Abstract:At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens (IOL) during vitrectomy in cases with a moderate or severe inflammation is controversial. In order to call upon more discussion, we publish the article entitled “Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery” written by Guo et al in this issue. With recent advanced vitrectomy techniques, and critical measures for management of risk factors related to occurrence of infection, IOL remaining during timely vitrectomy for acute endophthalmitis can possibly be safe and effective in selected cases.

Abstract:The vitreous body, the largest intraocular component, plays a key role in eye development, refraction, cell barrier function, oxygen metabolism and the pathogenesis of assorted diseases. Age, refraction and systemic diseases can cause vitreous metabolic abnormalities. With the continuous development of vitrectomy techniques and equipment, vitreous injections and vitrectomies have increased over the recent decades. However, the normal oxygen tension gradient in the vitreous helps to protect the lens and anterior chamber angle from oxidative stress damage, whereas the increased vitreous oxygen tension around lens and the trabecular meshwork after vitrectomy. It may lead to postoperative nuclear cataract and increase the risk for glaucoma. As a conventional procedure, scleral buckling holds several advantages over vitrectomy in selected cases. This review raises concerns regarding the function of the vitreous and encourages conducting vitreous interventions prudently if it is possible.

Abstract:AIM: To investigate the role of procollagen C-proteinase enhancer 1 (PCPE1) in retinal angiogenesis and relevant mechanisms. METHODS: The Pcolce1-knockout (KO) mice were used to explore the effect of PCPE1 on retinal angiogenesis in vivo. Pcolce1 siRNA were designed, cell count kit 8 (CCK8) assays and tube formation assays were performed to investigate the cell proliferation and tube formation abilities of retinal microvascular endothelial cells (hRMECs) in vitro. Mouse embryo fibroblasts (MEF) cells were isolated and cultured to analyze the effect of PCPE1 on enhancing procollagen cleavage. RESULTS: In vivo studies showed that the retinal vascular density of Pcolce1-/- mice was significantly lower than that of the control group. Furthermore, silencing of Pcolce1 inhibited cell proliferation and tube formation abilities of hRMECs in vitro. Additionally, much more pro-collagen was found in Pcolce1-/- MEF cells, compared to wild type MEF cells. CONCLUSION: PCPE1 may promote physiological retinal angiogenesis by regulating the processing of collagen, which may provide a potential therapeutic target of retinal vascular disease.

Abstract:AIM: To investigate whether ultrasound-targeted cationic microbubbles (CMBs) destruction could deliver endostatin-green fluorescent protein (GFP) plasmids efficiently to the human retinal endothelial cells (HRECs) and inhibit retinal neovascularization in mice. METHODS: CMBs were prepared and the presentation of GFP reporter was confirmed by flow cytometry and laser confocal microscopy. Experiments assessing HRECs migration and vascular formation were performed to evaluate gene therapy's efficiency in vitro. A mouse model of oxygen-induced retinopathy was employed and the expression of Bcl-xl, Bcl-2, vascular endothelial growth factor (VEGF) and endostatin in the retina of mice were determined by Western blotting and quantitative polymerase chain reaction (qPCR). The expression of endostatin-GFP in the retina was examined by laser confocal microscopy at 5, 14, and 28d after treatment. RESULTS: The gene expression of endostatin was the highest in the group of the CMBs. Besides, the inhibition and antiangiogenesis effect of the migration and development of HRECs were improved following treatment with CMBs compared with the other groups in vitro. In vivo, retinal neovascularization was significantly inhibited and the fluorescence intensity of endostatin-GFP in the mouse retina was importantly higher in the group of CMBs than that in other groups. CONCLUSION: The research illustrates ultrasound-targeted CMBs destruction possessed distinct effect on the inhibition of the vascular formation and the development of retinal neovascularization both in vitro and in vivo.

Abstract:AIM: To compare choroidal neovascularization (CNV) lesion measurements obtained by in vivo imaging modalities, with whole mount histological preparations stained with isolectin GS-IB4, using a murine laser-induced CNV model. METHODS: B6N.Cg-Tg(Csf1r-EGFP)1Hume/J heterozygous adult mice were subjected to laser-induced CNV and were monitored by fluorescein angiography (FA), multicolor (MC) fundus imaging and optical coherence tomography angiography (OCTA) at day 14 after CNV induction. Choroidal-retinal pigment epithelium (RPE) whole mounts were prepared at the end of the experiment and were stained with isolectin GS-IB4. CNV areas were measured in all different imaging modalities at day 14 after CNV from three independent raters and were compared to choroidal-RPE whole mounts. Intraclass correlation coefficient (ICC) type 2 (2-way random model) and its 95% confidence intervals (CI) were calculated to measure the correlation between different raters' measurements. Spearman's rank correlation coefficient (Spearman's r) was calculated for the comparison between FA, MC and OCTA data and histology data. RESULTS: FA (early and late) and MC correlates well with the CNV measurements ex vivo with FA having slightly better correlation than MC (FA early Spearman's r=0.7642, FA late Spearman's r=0.7097, and MC Spearman's r=0.7418), while the interobserver reliability was good for both techniques (FA early ICC=0.976, FA late ICC=0.964, and MC ICC=0.846). In contrast, OCTA showed a poor correlation with ex vivo measurements (Spearman's r=0.05716) and high variability between different raters (ICC=0.603). CONCLUSION: This study suggests that FA and MC imaging could be used for the evaluation of CNV areas in vivo while caution must be taken and comparison studies should be performed when OCTA is employed as a CNV monitoring tool in small rodents.

Abstract:AIM: To evaluate the effect of miRNA-451 on rhesus macaque choroid-retinal endothelial (RF/6A) cell function and proteome profile. METHODS: The RF/6A cells were transfected with miRNA-451 mimic and inhibitor. The role of miRNA-451 on proliferation ability was evaluated by CCK-8 assay. Furthermore, iTRAQ quantitative proteomic analysis was applied to comprehensively illuminate the change of cellular proteins and biological function between different groups. RESULTS: In miRNA-451 overexpression group, cell proliferation of RF/6A decreased both at 24h and 48h; while in miRNA-451 inhibition group, on the contrary, RF/6A cell proliferation was increased at 48h. Based on iTRAQ quantitative proteomic analysis, 23 differentially expressed proteins (DEPs) were detected in the comparison of miRNA-451 mimic and mimic control-transfected RF/6A cells, and 30 DEPs were identified in the comparison of RF/6A cells transfected with miRNA-451 inhibitor and inhibitor control. DEPs such as GORASP2, KRT1, SLC7A2, RIC8A, DDX42, CAP1, PCBP2 might be closely related to the inhibitory effect of miRNA-451 on RF/6A cell proliferation, while PCYT1A, MGAT1, TUBB, MCU, SIL1, BID, MSH6 might account for the positive effect of miRNA-451 inhibitor on RF/6A cell growth. PTPN1, as the only protein exhibiting an opposite trend between miRNA-451 mimic and inhibitor-transfected cells, was most likely accountable for the inhibition of miRNA-451 mimic on RF/6A cell growth, and the promotion of miRNA-451 inhibitor on RF/6A cell proliferation. CONCLUSION: miRNA-451 overexpression can suppress the growth of RF/6A cells while knockdown of miRNA-451 can promote RF/6A cell viability. Among all DEPs, increased PTPN1 is most likely to account for the negative regulation of miRNA-451 on RF/6A proliferation. miRNA-451 can be a protective factor for neovascular disease of fundus via regulating choroid retinal endothelial cell function.

Abstract:AIM: To investigate the effects of curcumin (Cur) nanoparticles loaded with chitosan derivatives grafted by deoxycholic acid (Chit-DC) on human retinal pigment epithelial (hRPE) cell proliferation and vascular endothelial growth factor (VEGF) mRNA expression. METHODS: Cur nanoparticles were synthesized with Chit-DC as the carrier and Cur as the supported drug. Cell counting kit-8 (CCK-8) method was used to detect the effects of different concentrations of Cur/Chit-DC, Chit-DC, and Cur on the proliferation of hRPE cells for different times. The changes of Cur/Chit-DC and Cur on hRPE cell cycle were determined by flow cytometry. Semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA expression levels of VEGF in hRPE cells treated with Cur, Chit-DC and Cur/Chit-DC at 10 μg/mL for 24h. RESULTS: Different concentrations of Chit-DC nanoparticle treated hRPE cells had no significant difference in terms of optical density (OD) values compared with the control group at 24h and 48h. Moreover, there was no change in the cell morphology under a light microscope. After 24h treatment with Cur/Chit-DC and Cur, the percentage of G0-G1 phase cells increased and the percentage of S phase cells decreased in all concentration groups. Cur/Chit-DC and Cur in all concentration groups inhibited the proliferation of hRPE cells in a time and dose dependent manner, and reduced the expression level of VEGF mRNA. CONCLUSION: The Cur/Chit-DC nanoparticles can release Cur continuously and have sustained release function. Both Cur/Chit-DC nanoparticles and Cur could inhibit hRPE cells cultured in vitro, and could reduce the expression level of VEGF mRNA in hRPE cells.

Abstract:AIM: To investigate the efficacy of nintedanib on reducing postoperative inflammation, fibrosis and adhesion formation following extraocular muscle surgery in rabbits in comparison with triamcinolone acetonide (TA). METHODS: Reinsertion of superior rectus muscle in right eyes of 30 New Zealand white rabbits were performed. They were randomized to receive one of the following treatments: 0.9% normal saline, one of 1-, 5-, and 10 μmol doses of nintedanib subconjunctivally immediately after surgery and on postoperative day 1, 2, 3, 5, and 7, and TA immediately after surgery. As a control group, unoperated left eyes (n=6) were used. On the 28th day, six eyes from each group were enucleated and histopathologically and immunohistochemically analyzed to assess the postoperative inflammatory changes, fibrosis and adhesion. Transforming growth factor beta, matrix metalloproteinase-2 and alpha smooth muscle actin expressions were evaluated. RESULTS: Conjunctival and scleral inflammation in TA and nintedanib groups were significantly reduced compared to saline (sham) group. Conjunctival vascularity and rectus muscle fibrosis were significantly reduced in 10 µmol nintedanib group. Nintedanib groups were the most effective groups in reduction of perimuscular fibrosis. Neither three nintedanib groups nor TA group differed statistically from sham group with regard to adhesion. The expressions of transforming growth factor beta, alpha smooth muscle actin and matrix metalloproteinase-2 were reduced in nintedanib groups compared to saline group. CONCLUSION: Nintedanib appears to attenuate postoperative inflammation and fibrosis after extraocular muscle surgery. Nintedanib may be a safer and stronger alternative agent in extraocular muscle surgery when compared to steroids. Further investigation is needed to prove antiadhesive effect of nintedanib.

Abstract:AIM: To investigate the binocular intraocular lens (IOL) power difference in eyes with short, normal, and long axial lengths (AL) using Lenstar LS 900 optical biometry. METHODS: A total of 716 (1432 eyes) participants were included. The groups were categorized into short (group A: AL<22 mm), normal (group B: 22 mm≤AL≤25 mm), and long AL groups (group C: AL>25 mm). The central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), AL, anterior corneal keratometry, white-to-white (WTW), pupil diameter (PD), as well as IOL power calculated using embedded Barrett formula were assessed. Bland-Altman plots were used to test the agreement of the binocular parameters. RESULTS: In group A, the CCT of the right eye was significantly thinner than that of the left eye (P=0.044) with a difference of -2±8 μm [95% limits of agreement (LoA), -17.8 to 13.2 μm]. For group B, the PD and IOL power in the right eye were significantly lower than those of the left eye (P=0.001, <0.001) with a difference of -0.05±0.32 mm (95%LoA, -0.68 to 0.58 mm) and -0.18±1.01 D (95%LoA, -2.2 to 1.8 D). The AL of right eye was longer than that of the left eye (P=0.002) with a difference of 0.04±0.25 mm (95%LoA, -0.45 to 0.52 mm). No significant difference was observed for all the binocular parameters in group C. The percentage of participants with binocular IOL power difference within ±0.5 D were 62% (31/50), 68.3% (339/496), and 38.8% (66/170) in groups A, B, and C, respectively. CONCLUSION: The binocular parameters related to IOL power are in good agreement, but the binocular IOL power difference of more than half of participants with long AL is more than 0.50 D.

Abstract:AIM: To assess the changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography (OCTA). METHODS: Fifty-two eyes of 52 patients with age-related cataract were randomized into two groups for phacoemulsification: Infiniti group (26 patients) using the Infiniti phacoemulsification system with gravity-fluidics and Centurion group (26 patients) using the Centurion phacoemulsification system with active-fluidics. The peripapillary vessel density (PVD) and macular thickness were examined using OCTA at baseline and at 1d, 1 and 3mo after cataract surgery. RESULTS: In the Infiniti group, the PVD was significantly reduced at 1d after the cataract surgery (P<0.001). However, the retinal nerve fiber layer (RNFL) thickness showed no significant change during the follow-up. Change in PVD 1d postoperatively was significantly negatively correlated to the cumulative dissipated energy (CDE), estimated fluid usage (EFU), effective phacoemulsification time (EPT), intraocular pressure (IOP), and total operating time (TOT; P<0.05). The macular thickness was significantly increased in all regions after the cataract surgery (P<0.05). However, no significant changes were found in the macular vessel density (VD) during the follow-up (P>0.05). In the Centurion group, the VD and thickness in the optic papilla and macula did not significantly change in all regions during the follow-up (all P>0.05). The best-corrected visual acuity (BCVA) significantly improved in both groups postoperatively (P<0.001). CONCLUSION: Using the Infiniti phacoemulsification system, OCTA provides a promising analysis of retinal vascular alterations, demonstrating a reduction of the PVD and an increase in the macular thickness. The Centurion phacoemulsification system can provide better retinal vasculature preservation during cataract surgery.

Abstract:AIM: To investigate the clinical characteristics and genetic features of a Bietti crystalline dystrophy (BCD) proband in a Chinese family. METHODS: A Chinese female diagnosed with BCD complicated by bilateral choroidal neovascularization (CNV) and her parents underwent complete ophthalmic examinations, including fundus autofluorescence (AF), fundus photography (FP), fundus fluorescein angiography (FFA), visual field testing, full-field electroretinography (ERG), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). The sequencing of the CYP4V2 gene was performed to the whole family. RESULTS: Bilateral tiny glittering crystal-like deposits and differing extent of atrophy of the retinal pigment epithelium (RPE) were found in the posterior pole of her fundus. The diffuse hypo-fluorescence shown on AF images and window defects shown on FFA both indicated the atrophy of the RPE and choriocapillaris. OCT showed the thinning of the RPE and choriocapillaris layer, ellipsoid zone (EZ) band defect and CNV in both eyes. OCTA images proofed bilateral type 2 CNV. The visual field test showed central and paracentral scotoma. ERG showed a slightly decreased b-wave in scotopic ERG. Gene sequencing identified three mutations of the CYP4V2 gene, c.802_807del, c.810delT, and c.1388G>A. The mutation c.1388G>A was a novel substitution mutation. CONCLUSION: The novel mutation c.1388G>A may be a possible cause that could induce the clinical phenotype of BCD.

Abstract:AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy (ERC) after Ahmed glaucoma valve (AGV) failure. METHODS: Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval. The number of anti-glaucoma medications (AGMs), intraocular pressure (IOP) and best corrected visual acuity (BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d. Intra- and postoperative complications were also recorded. Positive outcome was defined as IOP≤21 mm Hg with or without AGMs. RESULTS: Fourteen eyes [14 patients, median age 69.5y, interquartile range (IQR) 61.3-80] were included. Pseudoexfoliative glaucoma (n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo (IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0 (IQR 3.0-4.0) to 2.0 (IQR 1.5-3), the median IOP decreased from 26 mm Hg (IQR 22-29) to 16.5 mm Hg (IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1, 3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes (36%), which were resolved spontaneously during the first week following ERC. CONCLUSION: ERC has a high success rate for short-term management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.

Abstract:AIM: To evaluate the cost-utility of iStent inject® with cataract surgery vs cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma (POAG) in the Japanese setting from a public payer's perspective. METHODS: A Markov model was adapted to estimate the cost-utility of iStent inject® plus cataract surgery vs cataract surgery alone in one eye in patients with mild-to-moderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients' characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts. RESULTS: In the probabilistic base case analysis, iStent inject® with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ¥5 000 000/quality-adjusted life year (QALY) willingness-to-pay threshold. The incremental cost-utility ratio (ICUR) was estimated to be ¥1 430 647/QALY gained and the incremental cost-utility ratio (ICER) was estimated to be ¥12 845 154/blind eye avoided. iStent inject® with cataract surgery vs cataract surgery alone was found to increase costs (¥1 025 785 vs ¥933 759, respectively) but was more effective in increasing QALYs (12.80 vs 12.74) and avoiding blinded eyes (0.133 vs 0.141). The differences in costs were mainly driven by costs of primary surgery (¥279 903 vs ¥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent inject® with cataract surgery was found to dominate cataract surgery alone. CONCLUSION: The iStent inject® with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer's perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.

Abstract:AIM: To evaluate the image quality of a telemedicine screening program for retinal disease using a nonmydriatic camera among rural island communities in Bocas del Toro, Panama. METHODS: In June 2018, a group of three medical students volunteered at clinics operated by the Floating Doctors in the province of Bocas del Toro, Panama. Non-mydriatic images of the retina were obtained using the Pictor Plus (Volk Optical, Mentor OH), randomized, and sent to two board-certified ophthalmologists at the University of California, Irvine for analysis using a modified version of the FOTO-ED scale. Inter-rater reliability was calculated using the kappa statistic. RESULTS: Seventy patients provided a total of 127 images. Average image quality was 3.31, and most frequent image quality was 4/5 on the FOTO-ED scale. Thirty patients had at least one eye image with ideal quality (42.86%), while only one patient had no adequate photos taken (1.43%). However, high quality images were obtained in both eyes in only 12 patients (17.14%). The inter-rater reliability between the two ophthalmologists was 0.614. CONCLUSION: Further improvements are necessary to acquire higher quality images more reliably. This may include further training and experience or mydriasis.

Abstract:AIM: To assess the relationships of final best-corrected visual acuity (BCVA) and the optic nerve structural loss in varying age-cohorts of optic neuritis (ON) patients. METHODS: This is a retrospective, cross-sectional study. Totally 130 ON subjects (200 eyes) without ON onset within 6mo were included, who underwent BCVA assessment, peripapillary retinal nerve fibre layer (pRNFL) and macular segmented layers evaluation by optical coherence tomography (OCT). RESULTS: For the 0-18y cohort, the final BCVA (logMAR) was significantly better and less frequent recurrences than adult cohorts (P=0.000). The final BCVA (logMAR) in all age-cohorts of the ON patients had negative and linear correlations to the pRNFL thicknesses and macular retinal ganglion cell layer (mRGCL) volumes, when the pRNFL thicknesses were reduced to the thresholds of 57.2-67.5 µm or 0.691-0.737 mm3 in mRGCL volumes, respectively, with the strongest interdependence in the 19-40y cohort. The ON patients from varying age cohorts would be threatened by blindness when their pRNFL thicknesses dropped 36.7-48.3 µm or the mRGCL volumes dropped to 0.495-0.613 mm3. CONCLUSION: The paediatric ON has best prognosis and young adult ON exhibits perfectly linear correlations of final vision and structural loss. The pRNFL and the mRGCL could be potential structural markers to predict the vision prognosis for varying-age ON patients.

Abstract:AIM: To report the long-term outcome of posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic myopic foveoschisis (MF). METHODS: The records of 27 patients (44 eyes) treated with posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic MF were retrospectively reviewed. The best-corrected visual acuity (BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings and complications were analyzed. RESULTS: Forty-four eyes of 27 patients were included in this study. The follow-up period was 47.98±18.23mo (24-83mo). The mean preoperative BCVA (logMAR) was 1.13±0.63, and the mean postoperative BCVA was 0.30±0.33 at the last visit. There showed a significant improvement in BCVA postoperatively (P<0.001). Postoperative BCVA in 41 eyes (93%) was improved compared with the preoperative one. Forty-two eyes (95.45%) got total resolution of the MF after surgery. The remaining two eyes (4.55%) got partial resolution of foveoschisis. The preoperative foveal thickness was 610.45±217.11 μm and the postoperative foveal thickness at the last visit was significantly reduced to 177.64±55.40 μm (P<0.001). The preoperative axial length was 29.60±1.71 mm, and the postoperative axial length was 29.74±1.81 mm at the last visit. There was no significant increase in axial length within 47.98±18.23mo of follow-up (P=0.562). There was no recurrence of foveoschisis or occurrence of full-thickness macular hole during the whole follow-up period. CONCLUSION: For pathologic MF, PSR followed by vitrectomy is an effective procedure to improve the visual acuity and the anatomical structure of macula. It can also stabilize the axial length for a long time.

Abstract:AIM: To evaluate the visual outcomes of Contoura Vision (CV) with automatic eye tracking system in eyes with myopia and myopic astigmatism. METHODS: This prospective study included 160 eyes (80 patients) with moderate myopia and irregular astigmatism between January and August 2018. Subjects were randomly divided into CV group (80 eyes) that underwent CV femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and a control group (80 eyes) that underwent wavefront-optimized FS-LASIK. Visual outcomes and astigmatic vector analysis were evaluated and compared between preoperatively and 3mo postoperatively. RESULTS: Basic details were similar in both groups (P>0.05). At 3mo postoperatively, uncorrected distance visual acuity was 20/16, 20/20, and 20/25 in 24, 76, and 80 eyes of patients in CV group, respectively. The CV group was better in predictability of astigmatism correction at 3mo postoperatively. In CV group, 64 eyes had deviation of astigmatic axis within 15° and 28 eyes had deviation of astigmatic axis within 5°, both were better than those in the control group. The number of eyes with residual astigmatism within 0.5 D were less in CV group (48 eyes) than the control group (40 eyes). Compared with the preoperative, C7 significantly reduced to 0.056±0.030 in CV group at 3mo after the procedure (P<0.05), and were significantly lower than those in the control group (P<0.05). CONCLUSION: CV with automatic eye tracking system is safe and effective for the correction of myopia and myopic astigmatism.

Abstract:AIM: To assess and compare knowledge and awareness of glaucoma in subjects with and without glaucoma diagnosis attending an Ophthalmology Referral Center. METHODS: This cross-sectional study was conducted at Asociación Para Evitar la Ceguera in Mexico City, using a questionnaire formulated by a group of experts following the Delphi panel rules, and pre-tested in a pilot study. The questionnaire was applied and compared between: glaucoma patients, relatives of glaucoma patients and patients without glaucoma. Socio-demographic data was collected to assess correlation with the level of knowledge using Logistic regression models, estimating the odds ratios (OR), 95% confidence intervals, and P<0.05. RESULTS: Three hundred and ninety-four subjects were enrolled; with a median age of 61y. One hundred and thirty-four (34%) were patients with glaucoma, 152 (38.6%) patients without glaucoma, and 108 (27.4%) relatives of patients with glaucoma. Two hundred and ninety-one (73.9%) participants were aware of the term “glaucoma”. Regarding knowledge 46.7% had moderate knowledge, 37.8% had poor knowledge, and 15.5% good knowledge. Overall, relatives of glaucoma patients had the highest scores, and patients without glaucoma got the lowest scores. A positive correlation was found between better knowledge and frequent ophthalmological examinations OR 2.24 (P=0.02), higher education level OR 4.17 (P=0.00) and having a family member with glaucoma OR 3.28 (P=0.00). CONCLUSION: Awareness and knowledge of glaucoma in subjects attending an Ophthalmology Referral Center is predominantly moderate or poor. This has important implications regarding attitudes that can result in lack of follow up in ophthalmological care.

Abstract:AIM: To conduct a Meta-analysis pooling randomized controlled trials (RCTs) to compare hydrophobic with hydrophilic acrylic intraocular lenses in terms of posterior capsule opacification (PCO) development. METHODS: Electronic databases including PubMed, Embase, and the Cochrane Library were queried from their starting till January 2020. RCTs investigating the impact of hydrophobic versus hydrophilic acrylic intraocular lenses on PCO were considered eligible in this study. The pooled effect estimates were calculated using the random-effects model. RESULTS: Thirteen RCTs comprising of 939 patients (1263 eyes) were covered in this study. Patients with hydrophobic acrylic intraocular lenses had a lower PCO score than those with a hydrophilic acrylic intraocular lenses [standard mean difference: -1.80; 95% confidence interval (CI): -2.62 to -0.98; P<0.001]. Moreover, the frequency of neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy in patients with hydrophobic acrylic intraocular lenses was significantly lower than patients with hydrophilic acrylic intraocular lenses (relative risk: 0.38; 95%CI: 0.20-0.71; P=0.003). CONCLUSION: These findings suggest that hydrophobic acrylic intraocular lenses are superior to hydrophilic acrylic intraocular lenses in patients after cataract surgery due to lower PCO score and reduced Nd:YAG capsulotomy. While similar studies are conducted by other researchers, the present study conducted subgroup analyses that show superior results with hydrophobic lenses in trials conducted in western countries.

Abstract:Neovascular glaucoma is defined as iris and/or anterior chamber angle neovascularization associated with increased intraocular pressure. It is a secondary glaucoma that is most frequently caused by severe retinal ischemia. The most common diseases responsible for the development of neovascular glaucoma are diabetic retinopathy, ischemic central retinal vein occlusion, and ocular ischemic syndrome. Uncommon causes include ocular radiation, ocular tumors, uveitis and other miscellaneous conditions. Vascular endothelial growth factor is an important and likely predominant agent involved in the pathogenesis of intraocular neovascularization and neovascular glaucoma. The evolution of clinical and histopathological changes from predisposing conditions to the occurrence of rubeosis iridis and neovascular glaucoma is divided into four stages: prerubeosis, preglaucoma, open angle glaucoma, and angle-closure glaucoma.

Abstract:AIM: To investigate the clinical features, causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens (IOL) removal in the treatment of acute-onset endophthalmitis after cataract surgery (APCE). METHODS: We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018. Data on the clinical features, causative organisms, visual acuity, intraocular pressure (IOP) and complications were collected. The mean follow-up period was 25.5mo. RESULTS: The mean age of the patients was 71.4y. The mean time between cataract surgery and the onset of endophthalmitis was 2.0d. Preoperative visual acuity ranged from no light perception to hand motion. After vitrectomy, the visual acuity increased in nine eyes (90%), and was unchanged in one eye (10%). A significant difference was observed between the mean preoperative (36.3±7.1 mm Hg) and postoperative IOP (14.9±4.3 mm Hg, P<0.05). Staphylococcus epidermidis was isolated in 5 eyes, S. aureus in 2 eyes, and Enterococcus in 1 eye. Postoperative complications mainly included fibrin exudates in the anterior chamber at the early stages in all eyes and temporary IOP elevation in one eye. No retinal detachment or ocular atrophy was observed during the follow-up period. CONCLUSION: Under systemic antibiotic treatment and timely diagnosis, vitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.

Abstract:AIM: To identify the disease-causing mutation in a four-generation Chinese family diagnosed with Nance-Horan syndrome (NHS). METHODS: A Chinese family, including four affected patients and four healthy siblings, was recruited. All family members received ophthalmic examinations with medical histories provided. Targeted next-generation sequencing approach was conducted on the two affected males to screen for their disease-causing mutations. RESULTS: Two male family members diagnosed with NHS manifested bilateral congenital cataracts microcornea, strabismus and subtle facial and dental abnormalities, while female carriers presented posterior Y-sutural cataracts. A novel frameshift mutation (c.3916_3919del) in the NHS gene was identified. This deletion was predicted to alter the reading frame and generate a premature termination codon after a new reading frame. CONCLUSION: The study discovers a new frameshift mutation in a Chinese family with NHS. The findings broaden the spectrum of NHS mutations that can cause NHS in Chinese patients.

Abstract:

Abstract:

Abstract:

Abstract:

Abstract: