Comparison of the short-term and long-term outcomes of laparoscopic hysterectomies and of abdominal hysterectomies： a case study of 4,895 patients in the Guangxi Zhuang Autonomous Region, China

Background： To evaluate the short-term and long-term outcomes after laparoscopic hysterectomy （LH） compared with abdominal hysterectomy （AH） in case of benign gynecological disease. Methods： A multi-center cohort retrospective comparative study of population among 4,895 hysterectomies （3,539 LH vs.1,356 AH） between 2007 and 2013 was involved. Operative time （OT）, estimated blood loss （EBL）, intra-operative and post-operative complications, passing flatus; days with indwelling catheter, questionnaires covering pelvic floor functions and sexual functions were assessed. Results： The EBL （174.1±157.4 vs. 263.1±183.2 cc, LH and AH groups, respectively）, passing flatus （38.7±14.1 vs. 48.1±13.2 hours）, days with indwelling catheter （1.5±0.6 vs. 2.2±0.8 days）, use of analgesics （6.5% vs. 73.1%）, intra-operative complication rate （2.4% vs. 4.1%）, post-operative complication rate （2.3 % vs. 5.7%）, post-operative constipation （12.1% vs. 24.6%）, mild and serious stress urinary incontinence （SUI） post-operative （P〈0.001; P=0.014）, and proportion of Female Sexual Functioning Index （FSFI） total score 〈26.55 post-operative （P〈0.001） of the LH group were significantly less than those of AH group. There were no significant differences in OT （106.5±34.5 vs. 106.2±40.3 min） between the two groups. Conclusions： LH is a safe and efficient operation for improving patients＇ long-term quality of life （QoL）, and LH is a cost-effectiveness procedure for treating benign gynecological disease. LH is superior to AH due to reduced EBL, reduced post-operative pain and earlier passing flatus.

Application of a venous conduit as a stent for repairing rabbit facial nerve injury

BACKGROUND： Recently, many investigators have tried to use natural biomaterials, such as, artery, vein, decalcified bone, etc., as conduits for nerve repair. However, immunological rejection of conduits made of natural biomaterials limits their application. Therefore, it is essential to identify more suitable types of biomaterials. OBJECTIVE： To observe the characteristics of a bioengineering processing method using venous conduit as a stent for repairing facial nerve injury. DESIGN： A controlled observational experiment. SETTING： Animal Laboratories of the Third Hospital Affiliated to Sun Yat-sen University and the 157 Hospital. MATERIALS： Thirty-three male New Zealand rabbits of pure breed, weighing 1.5 to 2.0 kg, were provided by Medical Experimental Animal Room of Sun Yat-sen University. The protocol was carried out in accordance with animal ethics guidelines for the use and care of animals. Venous conduits and autogenous nerves were transplanted into the left and right cheeks, respectively. Eleven animals were chosen for anatomical observations at 5, 10 and 15 weeks after surgery. METHODS： This experiment was carried out in the Animal Laboratories of the Third Hospital Affdiated to Sun Yat-sen University and the 157 Hospital between May and November 2006. After animals were anesthetized, 15 mm of retromandibular vein was harvested for preparing a venous conduit. Approximately 3 cm of low buccal branch of facial nerve was exposed. A segment of 1.2 cm nerve was resected from the middle, and a gap of 1.5 cm formed due to bilateral retraction. The prepared venous conduit of 1.5 cm was sutured to the outer membrane of the severed ends of the nerve. Muscle and skin were sutured layer by layer. Using the same above-mentioned method, the low buccal branch of right autogenous facial nerve was resected, and the left facial nerve segment from the same animal was transplanted using end-to-end neurorrhaphy for control. MAIN OUTCOME MEASURES： （1）Post-operatively, food intake, vibrissae activity and wound healing of each animal were observed daily. （2） Animals were anesthetized at 5, 10 and 15 weeks after operation for observing the structural change of the venous conduit, the appearance of regenerated nerve, and the relationship between conduit and peripheral muscle tissue. （3） The action potential and latency of bilateral nerves of animals were measured by electrophysiologic examination, and nerve conduction velocity was calculated. （4）Neural myelination and neurite growth were observed by histological staining using an optical microscope. RESULTS： Thirty-three New Zealand rabbits were involved in the final analysis. （1）Immediately following the operation, vibrissae activity and orbicularis otis muscle activity of the upper lip on venous conduit side were more prominent, and their amplitudes of movement were larger as compared with autogenous nerve side. （2） At postoperative 10 weeks, by visual inspection, we found that on the venous conduit side, the venous conduit exhibited membrane structure which encased regenerated nerve. Regenerated nerve adhered to the muscle edge of orbicularis oris muscle. Muscle and nerve could be separated with a forceps. The muscle of musculus orbicularis oris of rabbit was darker and thicker as compared with autogenous nerve side. After the venous conduit was longitudinally split, the regenerated nerve and nerves at two the severed ends were connected together. When compared with postoperative 5 weeks, the connected nerve was thickened, texture was tough and its middle part was thicker than its two ends. On the autogenous nerve side, the regenerated nerve stem was enwrapped by scar tissue. It was bulky and adhered to peripheral muscle. Its neural profile structure was unclear. The two stomas were obviously enlarged. （3）At postoperative 10 weeks and 15 weeks, nerve action potentials could be elicited from both the venous conduit and autologous nerve side. The mean nerve conduction velocity on the venous conduit side was greater than that of the autologous nerve side. （4）At postoperative 10 weeks, using histochemical staining, it was found that in the venous conduit, regenerated medullated nerve fibers were densely distributed, with well split facial nerve structure, while on the autologous nerve side, nerve fibers were sparsely scattered, with immature medullated nerve structure. CONCLUSION： Biological natural venous conduit processed by bioengineering technology overcomes the tissue inflammatory reactions and connective tissue reactions caused by natural biomaterials. It is more conducive to promote neural regeneration and functional recovery than autologous nerve transplantation.

Compound soft regenerated skull material for repairing dog skull defects using bone morphogenetic protein as an inductor and nanohydroxyapatite as a scaffold

BACKGROUND：In previous studies of skull defects and regeneration, bone morphogenetic protein as an inductor and nanohydroxyapatite as a scaffold have been cocultured with osteoblasts. OBJECTIVE： To verify the characteristics of the new skull regenerated material after compound soft regenerated skull material implantation. DESIGN, TIME AND SETTING： The self-control and inter-group control animal experiment was performed at the Sun Yat-sen University, China from February to July 2007. MATERIALS： Twenty-four healthy adult dogs of both genders weighing 15–20 kg were used in this study. Nanohydroxyapatite as a scaffold was cocultured with osteoblasts. Using demineralized canine bone matrix as a carrier, recombinant human bone morphogenetic protein-2 was employed to prepare compound soft regenerated skull material. Self-designed compound soft regenerated skull material was implanted in models of skull defects. METHODS： Animals were randomly assigned into two groups, Group A （n = 16） and Group B （n = 8）. Bilateral 2.5-cm-diameter full-thickness parietal skull defects were made in all animals. In Group A, the right side was reconstructed with calcium alginate gel, osteoblasts, and nanometer bone meal composite; the left side was reconstructed with calcium alginate gel, osteoblasts, nanometer bone meal and recombinant human bone morphogenetic protein-2 composite. In Group B, the right side was kept as a simple skull defect, and the left side was reconstructed with calcium alginate gel, osteoblasts, nanometer bone meal and recombinant human bone morphogenetic protein-2 composite. MAIN OUTCOME MEASURES： Bone regeneration and histopathological changes at the site of the skull defect were observed with an optical microscope and a scanning electron microscope after surgery. The ability to form bone was measured by alizarin red S staining. In vitro cultured osteoblasts were observed for morphology. RESULTS： One month following surgery, newly formed bone trabeculae mostly covered the broken ends of the fractured bone and grew towards the defect regions. Two months after surgery, many disordered bone islands had formed. Three months after surgery, mature bone, medullary cavities and a large number of new bones were detected in the defect regions. Six months after surgery, the left defect was mostly repaired, with a high bone density compared with the right side in Groups A and B. The right defect was mostly repaired in Group A, but only a small fraction of the right defects was repaired in Group B. CONCLUSION： A composite of calcium alginate gel, osteoblasts, nanometer bone meal and recombinant human bone morphogenetic protein-2 can metabolize by itself, gradually ossify and form new bone.

PACK-CXL vs.antimicrobial therapy for bacterial,fungal,and mixed infectious keratitis:a prospective randomized phase 3 trial

Background:Infectious keratitis is a major cause of global blindness.We tested whether standalone photoactivated chromophore corneal cross-linking(PACK-CXL)may be an efective frst-line treatment in early to moderate infectious keratitis,compared with standard antimicrobial treatment.Methods:This is a randomized,controlled,multinational phase 3 clinical trial.Participants in fve centers in Egypt,India,Iran,Israel,and China,aged≥18 years,with infectious keratitis of presumed bacterial,fungal,or mixed origin,were randomly assigned(1:1)to PACK-CXL,or antimicrobial therapy.Outcomes measures included healing,defned as time to re-epithelialization of the corneal epithelial defect in the absence of infammatory activity in the anterior chamber and clearance of stromal infltrates.Treatment success was defned as the complete resolution of signs of infection.Results:Between July 21,2016,and March 4,2020,participants were randomly assigned to receive PACK-CXL(n=18)or antimicrobial therapy per American Academy of Ophthalmology(AAO)guidelines(n=21).No participants were lost to follow-up.Four eyes were excluded from the epithelialization time analysis due to treatment failure:two in the antimicrobial therapy group,and two in the PACK-CXL group.Success rates were 88.9%(16/18 patients)in the PACK-CXL group and 90.5%(19/21 patients)in the medication group.There was no signifcant diference in time to complete corneal re-epithelialization(P=0.828)between both treatment groups.Conclusions:PACK-CXL may be an alternative to antimicrobial drugs for frst-line and standalone treatment of early to moderate infectious keratitis of bacterial or fungal origin.

An engineered lamellar bone mimicking full-scale hierarchical architecture for bone regeneration

Lamellar bone,compactly and ingeniously organized in the hierarchical pattern with 6 ordered scales,is the structural motif of mature bone.Each hierarchical scale exerts an essential role in determining physiological behavior and osteogenic bioactivity of bone.Engineering lamellar bone with full-scale hierarchy remains a longstanding challenge.Herein,using bioskiving and mineralization,we attempt to engineer compact constructs resembling full-scale hierarchy of lamellar bone.Through systematically investigating the effect of mineralization on physicochemical properties and bioactivities of multi-sheeted collagen matrix fabricated by bioskiving,the hierarchical mimicry and hierarchy-property relationship are elucidated.With prolongation of mineralization,hierarchical mimicry and osteogenic bioactivity of constructs are performed in a bidirectional manner,i.e.first rising and then descending,which is supposed to be related with transformation of mineralization mechanism from nonclassical to classical crystallization.Construct mineralized 9 days can accurately mimic each hierarchical scale and efficiently promote osteogenesis.Bioinformatic analysis further reveals that this construct potently activates integrinα5-PI3K/AKT signaling pathway through mechanical and biophysical cues,and thereby repairing critical-sized bone defect.The present study provides a bioinspired strategy for completely resembling complex hierarchy of compact mineralized tissue,and offers a critical research model for in-depth studying the structure-function relationship of bone.

Sirius Scheimpflug-Placido versus. ultrasound pachymetry for central corneal thickness: meta-analysis

Background:To compare the difference in central corneal thickness(CCT)measurements in normal eyes between a rotating Scheimpflug camera combined with a Placido-disk corneal topographer(Sirius,CSO,Italy)and ultrasound pachymetry(USP).Methods:A systematic literature search was conducted for relevant studies published on PubMed,Medline,EMBASE,and the Cochrane Library and ClinicalTrials.gov from inception to August 1st,2019.Primary outcome measures were CCT measurements between Sirius and USP.A random effects model was used to pool CCT measurements.Results:A total of twelve studies involving 862 eyes were included in this meta-analysis.The meta-analysis found CCT measurements between Sirius and USP to be statistically significantly different(P<0.0001).The mean difference between Sirius and USP was-11.26μm with a 95%confidence interval(CI)(-16.92μm,-5.60μm).The heterogeneity Was IP=60%(P=0.004).Conclusion:CCT measurements with the Sirius Scheimpflug-Placido topographer were statistically significantly lower than USP.However,it may be argued that the mean difference of 11.26μm is not a clinically significant difference.

国人版角膜接触镜配戴者生活质量量表的研制与评估

目的:研制国人版角膜接触镜配戴者生活质量量表(CLIQ)并评估其信度和效度,分析得分的影响因素。方法:采用横断面研究。对英国原版CLIQ进行翻译、回译、文化调试,形成国人版量表。选择2015年4─12月在温州医科大学附属眼视光医院就诊的角膜接触镜配戴者205例进行问卷调查,其中再随机选取20例由2名调查员分别进行调查,对问卷数据进行统计分析。结果:回收有效问卷201例。视功能维度因应答率小于50%被删除。量表Cronbach'sα系数为0.77,眼部症状维度为0.68,便利性、经济和情感维度均>0.7,量表Guttmann Split-Half系数为0.89,眼部症状、便利性、经济和情感维度分别为0.75、0.78、0.65和0.93。认知维度Cronbach'sα系数和Guttmann Split-Half系数均为0.49故被删除;删除条目20后健康关注维度Cronbach'sα系数和Guttmann Split-Half系数分别为0.68和0.73。2名调查员之间的评分结果高度相关(r=0.87~0.99,P<0.001)。各条目的条目水平内容效度指数为0.83~1.00,量表的平均水平内容效度指数为0.95。探索性因子分析提取的5个因子分别对应各维度,累计方差贡献率60.43%。眼部症状维度与年龄(r=-0.153,P=0.03)和戴镜年数(r=-0.167,P=0.018)轻度相关,情感维度与戴镜年数轻度相关(r=0.209,P=0.003)。量表总分在不同戴镜年数[(3.60±0.34)年vs.(3.71±0.32)年,P=0.026]、每月戴镜天数[(3.60±0.33)d vs.(3.70±0.33)d,P=0.041]和无/有眼部症状(3.71±0.32 vs.3.60±0.34,P=0.021)的配戴者间差异有统计学意义。软镜配戴者的经济维度得分高于硬镜配戴者(t=2.588,P=0.017)。结论:删去视功能维度、认知维度和条目20后,CLIQ量表的信度和效度较好,戴镜年数越长、每月戴镜天数越多以及无眼部症状的患者得分较高,硬镜配戴者在花费方面的担忧更多。

冷敷疗法缓解经上皮准分子激光角膜切削术后疼痛的效果

目的:观察经上皮准分子激光角膜切削术(TPRK)后眼罩冷敷缓解患者术后不适的临床疗效。方法:前瞻性随机对照研究。选取2018年10月至2019年4月在温州医科大学附属眼视光医院之江院区行TPRK的患者87例(174眼),根据随机数字表随机分成冷敷组和对照组,2组均选取右眼进行观察。冷敷组在术后留观期间给予4℃冷藏硅胶眼罩冰敷袋,冷敷20 min,其余处理同对照组。对照组常规用药不冷敷。分别于术后2 h、1 d、2 d、3 d、5 d每天相对固定时间填写眼部不适感评分量表,包括视物模糊、畏光、异物感、流泪、眼痛、眼痒、眼部分泌物等术后不适情况。并于术后5 d、12 d、1个月、3个月分别评估角膜上皮愈合情况、裸眼视力(UCVA)、等效球镜度(SE)、角膜上皮下雾状混浊(haze)、调制传递函数截止频率(MTF cutoff)、客观散射指数(OSI)等指标。采用重复测量方差分析、独立样本t检验对数据进行分析。结果:术后2 h时,畏光、异物感、眼痛评分等指标在2组间差异均有统计学意义(F=15.93,P<0.001;F=9.52,P=0.003;F=13.57,P<0.001)。2组间视物模糊、流泪、眼痒、眼部分泌物差异均无统计学意义。术后1 d视物模糊指标在2组间差异有统计学意义(F=9.69,P=0.003),畏光、异物感、流泪、眼痛、眼痒、眼部分泌物等指标差异无统计学意义。术后2、3、5 d所有不适症状组间差异均无统计学意义。术后5 d、12 d、1个月、3个月,2组间角膜上皮愈合情况、UCVA、SE、Haze等差异均无统计学意义。术后3个月2组间客观光学质量评估差异均无统计学意义。结论:TPRK术后冷敷疗法能够改善术后早期疼痛、畏光、异物感等刺激症状,但对术后远期视力恢复没有明显作用,且对术后角膜上皮修复、视觉质量恢复等无负面影响。

Consideration of corneal biomechanics in the diagnosis and management of keratoconus: is it important?

Keratoconus is a bilateral,non-inflammatory,degenerative corneal disease.The occurrence and development of keratoconus is associated with corneal thinning and conical protrusion,which causes irregular astigmatism.With the disruption of the collagen organization,the cornea loses its shape and function resulting in progressive visual degradation.Currently,corneal topography is the most important tool for the diagnosis of keratoconus,which may lead to false negatives among the patient population in the subclinical phase.However,it is now hypothesised that biomechanical destabilisation of the cornea may take place ahead of the topographic evidence of keratoconus,hence possibly assisting with disease diagnosis and management.This article provides a review of the definition,diagnosis,and management strategies for keratoconus based on corneal biomechanics.

Catquest 9SF-CN量表在白内障中的最小临床重要差异研究

目的:评估Catquest 9SF-CN量表应用于白内障手术人群的反应度,并结合校标法和分布法确定最小临床重要差异值(MCID)。方法:前瞻性队列研究。对纳入温州医科大学附属眼视光医院的213例白内障术前患者进行Catquest 9SF-CN量表调查。术后1~3个月对来院复查的患者再次进行量表调查和7个选项的校标条目调查。分析量表的天花板和地板效应,通过配对t检验分析手术前后量表得分和视力的差异,采用效应值、标准化反应均数和变化率3个指标联合评估量表的反应度。然后根据术前视力、术前并发症(有/无)和术眼数量(单眼/双眼)分组,计算手术带来的得分变化。通过单因素方差分析(根据术前视力分组)或独立样本t检验(根据并发症或者术眼数量分组)分析组间差异。分布法通过1个效应值、1个测量标准误和1/2个得分变化标准差估算MCID,校标法通过校标选项和得分变化的线性回归分析估算MCID,最后根据平均值法确定取值。结果:共144例完成Catquest 9SF-CN量表的随访调查。量表术前的天花板和地板效应为4.2%,术后提高至17.4%。手术带来的量表总得分变化为11.0±7.9,logMAR视力变化为0.4±0.4,两者有相关性(r=0.30,P<0.001),且各自手术前后的差异具有统计学意义(t视力=13.44,t得分=16.75,P<0.001)。量表的效应值、标准化反应均数和变化率分别是1.71、1.40、44.46%。有完整随访资料的患者根据术前视力分成3组,或者根据术眼数量分成2组后,组间的得分变化差异均无统计学意义。根据并发症分组后,差异有统计学意义(t=2.90,P=0.004)。分布法中1个效应值、1个测量标准误和1/2个得分变化标准差估算MCID分别为1.71、2.12、3.96分。校标法中量表得分变化和校标条目选项呈负相关(r=-0.35,P<0.001),回归公式中的β系数为3.74,用来估计MCID值。结合分布法和校标法取平均值得到最终MCID值2.88分。结论:Catquest 9SF-CN量表适用于白内障患者生活质量评估,在中国白内障患者手术前后的反应度良好,并建立了MCID值2.88分作为应用参考。

Unintended changes in ocular biometric parameters during a 6-month follow-up period after FS-LASIK and SMILE

Background:Corneal refractive surgery has become reliable for correcting refractive errors,but it can induce unintended ocular changes that alter refractive outcomes.This study is to evaluate the unintended changes in ocular biometric parameters over a 6-month follow-up period after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE).Methods:156 consecutive myopic patients scheduled for FS-LASIK and SMILE were included in this study.Central corneal thickness(CCT),mean curvature of the corneal posterior surface(K_(pm)),internal anterior chamber depth(IACD)and the length from corneal endothelium to retina(ER)were evaluated before and after surgery over a 6-month period.Results:Both the FS-LASIK and SMILE groups(closely matched at the pre-surgery stage)experienced flatter Kpm,shallower IACD and decreased ER 1 week post-surgery(P<0.01),and these changes were larger in FS-LASIK than in SMILE group.During the 1 week to 6 months follow up period,K_(pm),IACD and ER remained stable unlike CCT which increased significantly(P<0.05),more in the FS-LASIK group.Conclusions:During the follow up,the posterior corneal surface became flatter and shifted posteriorly,the anterior chamber depth and the length from the corneal endothelium to retina decreased significantly compared with the pre-surgery stage.These unintended changes in ocular biometric parameters were greater in patients undergoing FS-LASIK than SMILE.The changes present clear challenges for IOL power calculations and should be considered to avoid affecting the outcome of cataract surgery.

Sirius Scheimpflug–Placido versus ultrasound pachymetry for central corneal thickness:meta-analysis

Background:To compare the difference in central corneal thickness(CCT)measurements in normal eyes between a rotating Scheimpflug camera combined with a Placido-disk corneal topographer(Sirius,CSO,Italy)and ultrasound pachymetry(USP).Methods:A systematic literature search was conducted for relevant studies published on PubMed,Medline,EMBASE,and the Cochrane Library and ClinicalTrials.gov from inception to August 1st,2019.Primary outcome measures were CCT measurements between Sirius and USP.A random effects model was used to pool CCT measurements.Results:A total of twelve studies involving 862 eyes were included in this meta-analysis.The meta-analysis found CCT measurements between Sirius and USP to be statistically significantly different(P<0.0001).The mean difference between Sirius and USP was−11.26μm with a 95%confidence interval(CI)(−16.92μm,−5.60μm).The heterogeneity was I^(2)=60%(P=0.004).Conclusion:CCT measurements with the Sirius Scheimpflug-Placido topographer were statistically significantly lower than USP.However,it may be argued that the mean difference of 11.26μm is not a clinically significant difference.

Effect of orthokeratology on precision and agreement assessment of a new sweptsource optical coherence tomography biometer

Background:To evaluate the effect of orthokeratology on precision of measurements in children using a new swept-source optical coherence tomography(SS-OCT)optical biometer(OA-2000),and agreement between its measurements and those provided by the commonly used IOLMaster based on partial coherence interferometry(PCI).Methods:This study recruited fifty-one eyes of 51 normal children(8–16 years).An operator took measurements with the two biometers.Then,a second operator took measurements with the SS-OCT biometer.After orthokeratology was performed for one month,the same operators repeated the same procedures.Axial length(AL),mean keratometry(Km)at 2.5 mm and 3.0 mm diameters(Km2.5 and Km3.0),central corneal thickness(CCT),anterior chamber depth(ACD),lens thickness(LT)and corneal diameter(CD)were analyzed.Results:With the SS-OCT optical biometer,the test-retest repeatability of AL measurements was<0.06 mm.For all parameters,the coefficients of variation were<1.23%and the intraclass correlation coefficients were>0.95.The 95%limits of agreement of difference between the two devices for CD parameter were up to 1.53 mm.After orthokeratology,the fluctuation ranges of difference for Km3.0 measurement was 1.11 times higher than before orthokeratology,while the absolute values of difference for AL,Km2.5,ACD and CD measurements were comparable.Conclusions:Before and after orthokeratology,the SS-OCT biometer showed high repeatability and reproducibility for all measurements.Wearing orthokeratology contact lenses affected the agreement between SS-OCT and PCI biometers for Km3.0 measurements.The CD measurement showed poor agreement between the two devices.

Brillouin显微镜测量角膜生物力学性能的研究进展

角膜具有各向异性、非线性和黏弹性等复杂的生物力学性能,随着基础和临床研究的不断深入,生物力学在角膜疾病的诊断和治疗中发挥着越来越重要的作用。离体角膜与在体角膜的力学性能存在显著差异,探索在体测量角膜生物力学的方法对角膜疾病的诊断与治疗有直接的指导意义。目前在体测量的仪器主要有眼反应分析仪和可视化角膜生物力学分析仪,但二者只提供角膜整体的生物力学参数,无法精确反映角膜局部性能。Brillouin显微镜使用低功率近红外激光束聚焦到角膜组织,通过分析角膜的返回信号谱来确定组织的纵向模量,可实现角膜各部分生物力学性能的在体无接触测量。现就Brillouin显微镜的测量原理、安全性,与其他设备的比较及其临床应用进展等做一综述。

High intercorneal symmetry in corneal biomechanical metrics

Backgroud:To evaluate the symmetry of corneal biomechanical metrics,measured using an ocular response analyzer(ORA)and self-built corneal inflation test platform,in bilateral rabbit corneas and to investigate their relationship with physical intraocular pressure(IOPp).Methods:Twenty fresh enucleated eyes from ten rabbits were used for ex vivo whole ocular globe inflation.IOP was increased from 7.5 to 37.5 mmHg with 7.5 mmHg steps and biomechanical metrics were acquired using the ORA.At least 3 examinations were performed at each pressure stage.Two biomechanical metrics,corneal hysteresis(CH)and corneal resistance factor(CRF)were recorded and analyzed as a function of IOPp.Corneal specimens were then excised from the intact ocular globe and tested under inflation conditions up to 45.7 mmHg posterior pressure.The experimental pressure-deformation data was analyzed using an inverse modeling procedure to derive the stress-strain behavior of the cornea.Results:A comparison of corneal shape parameters showed no statistically significant difference(P>0.05)between bilateral eyes.Similarly,there were no statistically significant differences in values of CH,CRF and corneal stiffness(as measured by the tangent modulus,Et)between bilateral eyes(CH:F=0.94,P=0.54;CRF:F=4.42,P=0.35;Et:F=3.15,P=0.12)at different pressure levels.IOPp was highly correlated with CRF while the relationship with CH was less pronounced.Conclusions:An obvious interocular symmetry in biomechanical metrics is found in this research.IOP has been shown to have important influences on the value of CRF provided by ORA.

准分子激光治疗性角膜切削术联合角膜胶原交联术治疗原发性圆锥角膜

目的：评估准分子激光治疗性角膜切削术（PTK）联合角膜胶原交联术（CXL）治疗原发性圆锥角膜的临床效果.方法：前瞻性自身对照临床研究.2014年9-10月期间在温州医科大学附属眼视光医院接受PTK联合CXL治疗的进展期圆锥角膜患者11例（11眼）,评估比较术前与术后12个月裸眼视力（UCVA）、最佳矫正视力（BCVA）、屈光状态、角膜形态、角膜最薄点厚度和角膜内皮细胞密度的差异.手术前后数据的比较采用配对t检验.结果：术后12个月时,UCVA较术前有所提高（t=3.692,P=0.008）,球镜度、等效球镜度（SE）、角膜前表面最大曲率值较术前均有所改善（t=-1.397,P=0.039;t=-2.363,P=0.040;t=2.941,P=0.007）,角膜最薄点厚度较术前降低（t=3.839,P=0.003）,内皮细胞计数无明显变化（t=-1.615,P=0.172）.结论：PTK联合CXL治疗进展中的原发性圆锥角膜是安全和有效的.

IOLMaster500测量2~6岁儿童眼轴长度的重复性和再现性

目的:评估不同操作者使用光学相干生物测量仪IOLMaster500测量2~6岁儿童眼轴长度的重复性和再现性。方法:横断面研究。共纳入2016年12月至2017年3月在温州医科大学附属眼视光医院杭州院区视光门诊部就诊的102名(102只右眼)2~6岁儿童,先由一名操作者连续测得3组有效眼轴长度数据,随即换另一名操作者重复测量操作再获得3组有效眼轴长度数据。采用重复测量方差分析、Bland-Altman分析和组内相关系数(ICC)计算相关数据;2位操作者的测量结果采用不同分析方法(3次测量数据的均值,第1次测量数据);其中2组单次测量数据、均值各自进行配对t检验、Bland-Altman分析,计算组内标准差(Sw)、2.77Sw和组内变异系数(CoV)。结果:同一测量者的重复测量方差分析P值均大于0.05,差异无统计学意义,并均具有很窄的95%一致性界限(LoA)(均小于-0.04至0.04mm),ICC为1.000。不同测量者的配对t检验P值均大于0.05,差异无统计学意义,并均具有很窄的95%LoA(均小于-0.04至0.03mm),且均值法的95%LoA比单次测量法窄42.86%,两者Sw、2.77Sw数据均分别小于0.01mm和0.03mm,CoV均小于0.05%。结论:同一操作者对IOLMaster500测量2~6岁儿童眼轴长度具有良好的重复性,不同操作者测量同一患者具有良好的再现性。此外,每位操作者连续测量3次的平均值比各测1次的值具有更好的再现性。

角膜胶原交联中核黄素浓度检测方法的研究进展

角膜胶原交联术(CXL)可以用于治疗进展期圆锥角膜、感染性角膜炎、角膜融解和角膜基质水肿等病变。临床上常用的CXL方案为核黄素-紫外光交联,角膜中的核黄素浓度和分布是影响疗效和安全性的重要因素之一。目前对角膜中核黄素浓度进行检测的方法主要包括荧光显微镜成像、高效液相色谱法、分光光度法、无创实时检测、眼前节裂隙灯显微镜观察法以及基质辅助激光解吸/电离质谱成像技术(MALDI-IMS)等,不同方法之间结果可能存在差异。现对目前研究中的核黄素浓度及其检测方法做一概述。