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Opportunities and challenges for glaucoma research

Chinese Journal of Experimental Ophthalmology.2019;37(6):401-404. doi:10.3760/cma.j.issn.2095-0160.2019.06.001

Elevation of intraocular pressure (IOP) is the most eminent risk factor for the presence and progression of glaucoma,which leads to optic nerve damages ultimately.With the advance of ocular imaging technology,several new structural and functional risk factors have been identified.The introduction of in vivo IOP measuring devices enables the real-time monitoring the IOP fluctuation.New anti-glaucoma drugs and surgical methodshave made more options for glaucoma treatment.Gene therapy and stem cell therapy have potential futures for glaucoma.Incorporation of imaging and deep learning techniques could enhance early detection and diagnosis of glaucoma.There were progresses in optic protection and regeneration.More studies are warrant to investigate the joint mechanism of gene,environment,anatomy and other factors,to develop new imaging techniques and artificial intelligence-assisted diagnostic software platform based on big data,to find new antihypertensive drugs based on different targets,and to assess the efficacy and safety of optic protection and regeneration therapies.

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The inhibitory effect of FoxF2 shRNA on the expression of extracellular matrix of human trabecular meshwork

Aihua LIU ; Meizi GAO ; Liangyu HUANG ; Xun LIU ; Ruihong SU ; Jinzhi ZHAO ; Liming WANG ; Xiaomin ZHANG ; Xiaorong LI ; Lijie DONG

Chinese Journal of Experimental Ophthalmology.2019;37(6):405-410. doi:10.3760/cma.j.issn.2095-0160.2019.06.002

Objective To explore the role of forkhead box F2 (FoxF2) in the extracellular matrix of trabecular meshwork.Methods The cultured human trabecular meshwork cells (HTMCs) were divided into Scramble control group and FoxF2 small hairpin RNA (shRNA) group,then FoxF2 shRNA,the FoxF2 restructuring interference carrier was built,HTMCs were infected with FoxF2 shRNA lentivirus.Western blot assay was used to detect the expression of FoxF2 protein and extracellular matrix.Furthermore,Transwell counting experiment was used to analyze the migration ability of HTMCs.Results The cultured HTMCs grew well and showed a long spindle shape.The growth status of HTMCs was well,and their morphological characteristics were consistent with the HTMCs in vivo.The relative expression level of FoxF2 protein in the FoxF2 shRNA group was lower than that in the Scramble control group,with a significant difference between them (0.72 ± 0.02 vs.1.27 ± 0.05;t =16.68,P ＜ 0.01).The relative expression level of fibronectin (FN),collagen type Ⅰ (COL Ⅰ) and α-smooth muscle actin (α-SMA) were 0.43±0.03,0.53 ±0.08 and O.86±0.15 in the FoxF2 shRNA group,and 0.87±0.04,1.66±0.06 and 1.73 ±0.13 in the Scramble control group,respectively,the relative expression levels of FN,COL Ⅰ and α-SMA in the FoxF2 shRNA group were significantly lower than those in the Scramble control group (t =15.08,18.81,7.50,all at P＜0.01).The migration number of HTMCs in the FoxF2 shRNA group was significantly lower than that in the Scramble control group (117.30±11.41 vs.251.00±10.37;t =8.72,P＜0.01).Conclusions The FoxF2 shRNA lentivirus are successfully constructed,which can decrease the expression of FoxF2 in HTMCs.Low expression of FoxF2 can reduce the expression level of extracellular matrix protein in HTMCs and inhibit the migration ability of HTMCs.

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The effect and mechanisms of chloride channel blocker NPPB on TGF-β1 induced HConF fibrosis

Lixia SUN ; Yingjun LI ; Renzhe CUI ; Di LU ; Yajuan ZHENG

Chinese Journal of Experimental Ophthalmology.2019;37(6):411-418. doi:10.3760/cma.j.issn.2095-0160.2019.06.003

Objective To study the effect and mechanisms of chloride channel blocker 5-Nitro-2-(3-phenylpropylamino) benzoic acid (NPPB) on thansforming growth factor β1 (TGF-β1) induced human conjunctival fibroblasts (HConF) fibrosis.Methods Cell counting kit (CCK-8) was used to screen out the optimal TGF-β1 treatment time and the optimal NPPB concentration.The cells were divided into control group,TGF-β1 treatment group and TGF-β1+NPPB group.Cell proliferation and cell cycle were detected by CCK-8 and flow cytometer,respectively.Cell migration ability were observed by scratch and transwell migration assays.Western blot and Real time-PCR were used to detect the expression of collagen Ⅰ (COL-Ⅰ),fibronectin (FN) and α-smooth muscle actin (α-SMA).The phosphorylation level of PI3K and Akt were measured by Western blot.Results TGF-β1 promotes cell proliferation in a time-dependent manner.There was no statistically significant difference in A values between 48 hours and 72 hours after TGF-β1 treatment (P =0.064).Forty-eight hours was selected as the most appropriate time for TGF-β1 treatment.NPPB inhibited HConF cell proliferation in a concentration-dependent manner.Compared with the control group,the proliferation A values of cells in the 50 mol/L and 100 mol/L NPPB groups were significantly reduced (P =0.020,0.000),and 100 mol/L was selected as the optimal concentration of NPPB.The cell proliferation A value,migration area and migration cell number of TGF-β1 +NPPB group were significantly lower than those of TGF-β1 treatment group (all at P＜0.05).Compared with the control group and TGF-β1 +NPPB group,the proportion of G1 phase cells in the TGF-β1 treatment group was reduced,and the proportion of cells in the S phase and G2/M phase were increased,with statistically significant differences between them (all at P ＜ 0.05).The protein and mRNA expression of α-SMA,COL-Ⅰ and FN in the TGF-β1 treatment group were higher than those in the control group and TGF-β1+NPPB group,with statistically significant differences between them(all at P＜0.05);the ratios of p-PI3K/PI3K and p-Akt/Akt in the TGF-β1 treatment group were significantly higher than those in the control group and TGF-β1 +NPPB group,with statistically significant differences between them (all at P＜0.05).Conclusions NPPB may inhibit TGF-β1 induced HConF fibrosis process by inhibiting phosphorylation of PI3K and Akt.

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Dynamic changes of ocular surface tissue of diabetic dry eye in mice

Qian WANG ; Lei WAN ; Jing LI ; Qingjun ZHOU

Chinese Journal of Experimental Ophthalmology.2019;37(6):419-424. doi:10.3760/cma.j.issn.2095-0160.2019.06.004

Objective To explore the occurring and developing characteristics of dry eye syndrome in type 1 diabetic mouse model induced with streptozotocin (STZ)-intraperitoneal injection.Methods Completely randomized design method was performed.Sixty SPF degree male C57BL/6 mice (6-8 weeks old) was randomly divided into diabetic group and control group,which were intraperitoneally injected with citrate buffer and STZ-citrate buffer (50 mg/kg per day),respectively.The average weight,blood glucose level and lacrimal gland weight were examined before injection and 1 month,2 months,4 months after the last injection;meanwhile,phenol cotton thread and rose bengal staining methods were used to check tear formation and ocular surface condition;corneal perception meter was used to test corneal sensitivity;periodic acid-schiff (PAS) staining method was used to test the density of conjunctival goblet cells;histopathological staining and Masson staining methods were used to test the tissue changes of lacrimal gland.Results Compared with before injections,the body weight and lacrimal gland weight in diabetic group were not significantly changed 1 month,2 months and 4 months after injection (all at P＞ 0.05),but these measurements in diabetic group 1 month,2 months and 4 months after injection were significantly lower than those in control group at corresponding time points (all at P＜0.05).Compared with before injections and control group at corresponding time points,the blood glucose level were dramatically higher and the tear formation were significantly decreased in diabetic group at 1 month,2 months,4 months after injection (all at P＜0.05).The ocular surface of diabetic model mice showed positive rose bengal staining 2 months after STZ injections.The corneal sensitivities were significantly lower in diabetic model mice 2 months and 4 months after injection than those before injection and in control group at corresponding time points (all at P＜0.05).The density of conjunctival goblet cells in diabetic group 4 months after injection was significantly decreased than those before injection in diabetic group and 4 months after injection in control group (all at P＜0.05).The apparent collagen fibrosis and inflammatory cell infiltration were observed at lacrimal gland in diabetic model mice 4 months after injection.Conclusions The major early stage manifestations of STZ induced type 1 diabetes mice include retarded growth of lacrimal gland and decreased tear secretion volume,which gradually develop along the course of diabetes;in the later stage,the manifestations include decreased corneal sensitivity,ocular structural damage,structural changes of lacrimal gland and decreased conjunctival goblet cell density.

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Protective effects of intravitreal injection of nerve growth factor on retinal ganglion cells in early diabetic rats

Hang LYU ; Qichang WANG ; Luosheng TANG

Chinese Journal of Experimental Ophthalmology.2019;37(6):425-431. doi:10.3760/cma.j.issn.2095-0160.2019.06.005

Objective To investigate the protective effect of intravitreal injection of nerve growth factor (NGF) on apoptosis of retinal ganglion cells (RGCs) in early diabetic rats and its possible mechanism.Methods SD rats were divided into normal control group,diabetic model group,phosphate buffer solution (PBS) group and NGF group according to random number table method,with each group contain 6 rats.The rats in diabetic model group,PBS group and NGF group were injected intraperitoneally with streptozotocin (STZ) to establish diabetic rat model.After 4 weeks of modeling,2 μl PBS and 2 μl NGF (0.5 μg/μl) were injected into the vitreous cavity in PBS group and NGF group,respectively.The right eyes served as the experimental eyes,inject once a week for 4 weeks.After 4 weeks of injection,the retina microangiopathy of each group was observed by Phoenix Micron Ⅳ small animal retinal imaging system.After high dose anesthesia,the eyeball of one rat from each group was taken to prepare ultrathin sections and observed by transmission electron microscopy.Five rat eyeballs were taken to prepare retinal paraffin sections from each groups.The RGC apoptotic index was observed by TUNEL method.The expressions of RGC bcl-2 protein and bax protein were analyzed by immunohistochemistry.This study was approved by the Experimental Animal Ethics Committee of Central South University,and the experimental procedures were in accordance with the National Institutes of Health(NIH) guidelines for the Care and Use of Laboratory,and follow the 3R principle.Results The weight of the diabetic model rats was significantly lower than that of the normal group,and the intake of water and food were significantly increased,the urine volume was also in creased.The body weight and blood glucose level of the rats were significantly different among different groups after 4 weeks of modeling (F=202.352,148.444,both at P＜0.001).Fundus photography of early diabetic rats showed no obvious diabetic retinal microangiopathy.The numbers of RGC in the diabetic model group and PBS group were significantly lower than that in the normal control group under the transmission electron microscope.The membrane shrinkage,cytoplasmic condensation,organelle edema,chromatin peripheral collection were obvious and the cell apoptosis number was increased.The RGC lesions in the NGF group were lighter than those in the diabetic model group and PBS group.The apoptotic indexs in the normal control group,diabetic model group,PBS group and NGF group were (3.88±1.28)％,(92.56±1.58)％,(92.64±2.30)％ and (59.34±3.89)％,respectively,the overall difference of apoptotic index between the four groups was statistically significant (F=854.554,P＜0.001);the RGC apoptotic index of the diabetic model group was significantly higher than that of the normal control group.The RGC apoptotic index of the NGF group was significantly lower than that of the diabetic model group and PBS group (both at P＜0.05).The expression levels of bcl-2 protein in normal control group,diabetic model group,PBS group and NGF group were 38.11 ± 1.01,22.38±3.90,23.04±3.14 and 84.69±1.45,respectively,with a significant difference among the groups (F =366.206,P＜0.001).The expression levels of bax protein in normal control group,diabetes model group,PBS group and NGF group were 4.22± 1.89,56.59±6.67,56.30±8.51 and 26.19±2.44,respectively,with a significant difference among the groups (F=61.435,P＜0.001).The expression of bcl-2 protein in the diabetic model group was significantly lower than that in the normal control group (P＜0.05),and the expression of bax protein was significantly increased (P＜0.05).The expression of bcl-2 protein in NGF group was significantly higher and the expression of bax protein was significantly lower than those in the PBS group and diabetic model group (all at P＜0.05).Conclusions The ultrastructural damage of RGCs has occurred in early diabetic rats without diabetic retinal microangiopathy.Intravitreal injection of NGF may produce retinal neuroprotective effects by inhibiting apoptosis of RGCs in diabetic rats.

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The effect of tanshinone on meibomian gland cell proliferation, differentiation and lipid synthesis

Qinghua LAI ; Yingying GAO ; Wei LI ; Chengyou ZUO ; Qingmin LI

Chinese Journal of Experimental Ophthalmology.2019;37(6):432-438. doi:10.3760/cma.j.issn.2095-0160.2019.06.006

Objective To investigate the effects of cryptotanshinone and tanshinone Ⅱ A,two major monomer components of tanshinone,on the proliferation,differentiation and lipid synthesis of rat meibomian gland epithelial cells in vitro.Methods The eyelid meibomian gland tissue was isolated from 2-month-old SD rats and co-cultured with 3T3 trophoblasts for 5 days.Cryptotanshinone and tanshinone Ⅱ A were prepared with DMSO into different concentrations.The cells were grouped to 0.125 μmol/L,0.250 μmol/L,0.500 μmol/L,1.250 μmol/L and 2.500 μmol/L drug groups and treated for 48 hours,respectively.Only dimethyl sulfoxide (DMSO) was added in medium in the DMSO control group.The expressions of keratin 14 (K14) and p63 in frozen sections of meibomian gland tissue and clones of meibomian gland cells were detected by immunofluorescence.Real-time fluorescence quantitative PCR was used to assay the relative expression of K16,cell proliferation related antigen 67 (Ki67) and CCAAT enhancer binding protein α (C/EBPcα) in meibomian gland cell clones.Crystal violet staining and oil red staining were used to evaluate the colony formation rate and lipid synthesis of meibomian gland epithelial cells.Results Primary cultured meibomian gland cells were cloned on day 4-5 in vivo,and the cloning area was increased on day 7 after culture,p63 and K14 were positively expressed in clones.Compared with the DMSO control group,the relative expression levels of Ki67 mRNA were significantly elevated in the 0.500 μmol/L,1.250 μmol/L and 2.500 μmol/L cryptotanshinone groups (all at P ＜ 0.05).The relative expressions of Ki67 mRNA in the 0.500 μmol/L and 1.250 μmol/L tanshinone Ⅱ A groups were significantly higher than those in the DMSO control group (all at P＜0.05).No significant difference was found in the relative expression of K16 and C/EBPα mRNA among different concentrations of cryptotanshinone or tanshinone Ⅱ A group (all at P＞0.05).No lipid drop was found in the tarsal gland cell clones;however,the accumulation of lipid was seen in the cell clusters at the margin of the clones by oil red O staining.The average clone formation rate of tarsal gland cells in the 1.250 μ mol/L cryptotanshinone group was (2.55±0.20)％,which was significantly higher than (2.05±0.13)％ in the DMSO control group (t =4.379,P＜0.05).The average clone formation rate of tarsal gland cells in the 1.250 μmol/L tanshinone Ⅱ A group was (2.25±0.20)％,there was no significant difference between 1.250 μmol/L tanshinone Ⅱ A group and DMSO control group (t=1.616,P＞0.05).Conclusions Cryptotanshinone and tanshinone Ⅱ A promote the proliferation of meibomian gland epithelia cells,but play less impacts to lipid synthesis of meibomian gland epithelia cells in vitro.cryptotanshinone promote the clone tormation of meibomian gland epithelia cells.

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Association of ABCA1 rare nonsynonymous variants with primary open angle glaucoma

Yuxia XU ; Lulin HUANG ; Bo GONG ; Yuhong CHEN ; Xinghuai SUN ; Zhenglin YANG

Chinese Journal of Experimental Ophthalmology.2019;37(6):439-445. doi:10.3760/cma.j.issn.2095-0160.2019.06.007

Objective To explore the rare nonsynonymous variants of ABCA1 gene in primary open angle glaucoma (POAG).Methods A prospective cohort study was carried out.Three hundred and ninety-eight POAG patients and 198 healthy controls matched in age and gender were recruited from March 2017 to March 2018 in Eye and Ear Nose Throat (ENT) Hospital of Fudan University.The periphery blood of 2-5 ml from all the subjects was collected for extraction of DNA,and rare variant analysis of the ABCA1 gene was conducted by whole exome sequencing (WES) data of these subjects.The study protocol was approved by Ethic Committee of Eye and Ear Nose Throat Hospital of Fudan University and Sichuan Provincial People's Hospital (No.2016-32-1,and written informed consent was obtained from each subject prior to entering the study cohort.Results A total of 21 rare nonsynonymous variants (minor allele frequency MAF＜0.O1) were detected in the coding regions of ABCA1 gene in 27 subjects of the 398 POAG,with the detection rate of 6.8％.Among them,c.4310C＞A (p.Thr1437Asn),c.3772G＞T(p.Asp1258Tyr),c.775A＞G (p.Lys259Glu) and c.1507_1508insGAGGT (p.Glu503GlyfsX7) were four novel variants.In the 198 healthy controls,five rare nonsynonymous variants were detected in the ABCA1 gene from five subjects respectively,with the detection rate of 2.5％,the detection rate of nonsynonymous in POAG group was higher than that in healthy control group,showing a significant difference (x2=4.72,P =0.03,OR =2.81).Conclusions Rare nonsynonymous variants in ABCA1 is associated with the pathogenesis of POAG.These variants can enrich the variation spectrum of ABCA1.

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Correlation analysis between macular thickness and visual field mean defect in pseudoexfoliation glaucoma

Fan LI ; Guangxian TANG ; Lihua MA ; Yulei GENG ; Hengli ZHANG ; Xiaowei YAN ; Qing ZHANG

Chinese Journal of Experimental Ophthalmology.2019;37(6):447-452. doi:10.3760/cma.j.issn.2095-0160.2019.06.009

Objective To compare and analyze differences in macular thickness and to discuss the correlation between macular thickness and visual field mean defect (MD) in early and moderate,late pseudoexfoliation glaucoma (PXG) patients and normal control subjects.Methods A series of cases-observation study was adopted.Thirty-three early and moderate PXG patients (33 eyes) and 24 late PXG patients (24 eyes) were collected in the First Hospital of Shijiazhuang from May 2013 to May 2018.Meanwhile,34 age,gender and diopermatched healthy subjects (34 eyes) were included as normal control group.Spectral domain optical coherence tomography (SD-OCT) was used to measure macular thickness and volume in every quadrant.The correlation between the macular thickness and visual field MD were analyzed.This study followed the Helsinki declaration and was approved by the ethics committee of the First Hospital of Shijiazhuang.Written informed consent was obtained from each subject prior to any medical examination.Results The average macular thickness in normal control group,early and moderate PXG group and late PXG group were (305 ± 15),(297 ± 15) and (287 ± 17) μm,respectively;the average macular volume were (0.94 ± 0.05),(0.91 ± 0.05) and (0.89 ± 0.05) μm3,respectively.The macular thickness and volume differences between the 3 groups were statistically significant in nasal inner macula,superior inner macula,temporal inner macula,inferior inner macula,superior outer macula,temporal outer macula,inferior outer macula quadrants (Fthickness =4.226,9.335,12.133,10.115,11.298,8.243,12.142;all at P＜0.05.Fvolume =3.812,9.152,12.774,8.889,11.284,7.937,11.652;all at P＜0.05).The macular thickness of early and moderate PXG group in superior inner macula,temporal inner macula,inferior inner macula,superior outer macula and temporal outer macula quadrants were statistically thinner than those in the normal control group (all at P＜0.05);the macular thickness of late PXG group in inferior inner macula,temporal inner macula,superior outer macula and inferior outer macula quadrants were statistically thinner than those in the early and moderate PXG group (all at P＜0.05);the macular thickness of late PXG group in inner and outer rings were statistically thinner than those in the normal control group (all at P＜0.05).The macular thickness was not correlated with visual field MD in normal control group and the early and moderate PXG group in every quadrants (all at P＞0.05),but it was positively correlated with visual field MD in the late PXG group in nasal inner macula,superior outer macula and temporal inner macula quadrants (r =0.527,0.544,0.417;all at P＜0.05).Conclusions SD-0CT can quantify the macular thickness,and can be used an important reference index for the staging and follow-up of PXG combined with perimetry.

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Clinical changes of contralateral unaffected eyes in patients with unilateral infectious keratitis under in vivo confocal microscopy

Xintian LIU ; Hong ZHANG ; Xin JIN ; Yan SHI ; Xue JIANG

Chinese Journal of Experimental Ophthalmology.2019;37(6):454-459. doi:10.3760/cma.j.issn.2095-0160.2019.06.011

Objective To evaluate the clinical changes of corneal epithelial cells,dendritic cells,endothelial cells and corneal nerves in contralateral eyes of patients with unilateral infectious keratitis.Methods A prospective serial case observation study was conducted in patients with unilateral infectious keratitis from January to August 2018 in the First Affiliated Hospital of Harbin Medical University.The corneal epithelial cells density,dendritic cells density,endothelial cells density,total nerve density,total number of nerves and branch nerve density were analyzed with in vivo confocal microscopy (IVCM),slit lamp microscopy was performed on all subjects to observe the conjunctiva,cornea and anterior chamber.Corneal branch nerve density and total nerve density were compared with the control group by homogeneity test of variance.This study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University (No.IRB-AF/SC-04/01.0).Results Slit lamp microscopy showed no significant changes in anterior segment of the contralateral uninfected eyes in the 3 groups.The corneal epithelial cells density of uninfected eyes in viral keratitis group,bacterial keratitis group and fungal keratitis group was 1 834 (1 584,2 107),1 905 (1 651,2 332) and 1 859 (1 477,1 995)/mm2,respectively,which were significantly lower than 3 479 (3 080,3 910)/mm2 in the control group,the dendritic cells densities in viral keratitis group and bacterial keratitis group were 175 (139,214)/mm2 and 156 (118,190)/mm2,which were higher than 69(57,76)/mm2 in the control group,the differences were statistically significant (all at P＜0.05).The corneal endothelial cells density of uninfected eyes in viral keratitis group was 1 107(945,1 270)/mm2,which was less than 1 905(1 651,2 332)/mm2 in the bacterial keratitis group and 1 859(1 477,1 995)/mm2 in the fungal keratitis group (both at P＜0.05).The corneal nerve number and total nerve density of uninfected eyes in viral keratitis group were l0(7,11)/mm2 and (1 822.85±622.34) μm/mm2,which were lower than 11 (9,13)/mm2 and (2 340.91±:408.70)μm/mm2 in the bacterial keratitis group,with significant differences between them (P＜ 0.05,P＜ 0.008 3).The morphology of corneal epithelial cells and endothelial cells in each infectious keratitis group was larger than that in the control group,while the morphology and number of dendritic cells in the contralateral eye of patients with viral and bacterial keratitis increased.Conclusions In unilateral uninfected eyes of infectious keratitis,the density of corneal epithelial cells,dendritic cells,endothelial cells and corneal nerves changes correspondingly.There may be a close relationship of corneal immunity and nervous system between the two eyes.

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Distribution of posterior corneal astigmatism and its effect on the calculation of Toric intraocular lens

Panpan LI ; Jian WU ; Ying XUE ; Jing ZHOU ; Yujian ZHANG ; Huaijin GUAN

Chinese Journal of Experimental Ophthalmology.2019;37(6):460-466. doi:10.3760/cma.j.issn.2095-0160.2019.06.012

Objective To analysis the distribution of posterior corneal astigmatism (PA) and evaluate the influence of keratometric astigmatism (KA) and total corneal astigmatism (TCA) on the calculation of Toric intraocular lens (Toric IOL) in patients with age-related cataract (ARC) and high corneal astigmatism.Methods An observational study design was adopted.Pentacam was used to measure 200 eyes of 181 patients with ARC and KA＞0.75 D in Affiliated Hospital of Nantong University from August 2016 to April 2017.KA,PA,TCA and anterior corneal astigmatism (AA) were recorded.The astigmatism magnitude and axis of PA was studied.The subjects were divided into astigmatism with the rule group,astigmatism against the rule group and oblique astigmatism group according to the axis of AA.The correlations of decomposition values between PA and AA or KA and TCA in each group were analyzed by Pearson linear correlation analysis.The difference of decomposition values between KA and TCA in each group was compared by paired sample t test.The type and axis of Toric IOL were calculated by online formula according to KA and TCA.This study followed the Declaration of Helsinki and written informed consent was obtained from each patient prior to any medical examination.Results The mean astigmatic magnitudes of PA was -0.32 D×93.1°.PA exceeded 0.5 D in 22 eyes (11％).The steepest posterior corneal meridian was vertically aligned in 163 eyes (81.5％).The decomposition value KP(0) and KP (45) of PA were positively correlated with those ofAA (r=0.480,P＜0.001;r=0.251,P＜0.001).The mean astigmatic magnitudes of KA and TCA were 1.44D×89.6° and 1.32 D×89.5° in astigmatism with the rule group,1.39 D×153.4° and 1.71 D×154.4° in astigmatism against the rule group and 1.13 D× 122.0° and 1.24 D× 124.2° in oblique astigmatism group.53 eyes (69.7％) had KA higher than TCA in astigmatism with the rule group.82 eyes (87.3％) had KA lower than TCA in astigmatism against the rule group;20 eyes (66.7％) had KA lower than TCA in oblique astigmatism group.There were significant differences in KP (0) between KA and TCA in different astigmatism groups (all at P＜0.001).The calculated Toric IOL type were inconsistent in 85 eyes(42.5％) and the calculated axis were inconsistent in 176 eye s (88.2％).Conclusions In patients with high corneal astigmatism,the astigmatism type of PA is mostly astigmatism against the rule.Ignoring the PA can lead to deviation of Toric IOL type selection and axis placement in some patients.For patients who cannot measure PA or TCA,the type of Toric IOL should be adjusted appropriately.

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