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Yu J.,Fudan University | Yu J.,Key Laboratory of Myopia of State Health Ministry | Gu R.,Fudan University | Gu R.,Key Laboratory of Myopia of State Health Ministry | And 13 more authors.
Investigative Ophthalmology and Visual Science | Year: 2016

PURPOSE. To investigate the relationship between retinal perfusion and retinal thickness in the peripapillary and macular areas of healthy subjects. METHODS. Using spectral-domain optic coherence tomography and split-spectrum amplitude decorrelation angiography (SSADA) algorithm, retinal perfusion and retinal thicknesses in the macular and peripapillary areas were measured in healthy volunteers, and correlations among these variables were analyzed. RESULTS. Overall, 64 subjects (121 eyes) including 28 males and 36 females with a mean ± SD age of 38 ± 13 years participated. Linear mixed-models showed that vessel area density was significantly correlated with the inner retinal thickness (from the inner limiting membrane to the outer border of the inner nucleus layer; P < 0.05), but not with the thickness of the full retina (P > 0.05) in the parafoveal area. The area of the foveal capillary-free zone was negatively correlated with the inner and full foveal thicknesses (all P < 0.001). In the peripapillary area, the vessel area density was positively correlated with the thickness of the retinal nerve fiber layer (P < 0.001). CONCLUSIONS. In healthy subjects, retinal perfusion in small vessels was closely correlated with the thickness of the inner retinal layers in both the macular and peripapillary areas. © 2016, Association for Research in Vision and Ophthalmology Inc. All rights reserved.


Yu J.,Fudan University | Yu J.,Key Laboratory of Myopia of State Health Ministry | Jiang C.,Fudan University | Jiang C.,Key Laboratory of Myopia of State Health Ministry | And 13 more authors.
Investigative Ophthalmology and Visual Science | Year: 2015

PURPOSE. To investigate macular perfusion in healthy Chinese individuals and examine its dependence on age and sex. METHODS. Healthy adult Chinese individuals were recruited. Macular perfusion was measured by spectral-domain optical coherence tomography (OCT) using the split-spectrum amplitudedecorrelation angiography (SSADA) algorithm. The parafoveal flow index and vessel area density as well as the area of the foveal capillary-free zone (CFZ) were quantified. RESULTS. A total of 76 eyes in 45 subjects were included (20 males and 25 females, mean age 36±11 years). The mean parafoveal flow index was 0.099 ± 0.013; the mean vessel area density was 0.891 ± 0.073; and the mean CFZ area was 0.474 ± 0.172 mm2. All three parameters were significantly correlated with age (flow index: P = 0.00; vessel area density: P = 0.00; CFZ area: P = 0.02). The flow index and vessel area density decreased annually by 0.6% and 0.4%, respectively, and CFZ area increased by 1.48% annually. The CFZ area was larger in females than in males, while all three parameters seemed to change more rapidly with age in males than in females. CONCLUSIONS. In healthy Chinese eyes, macular perfusion decreased with increasing age, and decreased more rapidly in males than in females. The application of OCT angiograms may provide a useful approach for monitoring macular perfusion, although caution must be exercised with regard to age- and sex-related variations. © 2015 The Association for Research in Vision and Ophthalmology, Inc.


Jiang D.,Second People Hospital | Xiao X.,Second People Hospital | Fu T.,People Hospital | Mashaghi A.,Massachusetts Eye and Ear Infirmary | And 5 more authors.
PLoS ONE | Year: 2016

Purpose: Diabetes mellitus is an increasingly common systemic disease. Many diabetic patients seek cataract surgery for a better visual acuity. Unlike in the general population, the influence of cataract surgery on tear film function in diabetic patients remains elusive. The aim of this study was to evaluate the tear function in diabetic and nondiabetic patients following cataract surgery. Methods: In this prospective, interventional case series, 174 diabetic patients without dry eye syndrome (DES) and 474 age-matched nondiabetic patients as control who underwent phacoemulsification were enrolled at two different eye centers between January 2011 and January 2013. Patients were followed up at baseline and at 7 days, 1 month, and 3 months postoperatively. Ocular symptom scores (Ocular Surface Disease Index, OSDI) and tear film function including tear film stability (tear film break-up time, TBUT), corneal epithelium integrity (corneal fluorescein staining, CFS), and tear secretion (Schirmer's I test, SIT) were evaluated. Results: In total, 83.9% of the diabetic patients (146 cases with 185 eyes) and 89.0% of the nondiabetic patients (422 cases with 463 eyes) completed all check-ups after the interventions (P = 0.095). The incidence of DES was 17.1% in the diabetic patients and 8.1% in the nondiabetic patients at 7 days after cataract surgery. In the diabetic patients, the incidence of DES remained 4.8% at 1 month postoperatively and decreased to zero at 3 months after surgery. No DES was diagnosed in nondiabetic patients at either the 1-month or 3-month follow-up. Compared with the baseline, the diabetic patients had worse symptom scores and lower TBUT values at 7 days and 1 month but not at 3 months postoperatively. In the nondiabetic patients, symptom scores and TBUT values had returned to preoperative levels at 1-month check-up. CFS scores and SIT values did not change significantly postoperatively in either group (P = 0.916 and P = 0.964, respectively). Conclusions Diabetic patients undergoing cataract surgery are prone to DES. Ocular symptoms and tear film stability are transiently worsened in diabetic patients and are restored more slowly than those in nondiabetic patients. © 2016 Jiang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Dai Y.,Fudan University | Dai Y.,Key Laboratory of Myopia of State Health Ministry | Jonas J.B.,University of Heidelberg | Ling Z.,Fudan University | And 5 more authors.
Retina | Year: 2015

Purpose: To examine the morphology of the optic nerve head in patients with unilateral peripapillary intrachoroidal cavitations (PICCs). Methods: The hospital-based observational study included patients with unilateral PICCs. Tomographic images of the parapapillary fundus were taken by enhanced depth imaging mode of optical coherent tomography. The ocular biometric parameters were compared between the affected eyes and the contralateral unaffected eyes. Results: The study population consisted of 30 patients with a mean age of 42.7 ± 13.8 years (range: 22-72 years), mean axial length of 26.7 ± 2.4 mm (range: 22.00-32.30 mm), and mean refractive error of -8.71 ± 5.21 diopters (range: -20.50 to +0.50 diopters). In the eyes affected by PICC as compared with the contralateral eyes, the vertical (P 0.001) and the minimal optic disk diameters (P 0.01) were significantly shorter, the ratio of minimal to maximal disk diameter was significantly lower (P 0.03), and the angle of disk rotation was significantly higher (P < 0.001). Conclusion: In patients with unilateral PICCS, the eyes with PICCs had optic disks that were more spindlelike configured because of a disk rotation around the vertical axis and around the sagittal axis as compared with the contralateral eyes.


Qian Y.,Fudan University | Qian Y.,Key Laboratory of Myopia of State Health Ministry | Huang J.,Fudan University | Huang J.,Key Laboratory of Myopia of State Health Ministry | And 3 more authors.
Journal of Cataract and Refractive Surgery | Year: 2015

Purpose To compare the efficacy of correcting myopic astigmatism with femtosecond laser small-incision lenticule extraction (SMILE, Carl Zeiss Meditec AG) versus laser-assisted subepithelial keratectomy (LASEK). Setting The study was conducted at the Ophthalmology Department, Eye and ENT Hospital, Shanghai, China. Design A retrospective, cross-sectional study. Methods This study included patients who underwent small-incision lenticule extraction or LASEK for the correction of myopia and myopic astigmatism. Preoperative and 6-month postoperative astigmatism values were analyzed. The efficacies of the 2 surgeries to correct astigmatism were compared. Results A total of 180 right eyes of 180 patients (small-incision lenticule extraction: n = 113, LASEK: n = 67) were included. No significant difference was found between the 2 groups in the preoperative astigmatism (small-incision lenticule extraction: 1.16 ± 0.85D, LASEK: 1.16 ± 0.83D, P > .05) or the postoperative astigmatism (small-incision lenticule extraction: 0.35 ± 0.37D; LASEK: 0.31 ± 0.42D, P > .05), determined by manifest refraction. No significant difference was found between the 2 groups in surgically induced astigmatism vector (small-incision lenticule extraction: 1.13 ± 0.83D, LASEK: 1.01 ± 0.65D, P > .05). The correction index was higher for the small-incision lenticule extraction group (1.05 ± 0.53) than for the LASEK group (0.95 ± 0.21, P = .045). The postoperative astigmatism was significantly higher for the small-incision lenticule extraction group when the preoperative astigmatism was 1.0 D or less (small-incision lenticule extraction: 0.26 ± 0.30D, LASEK: 0.12 ± 0.20D, P = .007) and lower for the small-incision lenticule extraction group when the preoperative astigmatism was more than 2.0 D (small-incision lenticule extraction: 0.48 ± 0.37D, LASEK: 0.89 ± 0.46D, P = .002). Conclusions An adjustment of nomograms for correcting low astigmatism (≤1.0 D) by small-incision lenticule extraction is suggested due to the tendency toward overcorrection, whereas a nomogram adjustment for tissue-saving ablation profile is needed for the correction of high astigmatism (>2.0 D) by LASEK due to the tendency toward undercorrection. © 2015 ASCRS and ESCRS.


Qian Y.,Fudan University | Qian Y.,Key Laboratory of Myopia of State Health Ministry | Huang J.,Fudan University | Huang J.,Key Laboratory of Myopia of State Health Ministry | And 5 more authors.
Journal of Cataract and Refractive Surgery | Year: 2014

Purpose To assess the influence of the origin of astigmatism on the correction of myopic astigmatism by laser-assisted subepithelial keratectomy (LASEK). Setting Ophthalmology Department, Eye and ENT Hospital, Shanghai, China. Design Prospective study. Methods Patients having LASEK to correct myopia or myopic astigmatism were divided into 2 groups according to their ocular residual astigmatism (ORA). Patients were examined preoperatively and 1 and 3 months postoperatively. The efficacy of LASEK was compared between those with and those without a significant amount of intraocular astigmatism. Results The study comprised 54 eyes of 54 patients. The mean index of success (ratio of magnitude of remaining uncorrected astigmatism to that of initial preoperative astigmatism) in the high ORA group (n = 21) and low ORA group (n = 33) was 0.85 and 0.48, respectively, 1 month after surgery (t = 2.17, P =.04) and 0.88 and 0.32, respectively, 3 months after surgery (t = 2.18, P =.04). The Zernike coefficient of horizontal coma, Z(3,+1), increased more after surgery in the high ORA group than in the low ORA group (1 month versus preoperative, t = 2.32, P =.024; 3 months versus preoperative, t = 2.07, P =.048). Conclusions Nine percent and 2% of the eyes had minimal corneal haze at 1 month and 3 months, respectively. Laser-assisted subepithelial keratectomy was less effective in correcting myopic astigmatism when astigmatism was mainly located at the internal optics. Horizontal coma increased more after LASEK in patients with higher ORA. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2014 ASCRS and ESCRS.


Jing Q.,Fudan University | Jing Q.,Key Laboratory of Myopia of State Health Ministry | Tang Y.,Fudan University | Tang Y.,Key Laboratory of Myopia of State Health Ministry | And 6 more authors.
PLoS ONE | Year: 2016

Purpose To evaluate the characteristics of the posterior corneal surface in patients with high myopia before cataract surgery. Methods We performed a cross-sectional study at the Eye and ENT Hospital of Fudan University, Shanghai, China. Corneal astigmatism and axial length were measured with a rotating Scheimpflug camera (Pentacam) and partial coherence interferometry (IOLMaster) in a high-myopia study group of 167 eyes (axial length ≥ 26 mm) and a control group of 150 eyes (axial length > 20 mm and < 25 mm). Results Total corneal astigmatism and anterior corneal astigmatism values were higher in the highmyopia group than in the control group. There was no significant difference in posterior corneal astigmatism between the high-myopia study group and the control group. In the study group, the mean posterior corneal astigmatism (range 0 - -0.9 diopters) was -0.29 diopters (D) ± 0.17 standard deviations (SD). The steep corneal meridian was aligned vertically (60° -120° ) in 87.43% of eyes for the posterior corneal surface, and did not change with increasing age. There was a significant correlation (r = 0.235, p = 0.002) between posterior corneal astigmatism and anterior corneal astigmatism, especially when the anterior corneal surface showed with-the-rule (WTR) astigmatism (r = 0.452, p = 0.000). There was a weak negative correlation between posterior corneal astigmatism and age (r = -0.15, p = 0.053) in the highmyopia group. Compared with total corneal astigmatism values, the anterior corneal measurements alone overestimated WTR astigmatism by a mean of 0.27 ± 0.18 D in 68.75% of eyes, underestimated against-the-rule (ATR) astigmatism by a mean of 0.41 ± 0.28 D in 88.89% of eyes, and underestimated oblique astigmatism by a mean of 0.24 ± 0.13 D in 63.64% of eyes. Conclusions Posterior corneal astigmatism decreased with age and remained as ATR astigmatism in most cases of high myopia. There was a significant correlation between posterior corneal astigmatism and anterior corneal astigmatism when anterior corneal astigmatism was WTR. If posterior corneal astigmatism is not accounted for when selecting toric intraocular lenses for high-myopia patients, the use of anterior corneal astigmatism measurements alone will lead to overestimation of WTR astigmatism and underestimation of ATR and oblique astigmatism. © 2016 Jing et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Rong X.,Fudan University | Rong X.,Key Laboratory of Myopia of State Health Ministry | Ji Y.,Fudan University | Ji Y.,Key Laboratory of Myopia of State Health Ministry | And 6 more authors.
PLoS ONE | Year: 2015

Aim: The aim of this study was to evaluate the long-term visual outcomes and factors affecting visual results in children undergoing secondary intraocular lens (IOL) implantation following primary congenital cataract extraction. Methods: Children with congenital cataracts who underwent secondary IOL implantation for aphakia at the Eye and ENT Hospital of Fudan University between January 1, 2001, and December 31, 2007, were retrospectively reviewed. One eye was randomly selected in children with bilateral cataracts. Laterality, type of cataract (total or partial opacity), sex, age at primary and secondary surgeries, visual axis opacity (VAO), compliance with amblyopia therapy, postoperative ocular complications, refractive error, ocular alignment, and best corrected visual acuity (BCVA) at last follow-up were recorded; potential factors that might have affected the visual results were evaluated. Results: Seventy-six bilateral and 34 unilateral congenital cataract cases were analyzed; the mean ages of the children were 12.70±5.06 and 12.50±2.71 years at final follow-up, the mean follow-up periods from IOL implantation were 94.93±24.22 and 109.09±18.89 months, and the mean BCVA (Log MAR) values were 0.51±0.37 and 1.05±0.46, respectively. Final BCVA after secondary IOL implantation was significantly associated with laterality, type of cataract, age at primary cataract extraction, compliance with amblyopia therapy, and refractive correction after surgery. No significant associations were found between BCVA and sex, age at secondary IOL implantation, VAO, or other ocular complications. The most common ocular complications were VAO and elevated intraocular pressure after surgery. There were no other complications, with the exception of one eye with IOL dislocation. Conclusions: The results indicate that the important determinants of long-term visual outcomes in children with congenital cataracts undergoing secondary IOL implantation are laterality, cataract type, age at initial cataract extraction, compliance with amblyopia therapy, and refractive error. © 2015 Rong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Qian Y.,Fudan University | Qian Y.,Key Laboratory of Myopia of State Health Ministry | Huang J.,Fudan University | Huang J.,Key Laboratory of Myopia of State Health Ministry | And 3 more authors.
Journal of Refractive Surgery | Year: 2015

PURPOSE: To evaluate corneal power distribution using the ray tracing method (corneal power) in eyes undergoing small incision lenticule extraction (SMILE) surgery and compare the functional optical zone with two lenticular sizes. METHODS: This retrospective study evaluated 128 patients who underwent SMILE for the correction of myopia and astigmatism with a lenticular diameter of 6.5 mm (the 6.5-mm group) and 6.2 mm (the 6.2-mm group). The data include refraction, correction, and corneal power obtained via a Scheimpflug camera from the pupil center to 8 mm. The surgically induced changes in corneal power (Δcorneal power) were compared to correction and Δrefraction. The functional optical zone was defined as the largest ring diameter when the difference between the ring power and the pupil center power was 1.50 diopters or less. The functional optical zone was compared between two lenticular diameter groups. RESULTS: Corneal power distribution was measured by the ray tracing method. In the 6.5-mm group (n = 100), Δcorneal power at 5 mm showed the smallest difference from Δrefraction and Δcorneal power at 0 mm exhibited the smallest difference from correction. In the 6.2-mm group (n = 28), Δcorneal power at 2 mm displayed the lowest dissimilarity from Δrefraction and Δcorneal power at 4 mm demonstrated the lowest dissimilarity from correction. There was no significant difference between the mean postoperative functional optical zones in either group when their spherical equivalents were matched. CONCLUSIONS: Total corneal refactive power can be used in the evaluation of surgically induced changes following SMILE. A lenticular diameter of 6.2 mm should be recommended for patients with high myopia because there is no functional difference in the optical zone.


Qian Y.-S.,Fudan University | Qian Y.-S.,Key Laboratory of Myopia of State Health Ministry | Huang J.,Fudan University | Huang J.,Key Laboratory of Myopia of State Health Ministry | And 9 more authors.
Journal of Refractive Surgery | Year: 2011

PURPOSE: To investigate the influence of the origin of astigmatism on the correction of myopic astigmatism by LASIK. METHODS: A retrospective study was conducted of the records of 192 patients (192 eyes) undergoing LASIK for correction of myopia and myopic astigmatism from January to September 2010. Ocular residual astigmatism (ORA) and lenticular astigmatism (LA) were determined by vector analysis using objective refraction and Pentacam (Oculus Optikgeräte GmbH) imaging of both corneal surfaces. Patients were divided into two groups according to ORA (high ORA group: ORA/preoperative refractive astigmatism >1; normal ORA group: ORA/preoperative refractive astigmatism ≤1) and LA (high LA group: LA/preoperative refractive astigmatism >1; normal LA group: LA/preoperative refractive astigmatism ≤1). Procedural efficacy was compared between those eyes with and without a significant amount of internal optical astigmatism using index of success. RESULTS: Mean preoperative vectors for the astigmatism of the anterior cornea, posterior cornea, and lens were -1.33×3.0°, -0.33×95.3°, and -0.27×103.3°, respectively. Mean indices of success in the high and low ORA groups were 1.75 and 0.59, respectively (t=7.81, P<.001). Mean indices of success in the high and low LA groups were 2.07 and 0.70, respectively (t=12.36, P<.001). The higher indices of success in the high ORA and high LA groups suggest a lower efficacy of LASIK in treating astigmatism primarily located intraocularly. CONCLUSIONS: Myopic LASIK is less effective in correcting astigmatism when astigmatism is mainly located at the internal optics. Topography and refractive value should be incorporated in the treatment of patients when a significant amount of internal optical astigmatism is detected preoperatively. Copyright © SLACK Incorporated.

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