Abstract:AIM:To investigate the healing process after severe corneal epithelial damage in rats treated with mesenchymal stem cells (MSCs) cultured with or without keratinocyte growth factor (KGF-2) and autologous serum (AS) on amniotic membrane (AM). Many patients are blind and devastated by severe ocular surface diseases due to limbal stem cell deficiency. Bone marrow-derived MSCs are potential sources for cell-based tissue engineering to repair or replace the corneal tissue, having the potential to differentiate to epithelial cells.METHODS:The study included 5 groups each including 10 female “Sprague Dawley” rats in addition to 20 male rats used as bone marrow donors. Group I rats received AM+MSCs, Group II rats AM+MSCs cultured with KGF-2, Group III rats AM+MSCs cultured with KGF-2+AS, Group IV rats only AM and Group V rats, none. AS was derived from blood drawn from male rats and bone marrow was obtained from the femur and tibia bones of the same animals. Therapeutic effect was evaluated with clinical, histopathological and immunohistochemical assessment. MSC engraftment was demonstrated via detection of donor genotype (Y+) in the recipient tissue (X) with polymerase chain reaction.RESULTS:Corneal healing was significantly better in Groups I-III rats treated with MSC transplantation compared to Group IV and Group V rats with supportive treatment only. The best results were obtained in Group III rats with 90% transparency, 70% lack of neovascularization, and 100% epithelium damage limited to less than 1/4 of cornea.CONCLUSION: We suggest that culture of MSCs with KGF-2 and AS on AM is effective in corneal repair in case of irreversible damage to limbal stem cells.

Abstract:AIM:To evaluate the inhibitory effects of regorafenib (BAY 73-4506), a multikinase inhibitor, on corneal neovascularization (NV).METHODS:Thirty adult male Sprague-Dawley rats weighing 250-300 g, were used. Corneal NV was induced by NaOH in the left eyes of each rat. Following the establishment of alkali burn, the animals were randomized into five groups according to topical treatment. Group 1 (n = 6) received 0.9% NaCl, Group 2 (n = 6) received dimethyl sulfoxide, Group 3 (n = 6) received regorafenib 1 mg/mL, Group 4 (n =6) received bevacizumab 5 mg/mL and Group 5 (n = 6) received 0.1% dexamethasone phosphate. On the 7d, the corneal surface covered with neovascular vessels was measured on photographs as the percentage of the cornea’s total area using computer-imaging analysis. The corneas obtained from rats were semiquantitatively evaluated for caspase-3 and vascular endothelial growth factor by immunostaining.RESULTS:A statistically significant difference in the percent area of corneal NV was found among the groups (P <0.001). Although the Group 5 had the smallest percent area of corneal NV, there was no difference among Groups 3, 4 and 5 (P >0.005). There was a statistically significant difference among the groups in apoptotic cell density (P = 0.002). The staining intensity of vascular endothelial growth factor in the epithelial and endothelial layers of cornea was significantly different among the groups (P <0.05). The staining intensity of epithelial and endothelial vascular endothelial growth factor was significantly weaker in Groups 3, 4 and 5 than in Groups 1 and 2.CONCLUSION: Topical administration of regorafenib 1 mg/mL is partly effective for preventing alkali-induced corneal NV in rats.

Abstract:AIM: To investigate the efficacy and safety of Honghua preserved amniotic membrane (AM) for preventing scar formation of the filtering bleb in a rabbit model of glaucoma trabeculectomy surgery.METHODS: Totally 36 rabbits (36 eyes) were randomly divided into 3 groups:the experimental group (ocular trabeculectomy in combination with Honghua preserved AM transplantation), the control group (ocular trabeculectomy surgery in combination with AM implantation), and the blank group (single trabeculectomy). Clinical observations [including intraocular pressure (IOP), filtering blebs and complications], Masson-Trichrome staining, real-time quantitative reverse transcription-polymerase chain reaction (real-time PCR), Western blot were performed on different time points (D1, D7, D14, D21 and D56) after the surgery.RESULTS: After operated for 14d, there were statistically significant differences in the filtering blebs compared to the situation before operation (P<0.05), whereas no statistically difference on that among three groups (P>0.05). After 21d, the IOP of experimental group was lowest (P<0.05). There was significant difference between control group and blank group (P<0.05). On postoperative D14, the mean number of fibroblasts in the experimental group was significantly lower (40.6±10.2) compared to those in the control group (54.4±10.8) and blank group (68.2±11.6) (P<0.05, respectively). The mean numbers of the macrophage in the experimental and control groups were respcitively significantly lower versus the blank group (P<0.05, P<0.05, respectively). Compared to that in blank group, the level of transforming growth factor-β (TGF-β1) expression in sclera and conjunctival areas was reduced in the experimental and control groups on protein and mRNA level (P<0.05), but not significant difference between these two groups (P>0.05).CONCLUSION:The trabeculectory surgery with Honghua preserved AM can control IOP, sustain the functional filtration bleb, inhibit the proliferation of fibroblasts and open the filtrating pathway on the rabbit glaucoma models.

Abstract:AIM:To develop a reliable, reproducible rat model of retinal vein occlusion (RVO) with a novel photosensitizer (erythrosin B) and study the cellular responses in the retina.METHODS:Central and branch RVOs were created in adult male rats via photochemically-induced ischemia. Retinal changes were monitored via color fundus photography and fluorescein angiography at 1 and 3h, and 1, 4, 7, 14, and 21d after irradiation. Tissue slices were evaluated histopathologically. Retinal ganglion cell survival at different times after RVO induction was quantified by nuclear density count. Retinal thickness was also observed.RESULTS:For all rats in both the central and branch RVO groups, blood flow ceased immediately after laser irradiation and retinal edema was evident at one hour. The retinal detachment rate was 100% at 3h and developed into bullous retinal detachment within 24h. Retinal hemorrhages were not observed until 24h. Clearance of the occluded veins at 7d was observed by fluorescein angiography. Disease manifestation in the central RVO eyes was more severe than in the branch RVO group. A remarkable reduction in the ganglion cell count and retinal thickness was observed in the central RVO group by 21d, whereas moderate changes occurred in the branch RVO group.CONCLUSION: Rat RVO created by photochemically-induced ischemia using erythrosin B is a reproducible and reliable animal model for mimicking the key features of human RVO. However, considering the 100% rate of retinal detachment, this animal model is more suitable for studying RVO with chronic retinal detachment.

Abstract:AIM:To investigate the effects of hepatocyte growth factor (HGF) on MMP-2 expression in scleral fibroblasts from guinea pig with LIM.METHODS:Sixty 1-week-old guinea pigs were chosen for the study. The right eyes were treated with -10.0 D lenses as the LIM group; the left eyes remained untreated as the control group. The refraction and axial length were measured by streak retinoscopy and A-scan ultrasonography respectively prior to and 4 weeks after the experiment. Four weeks later, the guinea pigs were sacrificed and primary scleral fibroblasts were taken for tissue culture. The 3^rd-5th generation scleral fibroblasts were chosen for the experiments. The expression levels of HGF and MMP-2 protein in the scleral fibroblasts were analyzed by Western blotting. After HGF with different doses acted on the scleral fibroblasts of the control group, MMP-2 protein expression in the scleral fibroblasts was analyzed by Western blotting. HGF siRNA was transfected into the scleral fibroblasts of the LIM group and the protein expressions of HGF and MMP-2 were analyzed by Western blotting.RESULTS:The LIM group became myopic with a significant increase in axial length (7.97±0.29 mm vs 7.01±0.26 mm, P<0.05), and a significant decrease in refraction (-5.06±0.31 D vs 0.55±0.25 D, P<0.05) compared with the control group. The protein expression of HGF in the scleral fibroblasts of the LIM group was significantly higher compared with the control group ( 1.26±0.04 vs 0.32 ±0.04, P<0.05). The protein expression of MMP-2 in the scleral fibroblasts of the LIM group was significantly higher compared with the control group (0.89±0.06 vs 0.42±0.05, P<0.05). In the scleral fibroblasts of the control group, HGF(0, 0.1, 1, 10 ng/mL) upregulated MMP-2 protein expression in a dose-dependent manner (0.35±0.03, 0.44±0.02, 0.91±0.03, 1.33±0.04, all P<0.05). In the scleral fibroblasts of the LIM group transfected with HGF siRNA, MMP-2 protein expressions were significantly decreased compared with the negative control group (0.29±0.03 vs 0.81±0.05, P<0.05).CONCLUSION:HGF is a upstream mediator of MMP-2 in scleral fibroblasts from guinea pig.

Abstract:AIM: To study the efficacy difference between form-deprived myopia (FDM) and lens-induced myopia (LIM), the degree of myopia, axial length and pathological changes of the posterior sclera from guinea pigs were evaluated.METHODS: Four-week pigmented guinea pigs were randomly assigned into 3 groups, including normal control (n=6), FDM group with monocular cover (n=11) and LIM group with monocular -7D lens treatment (n=11). FDM group was form-deprived while LIM group was lens-induced for 14 d. Refractive error and axial length were measured prior to and post treatment, respectively. Morphological changes of sclera were examined using both light and electronic microscopes.RESULTS: After 14d treatment, refractive errors for FDM group and LIM group were -3.05±0.71D and -2.12±1.29D, respectively, which were significantly more myopic than that of normal controls and fellow control eyes (P<0.01). As for axial length, it was 7.93±0.03 mm for FDM group and 7.89±0.06 mm for LIM group, which were significantly longer than both normal and fellow controls (P<0.01). With respect to both refractory error and axial length, the differences between FDM group and LIM group were not significant (P>0.05). Under light microscope, both FDM group and LIM group showed thinned sclera, disarrangement of fibrosis and enlarged disassociation between fibers. Consistently, ultrastructural examination showed degenerated fibroblasts and thinned fibers in posterior sclera.CONCLUSION:Following two weeks of myopia induction in guinea pigs, with regard to the degree of myopia, axial length and pathological alterations, there was no significant difference between FDM and LIM models. Therefore, FDM and LIM are equally effective and useful as a model of experimental myopia and guinea pigs are ideal animals for induction of experimental myopia because their high sensitivity to both form-deprivation and lens-induction.

Abstract:AIM:To report the visual outcome based on various patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with anti-VEGF intravitreal bevacizumab (IVB) injection.METHODS:Sixty-seven consecutive subjects with centre involving DME underwent intravitreal injection of Bevacizumab (1.25 mg/0.05 mL) in this retrospective, comparative, non randomized study. The DME was classified into one of four categories:focal, diffuse, focal cystoid and neurosensory detachment based on OCT. Best corrected visual acuity (BCVA), macular appearance, and OCT findings were used to decide whether the subject should have a repeat injection of intravitreal bevacizumab. Outcome measures were a change in mean BCVA (Snellen converted to logMAR) and central macular thickness (CMT) in each group during the six month follow-up period.RESULTS:The mean BCVA improved to logMAR 0.23 at final follow-up from a baseline of 0.32 logMAR (P=0.040) in the focal group, logMAR 0.80 at final follow-up from a baseline of 0.82 logMAR (P=0.838) in the diffuse group, worsened to logMAR 0.53 at final follow-up from a baseline of 0.43 logMAR (P=0.276) in the focal cystoid group, and improved to logMAR 0.79 at final follow-up from a baseline of 0.93 logMAR (P=0.490) in the neurosensory detachment group. The mean CMT before treatment were 298.8±25.03 μm in the focal group, 310.8±40.6 μm in the diffuse group, 397.15±31.05 μm in the focal cystoid group and 401.03±75.1 μm in the neurosensory detachment group. A mean of 2.05 (range:1-5) injections in the focal group, 1.32 (range:1-2) in the diffuse group, 2.6 (range:1-6) in the focal cystoid group and 2.6 (range:1-6) in the neurosensory detachment group were performed during the six month follow-up period. Following intravitreal bevacizumab treatment, vision improved, remained unchanged or worsened in 11, 7 and 2 subjects in focal group; 11, 9 and 8 in diffuse group; 0, 2 and 4 in focal cystoid group and 5, 5 and 3 subjects respectively in neurosensory detachment group.CONCLUSION:OCT morpholgy patterns in DME may predict the effects of intravitreal bevacizumab treatment, and patients with focal DME are most likely to benefit from the improvent of visual acuity from this treatment.

Abstract:AIM: To find the significant altered proteins in age-related macular degeneration (AMD) patients as potential biomarkers of AMD.METHODS: A comparative analysis of the protein pattern of AMD patients versus healthy controls was performed by means of proteomic analysis using two-dimensional gel electrophoresis followed by protein identification with MALDI TOF/TOF mass spectrometry.RESULTS: We identified 28 proteins that were significantly altered with clinical relevance in AMD patients. These proteins were involved in a wide range of biological functions including immune responses, growth cytokines, cell fate determination, wound healing, metabolism, and anti-oxidance.CONCLUSION: These results demonstrate the capacity of proteomic analysis of AMD patient plasma. In addition to the utility of this approach for biomarker discovery, identification of alterations in endogenous proteins in the plasma of AMD patient could improve our understanding of the disease pathogenesis.

Abstract:AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL) implantation. METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi''an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures:visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations.RESULTS: The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision.

Abstract:AIM: To evaluate differences in flap thickness resulting from use of an Alcon Wavelight FS200 femtosecond laser and a MORIA SBK microkeratome when making a 110-μm-thick corneal flap and to identify the potential factors that affect corneal flap thickness.METHODS: A prospective case study was performed on 120 eyes of 60 patients who were divided into two groups for LASIK, each group consisting of 60 eyes (30 patients). The corneal flaps were created using an Alcon Wavelight FS200 femtosecond laser or a MORIA SBK microkeratome. The central corneal flap thickness was calculated by subtraction pachymetry. Age, central corneal thickness (CCT), spherical equivalent refraction, mean keratometry, and corneal diameter were recorded preoperatively for analysis.RESULTS: Cutting of all flaps was easily performed without intraoperative complications. In the Alcon Wavelight FS200 femtosecond lasergroup, the mean right and left corneal flap thicknesses were 114.0±6.6 μm (range:98-126) and 111.4±7.6 μm (range:98-122), respectively. The difference (2.6±9.1 μm) in the corneal flap thickness between the right and left eyes was not significant (t=1.59, P=0.12). Stepwise regression analysis indicated that the resulting corneal flap thickness was unrelated to the patient’s age, preoperative CCT, spherical equivalent refraction, mean keratometry, or corneal diameter. In the MORIA SBK microkeratome group, the mean right and left corneal flap thicknesses were 110.6±7.4 μm (range:97-125 μm) and 108.2±6.1 μm (range:78-123 μm), respectively. The difference in the corneal flap thickness between the right and left eyes (2.4±6.5μm) was not significant (t=2.039, P=0.0506). The corneal flap thickness was positively correlated with the preoperative CCT through stepwise regression analysis (r=0.297, P=0.021). The corneal flap thickness was not related to age, spherical equivalent refraction, mean keratometry, or corneal diameter. The corneal flap thickness was estimated using the following equation:Tflap=67.77+0.076 CCT (F=5.63, P=0.021).CONCLUSION:Both the Alcon Wavelight FS200 femtosecond laser and the MORIA SBK microkeratome produced 110-μm-thick corneal flaps. The central corneal flap thickness was positively correlated with the preoperative CCT in MORIA SBK microkeratome surgery.

Abstract:AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty (PKP).METHODS: Patients with indications for PKP (n=141) were enrolled in a prospective study and randomly divided into general anesthesia group (group A, 70 eyes) and local anesthesia group (group B, 71 eyes). Patients received optical PKP (group A1, 30 eyes; group B1, 30 eyes) or therapeutic PKP (group A2, 40 eyes; group B2, 41 eyes). Measurement of anterior chamber treatment time (T) for PKP patients and the ratio (R) of the area of the pupils to that of recipient graft region. T and R values, as well as perioperative and postoperative complications, were compared between groups A and B using t-test or χ² test.RESULTS: Patients were followed for 2wk after PKP. T was (13.45±8.64)min for group A and (7.36±5.24)min for group B, a statistically significant difference (P<0.001). The R value for group A was stable during the operation, while for PKP patients in group B the value initially increased then gradually decreased to normal after suturing. In group B, extrusion of intraocular contents occurred in 5 eyes, and iridal prolapse occured in 11 cases; no perioperative complications occurred in group A. Relapse rate for fungal keratitis was 13.04% in group B and 0% in group A.CONCLUSION: Under general anesthesia, pupils remaine stable during PKP and perioperative complications are averted. General anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.

Abstract:AIM: To compare the efficacy and complications of Artisan iris-claw intraocular lens (IOL) implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy.METHODS:A prospective study of 45 cases was conducted. Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy (PPV) combined lens extraction were divided into two groups. Group A:25 eyes received Artisan iris-claw IOL implantation. Group B:20 eyes received posterior chamber IOL sulcus fixation. The corrected distance visual acuity (CDVA) and intraocular pressure (IOP), corneal endothelial cell loss rate, surgical time and complications were compared between the two groups. Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group.RESULTS:The mean surgical time of Artisan group was significantly shorter (P<0.05). No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point (P>0.05). CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery (P<0.05) and there was no statistically significant difference 1 and 3mo after surgery (P>0.05). Mean IOP showed no significant differences between groups before and after surgery. The postoperative complications of Artisan group were anterior uveitis, iris depigmentation, pupillary distortion and spontaneous lens dislocation. The complications of sulcus fixation group include choroidal detachment, intraocular haemorrhage, tilt of IOL optic part and retinal detachment.CONCLUSION:Secondary Artisan IOL implantation can be performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL. This technique is an effective and safe procedure. It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.

Abstract:AIM: To explore a simple and low-cost self-made disposable flexible iris retractor and study its clinical efficacy and safety in small pupil phacoemulsification. METHODS: Polyproplyene suture and scalp acupuncture were used to make iris retractor. A prospective study were carried on 50 patients (50 eyes) with a maximally dilated pupil size of 2.5-4.0 mm which underwent phacoemulsification using this self-made iris retractor. Another 50 cases of phacoemulsification with normal pupil size sever as control group. The mean operation time, ultrasound time and ultrasonic power, volume of irrigation fluid were documented intraoperatively. The visual acuity, pupil size and complication were observed on 1d, 1wk, 1mo and 1y after operation. Corneal endothelial cell was measured at 1mo postoperatively. RESULT: Pupils could be expanded to approximately 4.5-5.5 mm with our self-made iris retractor in operation. No serious postoperative complication was found. Most (88%) of the pupils returned round or oval shape, light reflex restored to varying degrees at the first day after surgery. Best corrected visual acuity stabilized in 37 eyes (74%) at one day, in 43 eyes (86%) at one week, in 44 eyes (88%) at one month and 46 eyes (92%) at one year. Compared with the control, more time was needed to complete the operation in the small pupil group. There was no significant difference of the mean ultrasound time, ultrasonic power, volume of irrigation fluid required and corneal endothelial cell loss in 1mo follow up between the two groups. CONCLUSION: Our self-made disposable flexible iris retractor could be easy obtained preoperatively or intraoperatively. It performed both safety and efficacy in our clinical trials. This simple self-made device has shown economic and practical values, especially in primary care hospital of the less developed districts.

Abstract:AIM: To evaluate the rates of retinopathy without diabetes and diabetic retinopathy (DR), associated with some markers of oxidative stress, antioxidants and cardiometabolic risk factors.METHODS: We determined the prevalence of DR in 150 type 2 diabetes mellitus (T2DM) patients, that of retinopathy in 50 non diabetics, the levels of body mass index (BMI), waist circumference (WC), blood pressure, lipids, 8-isoprostane, 8-hydroxydeoxyguanosine (8-OHdG), gamma-glutamyl transferase GT (GGT), oxidized low-density lipoprotein (OxLDL), thiobarbituric acid reacting substances (TBARS), reduced glutathione (GSH), superoxide dismutase (SOD), uric acid, creatinine, albumin, total antioxidant status (TAOS), zinc, selenium, magnesium, vitamin C, vitamin D, vitamin E, glucose, apolipoprotein B (ApoB).RESULTS: The prevalences of DR at 53y and Rtp at 62y were 44% (n=66) and 10% (n=5), respectively. The highest levels of 8-isoprostane, 8-OHdG, TBARS, SOD, and OxLDL were in DR. The lowest levels of vitamin D, vitamin C, TAOS, and vitamin E were in DR. In the case-control study discriminant analysis, the levels of vitamin C, vitamin D, ApoB, 8-OHdG, creatinine, Zn, vitamin E, and WC distinguished significantly non-diabetics without DR (controls), T2DM patients without DR and T2DM patients with DR.CONCLUSION: Anticipation of DR onset is significantly associated with the exageration of oxidative stress biomarkers or decrease of antioxidants in African type 2 diabetics. Prevention of oxidative stress and abdominal obesity is needed. Supplementation in vitamin C, D, and E should be recommended as complement therapies of T2DM.

Abstract:AIM: To compare the RTVue spectral optical coherence tomography (SD-OCT), Sirius Scheimpflug-Placido topographer, Lenstar optical low coherence reflectometry (OLCR) and ultrasound pachymetry (USP) devices in terms of their agreement and repeatability of measuring central corneal thickness (CCT).METHODS: In this prospective study, 50 eyes of 50 patients were included. Three repeated measures were obtained using SD-OCT, Scheimpflug-Placido topographer and USP and five measurements were determined with the OLCR. Bland-Altman plots were used to assess agreement among the instruments, and 95% limits of agreement (LoA) for each comparison were calculated. Intra-examiner repeatability was assessed using intraclass correlation coefficients (ICCs).RESULTS: The mean CCT by SD-OCT, Scheimpflug-Placido topographer, OLCR, and USP were 525.90±34.08 μm, 525.92±34.10 μm, 530.30±35.62 μm, and 543.50±37.11 μm respectively. All 4 modalities of CCT measurements correlated closely with each other, with Pearson correlation coefficients ranging from 0.977 to 0.995. The mean differences (and upper/lower LoA) for CCT measurements were -0.05±6.77 μm (13.3/-13.3) between SD-OCT and Scheimpflug-Placido topographer, 4.38±3.79 μm (11.8/-3.1) between OLCR and SD-OCT, 4.38±6.03 μm (16.2/-7.5) between OLCR and Scheimpflug-Placido topographer, 13.20±6.46 μm (25.9/0.5) between USP and OLCR, 17.59±6.76 μm (30.8/4.3) between USP and SD-OCT, and 17.58±8.13 μm (33.5/1.6) between USP and Scheimpflug-Placido topographer. Intra-examiner repeatability was excellent for all devices with ICCs>0.98.CONCLUSION: For most practical purposes, CCT measurements with the RTVue, Sirius and Lenstar can be used interchangeably. Although highly correlated, CCT measurement differences between USP and these 3 optical instruments can be significant depending on the clinical situation.

Abstract:AIM:To determine the normative values of white-to-white corneal diameter with Orbscan II Topography System and to compare right and left eyes data in the normal young population.Methods:A total of 1001 healthy participants aged 18-45y participated in this observational cross-sectional study. The study population consisted of 616 female and 385 male subjects. The corneal diameter was measured with the Orbscan II. The differences between genders, between right and left eyes and age-related changes were evaluated. Statistical analyses were performed using Student’s t-test.RESULTS:The average white-to-white distance in our study population was recorded as 11.65±0.36 mm (median:11.60 mm, mode:11.70 mm, minimum:10.50 mm and maximum:13.60 mm). The white-to-white distance was 11.60±0.35 mm in males and 11.71±0.36 mm in females which was statistically different between genders (P<0.01). However, white-to-white distance was not statistically different between right and left eyes. In addition, this parameter decreased with increasing age. Considering 95% confidence interval, corneal diameter less than 10.93 mm and greater than 12.34 mm would be considered as microcornea and megalocornea, respectively based on this study population, using the Orbscan II topography.CONCLUSION:Detailed description and analysis of corneal diameter with Orbscan demonstrate that the obtained average value of horizontal white-to-white is higher in male than female and decreases slightly with increasing age. Our data also suggests the cut off values for definition of microcornea and megalocornea, which can be employed with this population.

Abstract:AIM: To compare the anterior and posterior corneal parameters before and after collagen cross-linking therapy for keratoconus.METHODS: Collagen cross-linking was performed in 31 eyes of 31 keratoconus patients (mean age 30.6±8.9y). Prior to treatment and an average 7mo after therapy, Scheimpflug analysis was performed using Pentacam HR. In addition to corneal thickness assessments, corneal radius, elevation, and aberrometric measurements were performed both on anterior and posterior corneal surfaces. Data obtained before and after surgery were statistically analyzed.RESULTS: In terms of horizontal and vertical corneal radius, and central corneal thickness no deviations were observed an average 7mo after operation. Corneal higher order aberration showed no difference neither on anterior nor on posterior corneal surfaces. During follow-up period, no significant deviation was detected regarding elevation values obtained by measurement in mm units between the 3.0-8.0 mm-zones.CONCLUSION: Corneal stabilization could be observed in terms of anterior and posterior corneal surfaces, elevation and higher order aberration values 7mo after collagen cross-linking therapy for keratoconus.

Abstract:AIM:To compare the corneal parameters of children with congenital isolated growth hormone deficiency and healthy subjects.METHODS: In this cross-sectional, prospective study, 50 cases with growth hormone (GH) deficiency treated with recombinant GH and 71 healthy children underwent a complete ophthalmic examination. The corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) were measured with the Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured by a ultrasonic pachymeter.RESULTS: The mean age was 13.0±3.0 years in the GH deficiency group consisting of 21 females and 29 males and 13.4±2.4 years in the healthy children group consisting of 41 females and 30 males. There was no statistically significant difference between the groups for gender or age (Chi-square test, P=0.09; independent t-test, P=0.28, respectively). The mean duration of recombinant GH therapy was 3.8±2.4y in the study group. The mean CH, CRF, IOPg and IOPcc values were 11.0±2.0, 10.9±1.9, 15.1±3.3, and 15.1±3.2 mm Hg respectively in the study group. The same values were 10.7±1.7, 10.5±1.7, 15.2±3.3, and 15.3±3.4 mm Hg respectively in the control group. The mean CCT values were 555.7±40.6, 545.1±32.5 μm in the study and control groups respectively. There was no statistically significant difference between the two groups for CH, CRF, IOPg, IOPcc measurements or CCT values (independent t-test, P=0.315, 0.286, 0.145, 0.747, 0.13 respectively).CONCLUSION: Our study suggests that GH deficiency does not have an effect on the corneal parameters and CCT values. This observation could be because of the duration between the beginning of disease and the diagnosis and beginning of GH therapy.

Abstract:AIM: To examine the integrity of the ocular surfaces of subjects with and without diabetes with no conjunctival and dry eye signs and symptoms and compare conjunctival impression cytology findings in diabetics with non-proliferative and proliferative diabetic retinopathy.METHODS: Conjunctival impression cytology was performed on 43 eyes of 43 subjects with non-proliferative diabetic retinopathy (NPDR), 42 eyes of 42 subjects with proliferative diabetic retinopathy (PDR), and 30 eyes of 30 control subjects. Impression cytology specimens of each group were graded and scored in the range 0-3 according to Nelson’s method.RESULTS: There were 45 (52.9%) women and 40 (47.1%) men. The mean age of the patients was 59.6±9.3y (range, 43-76y) in NPDR group and 58.0±8.8y (range, 41-85y) in PDR group. Cases with NPDR and PDR showed statistically significant higher impression cytology scores than control group (P<0.05). There was no difference between the NPDR and PDR patients for impression cytology grading scores.CONCLUSION: It is determined that impression cytology grades are altered in patients with NPDR and PDR. Consequently, we suggest that there might be an association between the impression cytology grading scores and the severity of diabetic retinopathy

Abstract:AIM:To evaluate whether glaucomatous visual field defect particularly the pattern standard deviation (PSD) of Humphrey visual field could be associated with visual evoked potential (VEP) parameters of patients having primary open angle glaucoma (POAG).METHODS:Visual field by Humphrey perimetry and simultaneous recordings of pattern reversal visual evoked potential (PRVEP) were assessed in 100 patients with POAG. The stimulus configuration for VEP recordings consisted of the transient pattern reversal method in which a black and white checker board pattern was generated (full field) and displayed on VEP monitor (colour 14”) by an electronic pattern regenerator inbuilt in an evoked potential recorder (RMS EMG EP MARK II).RESULTS:The results of our study indicate that there is a highly significant (P<0.001) negative correlation of P100 amplitude and a statistically significant (P<0.05) positive correlation of N70 latency, P100 latency and N155 latency with the PSD of Humphrey visual field in the subjects of POAG in various age groups as evaluated by Student’s t-test.CONCLUSION:Prolongation of VEP latencies were mirrored by a corresponding increase of PSD values. Conversely, as PSD increases the magnitude of VEP excursions were found to be diminished.

Abstract:AIM: To evaluate the long-term response to the fixed combination of dorzolamide/timolol in patients with primary open angle glaucoma (POAG) and the addition of other intraocular pressure (IOP) lowering medications such as prostaglandin analogs and brimonidine.METHODS: A retrospective, non-randomized, and descriptive clinical study was performed with 182 eyes diagnosed with POAG. Patients were divided into three groups:a group with fixed combination of dorzolamide/timolol only, a second group with prostaglandin analogs plus fixed combination of dorzolamide/timolol, and a third group with the addition of brimonidine to the same fixed combination. IOP data were gathered retrospectively and the differences between groups were calculated.RESULTS: IOP was reduced satisfactorily in all three groups; however, a progressive IOP reduction was noted in the group with the fixed combination plus prostaglandin analogs. In this group, a progressive, significant and more homogeneous response of the reduction was noted in comparison with the other groups.CONCLUSION: IOP reduction was efficacious in all three groups. The addition of prostaglandin analogs showed progressive IOP reduction, progressive response and absence of long-term drift. Brimonidine did not show a significant additive effect.

Abstract:AIM: To evaluate the efficacy and safety of a combined treatment for myopic choroidal neovascularization (CNV) using photodynamic therapy (PDT) and intravitreal bevacizumab and to compare it with intravitreal bevacizumab monotherapy.METHODS: Thirty-four eyes with angiographic evidence of myopic CNV were randomly divided into two groups:17 were treated with one intravitreal bevacizumab injection (1.25 mg) and low-fluence-rate PDT within seven days of the injection (Group A). The other 17 received monotherapy with bevacizumab injections (Group B). Clinical evidence of complications, best corrected visual acuity (BCVA) and fluorescein leakage were evaluated. BCVA and optical coherence tomography (OCT) were evaluated monthly. The timepoints follow-up was established at 6 and 12mo. All patients were retreated following a PRN protocol.RESULTS:A total of 34 eyes of 34 patients (26 women and 8 men) with a mean age of 62.35 years were included. In Group A (17 eyes) the mean BCVA increased from 0.55±0.13 logMAR before the treatment to 0.40±0.09 logMAR at the 12mo follow-up (P<0.01). In Group B (17 eyes) the mean BCVA increased from 0.60±0.11 logMAR before the treatment to 0.55±0.12 logMAR at the 12mo follow-up (P<0.01). There was no statistically significant difference between the two groups in terms of LogMar visual acuity. In Group A the mean number of combined treatments was 1.8±0.11 per patient; in Group B the mean number of intravitreal bevacizumab injections was 3.1±0.08 per patient. The number of treatments was significantly fewer in Group A (P<0.01). No local or systemic side effects occurred among any of the patients treated in this study.CONCLUSION:The combination of anti-angiogenic injections and PDT appears to be a safe and effective option for myopic CNV treatment and allows for a significant reduction of intravitreal injections.

Abstract:AIM: To investigate and compare the cytopathological and clinical effects of amniotic membrane transplantation (AMT) and oral mucosal membrane transplantation (OMMT) in socket contraction. METHODS:Twelve patients who could not be fitted with ocular prosthesis due to socket contracture were included in this study. Seven patients underwent AMT and 5 patients underwent OMMT. Thirteen patients who had healthy sockets were included as control group. Depth of inferior fornix, degree of inflammation, extent of the socket contracture and socket volume were measured in the preoperative period and at sixth and twelfth weeks postoperatively. Impression cytology of conjunctival fornices and tear transforming growth factor beta-1 (TGFβ1) levels were determined. RESULTS:In the AMT group,socket volume and lower fornix depth values were significantly higher (P=0.030 and P=0.004 respectively) and inflammation levels and impression cytology stages (P=0.037 and P=0.022 respectively) were significantly lower in postoperative period compared to preoperative period. In the OMMT group, no statistical differences were found in terms of clinical parameters, inflammation levels and impression cytology stages of preoperative versus postoperative values. Preoperative tear TGFβ1 levels were higher in AMT and OMMT groups compared to the control group (25.5 ng/mL, 26.3 ng/mL and 21.7 ng/mL respectively). Decreased tear TGFβ1 levels were observed in both the AMT and OMMT groups postoperatively (median decrease value=2.1 ng/mL and 2.7 ng/mL respectively). CONCLUSION: AMT is associated with postoperative improvement in inferior fornix depth, socket volume, inflammation and impression cytology levels and may be a more proper alternative method than OMMT in the management of socket contracture.

Abstract:AIM: To investigate the effects of a new opening pattern in neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy on visual function.METHODS: This technique was conducted along a circular pattern. The energy ranged between 0.8 and 1.2 mJ/pulse was consumed and mean total energy levels were 74±21 mJ (mean±standard deviation:SD, from 40 to 167) and laser shots aimed at 150 μm away behind a datum point and went along an imaginary line which extends 0.5 mm inside from optic margin and into the circular en bloc pattern. Vitreous stands were attached with fragment and then they were cut off by the laser after circular application. The circular fragment was completely separated from vitreous, and then this fragment was quickly sunk in intravitreal space.RESULTS: The follow-up period ranges from at least a week to 40mo, making 15.8mo on average. The procedural outcome showed 96% (74 eyes out of the 77 eyes) enhancement in patients’ visual acuity. Cystoid macular edema or retinal detachment was not observed in any of the patients during follow-up periods.CONCLUSION: This new technique is expected to improve the weaknesses that the conventional procedures have by adding the process to cut off vitreous stands attached with the fragment by the laser to the circular application.

Abstract:AIM:To discuss and compare the fundus autofluorescence (FAF) and optical coherence tomography (OCT) in acute or chronic central serous chorioretinopathy (CSCR).METHODS: Medical records of 100 cases of CSCR were reviewed. Acute and chronic cases were evaluated according to the duration of decreased visual acuity, serous retinal detachment (RD) and focal leakage on fluorescein angiography (FA). Chi-square test was used for statistical analysis.RESULTS:Forty cases had acute and 60 cases had chronic CSCR. FAF showed focal hypo-autofluorescence in 34 (85%) and iso-autofluorescence in 6 (15%) of acute cases and hypo-autofluorescence in 51 (85%), hyper-autofluorescence in 6 (10%) and iso-autofluorescence in 3 (5%) of chronic cases. OCT showed serous RD with distinct borders correlated with FAF findings (hypo-autofluorescence) in all acute CSCR cases. In chronic CSCR group, OCT showed serous RD with indistinct borders correlated with FAF findings. The differences between the OCT and FAF findings of the two groups were significant (P=0.000).CONCLUSION: OCT and FAF findings can support the clinical observations in differential diagnosis of acute and chronic CSCR and help clinicians to evaluate retinal pigment epithelium, outer segments of photoreceptors and the components of serous RD.

Abstract:AIM: To compare the effectiveness and safety between bevacizumab and ranibizumab in the treatment of age-related macular degeneration (AMD) through a systematic review and meta-analysis.METHODS:We performed a comprehensive search of randomized controlled trials (RCTs), non-RCTs, case-control and cohort studies that compared bevacizumab and ranibizumab using PubMed and the Cochrane Library. After the related data were extracted by two investigators independently, pooled weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects or a fixed-effects model.RESULTS:A total of four RCTs involving 1927 patients and eleven retrospective case series involving 2296 patients were included. For the primary outcomes, no significant differences were found between ranibizumab group and bevacizumab group in visual acuity (WMD:-0.04; 95%CI:-0.08 to 0.00; P=0.06), best corrected visual acuity (WMD:-0.05; 95%CI:-0.10 to 0.00; P=0.05), retina thickness (WMD:-4.69; 95%CI:-13.15 to 3.76; P=0.86) and foveal thickness (WMD:10.91; 95%CI:-14.73 to 36.56; P=0.40). The pooled analyses in the evaluation of safety showed that compared to bevacizumab, ranibizumab was associated with decreased risks of ocular inflammation (RR:0.45; 95% CI:0.23 to 0.89; P=0.02) and venous thrombotic events (RR:0.27; 95%CI:0.08 to 0.89; P=0.03). However, there were no significant differences observed in deaths (P=0.69) and arterial thromboembolic events (P=0.71) between the two groups.CONCLUSION:With equal clinical efficacy, ranibizumab was found to be associated with less adverse events compared to bevacizumab, indicating that ranibizumab might be a safer management.

Abstract:The therapeutic effect of selenium (Se) has already been proven in thyroid disease and thyroid associated ophthalmopathy (TAO). In spite of clear scientific proof of its benefits in TAO, there appears to be no clear agreement among the clinicians regarding its optimum dose, duration of the treatment, efficacy and safety to date. In this review, the author summarises the findings of 135 English language articles published on this subject over the past four decades from 1973 to 2013. The regulation and metabolism of thyroid hormones require a steady supply of Se and recent studies have revealedseveral possible mechanisms by which Se improves the severity of thyroid disease and TAO. These mechanisms include 1) inhibitory effect of HLA-DR molecule expression on thyrocytes; 2) profound reductions of thyroid stimulating hormone (TSH) receptor antibodies (TSHR-Ab) and TPO antibodies (TPO-Ab); 3) prevention of dysregulation of cell-mediated immunity and B cell function; 4) neutralising reactive oxygen species (ROS) and inhibition of redox control processes required for the activation, differentiation and action of lymphocytes, macrophages, neutrophils, natural killer cells involved in both acute and chronic orbital inflammation in TAO; 5) inhibition of expression of pro-inflammatory cytokines and 6) inhibition of prostaglandin and leukotriene synthesis. An increased oxidative stress has been observed in both acute and chronic phases of thyroid disease with raised tissue concentrations of ROS. The benefits of Se supplementation in individuals with TAO appear to be proportionate to the degree of systemic activity of the thyroid disease. The maximal benefit of Se supplementation is therefore seen in the subjects who are hyperthyroid. Restoration of euthyroidism is one of the main goals in the management of TAO and when anti-thyroid drugs are combined with Se, the patients with Graves’ disease (GD) and autoimmune thyroiditis (AIT) achieved euthyroidism faster than those treated with anti-thyroid drugs alone. Se status of normal adult humans can vary widely and Se supplementation may confer benefit only if serum Se levels are insufficient. The author recommends that serum Se levels of patients with TAO to be assessed prior to and during Se supplementation at regular intervals to avoid potential iatrogenic chronic Se overdose.

Abstract:AIM:To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia.METHODS:This study was designed from a consecutive series of phakic intraocular lens complication and corrective surgeries. Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study. The mean age of patients was 38.6±6.35y (range 32-50y) and the mean time of history of pIOL implantation for high myopia was 6±2y (range 2-10y). Before corrective surgery, best spectacle-corrective visual acuity (BSCVA) ranged from perception to 20/200 in the eyes in which severe complications occurred.RESULTS:Corneal decompensation occurred in 12 eyes of 9 high myopic patients after anterior chamber pIOL implantation. Rhegmatogenous retinal detachment (RRD) occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation. Patients with corneal decompensation, had combined procedures consisting of pIOL removal and penetrating keratoplasty (PKP). Removals of pIOL, phacoemulsification and pars plana vitrectomy (PPV) with silicone oil tamponade were performed in patients with RRD. After corrective surgeries, all patients but one (P+, patient 2, right eye) achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit.CONCLUSION:Phakic IOLs may be effective for the correction of high myopia. Although these IOLs may have severe complications and it affects safety and efficacy of this surgery. As seen here, corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs. Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.