AIM: To observe the clinical effect of stopping and chopping method with manual nucleus extraction in hard nucleus cataract, and also discuss the surgical skills.METHODS: Totally 50 cases(50 eyes)of age-related cataract with above IV grade hard nucleus were randomly divided into two groups, 30 cases(30 eyes)were in observe group which was performed by stopping and chopping method combined with manual nucleus extraction and 20 cases(20 eyes)underwent phacoemulsification as control group, intraocular lenses implantation was performed in two groups. The processing time of nucleus, operative complications, postoperative visual acuity, the condition of corneal edema, intraocular pressure and corneal endothelial cells were observed.RESULTS: The processing time of nucleus of observe group and control group was 60±10s, 90±15s, respectively(P<0.05). Operative complications of the observe group, which were the incidence of posterior capsular rupture, the reaction of corneal edema and the damage of corneal endothelial cells, was less than control group and no statistical significance(P<0.05). The difference of postoperative visual acuity and intraocular pressure was not obvious in two groups.CONCLUSION: Stopping and chopping method combined with manual nucleus extraction in hard nucleus cataract has many virtues of security, faster visual recovery and less complications.It is one of the ideal treatment of age-related cataract with above IV grade hard nucleus.

AIM: To study the application value of phacoemulsification in treating angle-closure glaucoma and primary angle closure patients with cataract.METHODS: Angle-closure glaucoma patients with cataract and primary angle closure patients were collected as research objects and given phacoemulsification combined with intraocular lens implantation for treatment. Then the preoperative and postoperative mean value of visual acuity,intraocular pressure and astigmatism and postoperative complication of treated eyes were observed.RESULTS: The average visual acuity of treated eyes recovered from(0.15±0.02)to(0.48±0.13); the average intraocular pressure was dropped from(23.29±4.83)mmHg to(18.34±2.31)mmHg; astigmatism was dropped from(1.14±0.15)DC to(0.53±0.06)DC. As to postoperative complications, the occurrence rate of corneal edema, posterior capsular opacification and fibrous exudation in anterior chamber was 2.5%, 3.4 and 5.1%, respectively. CONCLUSION: Phacoemulsification can effectively improve intraocular pressure and visual acuity,which has positive therapeutic significances in treating angle-closure glaucoma and primary angle closure.

ATM: To analyze the result of bacterial culture and antibiotics sensitivity tests in conjunctival sacs of cataract patients in China before operation, so as to provide theoretical evidence for aseptic preparation of cataract surgery.METHODS: Database including the VIP Database for Chinese Technical periodicals, Wanfang database, CNKI and CBM Disc were searched to collect the relevant articles about bacterial culture and antibiotics sensitivity tests in conjunctival sacs of cataract patients in China before operation. The relative factors were analyzed by Meta-analysis. RESULTS: A total of 7 reports with 11499 eyes were selected. The number of positive specimens of bacterial culture in non-infectious cataract patients before operation was 2993(26.03%)from 11499 specimens G+ C(86.40%), G+ B(8.10%), G-B(4.13%)and G-C(1.37%)constituted predominant bacteria in the conjunctive sac of cataract patients in China before operation, mainly staphylococcous epidermidis(67.30%), staphylococcous aureus(12.53%)and micrococcus(6.98%). Most of them were susceptible to tobramycin, vancocin, ciprofloxacin and gentamycin, and improved the tolerance of tobramycin and ciprofloxacin. CONCLUSION: Staphylococcous epidermidis is the most frequent bacteria isolated in the conjunctival sac of eyes before cataract surgery. Most of themare susceptible to tobramycin, vancocin, ciprofloxacin and gentamycin, and improve the tolerance of tobramycin and ciprofloxacin.

AIM: To evaluate the clinical effects of residual triamcinolone acetonide(TA)on the treatment of idiopathic macular hole(IMH)and lessening of tissue edema.METHODS: A total of 32 patients(32 eyes)underwent closed vitrectomy. During the operation, TA was applied to 16 eyes of experimental group to assist internal limiting membrane peeling. A small amount of TA was left at the bottom of the macular hole. The others eyes of control group didn't use TA to assist internal limiting membrane peeling. Anatomical reduction, postoperative BCVA and macular hole index(MHI)were recorded and the statistical analysis was made. RESULTS:All the macular holes reached the anatomical reduction after operation, the closing rate was 100%. Postoperative BCVA of the two groups were improved(P=0.000). The visual improvement between the two groups had no statistical significance(P>0.05). There is a positive correlation between postoperative BCVA and MHI, and there is no correlation between postoperative BCVA and the hole degree. The operation time in experimental group was shorter than in control group. No serious complications occurred in both groups. CONCLUSION:Intraoperative application of TA was helpful for peeling off internal limiting membrane. Residual TA has no influence on the treatment of idiopathic macular hole or lessening of tissue edema. The MHI can be easily calculated to be used as a clinical index for visual acuity. It is an effective technique with no serious side effects.

AIM: To explore the effects of vitreoretinal surgery in diabetics and non-diabetic patients on corneal endothelial cell density and morphology. METHODS:Sixty patients with diabetes(diabetic group)and 60 non-diabetic patients(control group)was collected, of which 30 cases of diabetic group and 30 cases in the control group underwent vitrectomy combined with silicone oil tamponade surgery, 30 cases of diabetic patients and 30 control patients(lenticular vitreoretinal combined with silicone oil tamponade surgery). To detect the corneal endothelial cell density(CD), coefficient of variation of endothelial cell area(CV), percentage of hexagonal cells(RHC)of two groups of patients 1 day before surgery and three months after surgery. The differences of two groups were compared before and after surgery in corneal endothelial cell changes. RESULTS: After vitrectomy combined with silicone oil surgery, there were significant differences on the coefficient of variation of corneal endothelial cells and the percentage of hexagonal cells between the diabetic and control groups. In the diabetic and control groups, obvious differences were also found in corneal endothelial cell density, coefficient of variation and the percentage of hexagonal cells after lenticular vitreoretinal combined with silicone oil tamponade surgery. The different values for groups of diabetic and non-diabetic all were statistically significant in corneal endothelial cell density, coefficient of variation and the percentage of hexagonal cells before and after surgery.CONCLUSION: The effects of vitrectomy combined with silicone oil tamponade surgery on cornea endothelial cell were mainly reflected on changes of corneal topography. Compared with the non-diabetic group, the changes in corneal endothelial cell shape and destiny of diabetic patients underwent lenticular vitrectomy with silicone oil tamponade surgery are more evidently. Therefore, the strict examination of preoperative corneal endothelial cell has important significant for diabetic patients postoperative visual recovery.

AIM: To analyze the relationship between retinal function and retinal thickness in fovea in the patients of nonproliferative diabetic retinopathy(NPDR)without macular edema.METHODS:Multifocal electronic retinography(mfERG)and Spectralis optical coherence tomography(Spectralis OCT)examination were performed in 35 eyes of 20 NPDR patients without macular edema. Twenty eyes of 19 normal subjects underwent the mfERG and 15 eyes of 10 normal subjects underwent Spectralis OCT.RESULTS: Compared with normal group, the response densities P1 wave in Ring1 decreased and the change of latency of P1 wave and N1 wave had no statistical significance(P<0.05). The retinal and neurosensory retinal thickness in fovea were thicker than normal.CONCLUSION:The application of mfERG can detect the abnormal changes in retina without obvious structural changes, Spectralis OCT can measure the thickness of retinal layers, reflect the changes of retinal fine structure, and identify the abnormal changes of retinal structure. The associated examination of these two instruments offered available evidences in detecting visual function change in early DR, and offer information for therapy in time.

AIM: With the advancement of pars plana vitrectomy, especially the intraocular application of inert gases and silicone oil, many serious vitreoretinal diseases, such as vitreous hemorrhage, endophthalmitis, proliferative diabetic retinopathy etc. have received effective treatment. But it is undeniable that there are many complications after vitrectomy that have seriously affected patients' vision recovery. The aim of this study is to observe the incidence and pathogenesis of various complications after vitrectomy to provide some clinical references to avoid and reduce the incidence of complications.METHODS: This paper retrospectively analyzed records of 200 cases that underwent vitrectomy operated by the same surgeon. Inert gasesor silicone oil was filled accordingly. According to filling agent, patients were divided into simple vitrectomy group, inert-gas tamponade group and silicon-oil tamponade group; according to ocular hypertension onset, patients were divided into normal intraocular pressure group and ocular hypertension group; according to age, patients were divided into ≥50 group and <50 group. Relative analysis was made on the incidence, dangerous factors and management of complications in each group after vitrectomy.RESULTS: According to the study, the major postoperative complications of vitrectomy were increase of introculr tension, secondary glaucoma, corneal diseases, complicated cataract, vitreous hemorrhage, retinal detachment, iatrogenic retinal hole, fibrin formation in anterior chamber, choroid and ciliary body detachment, and so on. According to statistical analysis of data of this group, it was believed that there were obvious differences among simple vitrectomy group, inert-gas tamponade group, silicon-oil tamponade group in postoperative complications. The postoperative incidence of increase of introculr tension and secondary glaucoma in inert-gas tamponade group and silicon-oil tamponade group were obviously higher than that in simple vitrectomy group. What's more, in inert-gas tamponade group, the postoperative incidence of ocular hypertension was much higher. The postoperative incidence of corneal complications and complicated cataract in inert-gas tamponade group and silicon-oil tamponade group were obviously higher than that in simple vitrectomy group and closely correlated with postoperative ocular hypertension. There were no distinct differences among every group in vitreous hemorrhage, iatrogenic retinal hole and retinal detachment, fibrin formation in anterior chamber, choroid and ciliary body detachment. CONCLUSION:Vitrectomy is an important and effective treatment method for serious vitreoretinal diseases and most patients have obtained different visual improvement after the surgery. But postoperative complications seriously affect postoperative effect. The key to the success of vitreous retinal surgery in the future is that how to improve surgical techniques to avoid, reduce and timely dispose postoperative complications. It is also the emphasis of research of vitrectomy which deserves more exploration and research.

AIM: To analyze clinical features of Stargardt disease by fundus autofluorescence(FAF)and observe microstructural changes of the retina by frequency-domain optical coherence tomography(Spectralis OCT)to explore the clinical value of combined FAF and OCT in diagnosis of Stargardt's disease.METHODS:Non-interventional observation study. Confocal scanning laser ophthalmoscope(Heidelberg, Germany Company)was applied on 9 patients(18 eyes)with Stargardt disease for blue autofluorescence(BL-FAF, excitation 488nm, filter >500nm), Spectralis OCT examination, fundus photography, mfERG examination and fundus fluorescein angiography(FFA)examination. Seven cases also received indocyanine green angiography(ICGA)inspection. The study analyzed distribution characteristics of Stargardt's disease under FAF examination and microstructural changes of the retina under Spectralis OCT.RESULTS:The BL-FAF of the oval macular lesions presented low fluorescence and visible edge demonstrated varying thickness and strong fluorescence. OCT showed retinal pigment epithelial lesions(RPE), photoreceptors(PR)atrophy and neurosensory meager. Under FFA examination, scattered point-like fluorescence could be seen in the early stage, and macular atrophy tumor size appears consistent with the bull's-eye fluorescence could be seen in the late stage. The disease demonstrated choriocapillaris atrophy in the late stage under ICGA examination. New vessels could be seen in rare cases.CONCLUSION: FAF with Spectralis OCT and mf-ERG is an effective non-invasive examination methods for diagnosis of Stargardt disease. Changes of its clinical characteristics might suggest degeneration of both RPE and PR and various pathological and physiological changes of lipofuscin.

AIM: To investigate the compensation effects of internal higher-order aberrations(HOAs)on the corneal HOAs in youth with low and moderate myopia. METHODS: Seventy-six myopic patients(152 eyes)who received corneal refractive surgery from April to May in 2012 were included in this study. The HOAs of the anterior corneal surface and the total ocular HOAs(3-6 stage)ocular were measured using OPD Scan ARK-10 000. The root mean square values(RMS)of total HOAs, total coma(TC), total trefoil(TT)and total spherical aberration(TS)and Zernike terms of Z3-1, Z31, Z3-3, Z33, Z40 of a pupil with a diameter of 6mm were recorded to calculate the compensation factor. RESULTS: The corneal spherical aberration were positive in all eyes, but ocular spherical aberration were negative in 33 eyes(21.7%); The RMS values of corneal TC and Zernike terms of corneal Z3-1, Z31 were smaller than the ocular aberration. and their CFs were negative; The RMS values of corneal HOAs, TT, TS and Zernike terms of corneal Z3-3, Z33, Z40 were higher than the ocular aberration and their CFs were positive. CONCLUSION: Theintraocular HOAs mainly manifest compensation effect on the HOAs of the cornea; The intraocular spherical aberration compensates for the spherical aberration of cornea,which can reduce the ocular spherical aberration; The effects of intraocular coma and trefoil on corneal higher order aberrations vary widely and show partial compensation, overcompensation and superposition among subjects. The main role of coma is superposition, while that of trefoil mainly manifest as compensation action.

AIM: To investigate the various surgical techniques and their effects on correcting different types of entropion. METHODS: From June 2011 to June 2013, 1 027 eyes of 669 cases with entropion received the surgical treatment. For 171 cases(311 eyes)with congenital entropion, the surgical techniques included tarsal fixation, the resection of the strip skin and orbicularis muscle, epicanthoplasty and augmentation of orbicularis muscle of lower eyelid. While for 260 cases(407 eyes)with cicatricia entropion, the surgical techniques included tarsal fixation, the resection of part of the tarsus and the split of eyelid gray line, and lower lid retractors extension combined with implantation of allogeneic sclera. And for 238 cases(309 eyes)with spastic entropion, the surgical techniques mainly included augmentation of orbicularis muscle of lower eyelid.RESULTS: The satisfaction rate of the operation was 97.2%, and 0.7% patients obtained got improved, so total effective rate was 97.9%. The satisfaction rates of congenital entropion, cicatricia entropion and spastic entropion were 97.1%, 96.6% and 98.1%, respectively. After the operations, 22 eyes(2.1%)had some complications, mainly involving trichiasis recurrence, ectropion, scar formation, unnatural curvature of the eyelid and asymmetric appearance of eyes. After the proper treatment, the complications were cured. CONCLUSION: different types ofentropion trichisais need different surgical methods.

AIM: To observe the clinical efficacy of Nd:YAG laser dacryocystoplasty with retrograde placement of lacrimal drainage tube for lacrimal duct obstruction and the influencing factors in the operation.METHODS: A total of 20 patients(23 eyes)with lacrimal duct obstruction were treated with Nd:YAG laser dacryocystoplasty with retrograde placement of lacrimal drainage tubes for 3 months. All patients were followed up for 3-12 months. Nasal cavity condition on the affected side before operation, nasal cavity injury in operation, lacrimation, suppuration, recovery of lacrimal passage function and complications after operation were observed. RESULTS: By the last following up, 19 eyes(82.6%)had been cured, 2 eye(8.7%)had improved, 2 eyes(8.7%)had no improvement. And the total effective rate was 91.3%. The effective rate was 100%(2/2)in patients with obstruction of lacrimal canaliculus, 100.00%(15/15)in patients with obstruction of lacrimal duct, 66.7%(2/3)in patients with obstruction of nasolacrimal canal, and 66.7%(2/3)in pateints with obstruction of lacrimal ductule and nasolacrimal canal. One eye was with mild irritation at about postoperative 2 weeks, 3 eyes presented with red swelling in surrounding tissues of lacrimal ductule, 2 eyes manifested with laceration of lacrimal punctum. No other complication was found. CONCLUSION: Laser dacryocystoplasty with retrograde placement of lacrimal drainage tube is a useful method for treatment of lacrimal duct obstruction.

AIM: To observe the effectiveness and safety of orthokeratology in juvenile myopia patients. METHODS: There were 204 eyes of 102 myopic patients, whose average diopter was -3.36±1.07D(spherical equivalent). The changes of mean myopia diopter, uncorrected visual acuity(UCVA), axial length, corneal thickness, visual quality and complications during two years of receiving orthokeratology treatment by the way of clinical diagnosis, general examination, slit lamp examination and corneal thickness examination were observed. RESULTS: After receiving orthokeratology treatment for half a year, one year and two years, the naked vision and the mean myopia diopter had significant difference(P<0.05), the mean myopia diopter of all patients were decreased, and their naked vision were improve. There was no significant difference in corneal thickness and axial length(P>0.05). The corneal of patients were in good health. Discomfort symptoms due to wearing glasses can disappear after reasonable medication and adjustments with the glasses lenses.CONCLUSION: Orthokeratology is a kind of method of effectively correcting eyesight and controlling growth of myopia. In the premise of security products, standard processes, qualified fitting technology and rigorous review, Long-term wearing orthokeratology lens is safe.

AIM: To investigate the changes of macular retinal thickness after laser in situ keratomileusis(LASIK)in myopia.METHODS: Totally 138 eyes of 69 patients who underwent LASIK were recruited randomly. The average macular retinal thickness, and volume of nine zones which were the areas of 0.5mm diameter around the macular fovea, the superior, nasal lateral, anterior and bitamporal lateral of 1.5mm and 3mm diameter around from it, were measured pre-operatively and at 1 day, 1 week, 1 month, 3 and 6 months postoperatively by the use of optical coherence tomography(OCT). RESULTS:Compared with pre-operation, the retinal thickness and volume of 1.5mm diameter around the macular fovea areas(A1, A2, A3, A4)was lower at 1 day, 1 week, and was no obvious difference on 1 month, 3 and 6 months after operation; the areas of 0.5mm(A0)and 3mm(A5, A6, A7, A8)diameter around the macular fovea was no obvious difference at 1 day, 1 month, 3 and 6 months.CONCIUSION: The changes on part of macular retinal thickness are mild reversible in LASIK surgery.

AIM: To probe into the clinical application value of vitrectomy with laser in treatment of proliferative diabetic retinopathy. METHODS: Totally 89 patients(116 eyes)with proliferative diabetic retinopathy in our hospital were selected from March 2009 to March 2010. The patients were divided into control group(47 cases, 62 eyes)and study group(42 cases, 54 eyes)randomly. The patients in control group were treated with vitrectomy. The patients in study group were treated with vitrectomy combined with eye laser. The best-corrected visual acuity(BCVA)and FFA results of the patients before and after treatment, and occurrence of complications after treatment of the patients in two groups were compared and analyzed. RESULTS: After treatment, the proportion of patients with best-corrected visual acuity <0.1 was reduced significantly in both groups(P<0.05), which were 40% and 28%, respectively. And the proportion of patients with a BCVA ranging from 0.5 to 1.0 was also improved significantly(P<0.05), which reached 24% and 41%, respectively. Compared with control group, the patients in study group after treatment, the rate of BCVA ranging from 0.5 to 1.0 was improved significantly, so did the rates of comprehensive regression of macular edema and partial regression of macular edema. While the rates of macular edema aggravation, retinal leakage and recurrence of vitreous bleeding were reduced significantly, the differences above were statistically significant(P<0.05). CONCLUSION:Vitrectomy combined with laser treatment is an effective method for patients with proliferative diabetic retinopathy. It has a positive promoting role in improving postoperative visual acuity and reducing the occurrence of complications.

AIM: To evaluate the safety and efficacy of retrograde lacrimal intubation for treatment of nasolacrimal duct obstruction.METHODS: This study included 92 patients(106 eyes)with nasal lacrimal duct obstruction from August 2010 to February 2011. Retrograde intubation was performed with local anesthesia for all cases, and, the tube was removed after 3-6 months. Then, the patients were followed up for 12-18 months.RESULTS: The intubation was successful in all eyes, and the tubes were removed conventionally at 3-6 months. Among them 84 patients(97 eyes)were unobstructed when the tubes were removed, and the effective rate was 91.5%.CONCLUSION: Retrograde lacrimal intubation is safe, minimal invasion, effective, less bleeding and good efficacy, is an effective way to cure nasolacrimal duct obstruction.

AIM: To evaluate the surgery skill and efficacy of retrograde lacrimal intubation on treatment of chronic dacryocystitis with nasal endoscopic. METHODS: Totally 45 patients(52 eyes)with chronic dacryocystitis in this study received retrograde lacrimal intubation by nasal endoscopic, and the tube was removed after placing 2-3 months. The efficacy was observed after surgery.RESULTS: All operations on the patients were conducted successfully, and no serious complications during and after surgery. 41 eyes(79%)were cured, 4 eyes(8%)were improved and 7 eyes(13%)had no effective improvement. The effective rate was 87%.CONCLUSION: Retrograde lacrimal intubation on treatment of chronic dacryocystitis with nasal endoscopic can make the surgery safer, easier and less injury.

H2S is the third kind of endogenous gaseous signal molecule after NO and CO. Numerous studies have shown that H2S was involved in vasodilation, inhibiting smooth muscle proliferation, protecting hypoxic neurons, anti-inflammatory, anti-oxidation stress, anti-ischemia/reperfusion injury and other physiological/pathological processes. The present studies mainly concentrate on the circulatory system and nervous system rather than diabetes mellitus and diabetic retinopathy(DR). But the physiological and pathological effects of H2S and the pathological process of DR have various correlations in many ways in theory. In this paper, the progress and protection of H2S on the pathogenesis of DR are reviewed at the angle of molecular and cellular.

AIM: To evaluate the safety and efficacy of laser in situ keratomileusis(LASIK)by Intralase femtosecond laser or Amadeus II microkeratome. METHODS: Flap creation for LASIK was performed using IntraLase femtosecond laser(Intralase group)or Amadeus II microkeratome(Amadeus group)in 130 eyes with ametropia. Patients of Intralase group and Amadeus group were divided into three groups with different refractive degrees: <=-3.00D was A, '-3.00< B<-6.00D' was B, >=-6.00D was C. Data of visual activity, RMS values, spherical aberration, coma and trefoil of each group were recorded and compared at one month after surgery. RESULTS: One month after LASIK, the postoperative vision of 60 eyes(93.7%)were the same as or better than preoperative BCVA in Intralase group and the postoperative vision of 61 eyes(92.4%)were the same as or better than preoperative BSCVA in Amadeus group. There was no significant difference between two groups(P=0.421). There was no significant difference in RMS values, spherical aberration, coma and trefoil between the groups in refractive degrees.CONCLUSION: There is no significant difference in postoperative vision, RMS values, spherical aberration, coma and trefoil between Intralase femtosecond laser group and Amadeus Ⅱ microkeratome group. Both methods are effective and safe.

AIM: To evaluate the safety and efficacy of laser in situ keratomileusis(LASIK)by Intralase femtosecond laser or Amadeus II microkeratome. METHODS: Flap creation for LASIK was performed using IntraLase femtosecond laser(Intralase group)or Amadeus II microkeratome(Amadeus group)in 130 eyes with ametropia. Patients of Intralase group and Amadeus group were divided into three groups with different refractive degrees: <=-3.00D was A, '-3.00< B<-6.00D' was B, >=-6.00D was C. Data of visual activity, RMS values, spherical aberration, coma and trefoil of each group were recorded and compared at one month after surgery. RESULTS: One month after LASIK, the postoperative vision of 60 eyes(93.7%)were the same as or better than preoperative BCVA in Intralase group and the postoperative vision of 61 eyes(92.4%)were the same as or better than preoperative BSCVA in Amadeus group. There was no significant difference between two groups(P=0.421). There was no significant difference in RMS values, spherical aberration, coma and trefoil between the groups in refractive degrees.CONCLUSION: There is no significant difference in postoperative vision, RMS values, spherical aberration, coma and trefoil between Intralase femtosecond laser group and Amadeus Ⅱ microkeratome group. Both methods are effective and safe.

Intermittent exotropia is a type of strabismus between exophoria and constant exotropia, which is the most common exotropia. The onset age is usually six months to four years old. Different from other types of strabismus, intermittent exotropia can maintain normal binocular vision in a long period of time. So how to choose the optimal timing and effective treatment is a challenge for clinicians, meanwhile they hold different views about the choice of surgical approach and postoperative results. The objective of this article is to review the intermittent exotropia, including the pathogenesis and clinical features, the timing of surgery and surgical methods, and to provide reference for the treatment of intermittent exotropia.

Amblyopia is a kind of commonly encountered disease. The research method of amblyopia is associated with various clinical and basic subjects. Optical coherence tomography(OCT)is an important ophthalmic examination technique. It is an objective and easy-to-operate means to assess the structure of retina. In recent years, OCT has been frequently used in the retinal examination in amblyopia. This application of OCT in amblyopia is reviewed in this article.

AIM: To compare the effect of nasolacrimial duct stent placement and dacryocystorhinostomy under nose endoscope for chronic dacryocystitis.METHODS: Totally 80 cases(80 eyes)with chronic dacryocystitis were randomly divided into two groups. There were 40 cases in group A(nasolacrimial duct stent placement), 40 cases in group B(dacryocystorhinostomy under nose endoscope). The treatment effects were observed after operation. The graft patency of lacrimal passage was examined post operatively.RESULTS: Patients were followed up for 1 year. The effective rate of group A was 90%, 85% at six month and 1 year after the operation respectively. Effective rate of group B was 97.5%, 100% at six month and 1 year after the operation respectively. There was no statistically significant difference between the two groups at six month(P>0.05), while there was statistically significant difference at one year(P<0.05).CONCLUSION: The effect of dacryocystorhinostomy under nose endoscope is more reliable than nasolacrimial duct stent placement for chronic dacryocystitis.

AIM: To ameliorate the techniques and instruments forlacrimal duct obstruction in order to learn easily and achieve better surgical effects. METHODS:Group A: 90 eyes with lacrimal duct obstruction were treated with the ameliorated annular silicone stent intubation; Group B: 80 eyes were treated with the classical annular stent intubation. Follow up in 2 years after operation, comparing the rate of cure and efficiency between the two groups. RESULTS: After a two-year follow-up, in group A, 80(89%)eyes were cured, 7 eyes(7.8%)turned better and 3 eyes failed to respond, the total effective rate was 97%; in group B, 60(75%)eyes were cured, 9(11%)turned better and 11 failed to respond, the total effective rate was 86%. Differences in cure rate(χ2=5.62, P<0.05)and total effective rate(χ2=4.78, P<0.05)between two groups had statistical significance. CONCLUSION: The ameliorated means is simple and effective in treatment oflacrimal canaliculi occlusion, it is worth of spreading.

AIM:To investigate the surgical treatment in filtering operation for malignant glaucoma with high intraocular pressure. Application of anterior chamber gas injection technology combined with adjustable suture can relieve ciliary blockand reduce the occurrence of malignant glaucoma. METHODS:A total of 30 cases of closed-angle glaucoma patients with high intraocular pressure were selected as research objectives. Their intraocular pressure were >60mmHg at the first time. After detailed inspection those patients met the indications of compound trabeculectomy and were given drugs to reduce intraocular pressure with the preoperative intraocular pressure >45mmHg. The compound trabeculectomy were performed in those patients. After completion of the operation of scleral flap suture, it formed a state of intraocular hypertension with no anterior chamber(ciliary block). By suturing scleral flap with adjustable suture line and injecting sterile air into anterior chamber, anterior chamber was formed. RESULTS: During the follow-up of 30 cases in six months, there were no malignant glaucoma; anterior chamber depth was stable; 25 cases of intraocular pressure were less than 18mmHg; 5 cases of IOP after follicular limitation were between 21-28mmHg. CONCLUSION:If filtering surgery for closed-angle glaucoma is performed at a state of high intraocular pressure, the incidence of state of high intraocular pressure with no anterior chamber(ciliary block)state will be very high. By summarizing the 30 cases of this kind of surgery, this paper held that this method(suture of the scleral flap with adjustable suture combined with injection of sterile air in anterior chamber)can relieve ciliary block in the operation and avoid the occurrence of malignant glaucoma after this kind of operation.

AIM: To analyze the characteristic shapes of cystoid macular edema(CME)and the macular edema(ME)caused by central serous chorioretinopathy(CSC)through optical coherence tomography(OCT)examination, and to analyze the accumulate liquid in retina to explain their relationships with blood-retina barrier.METHODS: A total of 29 cases(30 eyes)with relative disease were enrolled, including one case with both eyes selected. The macular area of all patients was scanned by OCT horizontally and vertically.RESULTS: The OCT images of CME indicated: there were a lot of low reflection dark regions which had an oval honeycomb structure andcystoid shape; these regions were found between the outer nuclear layer and inner plexiform layer of retinal nerve fiber layer(RNFL); cyst wall appeared to be existed. The OCT images of ME result from CSC indicated: there were low reflection dark regions between photoreceptor inner segment/outer segment(IS/OS)junction layer and retinal pigment epithelium(RPE)layer; the RNFL was upheaved; RPE presented strong reflection but its shape was not different with that of normal macular. CONCLUSION: The image of OCT is a type of sectional anatomyfigures, the cystoids of CME exist not only in the outer plexiform layer, but also in the outer nuclear layer. The characteristic shapes of accumulated liquid of CME and CSC prove the existence of inner-outer barrier in retina.

AIM: To observe the application of anterior chamber air in avoiding hyphema after operation of small incision extracapsular cataract extraction(ECCE)and intraocular lens(IOL).METHODS: We retrospectively analyzed 25 patients who were performed anterior chamber air before the finish of surgery to keep intraocular hypertension temporarily so as to avoid hyphema after operation of small incision ECCE and IOL.RESULTS: There were 2 cases hyphema out of 25 patients. The air in the anterior chamber was absorbed in 2-5d after surgery.CONCLUSION: The application of anterior chamber air can avoid hyphema after operation of small incision ECCE and IOL.

AIM: To observe the application of anterior chamber air in avoiding hyphema after operation of small incision extracapsular cataract extraction(ECCE)and intraocular lens(IOL).METHODS: We retrospectively analyzed 25 patients who were performed anterior chamber air before the finish of surgery to keep intraocular hypertension temporarily so as to avoid hyphema after operation of small incision ECCE and IOL.RESULTS: There were 2 cases hyphema out of 25 patients. The air in the anterior chamber was absorbed in 2-5d after surgery.CONCLUSION: The application of anterior chamber air can avoid hyphema after operation of small incision ECCE and IOL.

AIM: To investigate the clinical characteristics, diagnosis, treatment and prognosis of ankylosing spondylitis(AS)associated with uveitis. METHODS: The retrospective analysis of clinical manifestation, laboratory examination and clinical diagnosis and treatment on 18 patients with uveitis(18 eyes)from June 2006 to June 2012 in our hospital. RESULTS: A total of 18 patients with AS associated with uveitis, including sixteen males and two females were included. Onset age of AS patients was(33±11)years old, while uveitis patient was(29±13)years old. Thirteen patients were diagnosed as AS first and then went to ophthalmology department; other five patients were diagnosed as uveitis first but later as AS. Uveitis duration of 18 patients was 15-46(27±7)days and thirteen patients among them had clear recurrent history. All patients showed typical sacroiliitis in X-ray imaging examination; thirteen patients(72.2%)had positive HLA-B27; twelve patients'(66.6%)erythrocyte sedimentation rate were increased; Seven patients'(38.8%)CRP were>10mg/L. Anterior uveitis of all patients cured after systemic treatment with corticosteroids and cycloplegic eye drops.CONCLUSION: AS associated with uveitis is usually presented in young males,which is often characterized by unilateral onset and recurrent relapse. Based on typical clinical features and radiographic results, the diagnosis can be made. Early and effective treatment can achieve good effects.

AIM: To evaluate the efficacy and safety of implantation of phakic posterior chamber intraocular lens for high myopia by a single incision. METHODS: Phakic posterior chamber intraocular lens implantation surgery by a single incision was performed in 9 patients(18 eyes)with high myopia. All patients were followed up for 3 to 9 months to record the clinical ocular data including uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), diopter, astigmatism, intraocular pressure, the number of endothelial cell etc. before and after surgery.RESULTS: Phakic posterior chamber intraocular lens were implanted successfully in all the operative eyes. The mean preoperative diopter was(-13.38±-5.32)D, and postoperative diopter was(-0.25±0.38)D. All eyes of the preoperative and postoperative uncorrected visual acuity(UCVA)and the best corrected visual acuity(BCVA)were 0.06±0.04, 0.6±0.2, 0.5±0.2, 0.7±0.3 respectively. It was obvious that postoperative UCVA and BCVA were better than the preoperative UCVA and BCVA(P<0.05). The mean preoperative and postoperative IOP was(13.23±3.18)mmHg,(15.03±1.25)mmHg, respectively. The cornea endothelial cell density was(3008±298)/mm2 before operation and(2896±246)/mm2 after operation; average preoperative anterior chamber depth was(3.56±0.29)mm; postoperative anterior chamber depth was(3.68±0.37)mm; preoperative corneal astigmatism was(0.52±0.30)D and postoperative refractive cylinder was(0.67±0.45)D, showing no statistical differences(P>0.05). CONCLUSION: Phakic posterior chamber intraocular lens implantation for high myopia by a single incision is a reliable and effective method with low risk, small ocular surface injury, low cost and small astigmatism induced by surgery. It can be a suitable operation method.

AIM: To investigate the relationship between types of cataract, density of cataract and high axial myopia. METHODS: An observational case-control study of 300 eyes of ophthalmological outpatients, more than 40 years old, was undertaken. All the patients were divided into high myopia group(axial length≥26.0mm)(n=150 eyes)and control group(axial length: 21.0mm-24.0mm)(n=150 eyes). The cataract type and cataract density between the two groups were compared. RESULTS: Nuclear cataract was more frequently encountered in high myopia group(P<0.05), and also nuclear cataract density was higher than control group. Mixed type cataract was more commonly found in control group(P<0.05). There was no statistical significant difference in cortical cataract and posterior subcapsular cataract between two groups(P>0.05). Nuclear density in high myopia group was higher than control group(P<0.01).CONCLUSION: There is a correlation between nuclear cataract and high axial myopia. Cataract density in the high myopia group is higher.

AIM: To analyze dry eye conditions of type 2 diabetes and its related factors.METHODS: Totally 45 patients(90 eyes)with type 2 diabetes and 40 patients(80 eyes)non-diabetic patients were chosen for this study. Tear film break-up time, Schirmer test, and corneal fluorescein staining differences between indicators and its related factors were analyzed. RESULTS:In diabetes group, the mean tear film break-up time was 6.23±2.36s, significantly shorter than that of the control group; Schirmer infiltration experiments average length of filter strips was 8.65±3.82mm, significantly lower than that of the control group; corneal fluorescein staining score was 1.89±1.31points, significantly higher. The incidence rate of dry eye was 58%, was significantly higher, the difference had statistically significant(P<0.05). The results of Logistic Multivariate analysis showed that basal secretion of tear volume and tear film break-up time were risk factors for type 2 diabetic patients with dry eye.CONCLUSION: In type 2 diabetes patients, the tear film breakup time is shortened, and the basal tear secretion is decreased corneal fluorescein staining score increased.Basal secretion of tear volume and tear film break-up time was risk factors for type 2 diabetic patients with dry eye.

AIM: To observe the change of tear meniscus measured by OCT to determine the effects of Augentropfen Stulln Mono eye-drops on the tear dynamics of dry eyes after and to evaluate its efficacy and persistence in treating dry eye. METHODS: A total of 25 patients, average age being 28.60±3.77, after excimer laser surgery(more than 6 months)were selected in the study. All patients had complications such as dry and sore eye and the tear break-up times(BUT)were less than 5s. The right eyes in the experimental group were given Augentropfen Stulln Mono eye-drop and the left eyes in the control group were given 0.9% normal saline. The heights and cross-sectional areas of the upper and lower tear menisci were measured by OCT before drop instillation and at 10min, 20min and 30min after drop instillation. Differences in each eye at different times were analyzed by one-way variance and compared by sample T test. RESULTS: The lower tear meniscus cross-sectional area(t=2.835, P=0.009)at 20min after drop instillation, and the upper tear meniscus height(UTMH)(t=2.368, P=0.026), upper tear meniscus cross-sectional area(UTMA)(t=4.293, P=0.000), lower tear meniscus height(LTMH)(t=3.060, P=0.005)and lower tear meniscus cross-sectional area(LTMA)(t=2.644, P=0.014)at 30min after drop instillation in the experimental group were significantly larger than that in the control group with no statistical differences. There were no statistically significant differences in upper and lower tear meniscus heights and cross-sectional areas between two groups before and after taking drugs(P>0.05), however, there was a trend of increase after treatment in the experimental group. CONCLUSION:Augentropfen Stulln Mono eye-drops can increase the volumes of upper and lower tear meniscus in patients with dry eyes after operation to some degree, and can maintain effects in a relatively long time period.

AIM:To investigate the eyesight situation among 2644 freshmen of Xinjiang Medical University in 2011, and to offer the references for eyesight protection and scientific basis for promoting the school health care. METHODS: The physical examination of a total of 2644 freshmen of grade 2011 of Xinjiang Medical University in September, 2011. Visual rating criteria by the State Education Commission promulgated the "Undergraduate PE Qualification Standard", the vision binocular unequal to vision whichever was lower, and the naked eye visual acuity of less than 5 was low vision.RESULTS: Among 2644 freshmen, a total of 885 people(33.5%)with poor vision. Poor eyesight of 250 people(24%)were found in 1041 boys; poor eyesight of 635 people(39.6%)were found in 1603 girls. CONCLUSION: In order to reduce the occurence of students' poor eyesight, enhancing physical exercise is very important.

AIM: To explore the major factors causing adolescent eyesight decline, so as to take effective prevention or timely intervention.METHODS: The myopic teenagers(n=2 050)were followed up for 6 consecutive years. The common causes of myopia were compared and the statistics were processed using logistic regression analysis, then the factors more obvious in inducing myopia were selected.RESULTS: In many factors causing adolescent myopia, operating coefficient of excessive homework and scintillating light source were respectively 1.132 and 1.254. Risk of the two factors were 3.590 and 3.681. Result of the stepwise regression model was(OR=2.054)for excessive homework and(OR=2.036)for scintilating light source.CONCLUSION: The excessive homework and persistent flickering light source are the main influence factors causing adolescent myopia.

AIM: To discuss the application and complications of ciliary sulcus suture fixation of posterior chamber in secondary intraocular lens(IOL)implantation after rupture of the ligament and posterior capsule, and posterior capsular surgeries in aphakic eyes including traumatic cataract, dislocation of the lens, etc. METHODS: From February 2007 to November 2012, 31 patients(32 eyes)were received suture fixation of posterior chamber IOL implantation in our department and got satisfactory results.RESULTS: The corrected visual acuity was >0.5 in 9 eyes(28%), 0.1-0.5 in 17 eyes(53%), and <0.1 in 6 eyes(19%)from 3 months to 1 year after operation. The main complications included bleeding from the puncture site of ciliary body, postoperative corneal edema, corneal astigmatism, loose or parted suspending suture, and IOL dislocation, etc. CONCLUSION: The suture fixation of posterior chamber IOL implantation is the first operation choice currently for eyes without posterior capsule or eyes with severe defects of posterior capsular lens suspensory ligament, but many complications in the operation need to be solved.

AIM: To analyze the accurate diagnosis of macular diseases by B-scan ultrasound with the help of SD-OCT which can provide the theory basis for prediction of visual function of postoperative cataract surgery. METHODS: Posterior segment lesion of cataract patients can be primarily understood by B-scan ultrasound. OCT can be performed to further diagnose if there is abnormal echo in macular area. RESULTS: A total of 178 cataract patients(217 eyes)who were suspected as macular diseases were examined by B-scan ultrasound and were scanned by OCT. A total of 213 eyes were diagnosed as maculopathy, including 70 eyes with wet age-related macular degeneration(AMD), 65 eyes with macular epiretinal membrane, 21 eyes with macular hole, 17 eyes with dry AMD and other 23 eyes with macular diseases. Results of frequency domain in 4 eyes showed that there were other lesions in the posterior pole in non-macular area. The fundus of 17 eyes can't be seen by OCT scan. These 17 eyes were diagnosed as maculopathy by SD-OCT of frequency domain after cataract operation. CONCLUSION: B-scan ultrasound can be important detection tool to understand the posterior segment lesion since most cataract patients' ocular fundus are not clear. As B type ultrasound operation is simple, inexpensive and widely used for examination with a low degree of patients' cooperation and no influences from opacity of optical media, it is often used as routine examine method before cataract surgery. If B-scan ultrasound examination shows signs of macular diseases, SD-OCT will be taken. The results of these two methods are quite constant.

AIM: To observe the therapeutic effects ofextracapsular cataract extraction(ECCE)by small incision with trabeculectomy in treating primary acute and chronic angle-closure glaucoma.METHODS:Twenty-three patients(24 eyes)were acute angel-closure glaucoma with cataract, while 11 patients(12 eyes)were chronic angel-closure glaucoma with cataract. All of them were performed ECCE and IOL implantation combined with trabeculectomy.RESULTS: Follow up for 1 month, before operation, the mean IOL of acute angel-closure glaucoma was(30.68±7.60)mmHg; after operation, IOL was(17.83±5.95)mmHg, the difference was statistically significant. Before operation, the mean IOL of chronic angel-closure glaucoma was(29.27±5.55)mmHg; after operation, IOL was(18.12±1.88)mmHg. The difference was also statistically significant. The differences of average intraocular pressure in two groups were not statistically significant. After surgery, intraocular pressure(IOP)of 26 eyes(72.3%)was under control(6-21mmHg)without anti-glaucoma drug, IOP of 8 eyes(22.2%)were kept in normal state with anti-glaucoma drug. The total effective rate amounts to 94%. while 2 eyes'(6%)intraocular pressure were still as high as 22-30mmHg even with anti-glaucoma drug. There was obvious improvement in visual acuity in 32 eyes(89%)with no serious complications. CONCLUSION: ECCE by small incision andintraocular lens implantation combined with trabeculectomy is an effective and safe surgery technique in treating primary angle-closure glaucoma and cataract,which can effectively manage intraocular pressure and improve visual acuity with few complication. And there is no difference in IOP management between the acute and chronic angel-closure glaucoma.

AIM: To observe the macula structure of the macula-off rhegmatogenous retinal detachment(RRD)with optical coherence tomography(OCT)5 years after successful scleral buckling(SB)surgery and to analyze the correlation between the duration of macular detachment(DMD)and postoperative visual acuity with OCT image. METHODS: Forty-seven eyes of 47 patients with macula-off RRD were retrospectively studied and follow-up was carried out for a period of 5 years. The correlation among the postoperative best-corrected visual acuity(VA), the DMD and the microstructural findings with OCT at the fovea were evaluated. RESULTS: The sub-acute RRD(DMD<7d)shows a greater foveal thickness(226 ±88μm)than the prolonged one(DMD>7 days)(209 ±76μm)with no statistical difference(P=0.791). Meanwhile, the sub-acute RRD had better mean final VA 0.53, compared with the prolonged one of 0.25, with significant difference(Student's t-test, P=0.008). Among 47 eyes, foveal anatomic abnormalities were detected in 5 eyes(10%); disruption of the junction between the photoreceptor inner and outer segments(IS/OS)in 4 eyes, and with a disrupted external limiting membrane(ELM)also(8.5%); and the mean VA of these 5 patients was 0.15 lower after 5 years. CONCLUSION: Sub-acute macula-off RRD has a better impact on the final visual recovery than the prolonged one. Furthermore, the retinal thickness in the fovea was positively correlated to the postoperative VA. The disrupted inner segment/outer segment(IS/OS)junction could be restored in the patients without disrupted ELM signals at the initial examination. The duration of macula-off RRD within 7d had fewer disrupted inner segment/outer segment(IS/OS)junction with disrupted ELM signals than those for more than 7d. It is recommended to perform OCT in cases where VA was not improved as expected.

AIM: To observe the suppressing effect of specific small hairpin RNA(shRNA)on TGFβ-R2 expression in human lens epithelial cells(LECs).METHODS: Specific shRNA expression vector was constructed according to the design principles of TGFβ-R2 mRNA human GeneBank siRNA synthesis and transfected into cultured 293T with TGFβ-R2 over expression vector. After effective RNAi vector was selected by Western blot, then amplification, purification, and titration. lentivirus-TGF beta-R2 shRNA was transfected into LECs, then TGFβ-R2 mRNA expression in these cells was detected by the real-time fluorescence quantitative PCR detecting system(qPCR). RESULTS: TGFβ-R2/GV115RNAi#1 target gene expression knockdown effect is the most obvious; the titer of packaging lentivirus is 8E+8 TU/mL; the knockdown effect is significant, the interfering efficiency is 78.1%(P<0.05). CONCLUSION: TGFβ-R2 RNAi vector was successfully constructed, and can inhibit the expression of TGFβ-R2 mRNA in human LECs.

AIM: To investigate the feasibility to use a new dilation agent, hydroxyethyl starch(HES)130/0.4, as a new deswelling additive in cornea organ-culture.METHODS: A half of 20 pairs of rabbit corneas just were cultured in ACF medium with a supplement of 10% HES 130/0.4 for 28d as the experimental group. The control was cultured in ACF for 28d and then dehydrated in 5% dextran T500 for 48h. The evaluation parameters included the endothelial cells viability, the mean corneal central thickness before and after preservation, the mean water content after storage, the corneal transparency and folding, F-actin expression of corneal endothelium using Western blotting, and the electron microscopy observation of corneal endothelial cells. RESULTS: After storage, the mean endothelial cell density of the HES 130/0.4 experimental group was 2 371±159/mm2. The experimental group also exhibited a thinner corneal thickness, better transparency and less folding compared with the control. After additional dehydration, the control became thin and transparent, however, its final endothelial cell density decreased greatly to 2 138±182/mm2. F-actin could be seen in corneal endothelium of two groups using Western blotting, whose expression level achieved higher in the experiment group. The ultrastructure of endothelial cells of the experiment group remained good compared with normal cornea. CONCLUSION: HES 130/0.4 has low toxicity, and is well tolerated for endothelial cells and can be used as a continuous supplement during organ culture. It also avoids excessive cornea swelling, simplifies the storage steps, reduces infection risk, and appears to be an alternative deswelling additive in cornea organ-culture.

AIM: To make further phenotypic analysis by establishing the mouse model of specific Smad4 conditional gene knockout in ocular tissue by Cre/LoxP system of this kind of mouse model. METHODS: Mouse of specific Smad4 conditional knockout in lens ectoderm(Le-Cre; Samd4fl/fl or also called mutant mouse)was obtained by mating the Pax6 promoter-driven Cre transgenic mouse(Le-Cre)with Smad4 wildtype mouse(Smad4 fl/fl). To confirm that Smad4 has been conditionally inactivated only in the specific tissue of ectoderm such as lens, cornea and ectoderm of the eyelids so on. A series of assays were carried out to reveal the validity and specificity of Smad4 gene knockout at molecular and cellular levels, including genotyping by PCR, detection of green fluorescence protein(GFP)in specific tissue and Smad4 protein. The expression of Le-Cre from Lacz staining using ROSA26 reporter genes in specific ocular tissue of mice can be visualized. Preliminary phenotype of mutant mouse was also observed. RESULTS: As early as around E10.0, strong GFP expression was observed in the embryonic lens and periorbital ectoderm of the mice, which showed Le-Cre was expressed in specific target tissue. Through genotyping for Smad4, Cre and Rosa genes, the mice were determined if they have carried Cre, Smad4 allele or Rosa reporter gene. It was further confirmed by lens-sampled genotyping that Smad4 gene was removed from some specific tissue such as lens. The spatial-temporal expression and tissue specificity of Le-Cre recombinase was also revealed by LacZ staining of Rosa; Le-Cre double transgenic mouse. According to Immunohistochemical staining, Smad4 was widely expressed in normal embryonic eyes, mainly appearing in the cytoplasm at the early embryonic stage and were transferred to nucleus with gestation developing, while in mutant embryonic eyes, Smad4 was void of expression in Cre-expressed tissues. It was observed that Smad4 mutant mouse could survive the conditional gene knockout. But those mice showed abnormal appearance such as microphthalmia, sunken socket, abnormal eyelid opening, and eyelid closure failure and periocular hair loss.CONCLUSION: In this study, mouse model of Smad 4 conditional knockout is precisely established and lack of expression of Smad4 in mutant mice is confirmed by related genetic and proteic detection. Lack of Smad4 expression in specific ocular tissues of mutant mouse can result in the abnormality of eye and adnexa, which provides a reliable animal model to investigate the ocular development and the roles of Smad4 on it.

AIM:To observe the clinical curative effects of different methods for the treatment of neovascular glaucoma. METHODS: From January 2011 to December 2012, 140(140 eyes)patients with neovascular glaucoma were selected as the research objects in our hospital. We made a retrospection analysis and they were randomly divided into group A(simplex small beam resection group)20 cases 20 eyes, group B(small beam resection and iris circumference resection group)19 cases 19 eyes, group C(ciliary body laser light coagulation surgery group)42 cases 42 eyes, group D(ciliary body condensation surgery)44 cases 44 eyes, group E(intravitreal medicine injection group)15 cases 15 eyes. The intraocular pressure, vision and clinical effects before and after the surgery were analyzed comprehensively RESULTS: The combination study of the groups: the differences were statistically significant when compared postoperative intraocular pressure recovery after surgery with before the treatment in each group(P<0.05). In group A, 20 eyes efficiency was 60.0%, group B 19 eyes efficiency was 84.2%, group C 42 eyes efficiency was 71.4%, group D 44 eyes efficiency was 54.5%, group E 15 eyes efficiency was 40.0%. Because the cases in some of the groups were less, there were no statistical significance when compare between them(P>0.05). The results of visual recovery were compared with that of prior treatment, the differences were statistically significant(P<0.05). CONCLUSION: For different conditions of patients with neovascular glaucoma, we can use different surgical methods. The recovery of visual functions for patients was the primary objective.

AIM: To compare the clinical effects of the intravitreal injection of triamcinolone acetonide(TA)and lucentis(LU)for macular edema in retinal vein occlusion. METHODS: Forty cases of retinal vein occlusion with macular edema were analyzed retrospectively, all the case's best corrected visual acuity(BCVA)≤0.6, fovea centralis thickness(CMT)≥250μm. All the eyes were treated with intravitreal injection of TA(22 cases, 4mg, 0.1mL)or LU(18 cases, 0.5mg, 0.05mL). The follow-up time was 1, 2wk, 1, 2, 3 and 6mo. BCVA and CMT were measured. RESULTS:The two group's BCVA were significantly improved than preoperation. There were significant differences at each follow-up time compared with preoperation(P<0.05). The best BCVA after intravitreal injection of TA was showed at 1mo(logMAR=0.30±0.20), while the intravitreal injection of LU was 2mo(logMAR=0.21±0.10). The two group's CMT were significantly relieved than preoperation. There were significant differences at each follow-up time compared with preoperation(P<0.05). The best CMT after intravitreal injection of TA and LU were all showed at 2mo(TA CMT=274.45±141.81μm, LU CMT=225.83±22.86μm).The BCVA is negatively related with CMT. The BCVA and CMT had no statistical difference between the two groups. CONCLUSION: Intravitreal injection of TA and LU in the treatment of macular edema in retinal vein occlusion can reduce macular edema and improve the visual activity. There is no significant difference between the two treatments.

AIM:To investigate the relationship between genetic variations of LOXL1 gene and pseudoexfoliation syndrome in Chinese Uygur population. METHODS: Fifty patients with exfoliation syndrome(case group, including 39 males and 11 females)and 58 cases of normal individuals(control group, including 40 males and 18 females)were randomly selected. Genomic DNA was extracted and 3 single nucleotide polymorphisms(rs1048661, rs2165241 and rs3825942)of LOXL1 gene were genotyped using PCR-sequencing technology for all subjects. Then a case-control study was conducted. RESULTS: The average age of the case group was higher than that of the control group(P=0.039). The distribution of the genotypes of rs1048661 and rs3825942 polymorphism was similar between case and controls(P=0.196, P=0.584). The CT and TT genotype frequency of rs2165241were significantly higher in case group than that of the control group(P=0.001). After adjustment for age and gender, the odds ratio of exfoliation syndrome was 2.850 for carriers of the CT genotype(P= 0.029), and 13.398 for carriers of the TT genotype(P=0.001). CONCLUSION: The genetic variations of LOXL1 gene(rs2165241)may be associated with the exfoliation syndrome in Uygur. T allele may be the risk factor for the predisposing of exfoliation syndrome in Uygur.

AIM: To evaluate the efficacy and influence factors of Graves' ophthalmopathy treated by oral low dose prednisone. METHODS: We examined the outcome at the end of 6 mo of oral prednisone 15mg daily treatment for Graves' ophthalmopathy in the First Affiliated Hospital of Sun Yat-sen University during the period January 2010 to December 2012. Totally 118 patients ranging in age from 14 to 67 years old(mean 35.4±12.2). There were 37 males and 81 females. We compared the changes of the severity and clinical activity score(CAS)of Graves' ophthalmopathy before and after treatment. We defined clinical effectiveness as the severity assessment improvement and/or clinical activity score improvement from active to non-active. We evaluated the efficacy and influencing factors of Graves' ophthalmopathy treated by oral low dose prednisone. RESULTS:After treatment, 58.5% patients were improved. The improvement in active patients were 72.6% significantly greater than in non-active patients 23.5%(P<0.01). Serum TRAb in active patients was significantly higher than in non-active patients(P<0.01). Among the severity assessment, less severity patients improved significantly greater than more severity(P<0.01). The longer the course, the more severity the patients(P<0.01). Either hyperthyroid or hypothyroid played a role in the exacerbation, leading to deterioration in patients(P<0.01).CONCLUSION:Active Graves' ophthalmopathy patients improved greater than non-active patients after received oral prednisone 15mg daily treatment for 3-6 mo. The shorter the course, the milder the patients, and the more effective the treatment. So, we should treat Graves' ophthalmopathy as early as possible, and try our best to keep the patients euthyroid to avoid deterioration.

AIM: To examine the effect of prophylactic tamsulosin in male candidates of cataract surgery on general anesthesia in preventing urinary retention.METHODS: In this double blind clinical trial, 67 male candidates of cataract surgery under general anesthesia randomly received oral tamsulosin(0.4mg daily for one week prior to cataract surgery, n=32), or placebo(n=35). Rates of post-operative urinary retention and floppy iris syndrome were compared between the two groups.RESULTS: The two groups were matched for the patients' age(tamsulosin group: 68.16±8.72 years, placebo group: 71.37±8.60 years, P=0.38). Post-operative urinary retention occurred less frequently in tamsulosin receivers(3.1% vs 48.6%, P<0.001, Odds ratio=29.28, 95% CI 3.59-238.79). There was only one case(2.9%)with floppy iris syndrome in the control group(P=0.52, Odds ratio=1.03 95% CI 0.97-1.09). CONCLUSION: Short-term prophylactic administration of oral tamsulosin before cataract surgery on general anesthesia is effective in preventing post-operative urinary retention without increasing the risk of floppy iris syndrome.

AIM: To observe the regrowth progress of corneal epithelium and the change of center thickness on rabbit corneal lesions after exposure to mustard gas.METHODS: Twenty rabbits(40 eyes)were divided into two groups randomly, the experimental group included 10 cases(10 right eyes), the control group included 10 cases(10 right eyes), and the left eyes were normal group. The corneas of the rabbits were contacted the liquid mustard gas 400μL/L(0.2mL)and 200μL/L(0.2mL)for 4min in the experimental group and the control group respectively. Then the corneal white light and photofluorography at were conducted at 1, 2, 3, 4, 5, 6d; 1, 2, 3wk; 1, 3mo and the corneal center thickness was measured respectively. RESULTS: The area of corneal epithelium lesions in experimental group degraded from Ⅳ to 0 after 1wk. The lesions were appeared as flake sample repeatedly in 2wk, 3wk, 1mo, delayed to healing. And that area in control group degraded from Ⅲ to 0 after 1wk. The lesions were appeared as pinpoint sample in 2wk, 3wk, 1mo. The central corneal thickness of experimental group was obviously higher than that of the normal and control group in 1-6d. There was statistically significant difference between the two groups(P<0.05). In 1wk-1mo the difference of three group was not statistically significant(P>0.05). In 3mo the experimental and control group were higher than the normal group, but the difference was not statistically significant(P>0.05).CONCLUSION: Mustard gas of different concentrations can lead different level corneal lesion and corneal thickness change. The corneal epithelium remodeling change appears within 1wk and completely recover in 1mo after the direct corneal contact. Corneal thickness gets right in 3mo.

AIM:To evaluate safety and stability of ICL implantation treatment of high myopia through the observation of anterior segment parameters such as ACD and ICA over time pre- and post-operation changes by Pentacam. METHODS:According to the proposed inclusion criteria, 90 eyes(48 patients)with high myopia who accepted ICL implantation treatment were selected. The mean follow-ups are 6 months. Anterior segment parameters such as ACD, ICA(3'clock), corneal aberration(CA), K-value and CCT were measured by Pentacam at pre- and postoperative different follow-up time points. Using SPSS 19.0 statistical software to describe the indexes distribution at different time points. We compared changes by matching t-test between preoperation and postoperation. RESULTS:The indexes presented normal distribution. During the follow-ups of all the patients, ACD and ICA(3'clock)were lower than before. Differences were all statistically significant(P<0.05). About CA, CTA and CLOA had no significant difference between preoperative and postoperative(P>0.05); but CHOA increases statistically significant(P<0.05). K-value slightly reduces, Differences are all statistically significant(P<0.05). CCT had no significant difference(P>0.05). For the indexes with statistically significant difference, they achieved stable state in postoperative 1-month. CONCLUSION:After ICL implantation treatment of high myopia,changes mainly include the ICA and ACD decrease, CHOA increases, K decreases by Pentacam observation,and it is within the scope of the security,all the values are stable during the follow-ups, no complications occur, but the long-term effect need further follow-ups.

AIM: To observe clinical effects and complications analysis of adjunctive mitomycin C(MMC)on photorefractive keratectomy(PRK)for myopia.METHODS: In this retrospective study, 80 eyes of 40 patients were treated by PRK in 2009 as control group with the LaserSight SLX excimer laser. Eighty eyes of 40 patients were treated with 0.2g/L MMC 20s during PRK in 2010 as MMC group. Uncorrected visual acuity(UCVA), refraction, corneal epithelial healing, erosions, dry eyes, and haze were examined at 1 month, 3, 6 and 12 months postoperatively, and the 2 groups were compared and analyzed.RESULTS: The differences between control and MMC group were not statistically significant in preoperative mean ages, UCVAs, best spectacle-corrected visual acuities, corneal depths, spherical equivalents(SEs), and laser ablation zones, depths, and times. During one year follow-up, the differences were also not in UCVAs, SEs, corneal epithelial healing, and dry eyes. But corneal erosions with filament keratitis were observed in 9 eyes in MMC group and 2 in control group, the difference was statistically significant(Pearson χ2=4.783, P=0.029). All the eyes were cured, and no recurrence occurred. The haze frequencies were 26%, 6%, 2%, 0 in MMC group at the 1 month, 3, 6, 12 months, and 44%, 25%, 10%, 2% in control group, respectively. The frequency differences were statistically significant at the 1 month(Pearson χ2=5.385, P=0.02)and 3(Pearson χ2=10.667, P= 0.001)months after surgery between the 2 groups. CONCLUSION:Intraoperative MMC can reduce the haze frequency and grade after PRK for myopia. The effect of MMC on preserved corneal epithelium may be one of the reasons to happen corneal erosions after PRK. It is important to avoid 0.2g/L MMC exposure to corneal epithelium outside treatment zone.

The biological measurement of eye is the application of many relevant inspection methods for structural parameters measurements. The purpose is to supply evidence for the diagnosis and treatment of the ocular diseases. Accurate biometrics has important clinical significance because the axial length measurement error caused by the deviation of intraocular lens power calculation is the main cause of postoperative refractive errors in cataract surgery. We summarized the current common clinical ocular biometry instruments in the paper.

Factors including intraocular lens power calculation error, corneal astigmatism, anterior chamber depth and lens position can lead to the change of refractive status, they also influence the overall postoperative visual quality. This article provides a comprehensive review of the main factors affecting postoperative visual function after uneventful refractive cataract surgery.

AIM: To investigate the clinical effects of phacoemulsification combined with post chamber intraocular lens(PC-IOL)implantations for primary acute angle-closure glaucoma. METHODS: The clinical data of 87 cases(92 eyes)with primary acute angle-closure glaucoma complicated with cataract of which intraocular pressure(IOP)over 45.0mmHg were collected. Phacoemulsification and PC-IOL implantations were performed for 60 eyes which IOP was controlled to 25.0mmHg below by general and topic medical management. IOP of 25 eyes was over 30.0mmHg and the depth of anterior chamber was well, puncture of anterior chamber was performed to decrease the IOP. Then 1 day to 2 days later, phacoemulsification, PC-IOL implantations and goniosynechialysis were performed. IOP of 7 eyes were still over 35.0mmHg with shallow of anterior chamber, phacoemulsification and PC-IOL implantation combined with goniosynechialysis and paracentesis anterior chamber were performed after vitreous aspiration and puncture of anterior chamber. IOP, visual acuity, surgery complications, central anterior chamber depth and gonioscopie findings before and post operation were recorded and analyzed.RESULTS: The IOP of all cases was controlled under 20.0mmHg during the follow-up 6 months to 2 years. 2% carteolol hydrochloride only need for two cases after 6 months. The visual acuity were improved for most cases, the visual acuity were better than 0.3 of 65 eyes post-operation while all were lower than 0.3 pre-operation. The depth of anterior chamber was deeper in all cases and the anterior chamber angle opening range was more than 180 degree in 87 eyes. More than 60 cases suffered the complications of anterior chamber inflammation and 16 cases anterior fibrinous exudates.CONCLUSION: Phacoemulsification is safe and effective in management of primary acute angle-closure glaucoma complicated with cataract. Goniosynechialysis, paracentesis anterior chamber and vitreous aspirations were benefit for the patient whose IOP was uncontrolled before surgery.

AIM: To observe the visual quality and capsular stability after implantation ofAcrysof Toric intraocular lens(IOL)in cataract patients with corneal astigmatism.METHODS: Totally 20 patients 23 eyes were implanted with the Acrysof Toric IOL between April 2010 and April 2012. All the patients were followed up for 12 months. The pre and post-operative uncorrected visual acuity(UCVA), preoperative corneal astigmatism, postoperative residual astigmatism, IOL axis, IOL decentration, IOL tilt and the capsule were detected and measured. RESULTS: After 12 months, UCVA was ≥0.6 in 23 eyes(100%); ≥0.8 in 17 eyes(74%). The mean preoperative corneal astigmatism was(2.31±0.70)D and the postoperative refractive cylinder was(0.43±0.28)D, which was statistically significance(P=0.00). The mean rotation of Toric IOL in 17 eyes(74%)was(4.98±0.25)°, of which 2 cases' rotation was >10°, the maximum was 12.9°. IOL decentration was in 11 eyes(48%)in which 7 eyes(30%)<0.5mm, 0.5mm≤3 eyes(13%)≤1mm, 1 eye(4%)=1.1mm. 20 eyes(87%)was not tilted while 3 eyes(13%)was tilted an less than 5°.CONCLUSION: Implantation of theAcrysof Toric IOL proves to be an effective, safe, and stable method of managing corneal astigmatism in cataract patients and provides patients with good visual quality. The Acrysof Toric IOL demonstrates excellent rotation and centration stability.

AIM: To observe the effect of scleral fixation posterior chamber intraocular lens implantation in the treatment of aphakia without capsule supporting after vitrectomy. METHODS: A retrospective analysis was conducted in 14 patients(14 eyes)who had scleral fixation posterior chamber intraocular lens implantation. Loops of the three-piece foldable intraocular lens were lead from incisions beneath the scleral flap at 2 and 8 o'clock part from the corneal limbus 1.5mm and it was fixed in the pre-made scleral tunnels. Finally, scleral flap were sutured so as to cover the punctures and loops. RESULTS: Fourteen patients were successfully implanted intraocular lens. Follow-up from 6 to 12 months, all patients received the improved visual acuity, stable IOL position, normal intraocular pressure and no other complications. CONCLUSION: Scleral fixation posterior chamber intraocular lens implantation is a safe, simple, effective method to treat aphakia without capsule supporting after vitrectomy and worthy further observation and practice.

AIM: To investigate the clinical effects of phacoemulsification with intraocular lens implantation and trabeculectomy in management of acute angle-closure glaucoma patients with cataract. METHODS: Twenty-six cases(26 eyes)with acute angle-closure glaucoma patients with senile cataract all underwent phacoemulsification with intraocular lens implantation and trabeculectomy, the visual acuity, intraocular pressure and anterior chamber depth variation and postoperative bleb morphology, postoperative complications were observed. RESULTS: Six months after operation, the visual acuity of 14 patients were ≥0.5 and 10 patients were from 0.12 to 0.4, which were improved significantly compared with preoperative, the differences were significantly(P<0.05); the mean intraocular pressure in postoperative 1 week, 3 months and 6 months were respectively 12.5±1.2mmHg, 14.3±1.5mmHg and 14.6±1.3mmHg respectively, which were lowered compared with the preoperative intraocular pressure, the differences were statistically significantly(P<0.05). The postoperative central anterior chamber depth was significantly deepened and functional diffuse blebs were formed. The main complications were corneal edema and anterior chamber inflammation. CONCLUSION: Phacoemulsification and intraocular lens implantation and trabeculectomy in management of acute angle-closure glaucoma with senile cataract is safe and effective with minor postoperative complications, which deserves clinical application and recommendation.

AIM: To summarize experience of posterior capsule opacification(PCO)model in rabbit eye.METHODS: Ten New Zealand white rabbits whose right eyes had ultrasonic emulsification operation were randomly selected. Emulsifying power, time and other parameters were collected. The follow-up time was 3 months. The complications and the formation of PCO were recorded and classified according to Odrich PCO classification system.RESULTS: One case of 10 rabbits occurred posterior capsular rupture, 1 case died 1 week after surgery. PCO occurred in the remaining 8 rabbits 1 month after operation and range enlarged 2 months later. Dense fibrosis layer and thick fibrosis layer occurred 3 months later.CONCLUSION: An ideal PCO animal model can be built in rabbit eye. We should pay attention to reduce the complications.

Femtosecond laser has the characteristic of high precision cutting, so it has great application potential in keratoplasty. It can replace the mechanical microkeratome used for penetrating keratoplasty, lamellar keratoplasty and endothelial keratoplasty according to the clinical need to produce different shapes of corneal graft and the graft bed. Femtosecond laser provides a new way for improving and optimizing the operation of various keratoplasty. In this paper, we reviewed the use of femtosecond Iaser in keratoplasty.

Anisometropia means a certain difference between two eyes in the degree of diopter and(or)the nature of diopter. The main associated reason is due to the eyes ocular axial length development imbalance. However, stereopsis is the highest visual function of human beings and higher animals, which is necessary for working people in daily life. The main reason of effecting on binocularity is retinal image blur and aniseikonia caused by uncorrected anisometropia. Different methods of anisometropia correction have different effects on stereo vision.

AIM: To evaluate the value of Nd: YAG laser iridotomy in glaucoma secondary to uveitis. METHODS: Totally 35 eyes of 35 patients with glaucoma secondary touveitis were treated by Nd: YAG laser iridotomy and retrospectively analyzed. The patients were followed up for 8 months to 39 months(mean 24.6 months).RESULTS: All eyes got laser holes in iris after the initial treatment. Three days after surgery, the intro-ocular pressure of all patients varied from 14 to 23mmHg with an average of 19.8±6.5mmHg. Compared with that before surgery(43.5±10.3mmHg), the difference in the intro-ocular pressure was significant(t=2.421, P<0.01). Compared with that before surgery, the anterior chamber of all the eyes were deepened after surgery. As shown in the UBM examined 2 weeks after surgery, the anterior chamber angle of 14 eyes were re-opened, which was significant in comparison with that before the surgery(χ2=12.78, P<0.01).CONCLUSION:Nd: YAG laser iridotomy is a safe and effective therapy in the control of glaucoma secondary to uveitis, which can avoid the permanent adherence of anterior chamber angle.

AIM: To investigate the surgical treatment of thecongenital superior oblique muscle paralysis. METHODS:The 68 cases of congenital superior oblique muscle paralysis were reviewed and analyzed. According to the degrees of the overaction of inferior oblique muscle and the extension of vertical deviation, we performed three different surgeries: inferior oblique muscle myotomy, inferior oblique muscle anterior transposition and inferior oblique muscle anterior transposition plus superior rectus muscle shortening or inferior rectus muscle recession. Based on the correct principles of horizontal strabismus, the patients were successfully treated if they also have horizontal strabismus problems. RESULTS:Totally 58 cases were cured(85.3%), 7 cases were improved(10.3%)and 3 cases had no effective improvement(4.4%). CONCLUSION: According to degree of the overaction of inferior oblique muscle, the extension of vertical and horizontal deviation, reasonable choice of surgical manners might increase cure rate of the congenital superior oblique muscle paralysis. The most patients obtained satisfactory results after one stage or multiple surgeries.

AIM: To investigate the effect of calcium dobesilate in treating early-to-mid diabetic cataract patients.METHODS: Totally 86 patients(126 eyes)with diabetic cataract of incipient stage andimmature stage, treated in our hospital from January 2010 to December 2011, were enrolled. All patients were randomly divided into treatment group(Group T)and control group(Group C). Group T was treated with routine medicine glucose-lowering therapy. Group C was further treated with calcium dobesilate capsule(0.5g, 3 times per day)for six months. Preoperative and postoperative data of fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin, blood calcium level, hs-CRP, IL-6 and TNF-α level were observed. Progress rate and remission rate of cataract in different stages were evaluated in the two groups postoperatively. RESULTS: There was no significant difference in FBS, postprandial blood glucose, HBALC and blood calcium level between the two groups neither at the experiment onset nor after 6 months. As to the data of hs-CR, IL-6、and TNF-αlevel, there was no obvious change from preoperation to postoperation in Group C, while in observation group, those data decreased obviously(P<0.05). And compared to Group C after treatment, there were statistical differences(P<0.05). As to the progress rate and remission rate of diabetic cataract in different stages, the data were 3.2%,21.0% in Group C and 29.7%, 7.8% in Group T treated with calcium dobesilate. The difference was of statistical significance(P<0.05). CONCLUSION: Calcium dobesilate can improve the clinical stage of diabetic cataract patients, probably because of its function of improving the patients' microinflammatory state.

MicroRNAs(miRNAs)are a class of single-stranded, small non-coding RNAs with 21 to 23 nucleotides, which can promote the degradation of mRNA or suppress their translation to regulate the expression of target gene through their incomplete combination with non-coding region at 3'terminal of target mRNAs. miRNAs are widely involved in the physiological and pathological processes in vivo and affect the cell development, the processes of diseases by changing their expression levels. In recent years, more researchers have found that miRNAs are identified widely and specifically in eyes including the lens, retina and cornea and their abnormal expressions may be associated with some eye diseases. This review summarizes the current information about expressions and functions of miRNAs in the lens, in order to seek for new targets for the clinical diagnosis and treatment of the lens opacity.

Micro-incision coaxial phacoemulsification is a new operation carried out in recent years. Compared with conventional incision phacoemulsification, micro-incision coaxial phacoemulsification has the advantages of smaller incision, less tissue damage, faster visual outcomes. The article summarizes the effects of micro-incision coaxial phacoemulsification on corneal incision change, astigmatism change, corneal endothelial injury, anterior chamber stability, and intraocular lens implantation by reference to the literature in recent years.

AIM: To observe the inhibitory effects of formation of choroidal neovascularization(CNV)in rats induced by laser by naringenin and complex of copper(II)with free ligand.METHODS: A total of 24 male Brown-Norway rats were selected including 18 rats as CNV model and 6 as normal comparison. A total of 18 model rats were divided randomly into control, naringenin and its complexes of copper group with 6 rats in each group. Naringenin and its complexes \〖20mg/(kg·d)\〗 were given once-daily through intraperitoneal(i.p.)injection after laser treatment for 30d in two experimental groups, respectively. Complex samples of retina, choroid membrane and sclera in each group were taken after 30d of the establishment of animal model. The sizes of CNV lesions were observed under fluorescence microscope. Samples of choroid in each group were taken. The expression of protein and mRNA of COX-2, VEGF, PI3K, MAPK, MMP-2 and MMP-9 were examined by Western blotting and RT-PCR method at 30d.RESULTS: The animals treated with naringenin and its complexes of copper showed significant decrease in their average CNV sizes, compared with that of the vehicle-treated animals(P<0.01), especially with naringenin's and its complexes of copper group. Compared with the vehicle-treated animals, the mRNA and protein expressions of VEGF, COX-2 and so on were significantly higher than that in the model control group(P<0.01). The expression of gene and protein in each experimental group both decreased when compared with model group. Except PI3K, MMP-9, the reduction degree in the naringenin and its complexes of copper group were larger than that in the single naringenin group(P<0.05). The differences of reduction degree were statistically significant. CONCLUSION: These results indicate that the biological activity of naringenin can be enhanced by the formation of its complexes, and that complexes of naringenin have stronger inhibition effect on the formation of CNV in rats induced by laser.

AIM: To evaluate the safety and efficacy of laser in situ keratomileusis(LASIK)by Intralase femtosecond laser or Amadeus II microkeratome. METHODS: Flap creation for LASIK was performed using IntraLase femtosecond laser(Intralase group)or Amadeus II microkeratome(Amadeus group)in 130 eyes with ametropia. Patients of Intralase group and Amadeus group were divided into three groups with different refractive degrees: <=-3.00D was A, '-3.00< B<-6.00D' was B, >=-6.00D was C. Data of visual activity, RMS values, spherical aberration, coma and trefoil of each group were recorded and compared at one month after surgery. RESULTS: One month after LASIK, the postoperative vision of 60 eyes(93.7%)were the same as or better than preoperative BCVA in Intralase group and the postoperative vision of 61 eyes(92.4%)were the same as or better than preoperative BSCVA in Amadeus group. There was no significant difference between two groups(P=0.421). There was no significant difference in RMS values, spherical aberration, coma and trefoil between the groups in refractive degrees.CONCLUSION: There is no significant difference in postoperative vision, RMS values, spherical aberration, coma and trefoil between Intralase femtosecond laser group and Amadeus Ⅱ microkeratome group. Both methods are effective and safe.