Effectiveness and Safety of Auricular Acupressure Combined with Periocular Thumbtack Needle Therapy for Premyopic Children: A Multicenter, Randomized, Controlled Trial.

To compare the efficacy of bandage contact lenses with two different base curves in promoting epithelial healing after epithelial laser in situ keratomileusis (epi-LASIK). A prospective, observer-masked study was conducted in 27 patients. Each patient randomly received one bandage contact lens with an 8.4-mm base curve in one eye and one with an 8.8-mm base curve in the fellow eye. Corneal epithelial status, pain score, spherical equivalent, and uncorrected visual acuity (UCVA) were examined during the first postoperative month. Corneal epithelial status, postoperative pain, and spherical equivalent were similar for both lenses during the first postoperative month. The eyes with lenses with an 8.8-mm base curve had better UCVA on postoperative day (POD) 4, but there was no significant difference in UCVA after POD 7. In the patients with preoperative low to moderate myopia and low keratometric values (<43.0 D), there was no significant difference in the postoperative UCVA between the lenses. On the other hand, in patients with preoperative high myopia and high keratometric values (> or =43.0 D), UCVA was better in eyes with lenses with an 8.8-mm base curve on POD 4. These findings suggest that the base curves of bandage contact lenses affect visual rehabilitation after epi-LASIK, particularly in patients with a steep cornea and high myopia.

Comparison of Epi-LASIK and Off-Flap Epi-LASIK for the Treatment of Low and Moderate Myopia

Objective Investigating whether the effect of long-term wearing orthokeratology on cornea is completely reversible or not and its myopia control effect. Methods This was a prospective cohort study. Fifty-five adolescent (110 eyes) wearing orthokeratology and 55 adolescent (110 eyes) wearing full correction single vision(SV) spectacles were collected. After 2 years' wearing, orthokeratology group stop wearing at least 30 days before re-examination. Spherical equivalent (SE) and axial length(AL) of SV spectacles group were tested before trial and 2 years later. SE, AL, astigmatism, SimK, corneal horizontal and vertical refractive power (corneal k value), uncorrected visual acuity(UCVA), etc. were recorded in orthokeratology group before trial and 2 years later. Data were analyzed using paired and independent t test, repeated measurement ANOVA, and Pearson correlation regression analysis. Results Forty-six cases (92 eyes) and 43 cases (86 eyes) finished the trial in SV and orthokeratology group, respectively. Two years later, SE and axial length increased -1.68±0.84 D, 0.59±0.48 mm in SV spectacles group and -0.80±1.04 D, 0.37±0.34 mm in orthokeratology group, respectively, there were significant difference between the two groups (t= 25.81, 20.13, P<0.01). For orthokeratology group, there are some increase in astigmatism and SimK, 0.30 ± 0.24 D and 0.28 ± 0.22 D respectively (t=5.83, 5.45, P<0.05), in corneal horizontal refractive power reducted (0.31 ± 0.18 D, t=7.43, P<0.05). There was a significant difference in UCVA at different time points before and after wearing orthokeratology, and the UCVA was significantly improved after wearing orthokeratology (F=250.80, P<0.01). Conclusion Wearing orthokeratology could significantly improve the UCVA of myopia patients, and control the progression of adolescent myopia. But Long-term wearing may result in slight increase in astigmatism, slight reduction in corneal horizontal K, this indicates that the effect of orthokeratology may not be completely reversible. Key words: Orthokeratology; Myopia; Reversible; Corneal refractive power

Obiective To observe the therapeutic effect of iris-claw phakic intraocular lens(IC-PIOL) and angle-supported phakic intraocular lens (AS-PIOL) implantation for correction of high myopia,and investigate the efficacy, safety and complications of the two lenses. Methods 35 myopic eyes of 23 patients with spherical equivalent(SE) (-9.38～-24.13) D was implanted with the Verisyse IC-PIOL (IC-PIOL group), 31 myopic eyes of 22 patients with SE (-9.88～-22.25)D was implanted with the Phakic 6H AS-PIOL(AS-PIOL group). The follow-up period was 18 months. All of the treated eyes were observed for uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),manifest refraction,intraocular pressure,corneal endothelial cell and complications preoperatively and postoperatively. Results There is no significant difference in UCVA,BCVA,SE and astigmatism between the IC-PIOL group and AS-PIOL group preoperatively. Compared with preoperative data, UCVA, BCVA and SE of the two groups were improved significantly, furthermore there is no significant change from 7d to 18months among the groups. At 18-months, the data of IC-PIOL group and AS-PIOL group were as follows,the safety index (SI) was 1.018±0.017 and 1.019±0.022,the efficacy index (EI) was 0.983±0.024 and 0.979±0.036,and there is no significant difference in SI and EI between the two groups; the corneal endothelial cell loss rate was 4.41% and 4.46%, and there is no significant difference between preoperatively and postoperatively. Pupil block: 1 eye and 1 eye, pupil size abnormality: 8 eyes (under medical mydriasis) and 4 eyes ,IOL position abnormality: 2 eye and 3 eyes,halos or glare: 2 eyes and 8 eyes. NO other severe complications occurred. Conclusions During 18 months follow-up period, the implantation of the IC-PIOL and AS-PIOL proved to be safe and effective for the correction of high myopia in phakic eyes. However, longer follow-up period with larger numbers of patients is necessary to evaluate long-term efficacy, safety and complications. Key words: Lenses, Intraocular; Myopia; Complications

Objective To compare early visual outcomes of SmartPulse Technology (SPT)-assisted transepithelial photorefractive keratectomy (TPRK) or femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) with that of traditional TPRK/FS-LASIK. Methods This was a retrospective comparative study of two main groups, a surface surgery group and a stromal surgery group. The surface surgery group included two subgroups: an SPT-TPRK group consisting of 36 eyes of 19 patients and a TPRK group consisting of 40 eyes of 21 patients. All patients were followed up on the 3rd day, 10th day, 1st month and 3rd month after surgery and uncorrected visual acuity (UCVA) was measured and recorded. The stromal surgery group included two subgroups: an SPT-FS-LASIK group consisting of 49 eyes of 25 patients and a FS-LASIK group consisting of 48 eyes of 24 patients. All patients were followed up on the 1st day, 10th day, 1st month, and 3rd month after surgery, and UCVA was measured and recorded. Topography was performed before surgery and on the 1st month and 3rd month after surgery in all patients. Statistical analysis included repeated measures ANOVA, χ2 test and independent t-test. Results There were no significant differences between the SPT-TPRK group and TPRK group in age, spherical equivalent, best corrected visual acuity or central corneal thickness before surgery, nor were there any significant differences between the SPT-FS-LASIK group and FS-LASIK group in the pre-operative examinations. There were no significant differences in post-operative UCVA between the TPRK and SPT-TPRK groups at any time point after surgery. However, there was a significant difference in UCVA between the SPT-FS-LASIK group and FS-LASIK group (F=12.067, P<0.01) on the 1st day and 10th day (P<0.05) after surgery with better acuity results in the SPT-FS-LASIK group. But there was no significant difference in post-operative visual outcomes between these two groups on the 1st and 3rd months. The surface regularity index (SRI) of the SPT-FS-LASIK group on the 1st month was significantly lower than that of the FS-LASIK group (t=2.95, P<0.01). Conclusion SPT-FS-LASIK tends to provide better UCVA than traditional FS-LASIK during the early days after surgery. Key words: Myopia; Refractive surgical procedures; Keratomileusis, laser in situ; Femtosecond laser; Transepithelial photorefractive keratectomy

Comparative evaluation of 'flap on' and 'flap off' techniques of Epi-LASIK in low-to-moderate myopia. Sixteen eyes of eight consecutive patients with myopia < or = 6 D were selected for this prospective, randomized, comparative, interventional case series. Epi-LASIK surgery was performed in all eyes. In one eye of each patient, the epithelial flap was retained after excimer laser ablation (flap on). In the fellow eye, the epithelial flap was discarded (flap off) after ablation. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SEQ), postoperative pain score, time to epithelization, and corneal haze were recorded on postoperative visits. The mean preoperative SEQ in the two groups was -3.61+/-1.32 D (flap on) and -3.49+/-1.86 D (flap off; P=0.752). The mean follow-up period was 8.5+/-4.9 months. The mean pain score was comparable on all postoperative days except the second postoperative day when the group with flap off had a lesser mean pain score (P=0.053).Time for epithelial healing was 3.63+/-0.52 days in cases with flap off and 4.13+/-0.64 days in cases with flap on (P=0.113). Eyes with flap off had a better UCVA on the first postoperative day (0.19+/-0.11 logMAR) compared with eyes with flap on (0.41+/-0.28 logMAR; P=0.032). There was no significant difference in UCVA, BSCVA, SEQ, contrast sensitivity, corneal haze, and higher order aberrations at any other postoperative visit. There is no difference between flap on and flap off techniques of Epi-LASIK with regards to overall outcome of surgery.

Objective To evaluate the clinical efficacy of the combined application of 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction in the treatment of neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) combined with vitreous hemorrhage (VH). Methods Eighty-three patients (91 eyes) with PDR diagnosed as NVG phase III complicated with VH from June 2018 to May 2020 were selected as the study subjects. The subjects were randomly divided into 3 groups: group A was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation; group B was given 23G minimally invasive vitrectomy combined with phacoemulsification cataract extraction; and group C was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation and phacoemulsification cataract extraction. The uncorrected visual acuity (UCVA), intraocular pressure (IOP), and iris neovascularization (INV) scores were recorded and compared among the 3 groups before and after operation, and then the postoperative pain relief and complications were observed. Results Through observation, there was no significant difference in the UCVA, IOP, and INV scores in the 3 groups before operation. After the operation, the UCVA, IOP, and INV scores of the 3 groups were significantly lower than those before operation. After operation, the UCVA of the 3 groups increased first and then decreased, and it improved most significantly in the 3rd month after operation and decreased in the 4th month after operation. There were significant differences in UCVA among the 3 groups at each time point after operation. From the 1st day to the 6th month after operation, the IOP of the 3 groups showed an upward trend, and there was no significant difference among the 3 groups in IOP at each time point after operation. At the 1st, 3rd, and 6th months after operation, the INV score of group A and group B was higher than that of group C. There was no significant difference in the INV score between group A and group B. The incidence of complications was not significantly different among the 3 groups. Conclusion 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction can effectively improve the UCVA, IOP, and INV scores of NVG secondary to PDR with VH, and the combined application of the 3 methods has better security.

Objective: To study the safety and efficacy of topography-guided customized excimer laser subepithelial ablation combined with accelerated collagen cross-linking technique in treatment of early keratoconus. Methods: Ninteen patients(20 eyes) (13 males 14 eyes, and 6 females 6 eyes), aged 12 to 44 years (24.7±8.0) were diagnosed as keratoconus by three-dimensional corneal topography and tomography, clinical history and examinations, and classified as KC1~KC3. Based on the classical excimer laser subepithelial keratomileusis (LASEK) method, topography guided laser ablation was performed with an excimer laser system (WaveLight EX500). After laser ablation, the corneal stromal bed was immersed with 0.1% riboflavin for 10 minutes, and then was irradiated by ultraviolet light (Avedro KXL) at 30 mW/cm(2) for 4 minutes. All the patients were followed up for more than 12 months. The uncorrected visual acuity (UCVA), diopter, best corrected visual acuity (BSCVA), corneal topography, central corneal endothelial cell density (ECD), hexagonal cell percentage (HEX), coefficient of variation (CV) and other indicators were observed. For normal distribution variables, Dunnett-t test was used before and after operation, and Wilcoxon test was used for variables with abnormal distribution. And the complications were recorded. Results: There was no loss of BSCVA at 12 months postoperatively, 20% of the eyes had no change of BSCVA, and 15% of the eyes gained 1 line of BSCVA, 15% of the eyes gained 2 lines of BSCVA, 50% of the eyes gained 3 lines and more of BSCVA. There was no significant difference in UCVA, BSCVA, manifest refractive spherical equivalent (MRSE) and the cylinder at 3 months postoperatively (P>0.05). The BSCVA were significantly improved at 6 and 12 months postoperatively compared with those before operation (t=3.095, 3.079, <0.05). Although there was no significant difference in UCVA and MRSE, the cylinder was significantly reduced at 6 and 12 months postoperatively (t=-2.890, -2.435, P<0.05). Apex curvature (Kapex) and mean pupil power (MPP) within 4.5mm of central cornea decreased significantly (Z=-2.903, P<0.01; Z=-2.667, P<0.01). Even though the thinnest corneal thickness decreased from pre-operational (461.9±31.1) μm to post-operational (416.6±27.0) μm (Z=-3.059, P<0.01), the cornea became regular with keratometric asymmetry index of anterior corneal surface decreased (Z=-2.667, P<0.01). The corneal optical quality parameters were improved. There was no significant difference in ECD, HEX and CV at 12 months postoperatively (P>0.05). Twelve months after operation, grade 0, 0.5, 1 and 2 haze were seen on 20%, 55%, 20% and 5% corneas respectively. Conclusions: The topography guided excimer laser ablation combined with accelerated corneal collagen cross linking is safe and effective in treatment of early stage keratoconus. It can significantly improve corneal regularity while preventing keratoconus progression, so as to improve the best corrected visual acuity postoperatively. (Chin J Ophthalmol, 2019, 55: 904-910).

BackgroundTo evaluate the stability and predictive ability of uncorrected visual acuity (UCVA), non-cycloplegic refraction (NCR), and axial length (AL) as indicators in non-cycloplegic school vision screening for myopia.MethodsThis retrospective cohort study is based on the Shanghai Child and Adolescent Large-scale Eye Study (SCALE). Participants included students who failed school screenings and were referred for follow-up cycloplegic refractions at eye hospitals within three months. We evaluated the differences in UCVA, spherical equivalent (SE), and AL between school screenings and hospital re-evaluations. Furthermore, we assessed the validity of using UCVA in combination with NCR as predictive metrics for myopia referral.ResultsAmong the 8,492 children, 4,357 (51.3%) were boys, with a mean age of 8.26 years (SD = 2.77). AL was identified as a reliable myopia screening indicator across all age groups (ICC = 0.981; 95% CI: 0.978–0.984), outperforming UCVA (ICC = 0.791) and SE (ICC = 0.806). The estimated prevalence of myopia using UCVA and NCR was 76.10%, significantly higher than 58.37% observed with cycloplegic testing. Sensitivity was 96.93% and specificity was 53.13% (Youden index = 0.5). In preschoolers, myopia rates decreased from 50.17% before to 19.82% after cycloplegia, while school-aged children exhibited better consistency. Decision curve analysis showed that the full model incorporating AL did not significantly benefit school-aged children, but may offer greater net benefits for preschoolers.ConclusionsAL should be integrated into screening programs for preschoolers. For school-aged children, the combination of UCVA and NCR suffices for myopia prediction, potentially eliminating the need for cycloplegia.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04383-3.

Objective To evaluate the effect and safety of femtosecond laser assisted LASIK (FS-LASIK) in the treatment of ultra-high myopia , and to evaluate the efficacy and safety of different times after the operation. Methods The clinical data of 106 patients (211 eyes) with ultra-high myopia who were followed up for more than 1 year, was conducted between January 2013 and January 2016 in Hospital of Shanxi Province. Among them, there were 50 males (100 eyes) and 56 females (111 eyes). Age from17 to 43, average (24.09±5.32) years old. Routine ophthalmologic examinations were performed before and after surgery at 1 month, 3 months, 6 months and 1 year. Routine visual acuity was performed before surgery, including uncorrected visual acuity (UCVA) and corrected visual acuity (BCVA). The visual acuity records were indicated by the logMAR. The range of refraction, including balloon, column, and equivalent spherical lenses were examined. Exclusion of anterior segment disease, using non-contact tonometer, using binocular indirect ophthalmoscope after mydriasis fundus examination, using phoropter, using corneal topography exam and corneal shape by AB ultrasound scanning and biological measurement of corneal thickness and axial length by slit lamp microscope examination. The cornea was cut by femtosecond laser system and excimer laser. UCVA, BCVA, safety index, effective index and diopter were examined at different time after operation. Validity index=postoperative UCVA/preoperative BCVA, safety index=postoperative BCVA/preoperative BCVA. The visual acuity, safety index, effective index and diopter before and after the operation were indicated by mean ± standard deviation(±s). The overall difference between the indexes at different time points before and after the operation was compared by single factor repeated measures analysis of variance, and the multiple comparisons in the group were checked by LSD-t test. The comparison of refraction regression at different time points after operation was performed by chi square test. Results There were significant differences in UCVA at different time points before and after operation (Ftime=2767.01, P 0.05). There were significant differences in refractive regression at different time points (χ2=13.69, P<0.05). Conclusions FS-LASIK are effective in the treatment of ultra-high myopia. UCVA at each time point after 1 year was better than preoperative BCVA. With the increase of time, refractive regurgitation rate increased, after 1 year to reach 7.58%. Key words: Femtosecond laser; Laser in situ keratomileusis; Ultra-high myopia

Purpose To investigate the change and recovery of choroid thickness after short-term application of 1% atropine gel and its influencing factors in 6-7-year-old children. Materials and Methods 71 right eyes of 71 children were enrolled and divided into myopia and control group. 1% atropine gel was administered twice a day for one week and then stopped. Spherical equivalent (SE), accommodative amplitude (AA), keratometry (K), axial length (AL), and choroidal thickness (CT) were obtained at baseline and 1st, 4th, and 8th weeks. CT was measured at subfovea and 1 mm, 2 mm, and 3 mm temporal, superior, nasal, and inferior from the fovea using spectral-domain optical coherence tomography. Results In both groups, all CTs increased following the change in SE, AA, and AL after administration of 1% atropine for one week. They gradually recovered to baseline levels seven weeks after withdrawal. The change (Δ) in CT at 3 mm superior from the fovea was significantly higher in the myopia group than in the control group. In both groups, ΔCT at subfovea had no significant correlation with SE, AA, and AL, both at baseline and one week. However, ΔCT at subfovea was negatively correlated with ΔAL in the control group. Conclusions One-week application of 1% atropine gel may increase CT in 6-7-year-old Chinese children. Meanwhile, the recovery process after withdrawal lasts seven weeks. During the recovery process, the changes in structural parameters (AL, CT) and functional parameters (AA, SE) in both groups occurred synchronously. The SE, AA, and AL at baseline may not predict the extent of atropine’s effect on CT.

Objectives: To identify the effect of alternating monocular instillation (AMI) of 0.125% atropine in Korean children with progressive myopia. Methods: This retrospective single-center study included 120 children with progressive myopia. A total of 60 children (mean age 9.2 ± 2.0 years) wearing glasses who received AMI of 0.125% atropine for one year were allocated to the treatment group. The remaining 60 children (mean age 9.2 ± 1.9 years) with the same refraction, SE, and axial length (AL) who did not receive any treatments except for wearing glasses were allocated to the control group. Ocular findings and the progression rate were compared between the groups pre- and post-treatment, and adverse events were investigated in the treatment group. Results: The mean spherical equivalent (SE) at baseline was -3.87 ± 1.55 D in the control group and -3.90 ± 1.56 D in the treatment group. Pre-treatment SE, age, and AL were similar between the groups; however, post-treatment SE and AL changes were smaller in the treatment group (-0.36 ± 0.46 D/y, 0.21 ± 0.20 mm/year in the treatment group vs. -1.02 ± 0.57 D/y, 0.51 ± 0.20 mm/year in the control group) (Ps < 0.001). The pre-treatment progression rate diminished in the treatment group compared to the control group after one year (p < 0.001), and the changes in pupil size under mesopic and photopic conditions in the treatment group increased by 0.03 ± 0.05 mm and 0.76 ± 0.90 mm, respectively. Regarding adverse events, a tingling sensation was noted in two patients (3.3%) in the treatment group. Conclusions: Alternating monocular 0.125% atropine eye drop instillation may be effective and suitable for progressive myopia in Korean children.

To analyze the distribution of refractive status in school-age children with different corneal curvatures (CC) and the correlation between CC and refractive status. A total of 2214 school-aged children of grade 4 in Hangzhou who were screened for school myopia were included. Uncorrected distance visual acuity (UCDVA), non-cycloplegic refraction, axial length (AL), horizontal and vertical corneal curvature (K1, K2) were measured and spherical equivalent (SE), corneal curvature radius (CCR) and axial length/corneal radius of curvature ratio (AL/CR) were calculated. UCDVA<5.0 and SE≤-0.50 D were classified as school-screening myopia. According to the different CCRs, the patients were divided into the lower corneal curvature (LCC) group (CCR≥7.92) and the higher corneal curvature (HCC) group (CCR<7.92). Each group was further divided into the normal AL subgroup and the long AL subgroup. The refractive parameters were compared to identify any differences between the two groups. Both SE and AL were greater in the LCC group (P=0.013, P<0.001). The prevalence of myopia was 38% in the LCC group and 44% in the HCC group (P<0.001). The proportion of children without screening myopia was higher in the LCC group (62%) than in the HCC group (56%). Among these children without screening myopia, the proportion of long AL in the LCC group (24%) was significantly higher than that in the HCC group (0.012%; P<0.001). The change of SE in the LCC group was less affected by the increase of AL than that in the HCC group. School-aged children in the LCC group have a lower incidence of screening myopia and longer AL. Low CC can mask SE reduction and AL growth to some extent, and the change of AL growth change more in children with low CC than high CC. Before the onset of myopia, its growth rate is even faster than that after the onset of myopia.

Clinical results of laser in situ keratomileusis with superior and nasal hinges

At completion of transepithelial photorefractive keratectomy (t-PRK) surgery, the eye is usually fitted with a bandage contact lens to reduce discomfort and promote epithelial healing. This study aimed to compare the outcomes of eyes fitted with lotrafilcon B versus comfilcon A, silicone hydrogel bandage contact lenses after t-PRK for the correction of low to moderate myopia, with or without astigmatism. In this comparative, prospective study, patients with myopia < -6 D with or without astigmatism (< 1.75 D), who underwent t-PRK between January and June 2018, were randomly allocated to the lotrafilcon B and comfilcon A groups. Preoperative characteristics, including age, sex, eye treated, uncorrected visual acuity (UCVA), best-corrected visual acuity, mesopic pupil size, central corneal thickness, and refractive error were recorded. Postoperatively, pain score, UCVA, and corneal epithelial defect size on days 1, 4, and 7 were compared between the two groups. Twenty-nine eyes were included in each group. Demographic characteristics and preoperative measurements were similar between the two groups. UCVA was significantly improved on day 7 as compared to day 1 in the comfilcon A group (P = 0.03), but remained the same in the lotrafilcon B group (P = 0.70) as on day 1 postoperatively. There was no significant difference in UCVA between the two groups at any follow-up visits (all P > 0.05). The pain score on the first postoperative day was significantly higher in the lotrafilcon B-fitted eyes than in the comfilcon A group (P < 0.001), but was significantly reduced in both groups compared to day 1 (both P < 0.001). The epithelial defect in the comfilcon A group was significantly greater than in the lotrafilcon B group (P < 0.001) at day 1 postoperatively, with significant improvement in both groups (both P < 0.001). Healing responses were better with lotrafilcon B than with comfilcon A bandage contact lenses. The patients had a greater mean pain score with lotrafilcon B than with comfilcon A lenses on the first postoperative day, yet the final outcome was comparable between the two groups. We did not encounter any postoperative complications related to contact lens wear.