimental group and 23 eyes in the control group), and improved visual acuity (13 eyes in the experimental group and 5 eyes in the control group) (P=0.053). There was no recurrence in the two groups at 12 months after surgery, and there was no significant difference between the two groups in the number of patients with conjunctival hyperplasia of grades 1, 2 and 3 (P=0.405).

Modified conjunctival transplantation and amniotic membrane transplantation combined with use of IFN alpha-2b eye drops got low recurrence rate for primary pterygium and less damage to the healthy conjunctival tissue. This combined treatment strategy provides a new choice for the treatment of pterygium. (Chin J Ophthalmol, 2020, 56: 768-773)

To evaluate the application value of a deep-learning-based imaging method for rapid measurement and evaluation of meibomian glands.

Diagnostic evaluation study. From January 2017 to December 2018, 2 304 meibomian gland images of 576 dry eye patients who were treated at the Eye Center of Wuhan University People′s Hospital with an average age of (40.03±11.46) years were collected to build a meibomian gland image database. These images were labeled by 2 clinicians, and a deep learning algorithm was used to build a model and detect the accuracy of the model in identifying and labeling the meibomian glands and calculating the rate of meibomian gland loss. Mean average precision (mAP) and validation loss were used to assess the accuracy of the model in identifying feature areas. Sixty-four meibomian gland images apart from the database were randomly selected and evaluated by 7 clinicians independently. The results were analyzed with paired t-test.

This model marked the meibomian conjunctiva (mAP>0.976, validation loss<0.35) and the meibomian gland (mAP>0.922, validation loss<1.0), respectively, thereby achieving high accuracy to calculate the area and ratio of meibomian gland loss. The proportion of meibomian glands marked by the model was 53.24%±11.09%, and the artificial marking was 52.13%±13.38%. There was no statistically significant difference (t=1.935, P>0.05). In addition, the model took only 0.499 second to evaluate each image, while the average time for clinicians was more than 10 seconds.

The deep-learning-based imaging model can improve the accuracy of the examination and save time and be used for clinical auxiliary diagnosis and screening of diseases related to meibomian gland dysfunction.(Chin J Ophthalmol, 2020, 56: 774-779)

To investigate the feasibility and clinical efficacy of low-temperature plasma ablation for the treatment of fungal corneal ulcers.

Retrospective case series. Twenty-six patients (26 eyes) were hospitalized for fungal corneal ulcers from January 2017 to July 2018, including 15 males and 11 females, aged (54±12) years old. The conventional topical and systemic antifungal drugs were not or poorly effective. In the cases of poor clinical results, low-temperature plasma ablation was performed, and comprehensive antifungal treatment was continued after operation. The follow-up time was ≥6 months. The patients′ subjective symptoms, visual acuity, and corneal ulcer healing were observed. Slit-lamp microscopy, confocal microscopy and anterior segment optical coherence tomography were performed. Paired t test was used to analyze the uncorrected visual acuity and the best corrected visual acuity before and after treatment.

Photophobia, tearing, pain and other symptoms gradually reduced postoperatively, and the corneal ulcer lesions gradually became stable in all eyes. One patient had recurrence although the corneal ulcer was basically healed in the early postoperative period, and finally the ulcer was perforated, so penetrating keratoplasty was performed. In the other 25 patients, corneal ulcers gradually healed. Confocal microscopy and anterior segment optical coherence tomography examination showed scarring of corneal lesions. At the last follow-up, the uncorrected visual acuity of the 26 patients was 0.43±0.27, and the best corrected visual acuity was 0.22±0.18. Compared with the preoperative data, the difference was statistically significant (t=4.422, 4.736; P=0.000).

Low-temperature plasma ablation is feasible for the treatment of fungal corneal ulcers. Its combination with medication has obvious clinical effects on fungal ulcers in the cornea. (Chin J Ophthalmol, 2020, 56: 780-785)

The patient was a 36-year-old male. Because of blurred vision in his right eye for 1 month, he went to the Optometry Hospital affiliated to Wenzhou Medical University. He was in good health and denied his history of hypertension and diabetes. Eye examination: visual acuity was 0.12 for the right eye and 1.0 for the left eye; IOP was 14 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye; For the fundus of the right eye, seeQuintessence Picture 1。 Coherence light tomography examination showed that the continuity of internal and external segments of retinal photoreceptors in the macular area of the right eye was interrupted, and the retinal structure in the macular area of the left eye was normal. The results of autofluorescence examination of right eye fundus are shown inQuintessence Picture 2； The results of fluorescein choroidal angiography in the right eye are shown inQuintessence Picture 3。 Clinical diagnosis: Multiple transient white spot syndrome in the right eye.

The patient was a 66-year-old female. Because of red and astringent discomfort in both eyes for more than 1 month, he went to Rongcheng Eye Hospital in Shandong Province. No prior pet contact history. Ophthalmological examination: mixed conjunctiva congestion of the right eye, a small amount of filamentous yellow-white secretion in the conjunctival sac, and no obvious abnormalities in the cornea and intraocular structures; When using a cotton swab to remove the secretion of the conjunctival sac, it was found that there was a white worm peristalsis at the fornical conjunctiva above the nose of the right eye, and the abdomen was brown (essence video image;Quintessence Picture 1，2）。 Please consult the microbiology room of Beijing Institute of Ophthalmology. Clinical diagnosis: conjunctival larvae of M. ovina in the right eye.

Dry eye is the most common ocular surface disease, the core pathogenesis of which is ocular surface inflammation. Anti-inflammation is one of the important clinical treatments of dry eye. Since the definitely immunosuppressive effect, topical ophthalmic cyclosporine A (CsA) has been used in dry eye for many years. A large number of studies have been published in recent years, including its therapeutic effects, indications and applications. This article will introduce the mechanism of ophthalmic CsA, summarize its clinical treatment effects in dry eyes of different countries, different causes, and different severity. Meanwhile we will analyze the pros and cons and the applied prospects of ophthalmic CsA with various forms, and generalize the indications, treatment suggestions and safety of CsA used in dry eye, in order to provide references for the clinical applications. (Chin J Ophthalmol, 2020, 56:787-795)

Secondary glaucoma is one of the common complications of vitreoretinal surgery, with high incidence and complex and diverse pathogenesis, which can cause further irreversible damage to the residual visual function of patients. This article mainly aims at summarizing the pathogenesis and treatment of secondary glaucoma after vitreoretinal surgery, in order to guide the clinical work.(Chinese Journal of Ophthalmology, 2020, 56:796-800)