Objective: To investigate the effect of corneal diameter on Belin/Ambrósio enhanced ectasia display (BAD). Methods: 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. Results: 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). Conclusions: 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).

Ocular tumors include intraocular tumors and tumors of the eyelid, orbit, conjunctiva and lacrimal apparatus. After seventy years of continued growth, ocular oncology in China, from small to large and from weak to strong, has made great achievements. Especially since the beginning of the new century, there has been all-round and rapid development. The mechanism of ocular tumorigenesis has been elucidated based on the biobank and animal models. New therapeutic techniques and treatment modalities have been established based on multi-center cohort studies. The team competence and the discipline level have been improved based on academic organization constructions and international exchanges. Looking into the future, ocular oncology in China will move on in gene detection and early diagnosis, basic research and drug targeting, interdisciplinary, intelligent diagnosis and treatment, clinical research and translational medicine, with the support of national strategies and scientific and technological innovation, to further improve the survival rate, the ocular salvage rate and the quality of life for patients with ocular tumors. This article is written to congratulate the Chinese Journal of Ophthalmology on the 70th anniversary of its publication. (Chin J Ophthalmol, 2020, 56: 646-652).

Objective: To investigate the prevalence, causes and risk factors of moderate or severe visual impairment and blindness in people with type 2 diabetes over 50 years old in Funing County, Yancheng. Methods: This is a cross-sectional study. Using cluster random sampling, 84 survey sites were selected, and eye examination was performed on people with type 2 diabetes over 50 years old who were registered with the chronic disease information center of Funing County Center for Disease Control and Prevention in Yancheng, Jiangsu. The prevalence of moderate or severe visual impairment and blindness were calculated by different ages and genders. The causes of blindness and visual impairment were determined, and their influencing factors were analyzed by univariate and multivarite logistic regression. Results: A total of 2 067 people were investigated in this study, and 1 909 people were included. The response rate was 92.4%. Based on PVA, the prevalence of blindness and moderate to severe visual impairment was 5.29% (95%CI: 4.29%-6.30%) and 18.54% (95%CI: 16.80%-20.29%). The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, systolic blood pressure and nuclear opacity. The prevalence of moderate or severe visual impairment was related to age, gender, educational level, diabetes treatment, exercise, and glycated hemoglobin. The prevalence of blindness and moderate to severe visual impairment was 3.67% (95%CI: 2.82%-4.51%) and 9.80% (95%CI: 8.46%-11.13%) based on BCVA. The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, exercise and systolic blood pressure, while the prevalence of moderate or severe visual impairment was related to age, educational level, diabetes treatment and nuclear opacity. The primary cause of blindness and visual impairment is cataract, followed by diabetic retinopathy. Conclusions: The prevalence of moderate or severe visual impairment and blindness in people with type 2 diabetes in Funing County is relatively high. Attention should be paid to the prevention of blindness in this population. (Chin J Ophthalmol, 2020, 56: 593-599).

The Boston Keratoprosthesis (KPro) is one of several types of artificial cornea manufactured worldwide that are being implanted in increasing numbers in patients with severe corneal diseases and graft failures. To summerize the advances in design of the Boston type I keratoprosthesis and in the treatment strategies to conquer the post operative complications have expanded the indications and application of this technology. Many modifications to the design of the Boston type I keratoprosthesis and treatment of the patient in the post operative period have occurred. Also, the technology has been more widely accepted as a primary surgical option for patients with a poor preoperative prognosis for traditional penetrating keratoplasty. The outcomes of visual acuity, retention, and post-operative infection rates have all significantly improved since the technology has been modified and offers patients an alternative for visual rehabilitation. This is implanted into a carrier corneal graft or into the patient's own cornea. The allograft cornea can be the carrier, which may solve the shortage of donor cornea in China.

Since the founding of the People's Republic of China, the diagnosis and treatment technology of corneal diseases has developed rapidly. In the field of infectious keratopathy, China was the first country that discovered chlamydia trachomatis in the world, which promoted the study on the pathogenesis as well as the diagnosis and treatment of infectious keratitis, especially fungal keratitis. In the aspect of surgical technology, we have learned from other countries and innovated different types of transplantation surgeries suitable for patients with corneal diseases in China. Regarding the construction of eye banks, the cornea donation process and the operation techniques have been developed and standardized. In addition, to improve the cornea disease-related inspection level, new equipment such as specular microscopy and confocal microscopy has been introduced. These efforts have decreased corneal diseases from the first blinding eye disease to the second in our country. In the past 70 years, China's diagnosis and treatment technology in corneal diseases has achieved remarkable progresses, but there are still many shortcomings. Standing on the shoulders of the older generations of ophthalmologists, we should continue to serve the patients with corneal diseases wholeheartedly. We would like to send congratulations on the 70th anniversary of Chinese Journal of Ophthalmology with this article. ( Chin J Ophthalmol, 2020, 56: 401-408).

Objective: To investigate the cellular changes and quantitative analysis of basal cell density (BCD) and corneal epithelial thickness (CET) in limbal stem cell deficiency (LSCD) by in vivo confocal microscopy (IVCM). Methods: Prospective case-control study. A total of 35 eyes of 23 patients diagnosed with LSCD and 25 eyes from normal subjects were included in this study. Based on slit-lamp presentation and the global consensus on classification, the LSCD patients were classified into LSCD Ⅰ, LSCD Ⅱ and LSCD Ⅲ. Confocal images of the central cornea, and the superior, inferior, nasal and temporal limbus were inspected by IVCM. Morphologic characteristics of LSCD were summarized. The BCD and CET in all locations were measured. ANVOA or Kruskal-Wallis test was used for analysis when appropriate. A receiver operating characteristic was used to detect the diagnosis efficiency of BCD and CET. Results: The characteristics in the corneal epithelium of LSCD on IVCM included nested corneal epithelial cells, goblet cells with hyper-reflective spots, irregular basal cells and decreasing subbasal nerve density. The mean BCD of the LSCD group was (8 976±1 096) cells/mm2 in the central cornea. Compared to the control group, the BCD in the central cornea, superior, inferior, nasal and temporal limbus decreased by 30.2%, 26.0%, 28.7%, 29.3% and 30.2%, respectively (all P<0.007). The CET in the central cornea was (47.3±8.1) μm. The CET in the central cornea, superior, inferior, nasal and temporal limbus decreased by 27.9%, 23.7%, 20.6%, 26.9% and 23.1%, respectively, compared to the control group (all P<0.007). There was a decline of BCD and CET in more serious LSCD. Additionally, the decline of BCD and CET was shown in the unaffected region. The receiver operating characteristic showed the diagnosis efficiency of BCD in the corneal center and limbus (0.931 and 0.916) was superior to CET (0.853 and 0.817). Conclusions: There was a series of characteristic cellular changes in LSCD on IVCM. Both BCD and CET decreased significantly in LSCD. The BCD had higher diagnostic efficiency for LSCD.(Chin J Ophthalmol, 2020, 56:447-455).

Objective: To explore the potential neuroprotection effects and associated mechanism of baicalin in a rodent acute hypertensive glaucoma model and oxygen-glucose deprivation/reperfusion (OGD/R) induced retinal ganglion cell (RGC) injury. Methods: Experiment research. A rapid and substantial elevation of intraocular pressure was performed to establish an acute hypertensive glaucoma model, and retinal thickness was assessed at 1, 3, 5, and 7 days. The mice were then randomly divided into three groups: normal control group, hypertension group, and baicalin (50 mg/kg) for hypertension group. The effects of baicalin on the RGCs were evaluated by retrograde transporting of Fluoro-Gold. The mRNA levels of tumor necrosis factor-α, interleukine-1β (IL-1β), and inducible nitric oxide synthase were detected by real-time PCR, and the protein levels were measured by Western blot in the retina tissue of acute hypertensive glaucoma model. Purified primary RGC survival under OGD/R stress was measured by flow cytometry, which was also performed to measure the survival rate of RGCs pretreated by different doses of baicalin (2.5 μmol/L, 5.0 μmol/L, and 10.0 μmol/L). The effects of baicalin on primary RGCs co-cultured with mouse microglia cell line BV2 were evaluated by flow cytometry. The cytokine IL-1β in the culture supernatant was measured by immunochemical analyses. Statistical analysis was performed using analysis of variance. Results: Retinal tissue injuries and RGC loss were observed both in vivo and in vitro. Retinal thickness was decreased to 87.32%±0.94% at 3 days (t=6.73, P<0.01), 74.86%±2.43% at 5 days (t=13.40, P<0.01), and 63.53%±2.15% at 7 days (t=19.46, P<0.01). Treatment of 50 mg/kg baicalin significantly promoted the RGC survival from 61.32%±5.94% to 89.93%±10.08% (t=4.84, P<0.01). Baicalin alleviated the retinal damages by suppressing the expression of inflammatory cytokines as revealed by Western blot and real-time PCR. In vitro the RGC survival under OGD/R stress was increased from 51.53%±1.36% to 69.37%±7.09% and 66.23%±4.25% with 5.0, 10.0 μmol/L baicalin administration (t=5.50, 4.53; both P<0.01). BV2 under OGD/R stress did extra damage to RGCs, and baicalin could reverse the damages and increase the survival from 69.37%±7.09% to 73.00%±5.20% (t=2.82, P=0.048) by reducing the release of IL-1β [(39.97±8.76) pg/ml vs. (61.33±5.78) pg/ml, t=4.19, P=0.010]. Conclusion: Baicalin could alleviate retina tissue injury directly and promote the survival of RGCs by downregulating the expression of inflammatory cytokines and protecting RGCs from ischemia reperfusion injury. (Chin J Ophthalmol, 2020, 56: 376-382).

Objective: To elevated the retinal toxicity of intravitreal ganciclovir in albino rabbit eyes. Methods: Experimental study. Twenty-four New Zealand albino rabbits (forty-eight eyes) were divided into four groups by random. Three groups were prepared for ganciclovir experiment, named A, B, C. Each group received intravitreal injection ganciclovir dose at 400 μg/0.05 ml, 2 mg/0.05 ml and 5 mg/0.05 ml respectively. The other group named D served as a control accepted intravitreal injection 0.9% normal saline 0.1 ml. Before and after 1, 2 and 4 weeks, flicker full field electroretina gram (ERG) was recorded. After 1, 2 and 4 weeks light and electron microscopic tests were recorded for further toxicity study. Results: There was significant difference in amplitude of maximal combined response a wave in one week(χ(2)=8.319, P=0.04), and pairwise comparison the 5 mg group (140.50 μV) was significantly lower than the control group (165.00 μV) (χ(2)=-2.830, P=0.028). Maximal combined response b wave in four weeks(χ(2)=-10.626, P=0.014), and pairwise comparison the 5 mg group (261.50 μV) was significantly lower than the control group (398.00 μV) (χ(2)=-2.973, P=0.018). 30 Hz flicker response in one, two and four weeks(χ(2)=17.589, 8.225, 8.997, P=0.001, 0.042, 0.02), and pairwise comparison the 5 mg group (71.3μV, 106.00μV, 63.60μV) was significantly lower than the control group (118.50μV, 129.00μV, 116.50μV) (χ(2)=-4.142, -2.826, -2.713, P=0.000, 0.028, 0.040). There was no histologic retinal toxicity evidence of group 400 μg and control group observed by light microscopy in any stage of the study. Histologic changes of group 2 mg four week later, group 5 mg two and four week later include inner nuclear layer loose arranged, nuclear of ganglia were widened and outer plexiform layer stained less in four week later. By electron microscopic observation, the ultrastructure of retina changed to different degrees and became worse in each experimental group with significant mitochondrial swelling and hydropic changes were seen in the inner segments of photoreceptors, loosely arranged and disordered in the outer segment of photoreceptors four weeks later. Conclusions: The retinal function and morphology were normal in group 400 μg. Group 2 mg and 5 mg had retinal toxicity, and 5 mg was more severe. Therefore, the clinical application of ganciclovir in the treatment of acute retinal necrosis (ARN) should select the minimum effective dose to avoid the occurrence of retinal toxicity. (Chin J Ophthalmol, 2020, 56:279-285).

This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on March 14, 2020. Novel coronavirus pneumonia broke out and spread to the whole nation since December 2019. The fight against the virus is now at a critical stage. Previous epidemiological investigations and animal experiments suggested aerosol could perform as a virus transmitter. Based on the clinical observation, the possibility of aerosol transmission of 2019 novel coronavirus has aroused much attention. This article focuses on the feature of aerosol transmission and the pathogens involved in. We analyze the possibility of aerosol transmission of the novel coronavirus. Relevant strategies for preventing novel coronavirus pneumonia are established for the medical personnel and general public during their work or daily life. (Chin J Ophthalmol, 2020, 56:653-656).

Intermittent exotropia is a common form of childhood strabismus, which is mainly treated by surgery. However, there are still controversies about the natural course of the disease, the assessment of the disease severity, the choice of the surgery time, the determination of the target eye position and the choice of the treatment method. This article reviews the clinical research progress of intermittent exotropia, aiming to provide the basis for the early detection, scientific diagnosis and standard treatment of intermittent exotropia. (Chin J Ophthalmol, 2020, 56: 231-234).