Objective To evaluate the effect of the four-port bimanual vitrectomy illuminated by assistants in severe vitreo-retinopathy. Design Retrospective case series. Participants 39 eyes of 39 patients of severve vitreoretinopathy. Methods Four-port bimanual vitrectomy illuminated by assistants were applied. All the patients were followed up for 6 to 18 months. The best corrected visual acuity and reattachment of retina were observed. Main Outcome Measures Operation duration,effect,and complications. Results All the 39 eyes were successfully operated. Time of membrane stripping of membrane ranged from 4 to 50 min (mean 16 min). No complications were found in operation. Retinal redetachment occurred in 4 case and vitreous rebleeding in 2 cases. No sclerotomy was found. Best corrected visual acuity improved in 35 eyes defined as 2-line increase in visual acuity chart or visual acuity from light perception to finger count post-operation. Conclusion Four-port bimanual vitrectomy has more advantages in the operation procedure. It is a promising method in treating patients with severve vitreoretinopathy.

Objective To discuss the clinical curative effect of pleating of levator palpebrae superioris in treating semiptosis. Design Retrospective case series. Participants Forty-three eyes from 30 patients with semiptosis of upper eyelid. Methods By using pleating of levator palpebrae superioris through the skin,isolating the levator muscle was skipped in rectification. Position of upper eyelid-margin before and after operation was observed. Main Outcome Measures The position change of upper eyelid-margin in the first position of eye in 3-6 months after surgery. Results The mean follow-up period was 13.1 months (6 months to 2 years),26 cases (39 eyes) got cured with normal eyelid-margin position,3 patients were below rectification and 1 patient over-rectification. Conclusion Pleating of levator palpebrae superioris is suitable for the treatment of semiptosis of upper eyelid.

Objective To investigate the difference between contrast sensitivity,noise and crowding phenomenon in normal and ametropic amblyopia children. Design Prospective case series. Participants 50 normal children and 50 ametropic amblyopia children. Method Using the noise visual acuity test chart,crowded visual acuity chart and contrast sensitivity visual chart of the visual perception system developed by the National Medical Care Apparatus Engineering Research Center,normal and ametropic amblyopia children were examined in Beijing Tongren Hospital. Main Outcome Measures The number and the constituent ratio of normal and abnormal children in contrast sensitivity,noise and crowding phenomenon. Results The abnormal results of contrast sensitivity in ametropic amblyopia children and normal children were 60 eyes (60%) and 15 eyes (15%) respectively; the abnormal result of noise visual acuity were 62 eyes (62%) and 30 eyes (30%) respectively; the crowded visual acuity were 56 eyes (56%) and 0 eye respectively (all P=0.000). In mild,moderate and severe ametropic amblyopia children,the abnormal results of contrast sensitivity were 32 eyes (51.61%),20 eyes (66.67%) and 8 eyes (100%) respectively (P=0.005),the abnormal results of crowding phenomenon were 30 eyes (48.39%),18 eyes (60%) and 8 eyes (100%) respectively (P=0.010),the abnormal results of noise were 39 eyes (69.90%),18 eyes (60.00%) and 5 eyes (62.5%) respectively (P=0.868). In mild,moderate and severe refractive error children,the abnormal results of contract sensitivity were 33 eyes (70.21%),9 eyes (34.12%) and 17 eyes (62.96%) respectively (P=0.011),the abnormal results of noise were 30 eyes (63.83%),15 eyes (57.69%) and 17 eyes (62.96%) respectively (P=0.868),the abnormal results of crowding phenomenon were 30 eyes (63.83%),11 eyes (42.31%) and 17 eyes (62.96%) respectively (P=0.172). Conclusion Contrast sensitivity,noise and crowding phenomenon in visual perception tests can be used to estimate the impairment of visual perception in amblyopia children.

Objective To observe the effectiveness of botulinum toxin A (BTXA) in the treatment of small sample patients with acute acquired concomitant esotropia. Design Retrospective case series. Participants 6 patients (3 female and 3 male) with acute acquired concomitant esotropia aged 6 to 34 years. Methods All the patients were received 2.5 units of BTXA injected into the bilateral medial rectus muscles once under electromyographic control. They were performed alter prism-cover test,synoptophore and stereoscopic charts test. Main Outcome Measures The alignment of eyes and binocular vision. Results The follow-up of patients was 4 to 39 months. The pre-injection angle of deviation was 43.3?1.0△; the angle of deviation at the last follow-up was 3.3?8.2△,and 5 patients achieved alignment. In pre-injection,one patient had distance stereopsis,2 patients had near stereopsis with 600 seconds and 40 seconds; after injection,5 patients demonstrated distance and near stereeopsis (3 patients 40 seconds,1 patient 60 seconds,and 1 patient 200 seconds). Conclusion This small sample study shows that BTXA injection is effective alternative in treating acute acquired concomitant esotropia.

Objective To improve the accuracy with magnetic resonance imaging (MRI) diagnosis of spontaneous intraocular hemorrhage. Design Retrospective case series. Participants 6 patients with spontaneous intraocular hemorrhage. Methods The image findings were retrospectively analyzed in 6 patients confirmed by surgery with or without pathology. All of them were examined with ultrasonography and 5 cases with color ultrasonography. MRI was performed in 6 cases,and enhanced MRI in 5 cases. Main Outcome Measures Configuration,signal intense,characteristics of enhancement signal and ultrasonograph. Results 1 case was crescent shape on MRI of spontaneous intraocular hemorrhage,2 cases were lenticular shape,3 cases were hump shape. 2 cases showed high signal intensity on T1WI,and low signal on T2WI. 2 cases showed high signal on both T1 and T2WI. 2 cases showed low signal on T1WI,and high signal intensity on T2WI. 2 cases presented a ring with hypointensity on T2WI. No enhancement was revealed within the lesions in 5 cases. Liner enhancement was showed in 2 cases; ring enhancement was showed in 1 case. 2 cases were corrected diagnosed by MRI,2 cases were misdiagnosed as melanoma,and 2 cases were misdiagnosed as tumor concomitant hemorrhage,and all cases were diagnosed as tumor with ultrasonography. With color Doppler imaging 4 cases were correctly diagnosed as hemorrhage based on without blood-flow signal,and 1 case was diagnosed as tumor. Conclusions The MRI signal characteristic of spontaneous ocular hemorrhage is variable,and the main feature is no enhancement within the lesion. MRI combined with ultrasonography can make the diagnosis more correctly.

Objective To investigate the characteristics of the morphological changes of the lens and related structures of human eyes before and after accommodation by magnetic resonance imaging(MRI). Design Prospective case series. Participants Healthy volunteers. Methods Eleven eyes of 8 healthy volunteers were measured by MRI before and after accommodation. Main Outcome Measures Thickness and sectional area of lens,anterior chamber depth,axial length. Results The thickness and section area of lens,anterior chamber depth,axial length was 3.51?0.20 mm,22.89?1.82 mm2,3.54?0.27 mm,23.91?0.90 mm before accommodation,and 3.73? 0.34 mm,23.17?1.66 mm2,3.29?0.32 mm,23.82?1.07 mm after accommodation. The thickness of lens and anterior chamber depth were significantly higher difference after accommodation(t=3.563,P=0.007; t=4.804,P=0.001). Conclusion As a useful tool of biometric measurement,MRI showed the morphological characteristics of the lens and related structures of human eyes,in an accomodated enviroment,and thus might play an important role in related researches.

Photography of slit-lamp biomicroscopy combined with retro-illumination photography is the gold standard in cataract evaluation. However the application is limited due to its complexity and low efficiency. We introduce digital non-mydriatic fundus photography as a new method for cataract screening in patients with visual impairment,which might play an important role in screening low vision and blindness caused by cataract. Two distinguished benefits are found in this method including compatibility for tele-diagnosis,and integration with screening of glaucoma and diabetic retinopathy. Cautions should be made on the photographs in which media opacity derived from other than cataract or low quality photos due to small pupils.

Cataract and age-related macular degeneration (AMD) often present concurrently in aged persons. There has been a longstanding controversy among clinicians as to whether cataract surgery is contraindicated in eyes with AMD. Most of previous researches indicated that cataract surgery could accelerate the progression of AMD. However recently studies suggested that cataract surgery improved visual function of the patients and didn't accelerate the progression of AMD. These are related to the development of cataract surgery and the using of phacoemulsification technique.

Objective To study the effect of using handhold magnifier on reading speed in patients with low vision and normal-sighted people. Design Prospective,control study. Participants Low vision (13 patients)and normal-sighted readers (37 persons) who use handhold magnifiers or the first time. Method Nine-point text was read by normal vision subjects without magnifier and then with two magnifiers with different magnification (+10 D,+20 D) in different eye-to-magnifier distance (10 cm,35 cm). Nine-point text was also read by low vision people with magnifiers. The big printed text under the same magnification without magnifier was also read by low vision group. Reading speed was recorded. Main Outcome Measures Reading speed (words per minute). Result For normal vision subjects,reading speed without magnifier (194.6?45.2 words/min) is faster than that with a 10D magnifier in an eye-to-magnifier distance of 10cm (159.7?44.7 words/min) (P=0.001),and distance of 35cm (162.5?46.7words/min) (P=0.002),respectively. Reading speed without magnifier is also faster than that with a 20D magnifier in an eye-to-magnifier distance of 10cm (150.3?43.3 words/min) (P

Objective To observe the time of occurance,morphologic characteristics,and development of the retinal neurons' apoptosis of the early phase indiabetic rats. Design Experimental study. Participants Sprague-Dawley (SD) rats. Methods In 36 male SD rats of 8-week old,18 were diabetic models induced by streptozotocin injection,and 18 normal ones as control. Each group were subdivided into 3 groups (each group,n=6),in which the rats were sacrificed at 4,8 and 12 weeks,respectively. The pathological change of the retina,and the retinal neurons ultrastructure were observed. Apoptosis of the retinal neurons was also examined by TdT-mediated dUTP nick end label (TUNEL) assay. Main Outcome Measures The pathological retinal structure,the ultrastructure of retinal neurons,and the apoptosis of the retinal neurons in each group. Results No obvious structural changes of retina were found pathologically in diabetic rats of 4-week and 8-week,comparing with age-matched control group. However decreased retinal ganglion cell number and thinner inner nuclear layer were observed in diabetic rats of 12 weeks. Apoptosis defined by electron microscope,including cell shrinkage,reduced cell volume,chromatin margination and nuclear shrinkage and collapse,was found in each subgroup of diabetic rats. Apoptosis in the retinal ganglion cells layer and the inner nuclear layer was dominant. The apoptosis of the retinal neurons by TUNEL assay occurred at 4 weeks after onset of diabetes,and the number of the apoptosis neurons increased at 8 and 12 weeks in diabetic rats,the apoptosis neurons mainly located in the retinal ganglion cells layer and the inner nuclear layer. Conclusion Apoptosis of the retinal neurons occurred at 4 weeks after onset of diabetes and the degree of the apoptosis was correlated with the process of disease in rat model.