Background The pre-chop technique can decrease the use of ultrasound power,and thus reducing the loss of corneal endothelial cells (CECs) and injuries of other intraocular structures.Many currently developed manual pre-chop techniques restrict the wide application of the pre-chop technique because of their intrinsic disadvantages.The present study describes a manual pre-chop technique for pre-slicing the lens nucleus by using a novel reverse chopper,which has not been reported yet.Objective This study was to compare the efficacy and safety of pre-chop technique using a reverse chopper and stop-and-chop phacoemulsification technique on Ⅳ degree hard nucleus cataract.Methods A prospective clinical-controlled interventional study was performed.Thirty-two eyes of 32 cataract patients with Ⅳ degree of nucles were enrolled in People's Hospital of Hetian District from March 2015 to January 2016.The patients were randomized into the prechop group and matched stop-and-chop group according to random number table.The self-made reverse chopper-assisted pre-chop phacoemulsification surgery and stop-and-chop phaco surgery were performed on the eyes of corresponding groups,respectively.The ultrasound power,effective phaco duration,corneal endothelium loss rate,the eye number of different grade of cornea edema after operation and vision outcome were compared between the two groups.Written informed consent was obtained prior to relevant examination and surgery.Results The mean effective Phaco durations were 42.56 (39.31,45.81) seconds and 78.63 (73.85,83.40) seconds in the prechop group and stop-and-chop group,with a significant difference between them (Z =-4.937,P =0.000).The eye number with different degree of best corrected visual acuity (BCVA) was significantly different between the two groups,at postoperative day 1 and day 3 (P =0.013,0.033).The number of corneal endothelial cells (CECs) 1 month after surgery was (2 026.05 ± 154.03)/mm2 in the prechop group,and the number was (1 866.50-± 117.16)/mm2 in the stop-and-chop group,with a significant difference between them (t =3.298,P=0.003).The CECs loss rate was (13.36±2.85) ％ in the prechop group,which was lower than (25.77±3.81) ％ in the stop-and-chop group (t=-6.996,P=0.000).The eye number with different degree of corneal edema was significantly decreased in the prechop group compared with the stop-and-chop group at postoperative day 1 and day 3 (P =0.001,0.002).Conclusions Compared with the stop-and-chop phaco technique,a reverse chopper-assisted pre-chopping technique can decrease the intraoperative complication,lighten the postoperative damage of CECs and accelerate visual rehabilitation in hard nucleus cataract eyes.

Objective To assess the clinical effects of supracapsular implantation with optic capture of the posterior chamber intraocular lens in pediatric cataract.Design Retrospective case series.Participants 15 cases(17 eyes)with pediatric cataract.Methods Phacoemulsification,posterior continuous curvilinear capsulorhexis,about 4 mm in diameter,supracapsular implantation with optic capture of the posterior chamber intraocular lens in pediatric cataract were performed.Main Outcome Measures Preoperative and postoperative visual acuity,intraocular pressure,position of IOL,intraoperative and postoperative complications.Results Implantation of optic capture of the posterior chamber intraocular lens was successfully performed in 17 eyes.Positions of IOL were changed in 5 eyes after operation 6 months,from post-capsule to supra-capsule.Among these 5 eyes,opaque optic axis were found in 4 eyes.No optic axis opaque was found in 13 eyes with optic capture.The major complications of optic capture were lenticular precipitates:grade 1 in 3 eyes(18%);grade 2 in 7 eyes(41%).Anterior synechia of iris occurred in 1 eye(6%);posterior synechia of iris in 4 eyes(24%).Pupil deformity occurred in 5 eyes(29%).Conclusions Posterior continuous curvilinear capsulorhexis and supracapsular implantation with optic capture of the posterior chamber intraocular lens are safe and effective in the treatment of pediatric cataract,especially in the prevention of secondary opacification from the visual axis.

Background The innovation of pre-chop technique lies in shortening surgery duration,reducing ultrasound power,and deseasing the loss of corneal endothelial cells (CECs).Objective This study was to compare the efficacy and safety of pre-chop technique using a reverse-chopper and phaco-and-chop phaco technique to super high myopia associated with hard nucleus cataract.Methods A prospective randomized-controlled-clinical interventional study was performed.Fourty eyes of 40 high myopia associated with cataract patients with Ⅲ-ⅣV degree of nucleus were enrolled in Beijing Tongren Hospital from March to September 2016.The patients were randomized into the pre-chop group and matched phaco-and-chop group according to random number table,and the self-made reverse chopper-assisted pre-chop phacoemulsification (phaco) surgery and phaco-and-chop phaco surgery were performed on the eyes of different groups,respectively.The phaco power,effective phaco duration and best corrected visual acuity (BCVA) were recorded and compared between the two groups to evaluate the efficacy,and the loss rate of corneal endothelial cells and eyes in different grades of cornea edema after operation were compared between the two groups to assess the safety of surgery procedure.Written informed consent from each patient was obtained prior to relevant examination and surgery.Results The surgery was finished smoothly in the eyes.The mean effective phaco duration was (47.30±11.29) seconds and (57.70± 14.51) seconds in the pre-chop group and phaco-andchop group,respectively,with a significant difference between them (t =-2.530,P =0.016).The BCVA was better at the seventh day after surgery in the pre-ehop group than that in the phaco-and-chop group (4.75t0.11 vs.4.67± 0.14),showing a significant difference between the two groups (t=2.147,P=0.038).In 1 month after surgery,the CECs loss rate was (10.82±3.77)％ in the pre-chop group,which was lower than (16.11±6.47)％ in the phacoand-chop group (t=-3.758,P=0.001).The number of the eyes with grade 2-3 of corneal edema in the pre-chop group was significantly decreased in comparison with the phaco-and-chop group 7 days after surgery (Z =11.822,P=0.008).Conclusions Compared with the conventional phaco-and-chop technique,reverse-chopper prechop technique appears to have a better efficacy and safety in phaco surgery for high-myopia associated with hard nuclear cataractous eyes.

Objective To observe the short-term visual effects of cataract surgery patients with 1CU accommodating intraocular lens (IOL) compared with aspheric monofocal IOL. Design Non-randomed comparative trial. Participants Consecutively 118 senile cataract patients (118 eyes). Methods 59 cataract patients (59 eyes) were implanted 1CU accommodating IOL (1CU group), and 59 cataract patients (59 eyes) were implanted aspheric monofocal IOL (Tecnis ZA9003 group). All patients were assessed at 3 months post-operation in the aberrations of crystalline, the modulation transfer function contrast sensitivity of 10/100 percent in three sorts distance(40, 63, 100 cm), uncorrected distanced visual acuity(UCDVA), uncorrected near visual acuity(UCNVA), best-corrected distance visual acuity(BCDVA), best-corrected near visual acuity(BCNVA), distance corrected near visual acuity(DCNVA), pseudo-accommodation, and the rate of off-near glasses. Main Outcome Measures Visual acuity, aberrations, modulation transfer function, contrast sensitivity, pseudo-accommodation, the rate of off-near glasses. Results At 3 months postoperatively, both UCNVA and DCNVA were significantly better in 1CU group than in the aspheric monofocal IOL group (t=8.85, P=0.00; t=13.05, P=0.00). The accommodative range was (2.58?0.37) D in 1CU group and (1.46?0.25) D in monofocal IOL group (t=14.33, P=0.00). In 3 mm and 5 mm pupil diameter the difference of the total aberration and spherical aberration in Tecnis ZA9003 group or 1CU group was significant (3 mm pupil t=18.48, P=0.00; t=5.70, P=0.00. 5 mm pupil t=19.98, P=0.00; t=6.70, P=0.00). At 40 cm and 63 cm, VA scores were higher in 1CU group (85%)than in Tecnis ZA9003 group (25%) (t=3.64, P=0.00; t=2.74, P=0.00; t=2.65, P=0.00; t=2.44, P=0.01). The rate of off-near glasses in 1CU group was better than in the aspheric monofocal IOL group(?2=41.95, P=0.00). Conclusions The 1CU accommodating IOL can provide better useful near visual acuity than aspheric monofocal IOL, especially for the patients who want to get rid of spectacles.

Background Pseudoexfoliation syndrome (PEX) has a high incidence in Uygur population and usually leads to secondary glaucoma and complicated cataract.The abnormal change of lens tissue and degeneration of zonular fibers bring a lot of difficulties for phacoemulsification (phaco) with intraocular lens implantation,especially stop-and-chop phaco technique.Prechop technique is a new choping technology,but its application in PEX with cataract is less.Objective This study was to compare the efficacy and safety of pre chop phaco technique and stop-and-chop phaco technique for PEX combined cataract.Methods A randomized controlled Clinical trial was designed.Forty-one eyes of 41 patients with PEX combined cataract of Ⅲ degree of nucleus were enrolled in People's Hospital of Hetian District from March 2015 to January 2016.The patients were randomized into the prechop group and stop-and-chop group according to random nubmer table,and cystotome-assisted prechop phaco surgery and stop-and-chop phaco surgery were performed in different groups,respectively.The effective phaco duration,corneal endothelium loss rate,cornea edema eye number after operation,vision outcomes and complications were compared between the two groups.Results The mean effective phaco duration was 14.0 (13.0,16.5) minutes and 18.5 (16.5,24.0) minutes in the prechop group and stop-and-chop group,with a significant difference between them (Z =17.354,P ＜ 0.01).The corneal endothelial cells were (2 101.90 ± 209.08)/mm in the prechop group,and the number was similar to (2 002.30 ± 207.04)/mm of the stop-and-chop group (t =-1.530,P =0.134).Corneal endothelial cell lossing rate was (8.27±2.23)％ in the prechop group,which was lower than (13.09±4.26)％ in the stop-and-chop group (t =3.810,P =0.001).The BCVA was better in the prechop group than that in the stop-and-chop group in postoperative day 3 (P =0.044),and the corneal edema degree was not signigicantly different in postoperative day 1 and day 3 between the two groups (P=0.221,0.446).Intraoperative complication was rapture of zonule and occurred in 1 eye and 2 eyes in the prechop group and stop-and-chop group,respectively.Conclusions Compared with the stop-and-chop phaco technique,the prechop phaco tequnique can decrease intraoperative complication,lighten the postoperative damage of corneal endothelial cells and accelerate visual rehabilitation in PEX combined with cataract patients.

Recurrent corneal erosion (RCE), a common disease caused by repeated episodes of corneal epithelial defects, is characterized by the sudden onset of eye pain, usually upon first awakening.Among many causes of the disease, trauma is the most common one, followed by epithelial basement membrane dystrophy.The disease can be diagnosed via the characteristic medical history, ocular symptoms and slit-lamp examination.Treatment of RCE includes both conservative management and surgical management.Conservative treatment is the first choice for the primary patients, including medication, bandage contact lens, application of serum drops, coverage of cryopreserved amniotic membrane, etc.The appropriate surgical procedures should be performed in patients when the conservative therapy failed.Surgical treatment mainly includes epithelial debridement, diamond burr polishing, anterior stromal puncture, alcohol delamination, phototherapeutic keratectomy, photorefractive keratectomy, femtosecond laser-assisted lamellar keratectomy, etc.RCE treatment progress was comprehensively reviewed in this article to provide references for clinical therapy.

AIM: To evaluate the diopter errors and safety of secondary intraocular lens(IOL)implantation in the ciliary sulcus using a modified incision procedure in children with bilateral aphakia.METHODS: The data of 12 children(24 eyes)with bilateral aphakia who had undergone secondary foldable IOL implantation in the ciliary sulcus using a modified incision procedure from 2020 to 2021 were retrospectively reviewed. Incision-related complications were analyzed intraoperatively and at 1 d and 1 mo postoperatively. Best-corrected visual acuity(BCVA), axial length(AL), white-to-white(WTW), and refractive outcomes in terms of preoperative reserved diopters(PRD)and actual equivalent spherical diopters(AESD). The patients were divided into two groups by age(≤7 and >7 a), AL(<23 and ≥23 mm)and WTW(≤11.5 and >11.5mm), and the diopter errors between their AESD and PRD predicted based on the measurement results were compared.RESULTS: The patients comprised 9(75%)boys and 3(25%)girls. Two(17%)patients had anterior subcapsular cataracts, 4(33%)had posterior polar cataracts, and 6(50%)had nuclear cataracts. The mean age at cataract extraction was 6.4±1.61(3.4-8.9)mo. The mean interval between cataract extraction and secondary IOL implantation was 6.8±1.82(4.4-11.5)a. The mean preoperative BCVA was 0.49±0.33(1.0-0.1)LogMAR. The mean postoperative BCVA was 0.38±0.32(1.0-0.0)LogMAR. The mean AL was 23.56±1.96(19.00-26.38)mm, and the mean WTW was 11.5±0.92(9.3-13.9)mm. The mean PRD was 1.57±0.60(0.73-2.77)D, the mean AESD was 0.57±0.55(-0.50 to 1.75)D, and the mean difference between the AESD and PRD was -0.99±0.52(-2.22 to 0.32)D. The differences in the AESD and PRD between the groups according to age, AL and WTW were not statistically significant(P=0.59, 0.56, and 0.53, respectively).CONCLUSION: IOL implantation in the ciliary sulcus after a modified incision is safe and feasible for children with aphakia. It is necessary to subtract approximately 1 D of IOL power from the formula-selected power when implanting an IOL in the ciliary sulcus. Age, AL, and WTW do not significantly affect the difference.

The optic nerve is the only pathway that transduct visual signals into visual centers, and is consisted of retinal ganglion cells and glial cells. Astrocytes, the most abundant neuroglia in center nerve system (CNS), are considered as structural supporter and carrier of metabolic components of neurons. In recent years, astrocytes have become treasure of neurological study due to their dual effects after nerve injury. The neurotoxic reactive astrocytes are termed as A1-type, and the neuroprotective ones are termed as A2-type. For the purpose of reducing neuron loss after optic nerve injury, it is critical to find out proper management methods of astrocyte reactivity. In this paper, we will concentrate on the inducers, mechanisms and influences of astrocyte reactivity in optic nerve and CNS, and then, summarize present possible interference ways to a neuroprotective outcome.

Objective:To investigate the effect and mechanism of bone marrow mesenchymal stem cell (BMSC)-derived exosomal microRNA-1297 (miR-1297) on hippocampal neuron damage in depressed rats.Methods:BMSCs and BMSCs-derived exosomes were prepared and identified. Rats were first injected with corticosterone to establish the model of depression, and then injected with BMSCs-derived exosomes. Superoxide dismutase (SOD), malondialdehyde (MDA), lactate dehydrogenase (LDH), TNF-α and IL-1β in rat serum samples, hippocampal tissues and neurons were detected. Expression of miR-1297 in hippocampal tissues and neurons was detected by RT-qPCR. A rat hippocampal neuron injury model was established to investigate the role of BMSC-derived exosomes and miR-1297 in neuronal apoptosis and proliferation. The targeting relationship between miR-1297 and connective tissue growth factor (CTGF) was analyzed using dual luciferase reporter genes.Results:In the hippocampus of depressed rats, the expression of miR-1297 was low, while the expression of CTGF was elevated. Exosomes derived from BMSCs can inhibit the expression of CTGF by up-regulating the level of miR-1297, thereby inhibiting neuronal cell apoptosis in the hippocampus of depressed rats, while increasing the level of SOD, and reducing inflammatory damage, and ultimately improving the behavioral function of depressed rats.Conclusions:Depressed rats showed decreased expression of miR-1297 and increased expression of CTGF. BMSC-derived exosomes inhibited CTGF expression through up-regulating miR-1297, thereby improving hippocampal neuron damage in rats with depression.