Journal of Ophthalmology

Purpose. This study aims to explore the risk factors of asthenopia in the myopic population. Methods. In this cross-sectional study, myopia patients were inquired about their eye habits and were requested to complete an asthenopia questionnaire and ocular examinations. Age, gender, occupation, anisometropia, eye care education, weekly outdoor activity time, duration of continuous near work, daily screen time, dry eye, near phoria, and binocular accommodative facility were calculated using the Student’s test-test, Mann Whitney U test, and Pearson’s chi-square test. Spherical equivalents and astigmatism were calculated using a generalized estimating equation. Binary logistic regression was performed on factors with a -value <0.05. Results. Of the 65 myopic patients, 57% showed asthenopia, 52% experienced blurry vision, 37% felt their eyes hurt or sore, and 28% felt tired when performing close work. Asthenopia patients were older than patients without asthenopia (Z = −2.887, ). Daily screen time, continuous near-work time, eye care education, and dry eye were positively correlated with asthenopia (χ² = 8.64, ; χ2 = 13.873, , χ2 = 9.643, ; χ2 = 7.035, ). After eliminating collinearity, eye care education and continuous near-work time were identified as independent risk factors of asthenopia, with odds ratios of 0.115 and 4.227, respectively. Conclusion. This study shows that receiving eye care education from schools and hospitals and limiting near-work duration to less than 45 minutes per session could reduce the occurrence of asthenopia in myopic patients. This approach may be a more economical and convenient way for myopic people to relieve asthenopia.

Objective. To assess the clinical efficacy of cyclosporine (0.05%) combined with diclofenac sodium eye drops (0.1%) in the treatment of dry eye disease. Methods. A prospective analysis was performed on clinical information of 128 patients diagnosed with dry eye at the ophthalmic clinic of the General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army from August 2020 to August 2021. Specifically, patients were randomly divided into a control group and a study group. In addition to conventional treatment, patients in the control group were treated with cyclosporine (0.05%) eye drops; while in the study group, patients received cyclosporine (0.05%) combined with diclofenac sodium eye drops (0.1%). Subsequently, comparisons and analysis were performed before and after treatment between the two groups in the clinical symptom questionnaire score of dry eye disease, the corneal fluorescein staining (CFS) score, determination of tear film break-up time (BUT), Schirmer I test (SIT) score, and curative effect. Results. After treatment, the clinical symptom scores and CFS scores were decreased while the BUT and SIT scores were increased in both groups; besides, compared with the control group, the clinical symptom scores and CFS scores were much lower while the BUT and SIT scores were higher in the study group. Moreover, the overall response rate in the study group (96.9%) was much better than that in the control group (79.7%); and the differences between the two groups were statistically significant ( < 0.05). Conclusion. The combination of cyclosporine (0.05%) and diclofenac sodium eye drops (0.1%) based on conventional treatment can be applied to the clinical treatment of dry eye disease due to its good clinical effects on relieving dry eye symptoms.

Background. To analyze the effects of the implementation of emergency surgical patterns in patients with rhegmatogenous retinal detachment (RRD) and provide evidence for promoting emergency surgical patterns for RRD. Methods. We reviewed the electronic medical records of 346 patients (348 eyes) who underwent surgical repair of RRD at the Zhongshan Ophthalmic Center in Southern China. A total of 140 patients (140 eyes) in the routine inpatient surgery group were collected at the fundus disease department between January 2019 and December 2019, and 206 patients (208 eyes) in the emergency surgery group were collected at the ophthalmic emergency department between January 2021 and December 2021. Demographics, best-corrected visual acuity (BCVA) expressed as the logarithm of the minimum angle of resolution (logMAR), the status of the macula before surgery, time to presentation, treatment interval, and postoperative BCVA measured at least three months follow-up were compared. Results. The preoperative BCVA (logMAR) of the emergency surgery group and the inpatient surgery group were 1.0 (0.4–1.7) and 1.4 (0.7–1.7), respectively, with significant differences between groups (). However, patients had a shorter time to presentation (7 days vs. 21 days, ), shorter treatment interval (2 days vs. 12 days, ), and significantly better postoperative BCVA (logMAR 0.5 vs. logMAR 1.0, ) in the emergency surgery group than in the inpatient surgery group. There was no significant difference in primary anatomical success between the two groups (). The median follow-up for the emergency surgery group and the inpatient surgery group were 6.08 months and 6.2 months, respectively, with no significant differences (). Conclusions. Patients who underwent emergency surgical patterns of RRD had better visual outcomes after surgery than patients with routine inpatient surgery, which might be attributed to a shorter duration, shorter treatment interval, and the preoperative status of the macula in the emergency surgery pattern. Emergency surgical patterns for RRD should be considered to achieve better surgical outcomes in suitable patients.

Purpose. Since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey (OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation. Methods. We used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman’s correlation coefficient and reliability is measured using Cronbach’s alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary. Results. We reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS. Conclusion. Through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly.

Purpose. To evaluate the influence of spectacle lenses with highly aspherical lenslets (HAL) on binocular vision and accommodation in myopic children with intermittent exotropia (IXT) and compare the changes after wearing HAL in binocular vision and accommodation in myopic children with or without IXT. Method. Forty myopic subjects aged 8–12 years were recruited: 20 with IXT and 20 visually normal children. Stereoacuity, phoria, accommodative facility, fusional vergence, vergence facility, near point of convergence, amplitude of accommodation, and accommodative response (AR) were measured by wearing HAL or single vision spectacle lenses (SVL) in a random order after adapting for 20 minutes. Accommodative microfluctuation (AMF) was defined as the standard deviation of AR. Changes in binocular vision and accommodation after wearing HAL were compared between the two groups. Results. No significant differences were found in binocular vision after wearing HAL versus SVL in either group (all ). A greater AMF was found after wearing HAL than after wearing SVL in both groups (0.04 D, 95% confidence interval (CI), 0.03 to 0.05 D, for the IXT group; 0.05 D, 95% CI, 0.03 to 0.07 D, for the visually normal group); however, the other accommodation parameters did not change significantly (all ). There were no differences in the changes after wearing HAL in any parameter between the two groups (all ). Conclusion. HAL did not significantly change the binocular vision and accommodation for myopic children with or without IXT except for AMF in the short term.

Purpose. To evaluate clinical outcome during 24 months follow-up between small incision lenticule extraction combined with cross-linking (SMILE Xtra) and small incision lenticule extraction (SMILE) only. Setting. Ophthalmology Division of San Rossore Medical Center, Pisa, Italy. Design. Retrospective comparative case series. Methods. The study comprised 70 eyes (35 patients); 40 eyes were corrected using SMILE and 30 eyes were corrected using SMILE Xtra using a low energy protocol. The outcomes were compared at 1, 6, 12, and 24 months postoperatively. Results. The mean spherical equivalent (SEQ) reduced from −7.18 ± 1.21 D to −0.01 ± 0.09 D in the SMILE group and from −6.20 ± 2.99 D to −0.04 ± 0.1 D postoperatively in SMILE Xtra (). At 24 months the mean SEQs were −0.01 ± 0.24 D for SMILE and −0.15 ± 0.33 D for SMILE Xtra (). At 1, 6, 12, and 24 months, there were no statistically significant differences between the SMILE and SMILE Xtra groups in logarithm of the minimum angle of resolution (logMAR) uncorrected distance visual acuity (UDVA), safety, and efficacy index (). The mean average keratometry (K-avg) at 1, 6, 12, and 24 months after surgery did not shown any statistically significant difference between SMILE and SMILE Xtra group (). The mean maximum keratometry (K-max) readings at 1, 6, 12, and 24 months were not statistically significant between SMILE and SMILE Xtra group (). The preoperative mean thinnest point pachymetry (TTP) was 543.90 ± 22.85 μm in the SMILE group and 523.40 ± 37.01 μm in the SMILE Xtra group (). At 1, 6, 12, and 24 months the mean TTP was not statistically significant between the SMILE and SMILE Xtra groups (). At 24 months, the TTP was 408.29 ± 38.75 μm for the SMILE group and 402.22 ± 37 μm for the SMILE Xtra group (). In the preoperative period, the mean maximum posterior elevation (MPE) was 8.63 ± 4.35 μm for SMILE and 8.13 ± 2.54 μm for SMILE Xtra (). After the surgical procedure, both groups showed a statistically significant increase of the MPE (). At 24 months, the MPE was 11.00 ± 4.72 μm for SMILE Xtra and 10.14 ± 3.85 μm for the SMILE group (). In the preoperative period, the means of the root mean square (RMS) of high-order aberration (HOA) were 0.08 ± 0.03 μm for the SMILE group and 0.08 ± 0.03 μm for the SMILE Xtra group (). At 24 months, the RMS of HOA was 0.13 ± 0.07 μm for the SMILE group and 0.14 ± 0.07 μm for the SMILE Xtra group (). In the preoperative period, the root mean square of coma aberration (RMS-Coma) aberration was 0.06 ± 0.09 μm for the SMILE group and 0.04 ± 0.03 μm for the SMILE Xtra group (). At 24 months, the coma aberration of SMILE group was 0.12 ± 0.21 μm and 0.16 ± 0.25 μm for SMILE Xtra group (). Conclusions. SMILE Xtra procedure is a safe and simple procedure that can be offered to patients with high corneal ectasia risk because there were no differences in the indices of ectasia compared to the group treated only with SMILE which has a low corneal ectatic risk.