Objective To explore the changes of plasma catecholamines(CA)[including epinephrine(E) and norepinephrine(NE)] and atrial natriuretic peptide(ANP) in children with varying degrees of left ventricular ejection function(LVEF) in chronic heart failure(CHF),and establish natriuretic hormone factors as one of the diagnostic criteria of CHF.Methods Thirty-five patients with CHF and 35 children in good health were enrolled,and the concentration of plasma NE,E,ANP and the LVEF were determined.Results 1.The levels of plasma NE,E and ANP in 35 patients with CHF before treatment were significantly higher than those in control group(Pa

Background Excimer laser corneal refractive surgery is one of the major methods to correct refractive error.Centration of the ablation zone is an important factor that affects visual quality after surgery.The pupil center and its shift is a major factor to determine the ablation center.Therefore further study on pupil centroid shift with illumination level alteration is needed.Objective This study aimed to study the characteristics of the pupillary centroid shift along with the change of pupil size under the different illumination conditions and the possible clinical application of the curve of pupillary centroid shift in exeimer laser corneal refractive surgery.MethodsThe variation of pupil size induced by illumination and the changes of pupil center were measured on 114 moderate myopia eyes of 57 subjects with Astra MaxTM Corneal Topographer.Illumination of placido target and image snap model of the topographer was customized to provide 5 illumination levels as follows:0.8,4.4,18.9,82.3,355.0 Lx.Vectorial analysis was used to graph the change of pupil center related to the Coaxially Sighted Corneal Reflex (CSCR).Raw data is converted to relative value to analyze the pupiilary centroid shift.The mean relative change of the pupil size(△P)and the mean of relative pupillary centroid shift(△C)in the form of percentage were used to attenuate the variation among subjects.The original value of illumination(darkest)is defined as 0％ and maximum value(lightest)was as 100％.Results With the increase of illumination,the shift of the pupil center towards nasal side when pupil constrict was found.The mean change of pupil size under the 5 illumination levels were 0,(1.28 +0.40)mm,(2.34 ±0.53)mm,(3.34+0.54)mm,(4.03 ±0.56)mm respectively,and the △P values was 0％,32％,58％,83％,100％ respectively.The mean of pupil centroid shift under the 5 illumination levels were 0,(78±33)μm,(116±60)μm,(143 ±66)μm,(170±71)μm respectively,and the △C was 0％,46％,68％,84％,100％respectively.There was a linear relation between the relative pupil centroid shift and the relative change of pupil size (r=0.980,P=0.025).The amount of pupil centroid shift has a positive correlation with amplitude of the change of pupil size(r=0.480,P＜0.01).Conclusion Pupil center shifts with the change of pupil size.The linear relation between relative pupil centroid shift and the relative change of pupil size can be applied in eximer laser corneal refractive surgery to improve the visual quality with customized ablation center location.

Background Nowadays,customized ablation is widely used in the excimer laser corneal refractive Burgery.And the Q-value guide LASIK is one of the research hotspots. Objective Present study was to evaluate and compare the effectiveness of Q-value guide LASIK and standardized LASIK for myopia.Methods A systematic literature retrieval from 2003 through 2010 was conducted in the MEDLINE,CNKI,Cochrane Library,EMBASE.The literature examine possible difierences in uncorrected visual acuity(UCVA),Q-value,higher order aberrations(HOAs),and spherical equivalent(SE) between Q-value guide LASIK and standardized LASIK for correcting myopia.Statistical analysis was performed using a Review Manager 5.0 software.The data was extracted,and the methodological quality was evaluated by two reviewers independently.The quality of included literature was scored according to the Jadad Scale. Results A total of 14 studies involving 1617 patients(2956 eyes)was included in the meta-analysis.Of these fourteen studies,six studies were randomized trials and the other eight studies were retrospective cohort studies.According to the Jadad Scale,2 studies scored 3 points,and the other 12 studies scored 1～2 points.The results showed that the Q-value guide LASIK group had a better postoperative effectiveness in uncorrective visual acuity(UCVA)(WMD=0.04.95% CI 0.00 to 0.08,P<0.05).Q-value(SMD=-1.52,95% CI -2.23 to-0.81,P=0.00),total HOAs (SMD=-1.63,95% CI-2.57 to-0.69,P<0.05) and spherical-like aberrations ( SMD =-1.49,95% CI-2.22 to-0. 76,P<0. 00) after surgery. However, the number of eyes achieved UCVA≥20/20 ( OR= 1.16,95% CI 0. 61 to 2. 19,P=0. 65) ,coma-like aberrations (SMD=-1. 02,95% CI-0. 36to 0.11,P=0.29) and SE (WMD=0.10,95% CI-0.11 to 0.31,P=0.34) after surgery were comparable.Conclusion The effectiveness of Q-value guide LASIK is superior to standardized LASIK for treatment of myopia.High-quality clinical randomized-controlled study should be performed to further evaluate the comparable outcome of Q-value guide LASIK with standard LASIK.

Background Recently,whether the epithelial flaps should be removed or preserved during the Epi-LASIK and its affection on clinical results are concerned.Objecfive This system analysis was to evaluate and compare the clinical effectiveness between on-flap Epi-LASIK and off-flap epi-LASIK for myopia. Methods A systematic literature retfieval was conducted in the MEDLINE,EMBase,Coehrane Library,CBM disc,CNKI from 2003 through 2009.The possible differences in reepithelization time,pain sensation,and haze after surgery were compared between on-flap and off-flap Epi-LASIK for myopia.The statistical analysis was performed using a RevMan 4.2 software.The data was extracted,and the methodological quality was evaluated by two reviewers independently with weighted mean difierence(WMD)for the effectiveness analysis and odds ratio(OR)for counting variable.The quality of included literature was scored according to the Jadad Scale. Results A total of 8 studies involving 251 patients(502 eyes)were included in the meta-analysis.Of these eight studies.five studies were randomized clinical trials and the other three studies were retrospective cohort studies.Compared with on-flap Epi-LASIK group,off-flap Epi-LASIK group had a better postoperative outcome in the mean reepithelization time(WMD=1.32,95％CI-1.82to-0.82,P<0.01)and pain scores at 3,5 day(WMD=-O.99,95％CI-1.71 to-0.28,P(0.01)(WMD=-0.94.95％CI-1.35 to-0.54,P<0.01)after surgery.No significant difierenees were found in the eye numbers of haze at 1 month(OR=0.62,95％C1 0.34 to 1.12,P=0.11),3 months(OR=0.70,95％C1 0.31 to 1.55,P=0.38)and 6 months(OR=1.14,95％C1 0.58 to 2.26,P=0.71)between these two types of operation.The pain scores at the first day after surgery was not significantly different between these two groups(WMD=-0.17,95％CI -0.55 to 0.20,P=0.37). Conclusion The effectiveness of off-flap Epi-LASIK is superior to on-flap Epi-LASIK for myopia.Some high-quality randomlizd and control studies are needed for the further clinical evaluation.

Background Biometry of the anterior ocular segment parameter is very important for the diagnosis and treatment of glaucoma and ocular injury as well as measurement of intraocular lens(IOL).Objective This study was to compare the differences in the anterior chamber depth(ACD) and the central corneal thickness (CCT) between Sirius and Pentacam and evaluate the agreement of these two measurement methods.Methods The ACD and the CCT of 38 right eyes from 38 health volunteers aged 23- 32 years were measured with both Pentacam and Sirius.Three times of measurement were pedormed on each eye for each method to obtain the average values.The repeatability and agreement from each method were assessed as intraclass correlation coefficient( ICC ) and coefficient of variation(CV) and the agreement between these two methods were evaluated using Bland-Altman mode.ResultsThe mean ACD value was( 3.18±0.21 ) mm from Pentacam with the ICC 0.995 and CV 0.066.The mean ACD value from Sirius was (3.22 ±0.21 )mm with the ICC 0.996 and CV 0.065.The difference value in ACD between two methods was 0.04 mm,showing a significant difference( t =-6.225,P＜0.05 ) and a positive correlation (r=0.977) between two methods.The 95％ limit of agreement was( -0.04-0.13)mm within 1 standard difference (SD) of the mean value( ±0.21mm),which was acceptable for clinical measurement.The CCT was( 535±33 )μm from Pentacam with the ICC 0.994 and CV 0.062.The CCT was(537±36)pm from Sirius with the ICC 0.999 and CV 0.067.The difference value in the CCT between two methods was about 2 μm,presenting a in significant difference ( t =1.771,P＞0.05 ) and positive correlation ( r =0.985 ).The 95 ％ limit of agreement was ( - 11.64-15.65 ) μm within 1 SD of the mean value( ±34.27 pm),which was acceptable for clinical measurement.ConclusionsSirius and Pentacam show good agreement in the measurement of ACD and CCT.The two methods offer an alternative choice for the biological measurement of the anterior ocular segment.

Background Dry eye syndrome is a frequent postoperative complication of laser in situ keratomileusis (LASIK).Some studies reported that the hinge location of corneal flap has influence on dry eye syndrome following LASIK,but others showed inverse views.Objective This systematic review was to evaluate and compare the effects of a superior-and nasal/temporal-hinge location on dry eye syndrome after LASIK.Methods A systematic literature retrieval was conducted in the Medline,Embase,Cochrane Library and CNKI from 1990 to 2011 according to designed searching strategy and relevant words.Published randomized-controlled clinical trial (RCT) data of the effect of superior-and nasal/temporal-hinge location on dry eye syndrome were extracted by two researchers separately.The outcome parameters,such as tear film breakup time (BUT),Schirmer Ⅰ test and corneal sensation were analyzed 1 week,3 months and 6-12 months postoperatively.The statistical analysis was performed using a RevMan 5.0 software and the quality of included literatures were graded according to the Jadad scale.Fixedeffect model was used for the inhomogeneity multiple studies (P≥0.1,homogeneity test I2 ＜50％),and random-effect model was used for the homogeneity studies.Results Ten pieces RCT papers were searched and 3 of them were rejected because of the lack of outcome data.In 7 included studies,652 eyes of 331 patients were involved in the Meta analysis,with the Jadad scores ≥ 3.BUT assessment was performed in 5 trials (530 eyes),Schirmer Ⅰ test evaluation was in 7 trials (652 eyes) and corneal sensation observation was in 4 trials (320 eyes),without significant homogeneity among the relevant literature(I2＜50％).Meta analysis revealed that BUT in the eyes with superior-hinge group was obvious shorter than that in the eyes nasal/temporal-hinge group at 1 week (WMD =-0.42,95％ CI:-0.79 to-0.06,P=0.020),but there was no signifieant difference in 3 months and 6-12 months duration postoperatively.Better corneal sensation was found at postoperative 3 months (WMD=-0.62,95％CI:-l.09 to-0.19,P=0.005) in the nasal/temporal-hinge group,but there was no difference in 1 week and 6-12 months duration postoperatively.No significant difference was seen between the two groups in Schirmer Ⅰ test during the follow-up period (P＞0.05).Conclusions LASIK with nasal/temporal-hinge corneal flap can improve the corneal sensation and relief the dry eye syndrome after LASIK to some extent.More high-quality evidence-based studies are still needed for the further clinical evaluation.

Background Axial length and anterior chamber depth are important parameters for the calculation of diopter of intraocular lens ( IOL ). Objective This study was to investigate and compare the measuring outcomes of axial length and anterior chamber depth with IOLMaster,Axis- Ⅱ A-scan and ODM 1000A sonograph.Methods This a observational study.Axial length and anterior chamber depth were measured in 83 eyes of 48 patients with IOLMaster,Axis-Ⅱ A-scan and ODM 1000A sonograph by the same operator.The measuring results were compared among the three methods.Results The axial length were(25.79±0.85) mm,(25.72± 0.82 )mm and ( 26.00 ±0.83 )mm respectively with Axis- Ⅱ,ODM 1000A sonograph and IOLMaster.The difference between Axis-Ⅱ and DM 1000A sonograph was (0.07 ± 0.35 )mm without statistical difference between them (t=1.711,P =0.091 ).The difference of axial length between IOLMaster and DM 1000A sonograph was ( 0.27 ±0.29) mm with a statistical difference between them ( t =-8.570,P =0.000 ).The difference between IOLMaster and Axis- Ⅱ was (0.21 ±0.32 ) mm and showed a statistical difference ( t =- 5.931,P ＜ 0.01 ).The positive correlations were found in the axial length values by the each other comparison among the three instruments( r=0.916,0.938,0.928,P＜0.01 ).The anterior chamber depth values were ( 3.81 ±0.21 ) mm,( 3.84 ±0.25 ) mm and ( 3.83 ±0.18 )mm respectively with Axis-Ⅱ,0DM 1000A sonograph and IOLMaster.The difference of anterior chamber depth between Axis- Ⅱ and DM 1000A was (0.03 ±0.17 ) mm without statistical difference between them ( t =- 1.324,P =0.189 ).The difference in the anterior chamber depth between IOLMaster and DM 1000A was (0.01 ±0.15 ) mm and that between IOLMaster and Axis-Ⅱ was( 0.01 ±0.12)mm without any statistical differences among them (t =0.815,P=0.417 ;t=-0.900,P=0.371 ).The high correlation between anterior chamber depth measurements were found by the each other comparison in the three instruments ( r =0.735,0.813,0.823,P ＜ 0.01 ).Conclusions ODM 1000A sonograph can provide precise axial length and anterior chamber depth values.However,ODM 1000Asonograph can not substitute for IOLMaster in the measurement of the anterior chamber depth and axial length.

Background Clinical research showed that the corneal endothelial cell density value from different corneal specula microscopies exist diversity.The relevant literature of SP02,Tomey EM-3000 and SP3000P is still seldom up to now. Objective This research was to assess the repeatability of endothelial cell density measurements by SP02,Tomey EM-3000 and SP3000P respectively and the agreement among 3 kinds of endothelial microscopes.MethodsFifty-four healthy volunteers with the age 17-38 years old were included this research.The written informed consent was obtained from each subject before examination.The corneal endothelial cell densities in the right eyes were analyzed with SP02,Tomey EM-3000 and SP3000P respectively for 3 times under the automatic mode,and the analytical procedure of SP3000P measurement were divided into automatic mode SP3000P (A) and manual correction modes SP3000P( M).The repeatability of each specula microscopy was analyzed by calculating the intraclass correlation coefficients (ICC) and coefficient of variation ( CV ),and the 95％ confidence intervals and plotting Bland-Altman graphs were used to analyze the agreement among these methods.ResultsThe mean corneal endothelial cell densities in the population ＜24 years were significantly higher than the ones ≥ 24 years (t =3.692,P＜0.05 ),but no statistical difference was found between different gender ( t =0.335,P =0.739 ).The mean corneal endothelial cell densities were ( 3058 ± 260 ),( 2954 ± 229 ),( 2668 ± 258 ),( 2734 ± 268 ) cell/mm2 ; the ICCs were 0.957,0.940,0.972 and 0.972 and the CV were 0.063,0.061,0.056,0.058 for SP02,Tomey EM-3000,SP3000P (A) and SP3000P ( M ) respectively.The 95％ confidence intervals were ( - 100.8 - 306.8 ),( 162.6 - 617.4 ),( 109.9-494.1 ) and ( -0.6 - 132.6 ) cell/mm2 for between SP02 and Tomey EM-3000,SP3000P ( A ) and SP02,SP3000P(A) and Tomey EM-3000,SP3000P(A) and SP 3000P(M) respectively.ConclusionsSP02,Tomey EM-3000 and SP3000P(A) have good repeatability in the measurement of corneal endothelial cell density,however the outcome is different.Therefore,it is not interchangeable for the detection of corneal endothelial cell density.The differences of corneal endothelial cell density obtained from these instruments shall be paid high attention for their differences.SP3000P(A) and SP3000P(M) can be used interehangeably and SP3000P(A) is a preferable choice due to its convenience and quickness.

Background Nowadays,keratoplasty is widely used in the treatment of keratoconus.Deep lamellar keratoplasty(DLKP)is one of the research hotspots.However,its effacacy and safety are still concerned.Objective This paper was to evaluate and compare the therapeutic outcomes between DLKP and penetrating keratoplasty(PKP) for keratoconus.Methods The peer-reviewed and published literature was searched from PubMed database,Cochrane Library,EMBase and CNKI to identify relevant trails comparing DLKP with PKP for keratoconus.Methodological quality and Meta-analysis were carried out according to the principle of evidence-based medicine.The statistical analysis was performed using Review Manager 5.0 software.Results Eleven studies with 2950 eyes were identified that compared the results of DLKP and PKP procedures for keratoconus directly.Of those studies reporting vision and refractive data,less patients underwent DLKP achieved a best corrected visual acuity (BCVA)of≥0.5 than DLKP(RR=0.91,95％ CI:0.84-0.99,P=0.030) ;patients with DALK had severer myopia that those with PKP(RR =-0.60,95％ CI:-1.43-0.23,P =0.150),but the astigmatism was comparative (WMD =0.21,95％ CI:-0.48-0.91,P =0.550).Endothelial cell density values were higher in the DLKP group and the differences were significant.Endothelial immune graft rejection did not occur after DALK,and PKP had a higher overall graft rejection rate than DLKP(RR=0.06,95％ CI:0.01-0.31,P=0.001).Conclusions According to the available data,PKP can imporve the BCVA and refractive results,but DLKP can avoid the risk of endothelial rejection and reduce the risk of late endothelial failure for keratconus.

Background Sirius system,a new Scheimpflug camera combined with Placido topography,improved the capability of imaging the anterior eye segment significantly.However,the study of assessing the repeatability and agreement between Sirius and Pentacam is still lack up to now.Objective This study was to evaluate the repeatability and agreement of the anterior ocular segment measuring parameters by Sirius and Pentacam in myopia received laser in situ keratomileusis (LASIK).Methods Thirty-five myopic eyes of 35 patients received LASIK were included in School of Optometry and Ophthalmology Eye Hospital from 2010 May through 2010 July.Corneal power flat keratometry (Kf),step keratometry (Ks),mean keratometry (Km),thinnest corneal thickness(TCT),the location of TCT,anterior chamber depth (ACD) and anterior chamber volume (ACV) were measured by Sirius and Pentacam in all the eyes,respectively.The repeatability of the measuring results were evaluated using intraclass correlation coefficients (ICC) and Cronbach's coefficient alpha (CoA),and the agreement of measuring parameters between Sirius and Pentacam was analyzed using Bland-Altman plot.Results Both Sirius and Pentacam demonstrated high intraobserver repeatability,with all ICC and CoA more than 0.90.No significant differences were found in Kf values and Ks values between the two methods (t =-1.533,-1.750,P＞0.05).Km value was (39.14 ± 1.95) D by Sirius measurement,which was sígnificantly higher than (39.05 ± 1.91) D by Pentacam measurement (t =3.572,P =0.001).The TCT was (457.6 ± 40.9) μm by Sirius method,showing a significant reduce in comparison with (465.4±37.5) μm of Pentacam method (t =-6.689,P＜0.001).A positive correlation was seen in the TCT between the two methods (r=0.988,P＜0.001).The Bland-Alrman plots showed the 95％ CI-21 μm to 6 pm in the TCT value between the two devices.Pairwise comparison of the location of TCT measurements showed significant differences between the two devices (t =-4.132,-5.696,P＜0.001),with a good correlation (r=0.751,0.775) and the 95％ CI (-0.36-0.17 mm,-0.35-0.12 mm).A very good agreement was seen in ACD between the two devices (-0.02-0.12 mm),but the agreement result was not very well in the ACV between the two devices with the 95％ CI (-27.70-6.20 mm3).Conclusions Sirius and Pentacam measurements for anterior ocular segment parameters have a very good repeatability in post-LASIK eyes.In addition,good agreement results are exhibited in corneal power,TCT and ACD between Sirius and Pentacam with an acceptable maximal different value between them.Sirius and Pentacam can be used interchangeably in clinical examination.However,the two devices can not interchangeably for ACV measurement and TCT location.