The Orthoptic Slit Lamp

To evaluate the changes in eye position and orbital content expansion following medial and lateral orbital wall decompression for thyroid-associated orbitopathy. The authors used a computer software program (syngo InSpace4D, syngo 3D, syngo fusion, and syngo Volume Evaluation; Siemens AG, Forchheim, Germany) to measure the orbital expansion gained by medial and lateral orbital wall decompression and the change in eye position between the digitized preoperative and postoperative orbital CT scans. Twenty patients (16 women and 4 men) with a mean age of 45 years (range, 18-64 years) were enrolled in this study. Of the 20 patients who underwent balanced decompression for thyroid-associated orbitopathy, 18 patients had bilateral medial and lateral orbital wall decompression, and 2 patients had unilateral medial and lateral decompression. The average orbital volume expansion was 3.21 mL (13.51%) of the preoperative orbital volume (2.1 mL [8.98%] gained by medial wall decompression and 1.03 mL [4.53%] by lateral wall decompression). Postoperatively, proptosis decreased by 2.53 mm on average (p < 0.0001). The eyes became closer to each other postoperatively in the horizontal plane by 2.6 mm on average (p < 0.0001). No change in the vertical eye position was detected postoperatively. A significant nasal shift in the eye position was noticed following balanced orbital decompression. Computerized assessment of preoperative and postoperative digitized orbital CT scans helps evaluate the orbital changes in response to different orbital decompression techniques and improve the surgical outcomes in thyroid-associated orbitopathy.

The neuronal circuitry that supports voluntary changes in eye position in tasks that require attention-driven oculo-motor control is well known. However, less is known about the neuronal basis for eye control during visual fixation. This, together with the fact that visual fixation is one of the most commonly used baseline conditions in resting-state functional magnetic resonance imaging (fMRI) studies, prompted us to conduct a study in which we employed resting-state fMRI and concurrent recordings of eye gaze to investigate the relationship between spontaneous changes in eye position during passive visual fixation and intrinsic brain activity. As a control experiment, we recorded fMRI brain activity related to cued voluntary vertical and horizontal changes in eye position in a block-related task-evoked fMRI experiment. Our results for the voluntarily performed changes in eye position elicited brain activity in the bilateral occipitotemporal cortex, supplementary motor cortex and frontal eye fields. In contrast, we show that slow fluctuations in eye position during passive visual fixation are linked to intrinsic brain activity, foremost in midline cortical brain regions located in the posteromedial parietal cortex and the medial prefrontal cortex, brain regions that act as core cortical hubs in the brain's default mode network. Our results suggest that subconscious and sustained changes in behavior are tied to intrinsic brain activity on a moment-by-moment basis.

Resident Perspectives 56–3

Background With the progression of cortical cataract, the lens thickness and anterior chamber will change and may have significant influences on the structure and function of the eyes.A special measurement is needed to observe the anterior and posterior surface of lens and detailed angle structure, and to quantify these changes. Objective This study was to compare the lens thickness and angle structures by CASIA SS-1000 anterior segment optical coherence tomography (AS-OCT) in early and intumescent stage of cataract and quantify the ocular anatomical differences. Methods An observational study was performed.Fifty cortical cataract patients (87 eyes) of the early stage or the intumescent stage in the ophthalmology outpatient clinic of Daping Hospital from October 16 to October 30, 2015 were continuously enrolled in this research.The eyes were assigned to the early stage group (28 patients 44 eyes) and the intumescent stage group (22 patients 43 eyes) according to the slit lamp examination results.The average age was (56.46±12.90) years in the early stage group and (70.95±8.81) years in the intumescent stage group.With the use of CASIA SS-1000 AS-OCT measurements, lens thickness, angle opening distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA), trabecular-iris angle (TIA) and anterior chamber depth (ACD) were measured and compared between the two groups. Results Lens thickness was (4.438±0.487)mm in the early stage group and (5.094±0.451)mm in the intumescent stage group, with an average increase of (0.656±0.101)mm, showing a significant difference between the two groups (t=-6.513, P=0.000). ACD in the early stage group was (2.966±0.326)mm and (2.534±0.376)mm in the intumescent stage group, with an average decrease of (0.432±0.075)mm, showing a significant difference between the two groups (t=5.730, P=0.000). AOD500, AOD750, ARA500, ARA750, TISA500, TISA750, TIA500 and TIA750 were all lower in the intumescent stage group than those in the early stage group, with significant differences between the two groups (all at P=0.000). Conclusions The lens was thicker, ACD was shallower and anterior angle was narrower in the intumescent stage than those in the early stage of cortical cataract patients.SS-1000 AS-OCT is efficiency with high definition, and is supposed to have promising prospect of clinical application. Key words: Anterior segment optical coherence tomography; Cortical cataract; Lens thickness; Anterior chamber

Vision and audition represent the outside world in spatial synergy that is crucial for guiding natural activities. Input conveying eye-in-head position is needed to maintain spatial congruence because the eyes move in the head while the ears remain head-fixed. Recently, we reported that the human perception of auditory space shifts with changes in eye position. In this study, we examined whether this phenomenon is 1) dependent on a visual fixation reference, 2) selective for frequency bands (high-pass and low-pass noise) related to specific auditory spatial channels, 3) matched by a shift in the perceived straight-ahead (PSA), and 4) accompanied by a spatial shift for visual and/or bimodal (visual and auditory) targets. Subjects were tested in a dark echo-attenuated chamber with their heads fixed facing a cylindrical screen, behind which a mobile speaker/LED presented targets across the frontal field. Subjects fixated alternating reference spots (0, +/-20 degrees ) horizontally or vertically while either localizing targets or indicating PSA using a laser pointer. Results showed that the spatial shift induced by ocular eccentricity is 1) preserved for auditory targets without a visual fixation reference, 2) generalized for all frequency bands, and thus all auditory spatial channels, 3) paralleled by a shift in PSA, and 4) restricted to auditory space. Findings are consistent with a set-point control strategy by which eye position governs multimodal spatial alignment. The phenomenon is robust for auditory space and egocentric perception, and highlights the importance of controlling for eye position in the examination of spatial perception and behavior.

This study proposes a visualization and analysis method for eye blinking pattern using high-frame-rate videos. The high-frame-rate video clips for visualization are taken using a camera without additional equipment. The partial video clips of eye blinking except for eyelid flutters and microsleeps are extracted from the entire video clip. The changes in shapes and positions of the upper eyelid during the eye blinking sequences are evaluated, and each eye blinking is visualized as a single image. The various parameters regarding eye blinking are calculated to analyze blinking patterns. The single eye blinking sequence is divided into phases to analyze and classify eye blinking patterns in more detail. In this experiment conducted on 80 volunteers, the proposed method was able to quantitatively analyze eyelid movements, and various parameters related to eye blinking were calculated. Additionally, different types of eye blinking patterns were visualized as graph images, and incomplete eye blinking and consecutive eye blinking were defined and detected. The proposed method can overcome the spatial and situational limitations of conventional bio-signal analysis methods, as it allows non-contact measurement in ordinary environments. In addition, since quantitative eye blink data obtained from high-frame-rate video contain more information than data obtained from bio-signals, it is expected that analysis methods using videos can be easily applied to a wider range of fields.

Objective To investigate the most practical examination method for diagnosis and treatment of retinal breaks and evaluate the value of early diagnosis and treatment for retinal breaks. Methods A total of 192 patients (216 eyes) diagnosed as posterior vitreous detachment (PVD) by ophthalmic A/B ultrasound underwent indirect ophthalmoscope, 90D mirror under the slit lamp, and three-mirror lens fundus examinations after mydriasis. Patients with retinal breaks uncombined with peripheral retinal detachment or accompanied by local superficial detachment were treated by 532 nm laser photocoagulation around the breaks; while patients with retinal breaks accompanied by peripheral retinal detachment were treated by surgery. Results In 216 eyes of PVD patients, 28 eyes of retinal tears were found by indirect ophthalmoscope, accounting for 12.96%; 26 eyes of retinal tears were found by the 90D under the slit lamp, accounting for 12.04%; 31 eyes of retinal tears were found by three-mirror lens, accounting for 14.35%, and there was no significant difference among the three groups inexamination results (P>0.05). Twenty-two eyes with retinal tears uncombined with peripheral retinal detachment underwent preventive photocoagulation treatmen for once; 6 eyes with retinal tears accompanied by local superficial detachment underwent retinal photocoagulation for 2 times; 3 eyes with retinal breaks accompanied by large range retinal detachment underwent scleral cryotherapy combined with scleral buckling. Followed up for 6 months, all the patients with retinal breaks had good therapeutic effect, without new retinal detachment. Conclusions Early detection and early diagnosis for retinal breaks are very important. The timely and proper treatment of retinal photocoagulation is the key to prevent the occurrence of retinal detachment; three-mirror lens is still very useful to detect retinal breaks. Primary level doctors should pay attention to the the importance and application of these methods. Key words: Retinal breaks; Posterior vitreous detachment; Photocoagulation; Early diagnosis; Treatment

We report a 17-year-old male patient with tubulointerstitial nephritis and uveitis (TINU) associated with hyperthyroidism. He presented with a 2-month history of fatigue, loss of appetite, low-grade fever, and a 12-kg weight loss when he was admitted to our hospital. He had iritis, which was complicated by fibrin in the anterior chamber, diagnosed by slit-lamp examination. On laboratory examinations, deteriorated renal function (blood urea nitrogen level was 25.9 mg/dl and creatinine level was 2.82 mg/dl) and elevated urinary levels of N-acetyl-beta-D-glucosaminidase (33.1 U/l) and beta2-microglobulin (78,600 microg/l) were observed. Serum thyroid-stimulating hormone (TSH) was undetectable, at less than 0.01 microIU/ml, and free triiodothyronine and free thyroxine were elevated, up to 5.23 pg/ml and 2.85 ng/dl, respectively. The titers of antithyroglobulin and antithyroid microsomal and TSH-receptor antibodies were not elevated. Abdominal and thyroidal ultrasonography showed evident bilateral enlargement of the kidneys and diffuse enlargement of the thyroid gland. Iodine-123 scintigraphy showed low uptake in the thyroid gland. The biopsied renal specimen showed mild edema and severe diffuse infiltration of mononuclear cells and few eosinophils in the interstitium, without any glomerular or vascular abnormalities. Based on the clinical features and pathological findings, a diagnosis of TINU syndrome with associated hyperthyroidism was made. Treatment was started with 30 mg/day of prednisolone. The iritis disappeared, and the patient's clinical status improved remarkably. This case suggests the possibility of thyroid dysfunction in some patients with TINU syndrome, and we believe thyroid function should be measured in all TINU patients. Moreover, histopathological diagnosis of the thyroid glands before treatment is necessary for TINU patients with thyroid dysfunction.

Objective To investigate the clinical manifestations and gene mutation of a pedigree with retinal lattice degeneration and granular corneal dystrophy (GCD) type 2. Methods Ten members in 3 generations of a pedigree with retinal lattice degeneration and GCD2 were included in the study, including 6 patients (3 males and 3 females) and 4 healthy family members. All members underwent visual acuity, slit lamp microscope, three-mirror lens, fundus color photography, optical coherence tomography, and corneal endothelial cells counting. Genomic DNA was extracted from peripheral venous blood (2 ml) from all the subjects and their spouses, who had no related inherited diseases. The next generation sequencing method was used to detect the mutation sites of transforming growth factor β (TGFBI), and all results underwent Sanger verification. Results Among the 12 eyes of 6 patients, the visual acuity was FC/20 cm-1.0. In the superficial central corneal stroma, snowflake-like deposits were observed in three cases (6 eyes), and a small amount of granular deposits were observed in three cases (6 eyes). Corneal endothelial cell counts were normal. Retinal lattice degeneration were observed in 3 cases, 6 eyes (including 3 cases of rhegmatogenous retinal detachment in 4 eyes); retinal thinning without obvious lattice degeneration in 4 eyes of 2 patients. Nystagmus in 1 patient and fundus examination showed no significant abnormalities. DNA sequencing results showed that the proband and 4 patients had missense mutation of TGFBI gene in exon 4 c.371G> A, the mutation site corresponding to the amino acid change encoded by TGFBI gene No. 124 Amino acids, from arginine to histidine (p.R124H). Patients with this mutation have varying degrees of clinical phenotype. Conclusions The mutation of c.701G> A (p.R124H) in TGFBI gene is the causative gene of GCD in this pedigree. The patients with this mutation have different clinical phenotypes. Key words: Corneal dystrophies, hereditary; Retinal degeneration; Mutation; Gene, TGFBI

Background Acute bacterial conjunctivitis is a common ocular infectious disease.It can be cured by topical administration of antibiotics,but these antibiotic eye drops often was used several times per day at present.Azithromycin is thought to offer less using times and shorten the duration of treatment.Objective The purpose of this clinical trail was to evaluate the clinical efficacy and safety of topical administration of 1％azithromycin eye drops for the treatment of acute bacterial conjunctivitis.Methods This study was approved by Ethic Committee of Beijing Tongren Hospital and followed the Declaration of Helsinki.Written informed consent was obtained prior to entering into this trial.A randomized,double-blind and placebo-controlled study was designed.One hundred and eighty patients with acute bacterial conjunctivitis were enrolled in Affiliated Hospital of Qingdao Medical College and Qingdao Municipal Hospital from may,2011 to September,2011.Azithromycin eye drops at the concentration of 1％ was topically administered on 89 eyes of 89 patients twice per day initial and once per day later for 9 days in the trial group,and placebo eye drops was used on 91 eyes of 91 patients in the same way in the control group.The inflammation response of all eyes was examined and scored under the slit lamp microscope,and germiculture was carried out.All adverse responses were assessed during the follow-up.Clinical efficacy was evaluated with the clinical cure rate as the primary indicator and bacterial clearance rate as the secondary indicator.The safety of drug was determined,including the ocular irritation sign,lens transparency and intraocular pressure.The differences of the examining results mentioned-above were compared with Chi Square test.Results One hundred and eighty patients completed the clinical trials according to the program without lost and exclusion cases.The clinical cure rate in 89 subjects in the trial group and 91 control individuals was 76.40％ (68/89) and 43.96％ (40/91),respectively,with significant difference between them (x2=19.73,P＜0.01).The bacterial eradication rate was 85.71％ (24/28) in the trial group and 60.53％ (23/38) in the control group,showing a significant difference (x2 =4.99,P＜0.05).Both 1％ azithromycin eye drops and placebo were well-tolerated with a low incidence of adverse events.Conclusions One percent azithromycin eye drops is effective and safe for the treatment of acute bacterial conjunctivitis with less adverse reaction. Key words: Azithromycin; Eye drops; Bacterial conjunctivitis; Randomized, double-blind and placebo-controlled clinical trail

Objective To investigate reproducibility of optical coherence tomography (OCT) for measuring the lower lid tear meniscus height (TMH) and to evaluate its clinical application in the diagnosis of lacrimal duct obstruction diseases.Methods The tear meniscus height of 67 patients with lacrimal duct obstruction diseases by OCT and slit lamp marker lens in Wuhan Aige ophthalmic hospital from November 2012 to September 2013.Then the spearman test and the paired t test were used for comparing TMH values between subject eyes and fellow eye in two different devices.Results There was positive correlation between OCT and slit lamp lens in measuring TMH in both subject eyes (r =0.886,P ＜0.001) and fellow eye (r =0.517,P ＜0.001).There was significant differences between subject eyes and fellow eye in OCT (t =14.510,P ＜0.001) and slit lamp marker lens (t =14.639,P＜0.001).Conclusions OCT is a valuable clinical tool to objectively grade epiphora,and can be used as a useful instrument for the clinical diagnostic value in lacrimal duct obstruction diseases. Key words: Lacrimal duct obstruction diseases; Optical coherence tomography; Tear meniscus

From 03 to 19 July 2023, field research was conducted in the city of Komsomolsk-on-Amur and in the villages of Belgo and Verkhnyaya Ekon of the Komsomolsky District in the Khabarovsk Region. Thirteen informants were interviewed from among the Amur Nanai people who suffered from the global flood of 2013, who do not break ties with their native culture and try to preserve it in samples and techniques of arts and crafts, as well as musical folklore. The main methods of ethnographic material collection included direct observation, interview, conversation. The information was recorded in a field diary, on a digital recorder, on a camera. Historical references, statistical data, festival scenarios were collected in state and cultural institutions. When analysing materials, the emphasis was placed on studying the process of change in the Amur Nanai people's livelihood system, their infrastructure and technologies after the large-scale flood of 2013, based on the concept of disaster anthropology. The process of the people's adaptation to natural and social transformations as consequences of the natural disaster that resulted not only in economic, social, and ethno-cultural damage, but also in positive changes in the system of livelihood and infrastructure, was also studied. The ability of the Nanai ethnic group to overcome negative natural factors, the actions of central and local authorities, ethnic leaders, public organizations, the Association of Indigenous Peoples of the North to eliminate the consequences of adverse natural impacts, the construction of new homes, the renovation of old ones, and the creation of museum exhibitions were studied. The ethnocultural potential of the indigenous peoples of the Amur was most effectively realized not only at the time of a natural disaster, but also during its liquidation and restoration of the usual way of life, crafts, cultural traditions, everyday life and materiality.

Objective To quantitatively evaluate the centration and fitting characteristics of the overnight orthokeratology lens using ultra-long scan depth spectral domain optical coherence tomography (UL-OCT).Methods This was a prospective cohort study.Thirty-three subjects (33 eyes,23 women and 10 men; mean age:26.0±3.2 years,range:22-37 years) were enrolled in the study to wear the reverse-geometry orthokeratology lenses in both eyes for one night.Images with the lens on the eye were acquired by a custom-built UL-OCT before and after one night of orthokeratology lens wear.Custom software was used to quantify lens decentration.At the same time,lens fitting under fluorescein staining patterns was evaluated by a slit-lamp microscope imaging system.A Kappa test was used.Results The mean decentration was 0.62±0.31 mm based on the UL-OCT evaluation method.Results showed that 42％(14/33) had optimal fitting,42％(14/33) had moderate decentration which was clinically acceptable,and 15％(5/33) had severe decentration.The fluorescein patterns showed 58％(19/33) had optimal fitting,33％(11/33) had moderate decentration,and 9％(3/33) had severe decentration.A Kappa test result for the consistency of the two methods was 0.647.The interactions between the orthokeratology lens and ocular surface were observed through the OCT images.Abnormal deformation of the corneal epithelium occurred when the fitting was not optimal.Conclusion OCT could quantify the orthokeratology lens under the condition lens on eye.The result of OCT evaluation matched with the traditional fluorescein staining by moderate consistency. Key words: Orthokeratology ; Lens fitting; Tomography, optical coherence

Objective To compare the effect of different corneal incisions on corneal refraction after phacoemulsification and foldable intraocular lens implantation.Methods 42 eyes of 35 patients with cataract were divided into two groups randomly:group A,received temporal clear corneal incision(18 eyes of 18 cases),group B,received superior(11:00) clear corneal incision (24 eyes of 17 cases).Patients were examined preoperatively and 1 day,1 week,1 month and 3 months postoperatively by using slit-lamp microscope and corneal topography,and visual acuity also was examined.Results The visual acuity in group A was better than that in group B at 1 day postoperatively.But at 1 week,1 month,2 months postoperatively,the difference of visual acuity between two groups was not statistically significant.At 1 day preoperatively and at 1 day,1 week,1 month,2 months postoperatively,the mean astigmatism were (0.543 ± 0.264) D,(0.821 ±0.317)D,(0.732±0.320)D,(0.690±0.283)D,(0.657 ±0.233)D and (0.51 ±0.27)D in group A respectively.And at the same time points,the mean astigmatism in group B were (0.568 ± 0.243)D,(1.092 ± 0.357) D,(0.987 ± 0.257) D,(0.934 ± 0.312) D and (0.866 ± 0.371) D respectively.The mean astigmatism in group A was lower than in group B,and the difference was statistically significant (P ＜0.05).The superior incision group showed against-the-rule astigmatic changes,whereas with-the-rule astigmatism was seen in the temporal incision group.Conclusion The visual acuity in the temporal incision group was better than that in superior incision group at 1 day postoperatively.And the mean astigmatism changes in group A was lower than in group B. Key words: Phacoemulsification, cataract; Incision, corneal; Refraction, corneal

A simple pupil-independent method for recording eye movements in rodents using video