Volume 57 · Issue 10 · 2021

Bacteria are among the main pathogens of eye infection. Bacterial infection usually occurs on the ocular surface, while intraocular infection is more harmful and can cause irreversible visual impairment in a few hours or days. There are many kinds of bacteria that could cause eye infection, and their distribution changes with time. With the widespread usage of antibiotics, the sensitivity of bacteria to antibiotics also changes. In order to improve the clinical diagnosis and treatment, ophthalmologists are suggested to focus on the changing of bacterial species distribution and drug sensitivity to understand the value of topical antibiotic application.(Chin J Ophthalmol, 2021, 57: 721-723)

The prevalence of myopia in China is increasing. The early onset and rapid progression of myopia in younger children have attracted more attention. The establishment of standardized children′s refractive development records is the basis of myopic prevention and control. It would be helpful to follow the refractive status and pay more attention to the refractive development of potential myopic children, so as to reduce the prevalence of myopia. (Chin J Ophthalmol, 2021, 57: 724-726)

An artificial corneal transplant (keratoprosthesis, KPro) is the only procedure to restore sight for patients with end-stage corneal blindness after multiple failed corneal transplants, severe eye burns, autoimmune-related and cicatricial keratoconjunctival diseases. At present, the representative KPros are Boston KPros and Russian MICOF KPros. They have been used for patients worldwide for nearly 30 years, and the success rate in two years after surgery reaches up to 85%. With the approval of the collar button design KPro (Boston Ⅰ-like artificial cornea) for marketing and the completion of clinical trials of the Miok KPro (MICOF-like artificial cornea) in China, domestic artificial corneas will bring Chinese patients with end-stage corneal blindness opportunities for recovery of eyesight. There are many differences between the KPro procedure and conventional corneal transplantation. In order to standardize the use of domestic KPros in clinical practice and reduce perioperative complications, the Cornea Group of Ophthalmoloy Branch of Chinese Medical Association convened meetings of experts with extensive experience in this field, and a consensus has been reached on the surgical indications, operating specifications, perioperative medication and complication management targeting domestic KPro procedure to guide the performance of artificial corneal transplantation in China. (Chin J Ophthalmol, 2021, 57: 727-733)

Ocular local or systemic medication may cause drug-related dry eye, which has become one of the important types of dry eye. A missed diagnosis or misdiagnosis of this type of dry eye is easy to occur clinically. To arouse the attention of ophthalmologists, experts from the Chinese Branch of the Asian Dry Eye Society and other related academic organizations have combined the new research progress and clinical practice associated with this specific disease, in terms of its definition, classification, risk factors, related drug types, pathogenesis, diagnosis, differential diagnosis, treatment principles and preventive measures, to form expert consensus opinions, hoping to promote the standardized diagnosis and treatment of drug-related dry eye in China. (Chin J Ophthalmol, 2021, 57: 734-742)

In addition to mechanical injury and secondary infection, long-term retention of orbital foreign bodies can cause inflammation, foreign body granuloma and fistula formation, affecting the appearance and visual function of patients. Trans-orbital craniocerebral foreign bodies can cause severe complications such as craniocerebral injury and intracranial infection. The Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association has formed the expert consensus on tissue injury, imaging examinations, diagnosis and treatment of orbital foreign bodies, hoping to provide the reference for clinical work and to standardize and improve the diagnosis and treatment of intraorbital foreign bodies. (Chin J Ophthalmol, 2021, 57: 743-748)

To investigate the longitudinal epidemiological characteristics of myopia in primary school students from grade one to grade three in Hubei province, and to analyze the main factors affecting the occurrence and development of myopia, so as to provide the direction and theoretical basis for the prevention and control of myopia in children and adolescents.

Longitudinal study. A total of 13, 244 primary school students from grade one to grade three in 17 prefectures and forest districts of Hubei province were included in the study by means of random stratified cluster sampling. Among them, there were 7, 331 boys and 5, 913 girls with an age of (7.7±1.0) years. The same group of students were followed up for two years from October 2017 to October 2019 to complete three data collections. All included subjects underwent visual acuity examination, which required further automatic computer optometry after using cyclopentolate hydrochloride eye drops if the visual acuity was less than 1.0. In the questionnaire, the general situation and eye behavior of the included subjects were collected. The Chi-square test was used to compare the prevalence of myopia among different genders,different reproductive history and grades. The Kruskal-Wallis H test was used to compare the difference in the mean spherical equivalent refraction, and logistic regression was used to analyze the influencing factors of myopia.

The prevalence of myopia was 23.10% at baseline in 2017, 28.67% after one year′s follow-up and 33.26% after two years′ follow-up among primary school students in grade one to grade three in Hubei province. The overall prevalence of myopia increased with time (χ²=307.47, P<0.05). It also increased with the increase of grades. After two years of follow-up, the myopia rate of students in grades one through three was 25.62%, 35.07% and 41.05%, respectively (χ²=200.98, P<0.05). In 2017, the prevalence of myopia was 21.62% in boys and 24.93% in girls, and it increased to 31.20% and 35.69% after 2 years of follow-up, respectively. Both the prevalence of myopia and the spherical equivalent refraction were higher in girls than in boys. Moreover, myopia was associated with parents′ myopia (OR=1.17), less time for outdoor activities (OR=1.06), no rest after half an hour′s study (OR=1.18), more time for daily exposure to electronic products (OR=1.07), longer time for extracurricular study (OR=1.09), and higher grades (OR=1.78). Children whose parents were more myopic and who ate sweets and fizzy drinks more often had greater levels of myopia.

Myopia occurs early in primary school students of grade one to grade three in Hubei province and increases rapidly. More attention should be paid to good habits for eyes, regular screening, outdoor activities and girls. (Chin J Ophthalmol, 2021, 57: 749-756)

To estimate the prevalence of uncorrected refractive errors among people aged 50 years and above in Funing county, Jiangsu province.

Randomly cluster sampling was used in selecting individuals aged ≥50 years in 82 clusters from Funing County Center for Disease Prevention and Control. Uncorrected refractive error was defined as an improvement of at least 2 lines in best corrected visual acuity compared with presenting visual acuity in the better eye. The mean±standard deviation was used to describe the continuous data, and the rate or composition ratio was used to represent the classified data. Univariate and multivariate logistic regression analyses were used to analyze the prevalence of uncorrected refractive errors in different ages, genders, educational levels, durations of diabetes and levels of glycosylated hemoglobin. Statistical significance was defined as P<0.05.

A total of 2 067 persons were enumerated, and 1910 (92.4%) participants were in the statistical analyses. The prevalence of uncorrected refractive error was 25.63%. The prevalence of uncorrected refractive error for myopia only, hyperopia only, astigmatism only, myopia with astigmatism and hyperopia with astigmatism was 72.55% (37/51), 46.77% (58/124), 17.81% (13/73), 63.95% (94/147) and 51.98% (100/194), respectively. The results showed that the older age, level of glycosylated hemoglobin, myopia and lens state were the independent influencing factors of uncorrected refractive error. The odds ratio (OR) for people aged 70 to<80 years and ≥80 years was 1.81 and 1.90, respectively, with statistical significance compared to people younger than 60 years. Compared with the level of glycosylated hemoglobin less than 5.6%, theOR with glycosylated hemoglobin from7.1% to 8.0% and more than 10% was 1.84 (P<0.05) and 1.82 (P<0.05), respectively. The OR of myopia, low myopia, moderate myopia and high myopia was 2.98 (P<0.01), 6.94 (P<0.01), 42.43 (P<0.01) and 77.85 (P<0.01), respectively. The OR of opacity of the eye lens was 7.60 (P<0.01).

Uncorrected refractive error is one of the important causes of visual impairment in diabetic patients aged 50 and above in Funing county, Jiangsu province; the important influencing factors were age, glycosylated hemoglobin concentration, myopia and lens status. Relevant health departments should popularize the eye health for diabetic patients and conduct regular optometry and fundus examination. (Chin J Ophthalmol, 2021, 57: 757-765)

To determine the 2-year visual prognosis in Chinese type 2 diabetic patients with mild visual impairment and identify the predictors factors.

This was a 2-year population-based cohort study. The study population consisted of 650 type 2 diabetic patients with bilateral mild visual impairment in 2014 who were followed up in 2016. The demographic information, systemic and ophthalmological examination results for each participant was collected. Mild visual impairment was defined as best-corrected visual acuity (BCVA)<20/25 to ≥20/63, moderate and severe visual impairment was defined as BCVA<20/63 to ≥20/400, blindness was defined as BCVA<20/400 following the International Council of Ophthalmology (ICO) 2002 definition. The two-year visual prognosis was divided into three groups: visual impairment regression, progression, and stable. Using chi-square test or independentt-test, the predictor factors of visual prognosis and the leading causes of visual impairment were studied.

605 patients completed the follow-up in 2016. Among them, 477 were still bilateral mild visual impairment, accounting for 78.8% (477/605). The level of unilateral or bilateral visual impairment regressed in 8.1% (49/605), while progressed in 13.1% (79/605). Young age (t=2.7, P<0.05), short duration of diabetes (t=2.5, P<0.05), low blood glycemic hemoglobin (t=2.5, P<0.05) and total cholesterol (t=2.8, P<0.05) were associated with regression of visual impairment. Low levels of education (t=5.2, P<0.05), high blood glycemic hemoglobin (t=2.4, P<0.05) and total cholesterol (t=2.4, P<0.05)were associated with progression of visual impairment. Cataracts and diabetic retinopathy were the first and second cause of mild, moderate severe visual impairment or blindness.

The percentage of 2-year visual acuity decline is relatively high in type 2 diabetic patients with mild visual impairment. We should strengthen blood glucose and cholesterol control to reduce the progress of visual impairment.(Chin J Ophthalmol, 2021, 57: 766-771)

To investigate the influencing factors of refractive status of preschool children in Changdu, Tibet.

From July 2020 to October 2020, a cross-section investigation was performed among preschool children in Changdu, Tibet. The general information was collected, and the uncorrected refractive status was recorded and investigated. The measurement data were expressed by mean±standard deviation, and the t-test and χ² test were used for univariate analysis. The questionnaire of factors influencing children′s visual acuity was distributed to the parents of the children. The independent variables included height, weight, nutritional status, parents′ eyesight, sleeping time and habits that were bad for eyes. Multivariate logistic regression analysis was used to explore the influencing factors of refractive status, including age and gender.

A total of 2 793 children were screened, among whom 2 646 (98.64%) children including 1 501 males and 1 145 females were inhabitants in the plateau region. The average age was (4.52±0.97) years. Refractive abnormalities were found in 253 children (9.56%). The detection rate of refractive abnormalities increased with age. There was no significant difference between males and females (χ²=1.79, P>0.05). The total abnormal refraction rate of preschoolers was lower in the plateau region than the non-plateau region (χ²=13.93, P<0.05). The parental refractive status (OR=0.06, 95%CI: 0.04-0.08) and nutritional factors (OR=0.11, 95%CI: 0.04-0.25) had higher correlations with the refractive abnormalities of preschoolers.

The rate of refractive abnormalities of preschool children was relatively low in Changdu, Tibet. One of the effective measures to prevent ametropia in the plateau area can be balanced nutrition. (Chin J Ophthalmol, 2021, 57: 772-776)

To explore the incidence and age distribution of fundus abnormalities in pediatric patients aged 0-3 years in northwest China.

A retrospective study of the clinical data of 8808 pediatric patients aged 0-3 years who underwent fundus examination with a wide-filed digital retinal imaging system and an indirect ophthalmoscope in our hospital from January 2008 to December 2019 were performed. There were 5092 males and 3716 females, with a median age of 1 month (range, 3 days to 3 years), a mean gestational age of 34.32 (SD 2.92) weeks (range, 24 to 42 weeks) and a mean birth weight of 2006.92 (SD 709.23) g (range, 490 to 5500 g), from Shaanxi Province (7415 cases, 84.18%), Gansu Province (770 cases, 8.74%), Ningxia Hui Autonomous Region (94 cases, 1.07%), Qinghai Province (53 cases, 0.60%), Xinjiang Uygur Autonomous Region (14 cases, 0.16%) and other neighboring areas (462 cases, 5.25%). The fundus condition of the enrolled pediatric patients was documented to calculate the annual detection rate. The joinpoint regression model was drawn to estimate the annual percent change and average annual percent change. The constituent ratios and age distribution of different types of fundus abnormalities were finally analyzed.

Fundus abnormalities were detected in 2 531 cases (28.74%). During the 12 years, the number of pediatric patients undergoing fundus examination each year in our center increased rapidly in the first 7 years, and then kept almost stable, while the number of fundus abnormality cases increased year by year. The positive detection rate showed an overall upward trend with an average annual percent change of +7.2%, and it was +30.09% from 2016 to 2019. Among all the pediatric patients with fundus abnormalities, there were 1 678 cases with developmental diseases (66.30%), 232 cases with hereditary diseases (9.16%), 140 cases with ocular tumor (5.53%), 64 cases with ophthalmic manifestations of systemic diseases (2.53%), 31 cases with ocular trauma (1.23%), 12 cases with infectious diseases or inflammation (0.48%) and 438 cases with other ocular abnormalities (17.31%). The top 5 abnormalities were retinopathy of prematurity (ROP; 1477 cases, 58.36%), gray patchy retinopathy (225 cases, 8.89%), retinal hemorrhage (157 cases, 6.20%), retinoblastoma (137 cases, 5.41%) and familial exudative vitreoretinopathy (77 cases, 3.04%). Fundus abnormalities varied with age. ROP, developmental diseases other than ROP, hereditary diseases, ocular trauma and infectious diseases were mostly detected in pediatric patients at 0-6 months old, while tumors were mostly detected after 1 year old.

The detection rate of fundus abnormalities in the Department of Ophthalmology of Xijing Hospital of Air Force Medical University, a tertiary referral center in northwest China, increased notably year by year. The abnormalities were mainly developmental and hereditary lesions as well as of certain age distribution. They occurred with the highest frequency between birth and 6 months of age, in which ROP was in the ascendancy. Meanwhile, the detection rate of other developmental, hereditary and neoplastic disorders increased with age. Therefore, a comprehensive and objective understanding of the fundus disease in infants is essential. (Chin J Ophthalmol, 2021, 57: 777-783)

The case is presented on a 33-year-old woman with sudden vision loss for more than 20 days without a history of steroid use either locally or systemically. There was a history of connective tissue disease. The fundus fluorescein angiogram and optical coherence tomography showed multiple central serous chorioretinopathy (CSC) complicated by exudative retinal detachment (ERD). Meanwhile, the computed tomography of the adrenal suggested an adrenal adenoma. After complete tumor resection, the visual and anatomical functions of this patient have been significantly improved. Moreover, recurrence of CSC complicated by ERD was not observed during 9 months clinical follow-up after surgery. (Chin J Ophthalmol, 2021, 57: 784-786)

A female patient with totally white hair and pink skin had gradual visual loss to hand motion in the right eye within one year. Upon her visit to the Department of Ophthalmology, she was found to have a totally white cataract and a family history of intermarriage, and was finally diagnosed with oculocutaneous albinism and complicated cataract in the right eye. The best corrected visual acuity of her right eye increased to 0.15 at 6 months after phacoemulsification and intraocular lens implantation. Clear choroidal vessels could be seen in the ultra-widefield color fundus image and autofluorescence image. No macular fovea structure was found on optical coherence tomography of the fundus. (Chin J Ophthalmol, 2021, 57: 787-790)

In recent years, the application of Mendelian randomization has become more and more widely in the world. By taking genes as instrumental variables, it can eliminate the interference of confounding factors and reverse causality in the system, and effectively judge the causal correlation between exposure factors and outcomes, which has a unique advantage for etiological exploration in the medical field. This article reviews the application of Mendelian randomization in ophthalmology and provides new ideas for the development of correlational and causal studies in Ophthalmology. (Chin J Ophthalmol, 2021, 57: 791-795)

Artificial intelligence (AI) has made important progress in image recognition and disease prognosis prediction in recent years. Along with the development of computer technology, the application scope of AI in the field of ophthalmology is expanding. Keratoconus screening is an important means to determine the indication of refractive surgery and avoid postoperative corneal ectasia, but the accuracy of traditional diagnostic methods is low, especially for subclinical keratoconus. Machine learning, a method to realize artificial intelligence, makes it possible to improve the accuracy of keratoconus screening, and has become a hotspot in the field of refractive surgery recently. The review has clarified the algorithms commonly used in keratoconus screening for refractive surgery, the extraction of corneal features, and the accuracy of model prediction.(Chin J Ophthalmol, 2021, 57: 796-800)