10-year fundus tessellation progression and retinal vein occlusion

AIM： To access the 10-year fundus tessellation progression in patients with retinal vein occlusion. METHODS： The Beijing Eye Study 2001/2011 is a populationbased longitudinal study. The study participants underwent a detailed physical and ophthalmic examination. Degree of fundus tessellation was graded by using fundus photographs of the macula and optic disc. Progression of fundus tessellation was calculated by fundus tessellation degree of 2011 minus degree of 2001. Fundus photographs were used for assessment of retinal vein occlusion. RESULTS： The Beijing Eye Study included 4403 subjects in 2001, 3468 subjects was repeated in 2011. Assessment of retinal vein obstruction and fundus tessellation progression were available for 2462 subjects（71.0%）, with 66 subjects fulfilled the diagnosis of retinal vein occlusion. Of the 66 participants, 59 participants with unilateral branch retinal vein occlusion, 5 participants with unilateral central retinal vein occlusion, 1 participant with bilateral branch retinal vein occlusion, and 1 participant with branch retinal vein occlusion in one eye and central retinal vein occlusion in the other eye. Mean degree of peripapillary fundus tessellation progression were significantly higher in the whole retinal vein occlusion group（0.33±0.39, P〈0.001）, central retinal vein occlusion group（0.71±0.8, P=0.025） and branch retinal vein occlusion group（0.29±0.34, P=0.006） than the control group（0.20±0.26）. After adjustment for age, prevalence of tilted disc, change of best corrected visual acuity, axial length, progression of peripapillary fundus tessellation was associated with the presence of retinal vein occlusion（P=0.004; regression coefficient B, 0.094; 95%CI, 0.029, 0.158; standardized coefficient B, 0.056）. As a corollary, after adjusting for smoking duration, systolic blood pressure, anterior corneal curvature, prevalence of RVO was associated with more peripapillary fundus tessellation progression（P〈0.001; regression coefficient B： 1.257; OR： 3.517; 95%CI： 1.777, 6.958）. CONCLUSION： Peripapillary fundus tessellation progresses faster in individuals with retinal vein occlusion. This may reflect the thinning and hypoperfusion of choroid in patients with retinal vein occlusion.

Clinical results of non-Descemet stripping endothelial keratoplasty

AIM： To investigate the impact of non-Descemet stripping endothelial keratoplasty（non-DSEK） on graft rejection rate,and its overall procedural effectiveness in patients.METHODS： Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity（BCVA）,endothelial cell density（ECD）,and other complications,were analyzed retrospectively.RESULTS： Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo（range,6-84mo）.The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2（range,637 to 3056 cells/mm^2）,and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty（PKP）.Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION： Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.

Evaluation of cyclorotation during femtosecond laser-assisted cataract surgery performed by using LenSx femtosecond laser

Objectives To evaluate degrees and percentages of cyclorotation in Chinese patients during femtosecond laser assisted cataract surgery performed by using LenSx femtosecond laser platform and to further sub-analyze bilateral cases to assess the congruency between both eyes. Methods This was a single-centre retrospective study(Beijing AIER-Intec Eye Hospital, Beijing, China) in which the records of 330 eyes of 274 patients who underwent femtosecond laser-assisted cataract surgery in 1 or two eyes(with placement of posterior chamber IOL) between May 2017 and July 2019 by using femtosecond laser platform(LenSx) were reviewed.LenSx Femtosecond Laser(Alcon Laboratories, Inc, Fort Worth, Texas, USA) was used to carry out corneal incisions, anterior capsulotomies and lens fragmentation in this procedure. All the patients were marked on corneal limbus(at 3 and 9 o’clock positions) by using sterile skin marker(Medplus.inc) while sitting upright preoperatively. Percentages of cyclorotation were calculated. Absolutes values were taken for all calculations. The cyclorotation data was tested to determine whether it followed a normal distribution. Descriptive statistics were applied to calculate percentile values of cyclorotation which is presented as(M [P25;P75]). Results This retrospective study evaluated 330 eyes of 274 Chinese patients who had femtosecond laser-assisted cataract surgery using the femtosecond laser platform. Of the 330 eyes, there were 90 eyes(27.27%) that did not show cyclorotation. Out of 330 eyes that were analyzed, 72.72%(240 eyes) exhibited cyclorotation. The median value of cyclorotation was 3.0[0.0;5.0](ranged between 0 to 19 degrees). Of the 330 eyes, there were 90 eyes(27.27%) that did not show cyclorotation. Overall anticlockwise rotation(172 eyes, 52.12%) was more common than clockwise rotation(68 eyes, 20.60%).The total numbers of right and left eyes were 169 and 161 respectively. In terms of laterality, 43.78% of right eyes(74 eyes out of 169) and 60.86% of left eyes(98 eyes out of 161) showed anticlockwise rotation. 25.44% of right eyes(43 eyes) and 15.52% of left eyes(25 eyes) exhibited clockwise rotation. Therefore anticlockwise rotation was considered as common occurrence in both left and right eyes. In order to assess the congruency of cyclorotation between eyes in bilateral cases, a subanalysis of all the patients who underwent bilateral femtosecond laser-assisted cataract surgery(56 out of 274) was performed. In total, 17 patients exhibited incylorotation(both eyes moved nasally) and 4 patients showed motion of eyes temporally exhibiting excyclorotation. In rest of patients some of them showed no rotation and others exhibited the movement of both eyes in opposite direction(one eye nasally and other temporally and vice versa).There were no AK-related complications or complications during femtosecond laser-assisted cataract surgery. Among them 56 were bilateral cases. Conclusion Clinically significant cyclorotation can occur during femtosecond laser assisted cataract surgery causing axis misalignment which might influence the desired astigmatism correction outcomes. It is highly recommended to take crucial compensatory measures to address this problem.