Coexistence of Interacting Charge Density Waves in a Layered Semiconductor.

Coexisting orders are key features of strongly correlated materials and underlie many intriguing phenomena from unconventional superconductivity to topological orders. Here, we report the coexistence of two interacting charge-density-wave (CDW) orders in EuTe_{4}, a layered crystal that has drawn considerable attention owing to its anomalous thermal hysteresis and a semiconducting CDW state despite the absence of perfect Fermi surface nesting. By accessing unoccupied conduction bands with time- and angle-resolved photoemission measurements, we find that monolayers and bilayers of Te in the unit cell host different CDWs that are associated with distinct energy gaps. The two gaps display dichotomous evolutions following photoexcitation, where the larger bilayer CDW gap exhibits less renormalization and faster recovery. Surprisingly, the CDW in the Te monolayer displays an additional momentum-dependent gap renormalization that cannot be captured by density-functional theory calculations. This phenomenon is attributed to interlayer interactions between the two CDW orders, which account for the semiconducting nature of the equilibrium state. Our findings not only offer microscopic insights into the correlated ground state of EuTe_{4} but also provide a general nonequilibrium approach to understand coexisting, layer-dependent orders in a complex system.

[Research progress in the diagnosis and treatment of childhood glaucoma].

Childhood glaucoma is a disease that seriously endangers children's visual health. It will accompany the patients throughout their lives and bring a heavy burden to families and society. Most childhood blindness caused by glaucoma is preventable or treatable. Relevant research has made progress in recent years. Based on the new consensus reached by the World Glaucoma Association and the latest medical evidence at home and abroad, this article summarizes the definition, classification, diagnosis, molecular genetics, pathogenesis and comprehensive treatments including drugs and surgery of childhood glaucoma, with a focus on the application of various surgical methods, so as to provide reference for clinical and scientific research and improve the clinical diagnosis and treatment of childhood glaucoma.

[Comparison of surgical outcomes between Kahook Dual Blade goniotomy and Trabectome surgery in patients with open-angle glaucoma].

Objective: To compare the medium-term therapeutic effects of Kahook Dual Blade (KDB) goniotomy and Trabectome surgery in the treatment of patients with primary open-angle glaucoma (POAG). Methods: This study was a non-randomized prospective interventional controlled clinical study. POAG patients who underwent KDB goniotomy or Trabectome surgery at Beijing Tongren Hospital from May 2017 to April 2022 were enrolled. The definition of successful surgery was postoperative average intraocular pressure (IOP)≤21 mmHg (1 mmHg=0.133 kPa) and IOP decrease≥20%. Follow-up visits were conducted on the 1st day, 1st week, 1st, 3rd and 6th month after surgery. The IOP value, the number of IOP-lowering medications, the proportion of surgical success (average IOP≤21 mmHg at 6 months), and complications were evaluated. Statistical methods included independent sample t-test, Mann-Whitney rank sum test, χ2 test, repeated measures two-factor analysis of variance, Bonferroni, Friedman M test, Wilcoxon, and Log-rank. The Kaplan-Meier method was used to calculate the cumulative success rate of each group. Results: Seventeen male patients (17 eyes) and 10 female patients (10 eyes) were included. The mean age was (39.9±17.7) years old. There were 11 patients in the KDB group and 16 patients in the Trabectome group. There was no significant difference in clinical baseline conditions between the two groups (P>0.05). The IOPs in the KDB and Trabectome groups at postoperative 1 week [(16.6±6.3) and (16.4±4.1) mmHg) and 6 months [(17.8±5.3) and (19.9±4.4) mmHg) were lower than those before surgery [(25.1±9.3) and (27.4±9.1) mmHg) (all P<0.05). There was no significant difference in the overall IOP between groups (P>0.05). The IOP reduction rates in the KDB and Trabectome groups were 23.4% and 19.0%, with no significant difference (P=0.674). The numbers of IOP-lowering medications used in the KDB and Trabectome groups at 3 months [2.0 (1.0, 4.0) and 2.0 (1.0, 2.3)] and 6 months [2.0 (0.0, 4.0) and 2.0 (1.0, 3.0)] after surgery were not significantly different from those before surgery [4.0 (2.0, 4.0) and 3.0 (2.0, 4.0)] (both P>0.05). There was no statistical significance in the overall number of IOP-lowering medications used between the two groups (P>0.05). There was also no statistically significant difference in the proportion of patients with an IOP decrease of≥20% and the proportion of patients whose mean postoperative IOP was≤21 mmHg (all P>0.05). The proportions of IOP≤21 mmHg in the KDB group and the Trabectome group at 6 months after surgery were 81.8% and 68.8% (P>0.05). Serious intraoperative or postoperative complications occurred in neither group. Conclusions: Both KDB trabeculotomy and Trabectome surgery can effectively reduce IOP and have a good safety profile in treating POAG, with the same number of IOP-lowering medications.

[Interpretation of 14th Five-Year Plan for National Eye Health (2021-2025)].

Eye health is an essential component of physical and mental health, concerning the whole life cycle and all age groups, which is a major public health and social issue related to people's livelihood. With 2020 being the final year of the 13th Five-Year National Eye Health Plan(2016-2020) and the VISION 2020 initiative, under the support of the Bureau of Medical Administration under the National Health Commission, the White Paper on Eye Health in China was prepared, aiming to comprehensively introduce the achievements of eye health in China, as well as the work experience and challenges in the development of eye health. Under the guidance of the "Healthy China 2030" and with the aim to further promote the high-quality development of eye health during the 14th Five-Year Plan period and further improve people's eye health, the National Health Commission formulated the 14th Five-Year National Eye Health Plan (2021-2025). This paper focuses on the interpretation of the core content of the Plan, aiming to better implement the plan and achieve the goals.

[Distribution and reference intervals of daytime intraocular pressure in the eye health screening population of Handan].

Objective: To describe the distribution and establish reference intervals (RI) of daytime intraocular pressure (IOP) in the eye health screening population of Handan. Methods: This cross-sectional study included subjects who participated in eye health screening at the Physical Examination Center of Handan First Hospital from May 2021 to June 2022. A complete general and ocular examination was performed, including measurements of visual acuity and IOP (using Goldmann tonometry), slit lamp microscopy, fundus photography, and anterior and posterior segment optical coherence tomography. Subjects with factors that could cause significant changes in IOP or affect the accuracy of IOP measurement, or with an inability to measure IOP were excluded. Simple random sampling was used to select participants, who were grouped by gender and age (18 to <30, 30 to <40, 40 to <50, 50 to <60, 60 to <70, and ≥70 years). Central corneal thickness and IOP at 8 to 11 o'clock in one eye of each participant were recorded. The independent sample t test and ANOVA were used for statistical analysis, and the RI of IOP values was calculated by x¯±1.96s. Results: A total of 9 310 subjects had their IOP measured, and 3 491 participants (3 491 eyes) were randomly selected from 7 886 healthy subjects. The age of the participants was (47.74±14.47) years old, ranging from 18 to 90 years old. There were 1 694 males and 1 797 females. The central corneal thickness of all participants was (525.56±49.39) µm. The daytime IOP of all participants was (15.40±2.54) mmHg (1 mmHg=0.133 kPa), and the RI was 10.42 to 20.39 mmHg. The IOP was (15.49±2.58) mmHg for males and (15.29±2.49) mmHg for females, and the gender difference was statistically significant (P<0.05). The RI of daytime IOP values was 10.43 to 20.54 mmHg for males and 10.41 to 20.18 mmHg for females. There were significant differences in daytime IOP [(15.13±2.58), (15.33±2.53), (15.49±2.50), (15.53±2.55), (15.39±2.62), and (15.28±2.52) mmHg] among 6 age groups (P<0.05). Conclusions: The distribution of daytime IOP in different gender and age groups in the eye health screening population of Handan and the RIs derived from the distribution were roughly the same as the international normal IOP RI (10 to 21 mmHg). It is recommended to refer to the RI of daytime IOP values of different genders and ages for clinical decision.

[Safety and efficacy of toric intraocular lens implantation for more than 5 years].

Objective: To evaluate the clinical safety and efficacy of toric intraocular lens (IOL) implantation for more than 5 years. Methods: This study was a prospective cohort study in which subjects were continuously observed over a two-year period (May 2014 to May 2016) in nine hospitals. The study randomly assigned subjects to two groups using a central dynamic randomization system: the study group, which received Proming® IQ toric IOL implants, and the control group, which received AcrySof® IQ toric IOL implants. The subjects completed a one-year follow-up, during which various measures were taken and evaluated, including visual acuity, IOL rotation, postoperative complications, intraocular pressure, and subjective evaluation (preoperatively and at 1 day, 6 months, 1 year, and 5 years post-surgery). The main statistical analysis methods include the Mann-Whitney U test, independent sample t-test, Wilcoxon signed rank test, paired sample t-test, chi-square test, and Fisher's exact test. Results: A total of 45 eyes (26 in the study group and 19 in the control group) completed the five-year continuous observation period. The mean age of the subjects was (72.07±10.67) years and the mean interval from surgery to the last visit was (5.39±0.47) years. After five years, there were no significant differences in uncorrected distance visual acuity (0.20±0.26 vs. 0.16±0.13, t=0.17,P=0.752), best corrected distance visual acuity[0.00(0.00, 0.20) vs. 0.05±0.10, U=188.00, P=0.880], uncorrected near visual acuity[0.50 (0.20, 0.60) vs. 0.42±0.20, t=0.35, P=0.857], and best corrected near visual acuity (0.13±0.16 vs. 0.17±0.23, U=161.00, P=0.884) between the two groups. However, all measures improved significantly from baseline levels in both groups (all P<0.05). Five years after surgery, no matter objective refraction [(-0.67±0.85) D vs. (-0.73±1.08)D] or subjective refraction[-0.50 (-1.00, 0.00)D vs. (0.69±0.87)D], the degree of cylindrical degree is significantly lower than preoperative corneal astigmatism [(1.27±0.49) D vs. (1.34±0.82) D, all P<0.001]. In addition, there were no significant differences in intraocular pressure, subjective evaluation of visual adverse symptoms, distance vision spectacle independence, or overall satisfaction evaluation between the two groups (all P>0.05). The IOL rotation was 3.0°(1.0°, 6.0°) in the study group and 4.0°(2.0°, 6.0°)in the control group (U=185.50,P=0.574), indicating no significant difference between the groups in terms of rotational stability. Five years after surgery, there were 7 cases of posterior capsular opacification in the study group and 4 cases in the control group. There were no cases of IOL glistening in the study group, but 5 cases (26.32%) were observed in the control group. Conclusions: The long-term effects of Proming® toric IOL implantation in correcting cataracts with regular corneal astigmatism are clear after five years, with few complications and stable results.

[A preliminary study on the efficacy and safety of a new type of trabeculotome tunnelling trabeculoplasty for open-angle glaucoma].

Objective: To compare the efficacy and safety of trabeculotome tunnelling trabeculoplasty and gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of open-angle glaucoma. Methods: A prospective randomized controlled study. The patients with open-angle glaucoma diagnosed in the ophthalmology center of Beijing Tongren Hospital affiliated to Capital Medical University from January to July 2022 were collected and divided into GATT group (undergoing GATT) and 3T group (undergoing 3T operation) using a random number table. Intraocular pressure (IOP) was recorded for both groups at 1 day, 1 week, 1 month, and 3 months after the operation, and the types and quantities of anti-glaucoma drugs used, postoperative complications, and surgical success rate were compared. Normal distribution measurement data were analyzed using independent sample t-tests, non-normal distribution measurement data were analyzed using non-parametric tests, and counting data were analyzed using chi-square tests. Results: This study included 35 patients (43 eyes), consisting of 27 males and 8 females, with an average age of (43.0±14.3) years. There were 21 patients (23 eyes) in the GATT group and 19 patients (20 eyes) in the 3T group. The maximum IOP without anti-glaucoma drugs before surgery, the highest IOP with the maximum number of anti-glaucoma drugs, and the IOP at 3 months after surgery in the GATT group were (33.5±9.1), (22.2±6.1), and (16.0±3.1) mmHg (1 mmHg=0.133 kPa), respectively. The corresponding values for the 3T group were (35.2±7.8), (21.5±6.8), and (16.1±2.0) mmHg. After surgery, the IOP in both groups was lower than before surgery, with a statistically significant difference (P<0.05) and no significant difference between the two groups (P>0.05). In the 3 months following surgery, 13 eyes in the GATT group and 11 eyes in the 3T group received more than two types of anti-glaucoma drugs, with no significant difference between the two groups (P>0.05). Three months after surgery, the complete and conditional success rates of the GATT group were 14/18 and 16/18, respectively, and those of the 3T group were 12/15 and 13/15, respectively, with no significant difference between the two groups (P>0.05). The incidence of hyphema, ciliary detachment, and shallow anterior chamber 1 day after surgery was 91%(21/23), 35%(8/23), and 30%(7/23), respectively, in the GATT group and 55%(11/20), 5%(1/20), and 0 in the 3T group, with a statistically significant difference between the two groups (P<0.05). Conclusion: 3T and GATT have similar success rates in the treatment of open-angle glaucoma. However, compared with GATT, 3T has fewer complications and is considered to be safer. (This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on February 28, 2023).

[The clinical value of using a distant-image screen for reading and learning].

Objective: To investigate the effect and comfort of using a distant-image screen for reading and learning. Methods: It was a prospective cross-over study. Thirty-nine volunteers, including 13 males and 26 females, aged (26.4±4.5) years (20 to 37 years), were recruited from Beijing Tongren Hospital Affiliated to Capital Medical University in July 2021. The volunteers read the digital correction table printed on paper and displayed on a distant-image screen in a random order and rest in an interval of 2 hours. Reading speed, efficiency and accuracy of using the two devices were recorded, and the changes of logMAR vision, diopter, flicker fusion frequency and visual fatigue score after reading were calculated. Comparison of the quantitative data was performed using the paired t-test. Results: The speed, accuracy and efficiency were (41.2±11.6) digit groups/min, 80.7%±13.3% and (32.4±7.4) digit groups/min in reading on paper, (41.7±11.1) digit groups/min, 76.4%±12.6% and (31.1±6.4) digit groups/min in reading from screen, respectively. There was no significant difference in reading speed (t=-0.462, P=0.648) and reading efficiency (t=1.954, P=0.058), but there was significant difference in reading accuracy (t= 2.226, P=0.032). The logMAR visual acuity of right eye and left eye decreased by 0.014±0.032 and 0.013±0.050 after reading on paper, but increased by 0.007±0.033 and 0.007±0.036 after reading from screen, respectively. The difference was significant (right eye, t=2.592, P=0.013; left eye, t =2.154, P=0.038). The myopia degree of right eye and left eye increased by (0.07±0.29) D and (0.06±0.24) D after reading on paper, and increased by (0.01±0.29) D and (0.02±0.28) D after reading from screen, respectively. The flicker fusion frequency decreased by (0.1±1.0) Hz after reading on paper, but increased by (0.3±1.2) Hz after reading from screen. There was no significant difference (P>0.05). The subjective scale score of visual fatigue increased in both groups, with no statistically significant difference (t=1.165, P=0.251). Conclusion: The use of a distant-image screen for reading and learning does not affect the reading efficiency or increase the visual fatigue, and can avoid the decline of visual acuity caused by near viewing compared with using the printed matter.

[Effects of special natural environments and mechanisms on intraocular pressure].

With the expansion of human exploration and activities, increasing people work and live in special natural environments with relatively unique characteristics, which can not only lead to pathophysiological changes and metabolic disorders, but also have a great impact on eyes and intraocular pressure (IOP). This article reviews the effects of the high-altitude hypoxia environment, space microgravity environment, deep water environment, dark environment, cold environment and ambient air pollution on IOP, and discusses the mechanisms of related IOP changes.

[Comparison study for the proportion of underdiagnosed zonulopathy in angle closure glaucoma].

Objective: To analyze the proportion and clinical characteristics of underdiagnosed zonulopathy in angle closure glaucoma (ACG) patients and to explore the related risk factors. Methods: Case-control study. Continuous cases of ACG patients who underwent phacoemulsification combined with intraocular lens implantation and goniosynechialysis surgery [ACG group, including acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG)] from November 1, 2020 to October 31, 2021 and age-related cataract patients who underwent phacoemulsification combined with intraocular lens implantation surgery in the same period (control group) were included. The diagnosis of zonulopathy was determined according to the intraoperative signs such as wrinkles of the anterior capsule during continuous circular capsulorhexis. The proportion of zonulopathy, preoperative diagnosis rate of zonulopathy, demographic characteristics, anterior chamber depth (ACD), axis length, difference of ACD in both eyes (ACD of the contralateral eye minus ACD of the operated eye) were compared between the two groups. The related risk factors were explored. The paired t-test (comparison between two groups of normally distributed data), non-parametric test (comparison between two groups of non-normally distributed data), Chi-square test (categorical variables), univariate and multivariate logistic regression analysis were used. Results: There were 104 ACG patients (104 eyes), including 63 AACG patients (63 eyes) and 41 CACG patients (41 eyes), and 117 controls (117 eyes). There was no significant difference in age (P=0.29) and gender (P=0.07) between the two groups. The ACG group had shallower anterior chamber (P<0.001), shorter axial length (P<0.001) and more ACD difference in both eyes (P<0.001). In the ACG group, the proportion of zonulopathy was 46.2% (48/104), which was significantly higher than that (6.0%, 7/117) in the control group (P<0.001). In the control group, only zonular laxity was found, while in the ACG group, besides the predominant zonular laxity (68.8%, 33/48), there was zonular dehiscence (31.3%, 15/48). The eyes with AACG (57.1%, 36/63) had a higher proportion of zonulopathy than those with CACG (29.3%, 12/41) (P=0.006). In the ACG group, only 14 cases (29.8%) were diagnosed preoperatively according to slit lamp examination and/or ultrasound biomicroscopy. The proportion of underdiagnosed zonulopathy was 70.8% in the ACG group (34/48). A smaller ACD was found to be related to the zonulopathy in the ACG group. All AACG cases with an ACD ≤2.0 mm and CACG cases with an ACD ≤1.9 mm had zonulopathy. Multivariate logistic regression showed that the ACD difference in both eyes (P=0.025) and the diagnosis of ACG (AACG vs. cataract, P<0.001; CACG vs. cataract, P=0.023) were independent risk factors associated with zonulopathy. Conclusions: The proportion of underdiagnosed zonulopathy among ACG patients is high. Better preoperative diagnostic methods for zonulopathy are needed. Zonulopathy is common in ACG patients, especially in AACG patients, suggesting that zonulopathy may be related to the pathogenesis of ACG. The shallower the ACD, the riskier the zonulopathy. ACD differences between two eyes and ACG types (including AACG and CACG) were related risk factors of zonulopathy.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 11, 2022).

[Cohort study on the association between hyperopia reserve and myopia incidence in primary school students: the Anyang Childhood Eye Study].

Objective: To analyze the longitudinal association between hyperopia reserve and the cumulative incidence of myopia in grade 1 primary school students. Methods: Cohort study. This study included 2 628 grade 1 primary school students (2 628 eyes) who without myopic at baseline from the Anyang Childhood Eye Study. There were 1 515 male and 1 113 female, aged(7.16±0.40) years. Every year, cycloplegic autorefraction was performed with 1% cyclopentolate eye drops to obtain data of hyperopia reserve. Students with different ranges of hyperopia reserve at baseline were analyzed. Axial length, anterior chamber depth, corneal curvature, lens thickness, and other parameters were obtained by ocular biometrics and compared by the independent sample t test. Qualitative data were described by frequency and percentage, and comparison between groups was performed by the Chi-square test or exact probability method. Linear regression was used to analyze the association between baseline hyperopia reserve and spherical equivalent at 5 years. Results: The average hyperopia reserve was (+1.09±0.78) diopters (D) in grade 1 non-myopic children. Axial length, anterior chamber depth, corneal radius of curvature, and lens thickness were (22.66±0.72), (2.88±0.24), (7.80±0.25) and (3.62±0.19) mm, respectively. The cumulative incidence of myopia among non-myopic grade 1 primary school students was 8.5%, 21.5%, 35.6%, 47.6% and 64.1% at 1, 2, 3, 4 and 5 years, respectively. The incidence of myopia in girls was significantly higher than that in boys at 3, 4 and 5 years. The 5-year cumulative incidence of myopia was 4.6%, 26.3%, 52.3%, 78.6%, 92.6% and 94.3%, respectively, corresponding to students with baseline hyperopia reserve of >+2.00 D,+1.50 D to +2.00 D,+1.00 D to +1.50 D,+0.50 D to +1.00 D, 0.00 D to +0.50 D and -0.50 D to 0.00 D, and the difference was statistically significant (χ²=490.59, P<0.001). The regression equation between baseline hyperopia reserve and 5-year spherical equivalent was as follows: 5-year spherical equivalent=-3.135+1.692·baseline hyperopia reserve (R2=0.454, P<0.001). Conclusions: The lower the hyperopia reserve, the higher the incidence of myopia. Monitoring children's hyperopia reserve and early protection to reduce its consumption and timely detection of children at high risk of myopia are of great significance to prevent the occurrence and development of myopia.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 15, 2022).

Unconventional Hysteretic Transition in a Charge Density Wave.

Hysteresis underlies a large number of phase transitions in solids, giving rise to exotic metastable states that are otherwise inaccessible. Here, we report an unconventional hysteretic transition in a quasi-2D material, EuTe_{4}. By combining transport, photoemission, diffraction, and x-ray absorption measurements, we observe that the hysteresis loop has a temperature width of more than 400 K, setting a record among crystalline solids. The transition has an origin distinct from known mechanisms, lying entirely within the incommensurate charge density wave (CDW) phase of EuTe_{4} with no change in the CDW modulation periodicity. We interpret the hysteresis as an unusual switching of the relative CDW phases in different layers, a phenomenon unique to quasi-2D compounds that is not present in either purely 2D or strongly coupled 3D systems. Our findings challenge the established theories on metastable states in density wave systems, pushing the boundary of understanding hysteretic transitions in a broken-symmetry state.

[Strictly following the indications during the promotion of micro-invasive glaucoma surgeries].

Lots of new micro-invasive glaucoma surgeries (MIGS) are clinically available in recent two decades. The common characters of these surgeries are micro-invasive and non-filter bleb dependent. There are some problems during the promotion of the MIGS in China, like performing the MIGS with inappropriate indications. The MIGS procedures have more strict indications than traditional trabeculectomy and need more technical skills. To promote the popularization of MIGS and improve the clinical treatment of glaucoma, strictly following the indications and standardizing the surgical technique training are needed. (Chin J Ophthalmol, 2021, 57: 641-643).

Photoinduced multistage phase transitions in Ta2NiSe5.

Ultrafast control of material physical properties represents a rapidly developing field in condensed matter physics. Yet, accessing the long-lived photoinduced electronic states is still in its early stages, especially with respect to an insulator to metal phase transition. Here, by combining transport measurement with ultrashort photoexcitation and coherent phonon spectroscopy, we report on photoinduced multistage phase transitions in Ta2NiSe5. Upon excitation by weak pulse intensity, the system is triggered to a short-lived state accompanied by a structural change. Further increasing the excitation intensity beyond a threshold, a photoinduced steady new state is achieved where the resistivity drops by more than four orders at temperature 50 K. This new state is thermally stable up to at least 350 K and exhibits a lattice structure different from any of the thermally accessible equilibrium states. Transmission electron microscopy reveals an in-chain Ta atom displacement in the photoinduced new structure phase. We also found that nano-sheet samples with the thickness less than the optical penetration depth are required for attaining a complete transition.

[The key points and difficulties in prevention of myopia in Chinese children and adolescents].

Myopia has emerged as a public health problem with its increasing prevalence in children and adolescents in China. The Chinese government has begun to take action to address this issue in recent years. In 2018, the Implementation Plan of the Myopia Prevention and Control for Children and Adolescents was issued by the Ministry of Education and other seven ministries and commissions. The plan emphasizes the myopia prevention and management will be a powerful national strategy to a major crisis of children's health in China. Based on the current situation and characteristics of myopia in children and adolescents in China, this article analyzes the key points and difficulties of related work, so as to provide scientific ideas and references for prevention and control of myopia in China. (Chin J Ophthalmol, 2021, 57:241-244).

[Paying attention to the promotion and evaluation of Chinese Glaucoma Guidelines (2020) after their release].

Glaucoma is the leading cause of irreversible blindness worldwide. The Chinese Glaucoma Guidelines (2020) formulated important references and suggestions for the treatment of glaucoma, based on the basic national condition of China and considering the latest global progress. To fulfill their guiding effect on clinical work, publicity and promotion of the Guidelines should be intensified to prompt the communication and application. The ophthalmology specialists should pay attention to the quality assessment and reevaluation of the Guidelines regarding their reliability and applicability in clinical work, and promote the evidence-based practice of glaucoma. Continuous feedbacks from clinical practice would enable timely updates and improvement of the Guidelines, thus building a better evidence ecosystem and constantly optimizing the diagnosis and treatment of glaucoma in China. (Chin J Ophthalmol, 2021, 57:161-165).

[Sub-foveal choroidal thickness in both eyes of patients with unilateral primary open-angle glaucoma and related influencing factors].

Objective: To investigate and compare the sub-foveal choroidal thickness (SFCT) in both eyes of patients with unilateral primary open-angle glaucoma (POAG) and healthy controls. Methods: Cross-sectional study. Patients with unilateral POAG and healthy controls were recruited from September 2018 to September 2019 in the Beijing Tongren Hospital. All subjects underwent enhanced depth imaging optical coherence tomography. The SFCT was measured at the fovea, and at 500 µm, 1 000 µm and 2 000 µm nasal and temporal to the fovea. Paired t test was conducted to compare the choroidal thickness between affected POAG eyes and unaffected fellow eyes. Analysis of covariance was conducted to compare the choroidal thicknesses between POAG eyes and controls. Multiple regression analysis determined the association between choroidal thickness and age, gender, spherical equivalent and mean deviation. Results: Seventy-five patients with unilateral POAG (mean age, 46 years; 48 males, 27 females) and 61 healthy controls (mean age, 44 years; 34 males, 27 females) were included in this study. The SFCT of POAG eyes was (244.41±83.18) µm, which was not significantly different from their unaffected fellow eyes [(254.28±88.92) µm, P>0.05] and controls (right eyes) [(272.98±55.87) µm, P>0.05]. Choroidal thickness at 2 000 µm nasal to the fovea was significantly decreased in the glaucomatous eyes compared with the unaffected fellow eyes [(167.84±70.44) vs. (188.84±89.06) µm, t=-3.55; P<0.01]. There were no significant differences among the glaucomatous eyes, unaffected fellow eyes and healthy controls in choroidal thickness at 500 µm and 1 000 µm nasal and temporal to the fovea, as well as at 2 000 µm temporal to the fovea (all P>0.05). The SFCT of POAG eyes was associated with mean deviation (ß=14.66, P<0.05) and spherical equivalent (ß=14.95, P<0.01) but not with age and gender (both P>0.05). Conclusions: The SFCT of affected eyes in patients with unilateral POAG has no significant difference from unaffected fellow eyes and healthy controls. However, the choroidal thickness at 2 000 µm nasal to the fovea is thinner in the POAG eyes as compared with the fellow eyes. A thinner SFCT is correlated with the loss of visual field and a higher spherical equivalent in myopia. This may suggest a contributing role of the perfusion of the choroid in the pathogenesis of glaucoma. (Chin J Ophthalmol, 2021, 57: 194-200).

[Safety and efficacy of A1-UV aspheric intraocular lens implantation over the postoperative 5 years].

Objective: To evaluate the clinical safety and efficacy of A1-UV aspheric intraocular lens (IOL) implantation over the postoperative 5 years. Methods: Prospective cohort study. The subjects came from a finished multicenter, randomized and controlled clinical trial with a follow-up period of 1 year from April to November 2012. The clinical research centers were Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Peking University Third Hospital, Tianjin Medical University Eye Hospital, and Daping Hospital of Army Medical University. Cataract patients in the experimental group were implanted with A1-UV type IOL, while cataract patients in the control group were implanted with SN60WF type IOL, and monocular patients were enrolled. From April to May 2018, patients enrolled in the previous study were recalled for follow-up and continued observation. The visual acuity, spherical equivalent, postoperative complications, non-contact intraocular pressure and subjective evaluation results were statistically analyzed preoperatively, at 1 to 2 days, 1 week, 1 month, 3 months, 6 months, 1 year and 5 years after operation. The main statistical methods included Mann Whitney U test, Wilcoxon signed rank test, independent sample t test, chi square test and Fisher exact test. Results: A total of 42 subjects (22 in the experimental group and 20 in the control group) completed 5-year continuous observation. Among the 42 subjects, 28 were female and 14 were male. The age was (70±9) years, and the time from surgery to recall was (5.77±0.19) years. The age, gender distribution, left/right eye distribution, axial length, IOL power and nucleus hardness classification data of the experimental group and the control group were balanced and comparable (all P>0.05). At different visiting time points, there was no significant difference in the best corrected distance visual acuity (BCDVA), best corrected near visual acuity (BCNVA), uncorrected distance visual acuity (UCDVA) and uncorrected near visual acuity (UCNVA) between the groups (all P>0.05). At 5 years after operation, the UCDVA, BCDVA and BCNVA of the two groups were significantly improved compared with the baseline [all P<0.01; UCDVA was improved from 0.75 (0.30 to 1.30) to 0.10 (-0.10 to 0.70) in the experimental group and from 0.75 (0.30 to 1.60) to 0.20 (-0.10 to 0.80) in the control group; BCDVA was from 0.60 (0.10 to 1.00) to 0.00 (-0.10 to 0.54) in the experimental group and from 0.60 (0.10 to 1.60) to 0.10 (-0.10 to 0.50) in the control group; BCNVA was from 0.55 (0.00 to 1.10) to 0.10 (-0.10 to 0.60) in the experimental group and from 0.55 (0.10 to 1.60) to 0.10 (-0.20 to 0.60) in the control group], but there was no significant change in the UCNVA (both P>0.05). There were no significant differences in the spherical equivalent, intraocular pressure, subjective evaluation of visual adverse symptoms, distance vision spectacle independence and comprehensive evaluation of satisfaction between the groups (all P>0.05). In the experimental group, one eye (4.5%) had an abnormal pupil, one eye (4.5%) had an abnormal IOL with a few particles on the surface of the IOL but no glistening, and 3 eyes (13.6%) had posterior capsular opacification (PCO); in the control group, one eye (5.0%) had an abnormal cornea, five eyes (25.0%) had abnormal IOLs [one eye (5.0%) had IOL calcification, and four eyes (20.0%) had IOL glistening], and one eye (5.0%) had PCO with posterior capsular folds and IOL tilt. There was no significant difference in PCO and IOL abnormality between the two groups (both P>0.05), but there was significant difference in the occurrence of IOL glistening (P=0.04). Conclusion: The long-term effect of A1-UV aspheric IOL on improving the UCDVA is stable and good, with high subjective satisfaction of patients, a low incidence of PCO, no glistening and good biocompatibility, over the postoperative 5 years. (Chin J Ophthalmol, 2021, 57: 41-47).

[Prevalence and risk factors of common blinding ocular diseases among people aged 30 years and above in rural area of Handan].

Objective: To explore the prevalence and risk factors of common blinding ocular diseases in the population aged 30 years and above in rural areas of Handan City from 2006 to 2012. Methods: A cohort study with 6 830 subjects from rural areas of Handan City, Hebei Province was designed and conducted. The follow-up duration was 6 years, and the prevalence and incidence of common blinding diseases were evaluated. Logistic regression was used to explore the influencing factors of common blinding ocular diseases. Results: In 2006, 6 830 people participated in the baseline survey. There were 3 163 (46.31%) males and 3 667 (53.69%) females. The average age was (52.3±12.2) years (range, 30 to 97 years). There were 3 435 subjects who had common chronic systematic diseases, with a prevalence of 50.29%. In addition, 1 250 people suffered from common blinding ocular diseases, and the prevalence was 18.30%. There were 4 118 subjects without common blinding ocular diseases at baseline who participated in the six-year follow-up, during the 6-year follow-up, 247 participants developed common blinding ocular diseases. 9% (171/1 899) of patients with chronic systematic diseases developed common blinding ocular diseases, while only 3.42% (76/2 219) of normal subjects developed common blinding ocular diseases, with a statistically significant difference (χ(2)=56.504, P<0.001). The incidence of common blinding ocular diseases was age-dependent. Multivariate regression analysis showed that age (OR=1.045, 95%CI: 1.028-1.062, P<0.001), intraoccular pressure (IOP) (OR=1.064, 95% CI: 1.014-1.116, P=0.011) and baseline chronic diseases (OR=1.749, 95% CI: 1.288-2.375, P<0.001) were risk factors for common blinding ocular diseases. Moreover, the contribution of age, IOP and chronic systematic diseases to the model was 0.436, 0.084 and 0.511, respectively. Conclusions: The prevalence of common blinding ocular diseases among people over 30 years old in Handan is relatively high. From 2006 to 2012, about 1.5% patients of chronic systematic diseases developed common blinding ocular diseases each year. Moreover, chronic systematic diseases increase the risk of blinding ocular diseases sharply, and the effect is stronger than age and intraocular pressure.