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Table of Content

    20 March 2020 Volume 34 Issue 2
      
    Editorial
    A discussion on the choice of surgical methods for correction of myopia
    Ying LI,Yang JIANG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  1-6.  doi:10.6040/j.issn.1673-3770.1.2020.001
    Abstract ( 178 )   HTML ( 7 )   PDF (1288KB) ( 59 )   Save
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    Adult myopia refractive surgery has developed rapidly over the past 30 years, and the number of operations has increased yearly. The main surgical methods include laser corneal refractive surgery and posterior chamber intraocular lens implantation (ICL). Laser corneal refractive surgery is suitable for low to moderate myopia and high myopia customized correction, which is safe, effective, and predictable and provides good long-term stability. Some special cases, however, including high refractive diopters, high corneal curvature, high corneal astigmatism, high corneal topography asymmetry, and thin corneal thickness, as well as too small a corneal diameter and irregular corneal shape, are not appropriate for laser corneal refractive surgery. For these cases, ICL provides many advantages, such as wide range of correction, stable effect, no need to remove corneal tissue, small effect of aberration, and good visual quality. ICL has been widely used in clinical practice, and the number of operations has increased year by year. However, ICL is not recommended for conditions such as insufficient anterior chamber depth, large corneal aberration, intraocular structural variation, and special occupation. These two surgical methods complement each other, widening the scope of refractive surgery indications and correction, and therefore, patients can receive the best choice of operation.

    Invited Review
    Key criteria for screening before corneal refractive surgery
    Fengju ZHANG,Yu LI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  7-12.  doi:10.6040/j.issn.1673-3770.1.2020.014
    Abstract ( 112 )   HTML ( 1 )   PDF (1291KB) ( 87 )   Save
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    Safety, efficacy, predictability, and long-term stability are the prerequisites for satisfied outcomes after corneal refractive surgery. The most important factors are strict pre-operative screening and reasonable selection for surgical indications. This article put forward the main criteria for screening before corneal refractive surgery, which purpose is to select surgical indications rationally and avoid medical pitfalls and risks effectively. And make sure the patients could achieve the safe, effective, and stable results as well as high visual quality after corneal refractive surgery.

    Surgical skills required for small incision lenticule extraction (SMILE), and the prevention and management of SMILE-related complications
    Caipei SU,Yabo YANG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  13-16.  doi:10.6040/j.issn.1673-3770.1.2020.007
    Abstract ( 178 )   HTML ( 2 )   PDF (1058KB) ( 70 )   Save
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    The rising incidence of myopia is a major global public-health problem. Small incision lenticule extraction (SMILE) is widely accepted by refractive experts and patients, owing to its advantages, such as its flap-free nature, requirement for a small incision, good safety, effectiveness, and predictability. However, SMILE surgery requires corneal micro-surgical skills, and the learning curve is relatively steep. Thus, surgical skills required for SMILE as well as the prevention and management of complications associated with SMILE will be discussed in this article.

    Clinical Study
    Analysis of the advantages of flaps created with an optical coherence tomography-guided femtosecond laser
    Jing ZHANG,Ye TAO,Fusheng LI,Shen WANG,Dongyi QU,Ying LI,Yuehua ZHOU
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  17-21.  doi:10.6040/j.issn.1673-3770.1.2020.002
    Abstract ( 112 )   HTML ( 1 )   PDF (1165KB) ( 97 )   Save
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    Objective

    To compare the features of corneal flaps created by using an optical coherence tomography (OCT)-guided femtosecond laser and those created by three other femtosecond lasers.

    Methods

    Four types of femtosecond laser laser-assisted in situ keratomileusis procedures were performed on 107 patients (200 eyes) with myopia and myopic astigmatism. Patients were divided into four groups of 50: group A, FEMTO LDV Z8 femtosecond laser; group B, Ziemer Crystalline femtosecond laser; group C, Wavelight FS200 femtosecond laser; and group D, Zeiss VisuMax femtosecond laser. Corneal flap thickness was measured and analyzed by RTVue OCT.

    Results

    At 1 week postoperatively, the corneal flap thickness in group A was close to the expected value and the variation range was small. The corneal flap thickness in group B was close to the expected value, but the variation range was large. The corneal flap thickness in group C was thin, that of group D was close to the expected value, and the variation ranges of both groups were small. The corneal flaps created by the four femtosecond lasers were regular and uniform in shape, and there was no statistically significant difference between central and peripheral thicknesses (P>0.05). The differences between the corneal flap thickness value and the predicted value of 110μm among the four groups were obviously different. The results of groups A(3.43±2.81)μm and D(3.13±2.89)μm were obviously better than those of groups B(6.88±4.13)μm and C(5.44±3.62)μm (F=2.397; P=0.018).

    Conclusion

    Compared with the Ziemer Crystalline and Wavelight FS200 femtosecond lasers, the OCT-guided femtosecond laser and the Zeiss VisuMax femtosecond laser featured higher accuracy and better predictability

    Early clinical observations of intraoperative corneal stromal pocket irrigation with dexamethasone in small incision lenticule extraction
    Gang LIANG,Rong MA,Fengju ZHANG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  22-31.  doi:10.6040/j.issn.1673-3770.1.2020.005
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    Objective

    This study aimed to evaluate the postoperative vision recovery and corneal morphological changes after corneal stroma pocket irrigation with dexamethasone during Small Incision Lenticule Extraction (SMILE).

    Methods

    This was a prospective case-control study, which included 48 eyes from 24 patients who underwent SMILE. One eye from each case was randomly selected to have corneal pocket irrigation with dexamethasone (experimental group, EG), while the other eye did not undergo irrigation (control group, CG). The morphological changes of the cornea were observed using in vivo confocal microscopy and anterior segment optical coherence tomography (OCT), 1 day and 7 days after surgery. The uncorrected visual acuity (UCVA), spherical equivalent (SE), corneal center thickness (CCT), and non-contact tension (NCT) values between the groups were compared 1 day, 7 days, and 1 month after surgery.

    Results

    No significant differences were observed in the UCVA (EG: 4.99±0.07, 5.06±0.08, 5.05±0.06; CG:5.01±0.07, 5.05±0.08, 5.06±0.09, P>0.05) and SE between the two groups (EG: 0.03±0.49, 0.1±0.37, 0.02±0.4; CG: 0.09±0.54, 0.19±0.48, 0±0.52) the same day as the procedure, and 1 day, 7 days, and 1 month after surgery, p>0.05. The two groups were compared at the same time, 1 day and 7 days before and after SMILE using confocal microscopy and anterior segment OCT. The cell shape, density, cell size and arrangement of the corneal epithelium[pre-operation(4 578.73±268.40, 4 539.57±329.25)cell/mm2, post-1d (4 565.21±247.31, 4 627.23±271.03)cell/mm2, post-7d(4 640.01±246.79, 4 517.71±281.43)cell/mm2] and endothelium [pre-(2541.50±259.59, 2 443.52±305.58)cell/mm2, post-1d(2 387.01±248.55, 2 495.27±238.52) cell/mm2, post-7d (2 484.49±223.71, 2 482.53±323.82)cell/mm2] were not significantly different (P>0.05). There were no significant differences observed in the corneal sub-epithelial nerve fibers. The degree of active corneal stromal cells near the cutting interface was similar between the groups, without any significant differences. Regarding the density of the corneal superficial-stromal cells [pre-(789.51±67.17, 802.03±6 794)cell/mm2, post-1d(889.37±60.62, 912.27±95.87)cell/mm2, post-7d (96.67±75.03, 818.39±59.65)cell/mm2], both groups revealed no significant difference pre- or post-operation. However, a significant difference (P < 0.05)was observed after SMILE in both groups between the day immediately before and after the procedure. Both groups revealed no significant differences regarding the density of the deep stromal cells. Comparisons of the preoperative and postoperative anterior segment OCT show no obvious inter-lamellar space and effusion in the corneal stromal pocket in the two groups. There was no significant difference in the CCT between the groups (P>0.05).

    Conclusion

    Irrigation with dexamethasone in the corneal stromal pocket during SMILE did not have a significant effect on postoperative UCVA, SE, and corneal morphological changes after surgery.

    Comparative study of the effects of different protective measures of the non-operative eye during SMILE surgery on tear film stability
    Tao ZHANG,Kaiwei CAO,Lina LIU,Ting LIU,Ji BAI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  32-35.  doi:10.6040/j.issn.1673-3770.1.2020.004
    Abstract ( 157 )   HTML ( 2 )   PDF (1127KB) ( 35 )   Save
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    Objective

    To observe the changes in the first non-invasive keratograph tear break-up time (NIKBUTf) and average non-invasive keratograph tear break-up time (NIKBUTav) of the non-operative eye with different protective measures during small incision lenticule extraction (SMILE) using the Keratograph 5M ocular surface analyzer and to observe the effects of different protective measures on tear film stability.

    Methods

    A prospective cohort study was conducted. From September 2019 to November 2019, patients who underwent SMILE in the Chongqing Vision Institute were included. The left eye was the observation eye. During SMILE of the right eye, the left eye was protected using deproteinized calf blood eye gel or eyeshade. The control group did not receive protective measures. The NIKBUTf and NIKBUTav of the left eye were measured using the Keratograph 5M ocular surface analyzer before and after the surgery of the right eye. SPSS 25.0 was used for statistical analysis.

    Results

    Thirty-five patients accounting for 35 left eyes were included in the study, of which 12 were allocated to the gel group, 11 to the eyeshade group, and 12 to the blank control group. Per the results of repeated-measurement analysis of variance, the variations in the NIKBUTf and NIKBUTav were significant in each group regarding time and grouping (P < 0.05). These two parameters also showed an interaction between time and grouping (P < 0.05). There was no significant difference in the left eye NIKBUTf of the gel group before and after surgery of the right eye (P<0.05). The NIKBUTav of the left eye in the gel group was longer immediately after surgery of the right eye (P < 0.05). In the eyeshade and blank control groups, both the NIKBUTf and NIKBUTav in the left eye decreased immediately after surgery of the right eye (P < 0.05). In the control group, the reductions in the NIKBUTf and NIKBUTav were the most significant (P < 0.05).

    Conclusion

    Different protective measures and time changes had an impact on the NIKBUTf and NIKBUTav. The protective measure of deproteinized calf blood eye gel in the non-operative eyes during SMILE played a protective role in the stability of the tear film. The protective effect of eyeshade on the tear film of the non-operative eye was not obvious, and the stability of the tear film was the worst during the conventional surgery with no protective measures for the non-operative eye.

    Lens vault changes and associated factors after implantation of implantable collamer lenses with central flow
    Bo WAN,Donghui LI,Yan LUO,Ying LI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  36-41.  doi:10.6040/j.issn.1673-3770.1.2020.008
    Abstract ( 199 )   HTML ( 8 )   PDF (1740KB) ( 84 )   Save
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    Objective

    To investigate the changes to the lens vault (LV) and anterior chamber structures after implantation of implantable collamer lenses (ICL) with central flow in patients with myopia. The relationship between LV and its associated factors, both preoperatively and postoperatively, will also be analyzed.

    Methods

    One hundred and forty eyes of 72 patients who underwent ICL implantations were enrolled between January 2015 and January 2017. Visual acuity, intraocular pressure (IOP), corneal endothelial cell count (ECD), refractive outcomes, LV, and other anterior chamber structures were evaluated and compared after 1 week, 1 month, 3 months and 1 year, postoperatively. We analyzed the relationship between LV and other anterior chamber structures.

    Results

    After 1 year, 73% of eyes had gained 1 or more lines of corrected distance visual acuity, progressively fewer eyes had gained an uncorrected distance visual acuity above 20/20, more than 63% were within±0.5D of the prospective mean refractive spherical equivalent (MRSE), and more than 86% were within±0.1D of the prospective MRSE. There were no significant differences in MRSE, IOP, and ECD, postoperatively (p>0.05). No complications occurred during the postoperative time. There were no significant LV differences at 1 month and 3 months postoperatively. Meanwhile, LV had decreased significantly in the first postoperative year and was negatively correlated with age, keratometric power, 500 μm angle open distance, 500 μm trabecular iris space area, and the anterior chamber angle. LV was positively correlated with the white-to-white distance, angle-to-angle distance, anterior chamber depth, axial length, and ICL length. Axial length and ICL length were independent factors of LV.

    Conclusion

    Implantations of phakic ICL with center flow are safe, effective, and predictable in correcting myopia. LV decreased significantly at 1 year postoperatively, which correlated with multiple factors, both preoperatively and postoperatively.

    Changes in visual quality during the ultra-early stage of SMILE for middle and low myopia
    Yang ZHAO,Yanyan FU,Xiaoying WU,Yewei YIN,Aiqun XIANG,Ying LU,Kaixuan DU,Yuanjun LI,Tu HU,Xingli LI,Dan WEN
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  42-46.  doi:10.6040/j.issn.1673-3770.1.2020.015
    Abstract ( 109 )   HTML ( 1 )   PDF (1146KB) ( 33 )   Save
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    Objective

    To observe the changes in visual quality within 24h (the ultra-early stage) after small incision lenticule extraction (SMILE) and explore the possible reasons behind these changes.

    Methods

    Forty-six eyes of 23 patients who underwent SMILE were chosen for this study. A subjective visual quality of questionnaire (SVQ) was competed by the patients before the procedure and 24 hours after treatment. The best-corrected visual acuity of the patients (distant vision 5 m, middle vision 60 cm, near vision 33 cm), contrast sensitivity (CS), glare sensitivity (GS), the near point of convergence (NPC) and the amplitude of accommodation (AA) were measured using a Binocular Vision Function Instrument (OCULUS Binoptometer 4p).

    Results

    The SVQ score illustrated a decrease in visual quality after SMILE at the ultra-early stage (P=0.001). However, uncorrected distance visual acuity (UCVA) significantly improved (P=0.0001). When comparing best-corrected visual acuity (BCVA), there was no difference between the distant vision results (P=0.096), but both the middle vision and near vision results were lower than before treatment (P=0.039, 0.003). CS and GS decreased following treatment (P=0.0001, 0.04), but there was no difference in the NPC and AA (P=0.68, 0.13).

    Conclusion

    Patients can expect improved distant vision in the ultra-early stage of SMILE. However, at the ultra-early stage, the middle vision and near vision have not yet recovered. The SVQ changes at the ultra-early stage of SMILE may be related to the changes in CS and GS.

    Evaluation of cyclorotation during femtosecond laser-assisted cataract surgery performed by using LenSx femtosecond laser
    Shazia BANO,Shaowei LI,Chang LIU,Xinxin LI,Saeed ALI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  47-52.  doi:10.6040/j.issn.1673-3770.1.2020.013
    Abstract ( 63 )   HTML ( 4 )   PDF (1791KB) ( 33 )   Save
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    Objectives

    To evaluate degrees and percentages of cyclorotation in Chinese patients during femtosecond laser assisted cataract surgery performed by using LenSx femtosecond laser platform and to further sub-analyze bilateral cases to assess the congruency between both eyes.

    Methods

    This was a single-centre retrospective study(Beijing AIER-Intec Eye Hospital, Beijing, China) in which the records of 330 eyes of 274 patients who underwent femtosecond laser-assisted cataract surgery in 1 or two eyes (with placement of posterior chamber IOL) between May 2017 and July 2019 by using femtosecond laser platform (LenSx) were reviewed.LenSx Femtosecond Laser (Alcon Laboratories, Inc, Fort Worth, Texas, USA) was used to carry out corneal incisions, anterior capsulotomies and lens fragmentation in this procedure. All the patients were marked on corneal limbus (at 3 and 9 o'clock positions) by using sterile skin marker (Medplus.inc) while sitting upright preoperatively. Percentages of cyclorotation were calculated. Absolutes values were taken for all calculations. The cyclorotation data was tested to determine whether it followed a normal distribution. Descriptive statistics were applied to calculate percentile values of cyclorotation which is presented as (M[P25; P75]).

    Results

    This retrospective study evaluated 330 eyes of 274 Chinese patients who had femtosecond laser-assisted cataract surgery using the femtosecond laser platform. Of the 330 eyes, there were 90 eyes (27.27%) that did not show cyclorotation. Out of 330 eyes that were analyzed, 72.72% (240 eyes) exhibited cyclorotation. The median value of cyclorotation was 3.0[0.0; 5.0] (ranged between 0 to 19 degrees). Of the 330 eyes, there were 90 eyes (27.27%) that did not show cyclorotation. Overall anticlockwise rotation (172 eyes, 52.12%) was more common than clockwise rotation (68 eyes, 20.60%).The total numbers of right and left eyes were 169 and 161 respectively. In terms of laterality, 43.78% of right eyes (74 eyes out of 169) and 60.86% of left eyes (98 eyes out of 161) showed anticlockwise rotation. 25.44% of right eyes (43eyes) and 15.52% of left eyes (25 eyes) exhibited clockwise rotation. Therefore anticlockwise rotation was considered as common occurrence in both left and right eyes. In order to assess the congruency of cyclorotation between eyes in bilateral cases, a subanalysis of all the patients who underwent bilateral femtosecond laser-assisted cataract surgery (56 out of 274) was performed. In total, 17 patients exhibited incylorotation (both eyes moved nasally) and 4 patients showed motion of eyes temporally exhibiting excyclorotation. In rest of patients some of them showed no rotation and others exhibited the movement of both eyes in opposite direction (one eye nasally and other temporally and vice versa).There were no AK-related complications or complications during femtosecond laser-assisted cataract surgery. Among them 56 were bilateral cases.

    Conclusion

    Clinically significant cyclorotation can occur during femtosecond laser assisted cataract surgery causing axis misalignment which might influence the desired astigmatism correction outcomes. It is highly recommended to take crucial compensatory measures to address this problem.

    Detection of four infection indicators in 4 630 patients before refractive surgery
    Yabin HU,Yan ZHENG,Jing ZHANG,Yan WANG,Qiulu ZHANG,Jing LIU,Wen XU,Changbin ZHAI,Yuehua ZHOU
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  53-56.  doi:10.6040/j.issn.1673-3770.1.2020.006
    Abstract ( 107 )   HTML ( 1 )   PDF (936KB) ( 30 )   Save
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    Objective

    To study and analyze the test results used for the detection of HBsAg, anti-HCV, anti-Treponema pallidum antibody (anti-TP) and anti-HIV in patients, prior to refractive surgery and to standardize the surgical management.

    Methods

    Enzyme-linked immunosorbent assay was used to detect four different indicators of infection in 4630 patients and the results were analyd retrospectively.

    Results

    The observed total positive rate, in the 4630 patients involved in the study, was 3.02% (n=140). The positive rates observed for HBsAg, anti-TP, anti-HCV, and anti-HIV were 2.13% (n=99), 0.62% (n=29), 0.19% (n=9), and 0.06% (n=3), respectively. In the present study, the total positive rate and the positive rates for HBsAg and anti-HIV were observed to be higher in male patients, compared to female patients (χ2 was 8.04, 16.11 and 6.05, respectively, P < 0.01).

    Conclusions

    Detection of infection indicators, prior to laser corneal refractive surgery, can aid in understanding the infection status of patients, which helps in decreasing the risk of infection and enhances the safe implementation of the surgical procedure.

    Efficacy of 0.1% diclofenac sodium eye drops post-SMILE
    Yang JIANG,Ying LI,Ge CUI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  57-60.  doi:10.6040/j.issn.1673-3770.1.2020.012
    Abstract ( 122 )   HTML ( 2 )   PDF (959KB) ( 29 )   Save
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    Objective

    To study the safety, efficacy, and tolerability of 0.1% diclofenac sodium eye drops after the small incision lenticule extraction (SMILE) procedure.

    Methods

    Two groups were observed, including 60 patients (60 eyes) with myopia. Thirty patients (30 eyes) were treated with topical compound tobramycin eye drops 4 times daily for 10 days as the control group. Meanwhile, 30 patients (30 eyes) were treated with topical compound tobramycin eye drops 4 times daily for 10 days, and diclofenac sodium eye drops 4 times daily for 20 days. All of the patients were observed in the preoperative and postoperative periods. The visual acuity, intraocular pressure, topography and adverse reactions were recorded at 10 d and after 1 month. The differences between the 2 groups were analyzed by the single factor analysis of variance (one-way ANOVA).

    Results

    There was no significant difference between the 2 groups in terms of uncorrected visual acuity at 10 d(P=0.12, F=2.50). However, there was after 1-month (P=0.001, F=29.78). There were no significant differences between the intraocular pressure values pre-operation, and postoperatively at 10 d and 1 month (P=0.45, 0.97, 0.66, F=0.56, < 0.001, 0.19). There were no significant differences between the 2 groups in the SRI and SAI values pre-operation and at 1 month in the SRI index(P=0.32, 0.05, 0.07, F=1.01, 3.86, 3.27). However, there was a significant difference in the SAI value 1-month post the operation (P=0.01, F=7.70). Eight patients (26.67%) in the diclofenac sodium eye drops group suffered from transient mild eye pain. However, this discomfort was relieved after a short time.

    Conclusion

    Diclofenac sodium eye drops can be an effective treatment combined with corticoids after SMILE. They are safe and were satisfactory in the recovery of visual acuity and ocular surface regularity.

    Comparison of corneal epithelial remodeling after FS-LASIK and SMILE treatment for myopia and astigmatism
    Ye TAO,Yuehua ZHOU,Fusheng LI,Shen WANG,Hongzhi YIN,Si QI,Haihong YANG,Tianfeng SHAN,Fang WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  61-66.  doi:10.6040/j.issn.1673-3770.1.2020.003
    Abstract ( 110 )   HTML ( 1 )   PDF (987KB) ( 33 )   Save
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    Objective

    To compare the characteristics of corneal epithelial remodeling after FS-LASIK and SMILE.

    Methods

    There were 33 males (65 eyes) and 27 females (54 eyes) with an average age of 26±6.5years. The mean spherical equivalent was -5.25±2 D. Patients were divided into two groups:the FS-LASIK group (29 patients, 58 eyes) or SMILE group (31 patients, 61 eyes). The RTvue-OCT system was used to measure the epithelium thickness within 0-2 mm and 2-5 mm from the central cornea of patients before and 1, 3, and 6 months after surgery.

    Results

    One month after surgery, however, there was a statistical difference between the average corneal epithelium thickness within 2 mm and 2-5 mm from the cornea in the FS-LASIK group (P=0.036). In the superior, nasal superior, temporal superior region, the thickness of the corneal epithelium within 2-5 mm increased less than the inferior, nasal inferior, and temporal inferior regions. These differences were statistically significant (P=0.042, P=0.031, P=0.049, respectively). There was a statistically significant difference between the average corneal epithelium thickness within 2 mm and 2-5 mm of the cornea in the SMILE group at 6 months after operation (P=0.047). In the range of 2-5 mm, the corneal epithelium thickness increased less in the superior, nasal superior, temporal superior regions than the thickness in the inferior, nasal inferior, and temporal inferior regions. These differences were statistically significant (P=0.012, P=0.035, P=0.009, respectively). Compared with the nasal and temporal sides, the thickness of the superior part was less, and the difference was statistically significant (P=0.045, P=0.017, respectively). For the FS-LASIK group, the corneal epithelium thickened from 1 to 6 months after surgery. It gradually decreased within 2 mm, and this difference was statistically significant (P=0.035). During this time period, the corneal epithelial thickness of the FS-LASIK group and the SMILE group was statistically significant at each position within a range of 0-5 mm (P<0.05).

    Conclusion

    Corneal epithelium thickening is more pronounced in FS-LASIK than in SMILE post-operation. The corneal epithelium thickening in FS-LASIK changes more obviously in the central area of the corneal resection. The corneal epithelium thickening in SMILE changes more obviously in the peripheral area of the corneal resection. Over time, the localized thickening of the corneal epithelium, which is located opposite to the incision location, continued after both procedures.

    Research Progress
    The efficacy and disadvantages of three excimer laser surface cutting surgeries
    Ge CUI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  67-71.  doi:10.6040/j.issn.1673-3770.1.2020.010
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    Contemporary excimer laser surgery includes both stoma and surface cutting surgeries. The advantages of surface cutting surgery are stable postoperative biomechanics and no flap related complications. However, the disadvantages include postoperative pain, haze under the corneal epithelium, long term use of glucocorticoids, and refractive regression. Surface cutting operations include photorefractive keratectomy (PRK), TransPRK, laser-assisted sub-epithelial keratectomy (LASEK), and Epi-laser assisted in-situ keratomileusis (Epi-LASIK). Of these, TransPRK is a truly contactless operation and involves only one set of epithelial and matrix cutting. The procedure is widely favored due to the ability to make more accurate cuts. Complications such as postoperative pain, haze, and retractive regression are the three most common complications after surface cutting surgery.

    Research advances on vault and relevant factors after implantable collamer lens implantation
    Xuanqi WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  72-78.  doi:10.6040/j.issn.1673-3770.1.2020.016
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    Implantable collamer lenses (ICL) have been widely used, with their implantation considered technically safe, efficient and stable. Vault, the distance between the posterior ICL surface and anterior crystalline lens surface, is an important follow-up index. A higher or lower vault results in a greater risk for potential complications and can affect the operation. Therefore, research on how to obtain the ideal vault and reduce postoperative complications has become increasingly important. This article summarizes the issues related to vault and attempts to provide a clinical basis for improving the safety of operations conducted and explore the direction of future clinical research.

    Recent advances and clinical applications in excimer laser surface ablation surgery
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  79-84.  doi:10.6040/j.issn.1673-3770.1.2020.011
    Abstract ( 133 )   HTML ( 4 )   PDF (959KB) ( 47 )   Save
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    Laser corneal refractive surgery is widely performed, and corneal surface excimer laser ablation surgery is one of the main surgical options. Corneal surface excimer laser ablation surgery includes:photorefractive keratectomy (PRK), laser-assisted subepithelial keratomileusis (LASEK), epipolis laser-assisted in situ keratomileusis (Epi-LASIK), transepithelial photorefractive keratectomy (TransPRK), and phototherapeutic keratectomy (PTK). It is mainly used to correct various refractive errors and corneal disorders. From epithelium-off PRK, alcohol soaking assistant LASEK, microkeratome-associated Epi-LASIK, to laser ablation corneal epithelial TransPRK, all of the procedures have no flap-related complications and they are of less corneal injury, painess and betrer visual quality after surgery. This review summarized the choice of current commonly used surgical options, clinical applications, and recent advances in excimer laser surface ablation surgery.

    Case Report
    Implantable collamer lens implantation for regression of refraction after radical keratotomy:case report
    Shali YUE,Yingping DENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  85-87.  doi:10.6040/j.issn.1673-3770.1.2020.009
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    Original Article
    COVID-19 prevention and control scheme in an ENT endoscopy unit in China
    Huimin LIANG,Liqin WANG,Wenjin WAN,Sailei SHI,Jing YUAN,Yujie SHEN,Jiacheng ZHANG,Zefan MAO,Jingzi NI,Yiwen PAN,Zhibin CHEN,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  88-92.  doi:10.6040/j.issn.1673-3770.0.2020.078
    Abstract ( 480 )   HTML ( 3 )   PDF (919KB) ( 237 )   Save
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    Due to the increasing spread of the novel coronavirus disease (COVID-19), prevention and control measures have become increasingly important. As a key location for diagnosing and treating upper airway diseases, strict precautions are required in ear nose and throat (ENT) endoscopy units. Endoscopy workers have a high risk of occupational exposure. Therefore, procedures must be strictly performed according to the prevention and control plan. The prevention and control requirements for COVID-19, as directed by the National Health Commission of China, have been universally deployed in our hospital. We have carefully analyzed the risk factors of infection during the epidemic period and subsequently formulated a prevention and control scheme for COVID-19 based on the infection control measures in the ENT endoscopy unit. These have helped to avoid cross-infection in the hospital and ensure the safety of patients and medical staff during the COVID-19 epidemic.

    Epidemic control practices of an otolaryngology-head and neck surgery ward in an area with non-high incidence of COVID-19
    Zhenhua JIANG,Lijun ZHANG,Ying LI,Yanqin XIAO,Chao LI,Bo SHI,Guiying ZHANG,Bin XU,Wei DENG,Gang LUO,Jifang LUO,Guoqi LIU
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  93-98.  doi:10.6040/j.issn.1673-3770.0.2020.057
    Abstract ( 157 )   HTML ( 585 )   PDF (4368KB) ( 64 )   Save
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    The COVID-19 epidemic is still severe. As a non-high incidence area outside Hubei, the epidemic prevention and control of primary otolaryngology-head and neck surgery has its own characteristics. Daily diagnosis and treatment are performed in the ward to prevent cross infection by medical staff. This article combines our department's experience and the measures taken in this area with respect to ward diagnosis and treatment practices. We hope that our experience will be helpful to our otolaryngology-head and neck surgery colleagues in non-high incidence areas outside Hubei.

    Study on the ultrastructure of the vestibular organs and construction of structural diagrams
    YANG Lijun, LI Lijuan, LIU Tao, WANG Liwei
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  99-105.  doi:10.6040/j.issn.1673-3770.0.2019.553
    Abstract ( 134 )   PDF (17414KB) ( 18 )   Save
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    Objective To observe the ultrastructure of the utricle, saccule, and ampulla in mice using scanning electron microscopy(SEM), analyze the significance of these structures, and construct a new schematic diagram of the vestibular organs. Methods Ten mice from each of the following age groups were recruited: young mice ≤ 2 months, 2 months < middle-aged mice ≤12 months, and aged mice >12 months. The utricle, saccule, and ampulla were harvested, and samples were prepared using the previously described method for SEM samples. Subsequently, samples were observed using Hitachi S-4800 SEM. Results 1)Different layers of the utricular macula and saccular macula were imaged using SEM. The macular surface showed “surface otolith,” which was accumulated and adhered together. There was an unstructured gelatinous substance under the surface otolith. The surface otoliths on the bottom penetrated into the unstructured gelatinous layer. Below the unstructured gelatinous layer was the hair cell cilia and “interciliary otolith” layer. There were interciliary otoliths between different cilium bundles, which stood on the flat surfaces of the supporting cells. The honeycomb gelatinous substance was connected to the unstructured gelatinous layer, interciliary otoliths, and hair cell cilia. 2)The ultrastructure of the ampulla was imaged using SEM. The cupula, an unstructured gelatinous substance, adhered to the lateral wall of the ampulla but was easy to separate. There were fine crystalline substances between the cupula and the lateral wall of the ampulla and on the walls of both sides of the ampulla crista(surface otolith of the ampulla crista). There were otolith structures between the cilia of different hair cells of the ampulla crista(interciliary otolith of the ampulla crista). Conclusion SEM of the vestibular organs revealed new structural components of the utricle, saccule, and ampulla, and we may be able to construct new ultrastructural diagrams of the vestibular organs.
    Study of airborne allergenic pollen in the urban district of Hohhot city
    XU Haixia, CUI Xiaobo, LIU Jiarong, LI Xin, LIU Jiayi, LIU Xiaoling
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  106-109.  doi:10.6040/j.issn.1673-3770.0.2019.443
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    Objective This study aimed to identify the species, quantities, and distribution of airborne allergenic pollens in the urban district of Hohhot city. Methods Daily airborne pollen was monitored using the Durham gravitational method from March 1 to October 31, 2018, and the species of airborne allergenic pollens were identified by optical microscopy. Results A total of 61,308 grains of airborne allergenic pollen were collected over 8 months. The peak of airborne allergenic pollen grains appeared from March to May and from August to September. A total of 18,420 pollen grains(30.05%)were collected in April and 20,064(32.72%)in September. In addition, the total number of pollen grains in the autumn peak increased than that in the spring. There were significant species and genus differences in pollen distribution. In spring, the main pollen species were birch(28.64%), clove(7.36%), and pine(6.71%),whereas in autumn, the main pollen genera were Artemisia(28.66%), Gramineae(17.44%), and Rosaceae(3.07%). Conclusion In 2018, the airborne allergenic pollen distribution showed two peaks, and the dominant species and genera at the peaks were birch and Artemisia.
    Prognostic role of preoperative fibrinogen levels in patients with laryngeal squamous cell carcinoma
    CHEN Huijun, SONG Shenghua, DONG Weida, ZHOU Han
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  110-114.  doi:10.6040/j.issn.1673-3770.0.2019.530
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    Objective This study aimed to evaluate the impact of preoperative fibrinogen(FIB)on the prognosis of patients with laryngeal squamous cell carcinoma. Methods The clinical data of 458 patients with laryngeal squamous cell carcinoma who underwent primary surgery in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. On observation of preoperative FIB levels, a receiver operating characteristic curve(ROC)was drawn to determine the FIB threshold, and then the patients were divided into lower and higher groups. Chi-square test, Kaplan-Meier analysis and Cox risk model were used to analyze the relationship between FIB, other clinicopathological parameters and overall survival. Results The area under the ROC curve(AUC)of FIB for overall survival(OS)of patients with laryngeal squamous cell carcinoma was 0.67. Univariate analysis showed that FIB, tumor classification, TNM stages, pathological differentiation, invasion of thyroid cartilage plate, lymph nodes metastasis and age were associated with OS of patients with laryngeal squamous cell carcinoma. Cox regression model identified high FIB level, TNM stages III and IV, and age as independent risk factors for the OS of patients with laryngeal squamous cell carcinoma (P<0.001; P=0.014; P=0.003). Conclusion Patients with laryngeal squamous cell carcinoma and high preoperative FIB levels are more likely to have lower OS. It could be a clinical biomarker for the prognosis of laryngeal squamous cell carcinoma.
    Application and prospect of artificial intelligence in otolaryngology
    ZHU Zhiling, LI SongOverview,GUAN GuofangGuidance
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  115-120.  doi:10.6040/j.issn.1673-3770.0.2019.598
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    With the development of artificial intelligence(AI)technology in recent years, it has gradually penetrated into various fields of medicine. Further, through deep learning of big data, AI technology has increasingly been applied in some medical fields. Although the literature on AI in otolaryngology has increased rapidly over recent years, most otolaryngologists are still unfamiliar with this technology. In this study, we will briefly introduce the fundamental principles of AI, enumerate and analyze the main applications in otolaryngology, and discuss the application limitations and possible applications of AI technology in otolaryngology in the future. Through discussion of the problems above, AI technology can be more clearly understood by otolaryngologists.
    Pathogenesis and treatment of idiopathic epiretinal membranes
    LIN XiaoqinOverview,WU MiaoqinGuidance
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(2):  121-128.  doi:10.6040/j.issn.1673-3770.0.2019.499
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    Idiopathic epiretinal membranes are common in older people. Some patients will have symptoms, including blurred vision, metamorphopsia, monocular diplopia, and micro/macropsia. These symptoms can seriously affect their daily life. Therefore, understanding the pathogenesis of idiopathic epiretinal membranes and how they can be effectively treated is important.