Clinical Observation of Recombinant Bovine Basic Fibroblast Growth Factor Eye Gel Combined with Tobramycin Dexamethasone Eye Drops in the Treatment of Dry Eye Syndrome in Patients after Cataract Surgery

Objective:To evaluate the therapeutic effect of recombinant bovine basic fibroblast growth factor(rbFGF)eye gel combined with tobramycin-dexamethasone(TOB-Dex)eye drops on dry eye syndrome(DES)after cataract surgery.Methods:86 patients with DES after cataract surgery,admitted from November 2021 to November 2023,were randomly divided into groups.The observation group included 43 patients treated with rbFGF eye gel combined with TOB-Dex eye drops.The reference group included 43 patients treated with TOB-Dex eye drops alone.Multiple indicators,including total effective rate and clinical symptom scores,were compared between the two groups.Results:The total effective rate in the observation group was higher than in the reference group(P<0.05).Before treatment,there were no differences in clinical symptom scores,serum factors,or disease severity scores between the two groups(P>0.05).Three weeks after treatment,the observation group had lower clinical symptom scores,serum factors,and disease severity scores compared to the reference group(P<0.05).The adverse reaction rate in the observation group was lower than in the reference group(P<0.05).Conclusion:rbFGF eye gel combined with TOB-Dex eye drops can improve the clinical efficacy for patients with DES after cataract surgery,alleviate disease symptoms,reduce inflammatory responses,and have fewer adverse reactions.

Efficacy of recombinant human epidermal growth factor plus sodium hyaluronate eye drops in diabetic dry eye post-cataract surgery

BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.

Silicone oil migrating into the conjunctival space and orbit after surgery for an eye-penetrating injury:A case report

BACKGROUND We report a case of eye-penetrating injury in which a massive silicone oil migration into the patient’s subconjunctival space and orbit occurred after vitrectomy.CASE SUMMARY A 30-year-old male patient sought medical attention at Ganzhou People’s Hospital after experiencing pain and vision loss in his left eye due to a nail wound on December 9,2023.Diagnosis of penetrating injury caused by magnetic foreign body retention in the left eye and hospitalization for treatment.On December 9,2023,pars plana vitrectomy was performed on the left eye for intraocular foreign body removal,abnormal crystal extraction,retinal photocoagulation.Owing to the discovery of retinal detachment at the posterior pole during surgery,silicone oil was injected to fill the vitreous body,following which upper conjunctival bubble-like swelling was observed.Postoperative orbital computed tomography(CT)review indicated migration of silicone oil to the subconjunctival space and orbit through a self-permeable outlet.On December 18,2023,the patient sought treatment at the First Affiliated Hospital of Nanchang University,China.The patient presented with a pronounced foreign body sensation following left eye surgery.On December 20,2023,the foreign body was removed from the left eye frame and an intraocular examination was conducted.The posterior scleral tear had closed,leading to termination of the surgical procedure following supplementary laser treatment around the tear.The patient reported a significant reduction in ocular surface symptoms just one day after surgery.Furthermore,a notable decrease in the migration of silicone oil was observed in orbital CT scans.CONCLUSION The timing of silicone oil injection for an eye-penetrating injury should be carefully evaluated to avoid the possibility of silicone oil migration.

Observation of Clinical Treatment Effect of Plastic Surgery of Asymmetric Double Eyelids

Objective:To explore the clinical efficacy of plastic surgery of asymmetric double eyelid.Methods:The clinical data of 70 patients with asymmetrical double eyelid who underwent plastic surgery in our hospital from April 2018 to December 2019 were retrospectively analyzed.The patients were divided into different groups based on different plastic surgery procedures.The control group(n=35 cases)were the patients who underwent double eyelid incision method,and the patients who used embedding double eyelid method were included in the observation group(n=35 cases).The operation time,intraoperative blood loss,incision size,healing time of incision,satisfaction of p1astic surgery and occurrence of complications were compared between the two groups.Results:The operation time and incision healing time of the observation group were shorter than those of the control group.The intraoperative blood 1oss and incision were less than those of the control group,and the satisfaction was higher than that of the control group.The difference was statistically significant(P<0.05).The incidence of complications in the observation group was slightly lower than the control group,but the difference was not statistically significant(P>0.05).Conclusion:For asymmetric double eyelid,it should undergo embedding double eyelid plastic surgery,because the operation time and incision healing time are shorter.And intraoperative blood 1oss and incision size are smal1er,which can improve patient satisfaction and reduce the incidence of complications.

Ocular surface and tear film changes after eyelid surgery

Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries.There are many categories of eyelid surgeries,the most common of which include blepharoplasty,ptosis surgery,and eyelid reconstruction.In many cases,these procedures are combined,and there are many different techniques for each type of operation.Upper eyelid blepharoplasty usually includes the excision of skin,preseptal orbicularis oculi muscle,and orbital fat.Common methods of lower eyelid blepharoplasty are the skin-muscle flap,the skin flap,and the transconjunctival.Ptosis surgery is mainly divided into three types:transcutaneous,transconjunctival,and sling surgery.Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction.Different types and methods of surgery have their own advantages and disadvantages,and postoperative complications may occur.Therefore,postoperative complications of eyelid surgeries,such as dry eye symptoms,should be taken into serious consideration.Relevant literature involving these complaints can be found in PubMed by searching the terms“dry eye”,“eyelid”,“surgery”,and other related keywords.Moreover,various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index(OSDI),tear film breakup time,Schirmer test,fluorescein staining,and lissamine green staining after various eyelid surgeries.As dry eye disease is prevalent in the general population,it is more urgent to figure out what we can learn from these complaints.Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.

Changes in ocular surface status and dry eye symptoms following femtosecond laser-assisted cataract surgery

AIM: To observe the changes in ocular surface and the dry eye symptoms following femtosecond laser-assisted cataract surgery(FLACS). METHODS: Patients with no eye signs or symptoms in Guangzhou Aier Eye Hospital between October 2017 and September 2018, who underwent FLACS and intraocular lens(IOL) implantation for age-related cataract were enrolled. Tear film stability assessed with OCULUS Keratograph 5 M, Schirmer’s I test(SIT), and corneal fluorescein staining(CFS) were evaluated before and after surgery at 1 d, 1 wk, 1, and 3 mo in order. Ocular Surface Disease Index scores(OSDI) and Subjective Symptom Questionnaires(SSQs) were recorded at the same time point.RESULTS: Thirty-eight eyes of 38 patients were enrolled. The noninvasive tear film break-up time(first break-up time and average break-up time) decreased in a peak at the 1 wk visit, and then increased to basic levels at 1 mo. The tear meniscus height(TMH) increased transiently at 1 d, and declined in the following 3 mo visits. The SIT had a transient increase at 1 d(P=0.357) and a decrease at 1 wk and 1 mo(both P<0.05) but returned to the preoperative levels at 3 mo after surgery(P=0.062). CFS scores were significantly improved compared with those before surgery, and had a statistical difference(P<0.05). OSDI scores and SSQs after surgery were obviously higher, and had a statistical difference(P<0.001) but didn’t return to the basic level by 3 mo. CONCLUSION: Dry eye signs and symptoms can occur immediately following FLACS and have a peak severity on day 7 postoperatively. Most signs of dry eye can return to preoperative basic levels within 3 mo postoperatively. However, all cases can not recover from CFS and dry eye symptoms at 3 mo postoperatively.

Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model

AIM： To compare the effects of the surgical insult of cataract surgery on corneal inflammatory infiltration, neovascularization （NV） and lymphangiogenesis （LY） between the dry eye and non-dry eye in murine cataract surgery models.METHODS： We established two groups of animals, one with normal eyes （non-dry eye） and the second with induced dry eyes. In both groups, we used surgical insults to mimic human cataract surgery, which consisted of lens extraction, corneal incision and suture. After harvesting of corneas on the 9th postoperative day and immunohistochemical staining, we compared NV, LY and CD11b＋ cell infiltration in the corneas.RESULTS： Dry eye group had significantly more inflammatory infiltration （21.75%±7.17% r/s 3.65%±1.49%; P=0.049）. The dry eye group showed significantly more NV （48.21% ±4.02% ys 26.24% ±6.01% ; P =0.016） and greater levels of LY （9.27%±0.48% ys 4.84%±1.15%; P= 0.007）. In corneas on which no surgery was performed, there was no induction of NV in both the dry and non- dry group, but dry eye group demonstrated more CD11b＋ cells infiltration than the non-dry eye group （0.360%± 0.160% vs 0.023%±0.006%; P=0.068）. Dry eye group showed more NV than non-dry eye group in both topical PBS application and subconjunctival PBS injection （P= 0.020 and 0.000, respectively）.

Evaluation of preoperative dry eye in people undergoing corneal refractive surgery to correct myopia

AIM: To investigate the incidence of preoperative dry eye and related factors in patients undergoing corneal refractive surgery to correct myopia.METHODS: A total of 141 patients with myopia who underwent corneal refractive surgery were surveyed by questionnaires, tear film break-up time(BUT) test, Schimer I test(SIt), corneal fluorescein staining(FL) test and diagnosed according to the currently recognized domestic diagnostic criteria for dry eye. Correlation analysis of factors such as age, gender, regular wearing of contact lens(CL), diopter(spherical equivalent), corneal thickness, and corneal curvature that may affect the onset of dry eye was carried out to clarify the main influencing factors. RESULTS: There were 64 patients(45.39%) diagnosed with dry eye. The male patients(20.31%) was significantly less than that of non-dry eye subjects(41.56%;χ~2=7.260, P=0.007);the proportion of patients with dry eye wearing CL(81.25%) was significantly higher than that of non-dry eye subjects(51.95%;χ~2=13.234, P<0.001);the median diopter level of dry eye patients was-6.59(IQR:-8.87,-4.58) D, and the median diopter level of non-dry eye subjects was-5.69(IQR:-7.15,-4.03) D. The diopter level of dry eye patients was significantly higher(Z=-2.086, P=0.019). However, the age, best corrected visual acuity, and intraocular pressure of dry eye patients were not statistically different from those of non-dry eye subjects(t=-0.257,-0.383 and 0.778, P=0.798, 0.702, and 0.438);the corneal thickness and corneal curvature(K1 and K2) were also not statistically different either(Z=-1.487,-1.036 and-1.707, P=0.137, 0.300, and 0.088). The research further analyzes the three significant factors in the single factor analysis(gender, CL wear, and diopter) in a multi-factor way: CL wear and diopter were the influencing factors of dry eye disease. Among them, CL wear increased the risk of dry eye by 2.934 times compared with no CL wear;for every 1 D increase in diopter, the risk of dry eye increased by 0.761 times.CONCLUSION: Preoperative dry eye is relatively common in patients who undergo corneal refractive surgery to correct myopia, especially in patients who have a history of CL wear and a high diopter level before surgery. Therefore, it is necessary to carry out preoperative screening and timely treatment of dry eye to obtain the best treatment outcome and postoperative satisfaction.

Severe prelenticular membrane formation on the surface of a hydrophilic acrylic intraocular lens after cataract surgery in an eye with an Ahmed valve implant

【正】Dear Sir,Iam Yong-Sun Ahn,from the Department of Ophthalmology of St.Vincent Hospital of Suwon,Kyungki-do,South Korea.Cataracts are a common problem in eyes with a glaucoma drainage device(GDD),because tube shunt surgery increases the incidence and progression of cataracts[1].An Ahmed valve,the most commonly inserted GDD,is composed of a silicone tube connected to a flat plate sewn to the sclera,and aqueous humor flows from the

A reasonable option in vitrectomized eyes: manual small incision cataract surgery

Dear Sir,It is known that cataract surgery is challenging in vitrectomized eyes.Cataract surgeons may have encountered with posterior capsular complications and nucleus drop events even with minimal ocular manipulations and low irrigation bottle height.Inadvertent damage to the zonular fibers,posterior or peripheral lens capsule with ocutome or microvitreoretinal(MVR)blade in previous

Eyelid malposition after orbital fracture surgery

Orbital fractures generally do not cause eyelid malposition.Studies have shown that mostly eyelid malposition is mainly due to the choice of surgical approaches of orbital fracture repair.Approaches are divided into transcutaneous and transconjunctival ones.The application of orbital fracture approaches depends on fractures’range and the surgeons’preferences.Eyelid malposition after orbital fracture surgery is not only an aesthetic concern but also a functional complication,which will cause eyes discomfort,such as corneal exposure and ocular irritation.Some patients may have multiple types of eyelid malposition.In this review,we summarized the surgical approaches of orbital fractures and the complications including scar,ectropion,retraction,entropion,flattening,laceration and lacrimal canaliculus avulsion and notch deformity that associated with eyelid,especially the lower eyelid.Reports revealed that the scar usually occurred in infraorbital incisions compared with subtarsal and subciliary incisions,and the transconjunctival approach had a higher incidence of entropion and flattening,and less ectropion than the transcutaneous approach.Meanwhile,pathogenesis of eyelid malposition after orbital fracture surgery are discussed.Furthermore,to prevent eyelid malposition complications,doctors should choose the appropriate orbital fracture approach according to the patient’s needs,and delicate tissue management,technical expertise,and meticulous hemostasis are necessary.Conservative treatment with taping,lubricating ointment,and steroid for eyelid malposition complications should be performed first,and then surgical intervention when the conservative treatment fails.

Macular edema after cataract surgery in diabetic eyes evaluated by optical coherence tomography

AIM：To assess quantitative changes of the macula in diabetic eyes after cataract surgery using optical coherence tomography（OCT）and to estimate the incidence of development or worsening of macular edema（ME）in diabetic eyes with or without pre-existing ME.·METHODS：In this prospective,observational study,92eyes of 60 diabetic patients who underwent cataract surgery were evaluated before surgery and 1,3mo after surgery using OCT.Macular thickness was measured with OCT at nine macular subfields defined by the 9zones early treatment of diabetic retinopathy study（ETDRS）,as well as total macular volume obtained by OCT at 1,3mo after surgery were compared with baseline features obtained before surgery.In addition,the incidence of development or worsening of ME was analyzed in diabetic eyes with or without pre-existing ME.·R ESULTS：The central subfield mean thickness increased 21.0μm and 25.5μm at 1,3mo follow-up,respectively（〈0.01）.The average thickness of inner ring and outer ring increased 14.2μm and 9.5μm at 1mo,18.2μm and 12.9μm at 3mo.Central-involved ME developed in 12 eyes at 3mo,including 4 eyes with preexisting central-involved and 8 eyes with pre-existing non-central involved ME.Pre-existing diabetic macular edema（DME）was significantly associated with centralinvolved ME development（〈0.001）.·C ONCLUSION：A statistically significant increase could be detected in the central subfield as well as perifoveal and parafoveal sectors though the increase was mild.And eyes with pre-operative DME prior to cataract surgery are at higher risk for developing central-involved ME.

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India

AIMTo determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India.METHODSWe performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within &#x000b1;1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis.RESULTSOf the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87).CONCLUSIONPCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.

Homemade lyophilized cross linking amniotic sustained-release drug membrane with anti-scarring role after filtering surgery in rabbit eyes

AIM: To investigate the antifibrotic effect of the freeze-dried bilayered fibrin-binding amniotic membrane as a drug delivery system on glaucoma surgery in rabbit model. The aim of this study was to prepare a novel local delivery system for the sustained and controllable release of 5-Fu. METHODS: Twenty-four Japanese white rabbits were randomized into three groups: the experimental group (ocular trabeculectomy in combination with 5-Fu loaded freeze-dried bilayered fibrin-binding amniotic membrane transplantation), the control group (ocular trabeculectomy in combination with 5-Fu) and the blank group (single trabeculectomy). HE staining, massion staining and immunohistochemistry for alpha -SMA were performed on days 7, 14, 21 and 30 following surgery. The concentration of 5-Fu in rabbit aqueous humor was examined by high performance liquid chromatography (HPLC) 3 days after the surgery. RESULTS: Statistical differences were noted in intraocular pressure among groups on day 7, 14, 21 and 30 following surgery. Histology further demonstrated that trabeculectomy in combination with freeze-dried bilayered fibrin-binding amniotic membrane yielded well wound healing and no scar formation and was beneficial for long term effect. CONCLUSION: HPLC showed a good slow-release effect with freeze-dried bilayered fibrin-binding amniotic membrane.

Epidemiological Particularities and Indications of the Mutilating Surgery of the Eyeball in Abidjan (Ivory Coast)

Objective: To describe the epidemiological profile and indications of mutilating eyeball surgery in Abidjan. Patients and methods: This is a retrospective descriptive study on the files of eviscerated, enucleated or exentered patients in the Ophthalmology Department of the University Hospital of Yopougon from January 2010 to December 2016. The parameters studied were: socio-demographic characteristics, indications of mutilating surgery, anesthetic technique, operative technique and patient evolution. Results: During the study period, 59 patients underwent surgery for mutilating eye surgery out of a total of 11,114 procedures, a frequency of 0.53%. The average age of the patients was 31 years with extremes of 3 years and 67 years. Men predominated in 62.1% of cases with a sex ratio of 1.64. Patients came from rural areas in 68.5% of cases. The main indications of the mutilating surgery were: post-inflammatory phthisis (58.6%) and tumoral affections (29.31%). Evisceration was the most common operative technique (67.2%). In 68% of cases the interventions were performed under peribulbar anesthesia. Patients with evisceration (67.2%) and enucleation (5.1%) all benefited from prosthetic equipment. Conclusion: The mutilating surgery of the eyeball is responsible for serious psychological and sociological impacts. The seriousness of these repercussions requires primary prevention through early and adequate management of eye conditions.

Establishment and application of eye surgery preparation room

This paper aims to discuss the application of eye surgery preparation room( ESPR),also called eye preoperative holding area,in nursing safety assessment and the surgery preparation before ophthalmologic operation. The establishment and application of ESPR optimizes the process of ophthalmologic surgery as w ell as decreases the surgery-w aiting time of patients and turnover period of surgical operations,w hich improves the utilization efficiency of surgery operating room. In addition,the application of ESPR also guarantees the safety of patients during surgical operations and enhances the doctors' satisfaction of cooperation and coordination in surgery operating room.

Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before,during,and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.

Long-term follow-up of cataract surgery in eyes filled with silicone oil

AIM:To evaluate the refractive and long-term outcome of eyes filled with silicone oil(SO)undergoing phacoemulsification cataract surgery(PCS).METHODS:This retrospective study evaluated patients with SO tamponade who were scheduled for PCS.RESULTS:Subjects(n=26)were followed for 29.5±13.9 mo after cataract surgery.The median spherical equivalent refraction(SER)was+5.3 D[interquartile range(IQR)+2.9 to+6.7]before PCS,and+3.4 D(IQR+2.0 to+4.4)after PCS.Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes(57.7%).In 13 eyes assessment of refraction after SO-removal was possible,and showed a myopic shift of-4.6 D(IQR-2.9 to-7.3)in the SER.After SO removal,5 of the 13 eyes(38.5%)were within±1.0 D of the target refraction,while 9 out of the 13 eyes(69.2%)were within±2.0 D.CONCLUSION:In our study,the refraction after PCS for eyes filled with SO manifested low predictability,as did the myopic shift following SO removal.A significant percentage of the eyes that underwent SO administration required a long-term tamponade.

Human eye ocular component analysis for refractive state and refractive surgery

AIM： To analyze the clinical factors influencing the human vision corrections via the changing of ocular components of human eye in various applications; and to analyze refractive state via a new effective axial length.METHODS： An effective eye model was introduced by the ocular components of human eye including refractive indexes, surface radius（r1, r2, R1, R2） and thickness（t, T） of the cornea and lens, the anterior chamber depth（S1） and the vitreous length（S2）. Gaussian optics was used to calculate the change rate of refractive error per unit amount of ocular components of a human eye（the rate function M）. A new criterion of myopia was presented via an effective axial length.RESULTS： For typical corneal and lens power of 42 and 21.9 diopters, the rate function Mj（j=1 to 6） were calculated for a 1% change of r1, r2, R1, R2, t, T（in diopters） M1=＋0.485, M2=-0.063, M3=＋0.053, M4=＋0.091, M5=＋0.012, and M6=-0.021 diopters. For 1.0 mm increase of S1 and S2, the rate functions were M7=＋1.35, and M8=-2.67 diopter/mm, respectively. These rate functions were used to analyze the clinical outcomes in various applications including laser in situ keratomileusis surgery, corneal cross linking procedure, femtosecond laser surgery and scleral ablation for accommodation.CONCLUSION： Using Gaussian optics, analytic formulas are presented for the change of refractive power due to various ocular parameter changes. These formulas provide useful clinical guidance in refractive surgery and other related procedures.

Re:Commentary on ten-year incidence of cataract surgery in urban south China:the Liwan Eye Study

We would like to thank Koo et al.for their comments regarding our study on the 10-year incidence of cataract surgery and its associations in an urban adult Chinese population aged 50 years and older(1).Our study indicated that although the annual incidence of cataract surgery in our study(0.9%)was higher than that previously reported by the Beijing Eye Study,it was notably lower than those in other high-income countries,especially for those aged 75 years and older.Participants with higher income,higher education levels,and diabetes at baseline were more likely to have cataract surgery during the 10-year follow-up period.